UHNS Annual Report 2011/12

Caring with knowledge, value through quality

REVIEW OF THE YEAR 2011/12

Contents Foreword................................................................................... 3 Understanding University Hospital of North Staffordshire NHS Trust....................... 4 2011/12 at University Hospital .............................. 6 Fit for the Future ............................................................... 8 Major Trauma Centre status................................... 10 In the spotlight.................................................................... 11 Protecting patients from hospital acquired infection...................................... 13 Our staff ..................................................................................... 14 Our clinicians of the future ..................................... 15 Research and development .................................... 16 Our wider responsibilities ......................................... 17 Our impact on the environment........................ 18 UHNS Charity......................................................................... 19 Finances ...................................................................................... 20 Financial outlook for 2012/13 ............................... 21 Our Trust Board .................................................................. 22

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Caring with knowledge, value through quality

Foreword This year the Trust realised the dream of moving into a hospital fit for the 21st Century. The new Main Building received its first patients in November 2011 and since then thousands of people have been treated in an environment designed to help improve recovery.

It will also be remembered as the year when University Hospital reduced the number of hospital acquired infections to an all time low. The Trust recorded just six MRSA bacteraemia, while achieving an 82 per cent reduction in Clostridium difficile infections.

Our staff continued collecting prestigious awards – the most notable was the Trust’s Heart Failure team, winning a Nursing Times award.

Meanwhile, our clinicians have been quietly revolutionising the way the Trust tackles harms, such as falls, pressure ulcers and poor nutrition.

The Trust met all key national targets except A&E four-hour access and we have improved efficiency through reduced length of stay and bed reductions, and workforce reductions as our staff move into the community. We have also reduced the number of people waiting longer than 18 weeks by over 1,000.

All these improvements are rapidly establishing University Hospital of North Staffordshire as a Trust known for embracing change. This includes the Trust winning Major Trauma Centre status.

The Trust is also very proud of its status as a teaching hospital and, as the second largest employer in the area, the Trust is positioned at the fulcrum of the community.

Our Healthcare Careers and Skills Academy has supported 221 unemployed people and helped 25 of those into employment.

The new hospital is much more than a new building, it is a driver for change and efficiency throughout the Trust.

Julia Bridgewater, CHIEF EXECUTIVE

John MacDonald, CHAIRMAN

University Hospital of North Staffordshire NHS Trust Review of the Year 2011/12

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Understanding University Hospital of North Staffordshire NHS Trust The Hospital is a large acute hospital on the Stoke-on-Trent and Newcastle-under-Lyme border.

It provides a full range of general acute services for approximately half a million people in and around North Staffordshire and specialised services for three million in a wider area.

Specialisms include cancer diagnosis and treatment, cardiothoracic surgery, neurosurgery, renal and dialysis services and paediatric intensive care. The Trust is recognised for expertise in areas such as trauma, respiratory conditions, spinal surgery and liver condition management.

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Caring with knowledge, value through quality

The Hospital also has one of the busiest emergency departments in the country – in 2011/2012 more than 100,000 patients attended A&E. The construction of a new £370 million hospital on the City General site is now complete. The Trust began moving into the building in November 2011 and will take approximately 12 months to complete. Landscaping and car park construction is still ongoing and will be finished in 2014.

The Hospital is one of nine NHS organisations located in the Staffordshire cluster, which forms

part of the Midlands and East NHS Strategic Health Authority. The Trust has a close relationship with local primary care trusts and also works with a wide range of private providers.

Services are organised into four divisions, each made up of a number of directorates or departments. Each division is led by an associate director, the clinical directors of each directorate and, in surgery and medicine, a divisional nurse.

They are supported by a human resources manager and a finance manager.

SAFETY IS A PRIORITY – We strive to keep our patients safe from harm and we create an environment to keep our staff safe in their work.

EVERYONE COUNTS – Our staff are valued, listened to and supported. Everyone is part of the University Hospital team and we treat everyone as an individual.

RESPECT & DIGNITY – Our patients are our first priority and we aim to provide consistent, high quality treatment. We treat our patients as individuals, listening to their particular stories and supporting them in their individual circumstances.

University Hospital of North Staffordshire NHS Trust Review of the Year 2011/12

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2011/12 at University Hospital Our key performance indicators are monitored every month by our Trust Board so we can ensure we are meeting the standards set for us.

This year the Trust was unable to meet the 95 per cent Accident & Emergency four-hour wait target.

This is a key indicator as to how efficient the Trust is performing.

A breakdown of the figures reveals that patients who did not need to be admitted were seen and discharged within four hours. However, the Trust did struggle to admit patients to a bed within four hours.

University Hospital recognises how important the 18 weeks referral to treatment target, A&E target and cancer targets are to our patients. These targets not only reflect how well our services are performing they also have a direct impact on the quality and safety of care we provide for patients.

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Caring with knowledge, value through quality

We must also ensure that the services we provide offer the best value.

The number of formal complaints fell this year compared to last, while the number of concerns raised with PALS has risen. Complaints are an important indicator of how well a Trust is performing – too many suggests there may be problems with services provided, too few may indicate patients don’t feel they can raise concerns.

The Trust met its cancer waiting targets this year.

The Cancer Centre, which opened in 2009, has been consistently praised by the local population.

Additionally, cancelled operations at short notice increased slightly this year. With the Trust moving into its new theatres and critical care ward, it is expected that this performance will improve.

Meanwhile, the number of patients having their operation re-arranged within 28 days improved.

2011/12

2010/11

Number of inpatients and day cases treated Elective inpatients Elective day cases Emergency inpatients

12,938 51,157 68,859

13,352 53,041 63,727

Number of outpatients seen New appointments Follow up appointments

140,504 338,681

137,414 307,009

Number of emergency attendances Emergency Centre

106,556

104,580

A detailed breakdown of the Trust's performance is available via www.uhns.nhs.uk

University Hospital of North Staffordshire NHS Trust Review of the Year 2011/12

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Fit for the Future During 2011/12 the first services moved into the Trust’s new ultra modern hospital. Since those early moves in November 2011, patients have the most modern environment and the most up to date facilities to complement the excellent work of our clinicians.

The Trust is finally able to deliver 21st Century care in 21st Century surroundings.

Just like the Maternity and Cancer Centres, the new building is airy, light and spacious. And unlike the older buildings scattered around the various sites, everything for patients is under one roof.

The Hospital is working with the local NHS to provide the right services for patients in the right place at the right time.

This includes 69,000 phlebotomy appointments moving into the community and enabling the NHS to provide services closer to where people live.

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Caring with knowledge, value through quality

By December 2012 all clinical services will be on one site. The remaining area of the City General will be landscaped and car parks will be added by 2014.

The Trust is also investing ÂŁ50 million in renovating the New Surgical and Paediatric Department building, which has become the Lyme Building and the Hartshill Orthopaedic and Surgical Unit, which has become the Trent building.

Accommodation in the new hospital is split evenly between four bedded areas with bathroom facilities and single bedded rooms with en-suite facilities, enabling the Trust to protect the privacy and dignity of patients.

The environment is vastly improved. Natural light floods into wards and day rooms have panoramic views. Each ward has a separate treatment room and day room for patients.

Emergency Centre

Retained Estate

The new Accident and Emergency department – known as the Hospital’s Emergency Centre – will treat more than 100,000 patients each year. It has 10 consultants and more than 200 staff. Walk-in patients use one entrance while a second is reserved for ambulance and air ambulance cases.

Amongst the retained buildings being redeveloped is the £2.3 million Central Treatment Suite located in the Lyme Building. The expanded unit, which treats people requiring care for a variety of ailments, has almost doubled in size.

The Central Treatment Suite will now see 14,000 patients a year instead of the previous 8,000.

Cheethams Children’s Centre The Trust now has its very own dedicated Children’s Centre – described as a hospital within a hospital. The new Centre has two 25-bed wards, a high dependency unit, a nine-bay assessments ward, two large treatment areas, a day care unit and 11 consulting rooms in a new spacious Children’s Outpatients Departments.

Additionally, the Children’s ICU has eight bays and two high-tech resuscitation bays.

Still to come The move into the new hospital continues from this year into next. The Main Entrance now receives most of the 440,000 outpatient visitors.

All in all, the new wards and departments will give the people of North Staffordshire and beyond and the staff who work for the Trust, a hospital they can be proud of.

University Hospital of North Staffordshire NHS Trust Review of the Year 2011/12

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Major Trauma Centre status In 2011/12 University Hospital was granted Major Trauma Centre status after The West Midlands Strategic Commissioning Group made the recommendation. It serves the population of Staffordshire, South Cheshire, Shropshire, North Wales and beyond.

The service builds upon the existing links with Keele University and increased excellent opportunities for research and academic development.

The status also provides opportunities to develop the Trust’s regionally-recognised medical and nursing education.

The Secretary of State Mr Andrew Lansley MP with trauma lead Dr Peter Oakley.

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Caring with knowledge, value through quality

The Major Trauma service is underpinned by expertise in resuscitation and specialist surgery and focuses upon co-ordination, standardised communication and real-time governance. It is co-ordinated by a team of trauma leaders.

The Trust provides comprehensive, integrated, timely, specialist care from the moment a patient arrives injured to the start of their rehabilitation.

And the specialist surgical teams deliver definitive care for patients with complex life-threatening injuries 24 hours a day.

The Centre has excellent links with partner trauma units and the West Midlands Ambulance Service and is supported in Neuro and General Rehabilitation by the North Staffordshire Rehabilitation Unit.

The vision is for the Centre to become a world-class provider of acute and specialised services. All the necessary ingredients are in place to provide a full range of immediate and emergency interventions, delivered within a purpose-built, single-site facility.

In the spotlight The independent regulator of health and social care – The Care Quality Commission (CQC) – made an unannounced visit to the Hospital’s A&E and assessment wards and the elderly care and surgical wards in 2011.

They obtained information from involvement groups who have an interest in the service and reviewed four of the 28 outcome standards.

The Hospital was found compliant on:

■ care and welfare of people who use services ■ safety, availability and suitability of equipment ■ assessing and monitoring the quality of service provision ■ records The CQC stated that patients at the Trust experienced safe and effective care and support and benefited from equipment that met their needs and from effective decision

making, care, treatment and support. They also said that patients could be confident that records kept about them are accurate and fit for purpose.

During a visit by the West Midlands Quality Review Service representatives assessed quality standards of mental health services and health services for people with learning disabilities, dementia services and care of vulnerable adults in acute hospitals.

The assessors found staff welcoming, passionate and had pride in their work. They identified no immediate risks but were concerned that mental health liaison services were limited.

The Trust is committed to involving patients and the public in its work and to develop services that are responsive. Links have been established with local stakeholder groups such as EngAGE, Hibiscus, Saltbox and Scope.

University Hospital of North Staffordshire NHS Trust Review of the Year 2011/12

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MISSION STATEMENT – We will be a leading centre in healthcare driven by excellence in patient experience, research, teaching and education.

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Caring with knowledge, value through quality

The Hospital has achieved an 80 per cent reduction in MRSA bacteraemia this year compared to the last 12 months. This reduction to just six cases is even more significant compared to the 100 cases reported in 2006/07.

A new Lead Nurse for Infection Prevention and Control was appointed and the Infection Prevention team was further enhanced by the appointment of an Information Analyst in July 2011. The 10-strong team team includes seven infection prevention nurses to help ward-based clinicians prevent, reduce and control infections.

During the year ÂŁ1.9 million has been invested to recruit 65 assistants trained in infection prevention and control and University Hospital has continued to screen all in-patients for MRSA.

The Clinical Information System (CIS) was launched to enable all wards and departments to have real-time alerts of patients with a resistant organism, making them aware of the infection.

120 100 80 60 40 20 0

Alcohol hand gel dispensers are placed at bedsides and entrances to all wards and departments.

Matrons have responsibility for regular hand hygiene audits in their areas.

06/07

07/08

08/09

09/10

10/11

11/12

09/10

10/11

11/12

Clostridium difficile During the year there was an 82 per cent reduction in Clostridium difficile cases compared to the previous year (there has been a year-on-year reduction in the number of cases since 2007).

The spread of Norovirus, commonly known as the winter vomiting virus, has been reduced with the help of a dedicated gastroenteritis ward.

Just 10 wards were closed this year compared to 28 ward closures last year – despite a rise in the number of norovirus cases throughout the region.

1,000 Number of infections

The prevention and control of infection, together with patient safety, remains a top priority at University Hospital of North Staffordshire.

MRSA bacteraemia

Number of infections

Protecting patients from hospital acquired infection

800 600 400 200 0

06/07

07/08

08/09

University Hospital of North Staffordshire NHS Trust Review of the Year 2011/12

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Our staff University Hospital staff built on the success of last year with a number of prestigious national awards and recognitions for their services.

Listening in Action (LiA) is a process of engaging staff that puts them at the centre of change and decision making.

The Heart Failure team won the Nursing Times Award of 2011 – Cardiac Nursing Category and University Hospital’s Supplies and Procurement team won the title of Highly Commended at the National Health Service Journal’s awards ceremony.

The team manages the largest local NHS buying service in the country, managing an annual spend of £250 million.

It is a structured approach that enables staff to identify barriers to delivering the best possible care and come up with solutions of all shapes and sizes.

Trust employees also won at the Patient Safety Awards 2011 for Improving Medication Safety and the Maternity Centre team were given Baby Friendly accreditation by UNICEF. The Hospital’s cancer services were ranked in the top 10 trusts for inpatient cancer care and has been identified as a beacon of excellence.

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Caring with knowledge, value through quality

While the programme has been running, 55 clinical and non-clinical teams have used the LiA process to hold events to resolve specific issues.

More than 3,500 staff have participated. Also, patients, GPs and a range of other health economy related staff have been involved in these events.

LiA is now embedded within the organisation and is seen as “business as usual/the way we do change” rather than a stand alone programme.

School of Medicine

Our clinicians of the future Keele University Medical school trains around 130 students in each of its five years of the MB ChB course. Next year is important as it is the first that this degree will have been awarded.

Before this, doctors qualifying from Keele were trained in a Manchester-based system.

The Keele curriculum is an innovative, modern medical curriculum that includes problem-based learning while still using traditional methods of teaching. It is designed to allow diversity and integration.

The GMC monitored standards through the five years of the new programme by Quality Assurance of Basic Medical Education (QAMBE), carried out by a team of medical and educational professionals, students representatives and lay members.

We maintain close links with Staffordshire University. We offer placements to some of their nursing students and they jointly train operating department assistants in conjunction with Keele University.

In the final course inspection the QAMBE panel said they would be happy to be treated by any of the final year students they had met.

We have many Registered staff who undertake additional qualifications and courses with Staffordshire University and we are involved in the development of these courses.

They also commented on the strengths of the relationship between Keele University Medical School and the partner NHS Trust.

Our Healthcare Careers & Skills Academy also works closely with Stoke on Trent College.

The primary aim is to deliver competent Foundation year trainees while helping students experience more specialty activity in areas by developing their natural strengths.

The General Medical Council (GMC) sets out and monitors standards in medical education.

University Hospital of North Staffordshire NHS Trust Review of the Year 2011/12

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Research and development Offering patients an opportunity to take part in high quality research projects continues to be a high priority at University Hospital.

During the year the Trust recruited 3,167 patients into 103 National Institute for Health Research (NIHR) projects across 20 medical or surgical specialities.

Since April 2011, 26 new NIHR studies were opened, of which five were commercial trials. In addition 46 non-portfolio trials were opened during the year, recruiting 225 patients.

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Caring with knowledge, value through quality

In partnership with Keele University, the Trust secured ÂŁ1.7 million grant income during the year and this partnership delivers a bench to bedside approach to research.

Notable research grant successes include an i4i award evaluating point of care testing in the management of COPD and two Research for Patient Benefit awards looking at peritoneal dialysis and memory loss in Parkinson’s Disease patients.

However, the Trust is committed to increasing the number of people involved in research and the target for 2012/13 is 4,800 patients.

Staff at the Guy Hilton Research Centre continued to build and expand the research activity of the NIHR networks based at the Hospital and in recent time 254 publications have resulted from the Hospital's involvement in research.

The NIHR portfolio work was supported by ÂŁ1.4 million of research network investment and during 2011/12 the Trust was ranked 34 out of 347 research-active trusts.

New appointments have been made to research posts in the last 12 months. In addition, clinical academics in stroke and paediatric respiratory medicine.

Our wider responsibilities Plans are in place to deal with any major or mass casualty incident under the Civil Contingencies Act 2004. A robust training and exercise programme means the Hospital has practised its response and preparedness.

In addition, the Trust is a member of the Staffordshire Resilience Forum, a multi-agency group co-ordinated by the Civil Contingencies Unit and the Local Health Resilience Board.

As part of these responsibilities the Trust jointly developed the Staffordshire Prepared website to warn and inform the public.

During the year the Hospital worked closely with partner organisations to plan for potential challenges posed by the Olympic Games and developed an annual staff training programme to strengthen the response.

The Trust also supports the local community with employment and training advice and opportunities. The Healthcare Careers and Skills Academy was recognised for work in this area, and was shortlisted for the national Lean Healthcare Academy award.

The Academy continues to use e-learning as an alternative to classroom-based training.

Since its introduction, 5,122 staff have either completed or are part way through their e-learning.

This has saved 20,000 hours of staff time away from the workplace.

A new Equality and Diversity module was introduced in October 2011 and 972 staff have already completed the package.

University Hospital of North Staffordshire NHS Trust Review of the Year 2011/12

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Our impact on the environment reducing the amount of energy used. A staff awareness campaign called Green Aware operates with a network of Green Champions promoting sustainability and energy saving.

Energy costs and emissions in 2011/12 increased due to site development, as expected. Emissions increased by 34 per cent and gas and electricity was up by 3,073 tonnes.

Staff awareness campaigns have been shown to deliver cost savings and associated reductions in carbon emissions.

Water consumption was reduced by 25,077 cubic meters in 2011/12 and 176 tonnes of waste was recycled on site (8 per cent of the total waste produced).

However, the future is bright as the Trust moves from the older energy inefficient 19th Century buildings.

The Trust also has steps in place to improve energy efficiency and cut emissions in the future. There is also a financial benefit which comes from

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Caring with knowledge, value through quality

The Trust has a sustainable Development Management Policy, Energy and Carbon Emissions Policy and Green Travel Policy.

In addition to the focus on carbon the Trust is also committed to reducing wider environmental and social impacts associated with activities, for example, in procurement and travel patterns.

The Trust Board lead on sustainability and an Executive and Non-executive Director ensure that sustainability issues have visibility and ownership at the highest level of the organisation.

Water consumption 420,000 Usage in cubic meters

The Hospital is committed to reducing its impact on the environment, with the Trust’s Carbon Management Plan setting a target of reducing CO2 emissions by 10 per cent by 2015.

400,000 380,000 360,000 340,000 320,000 300,000

2006/07 2007/08 2009/10 2010/11 2011/12

UHNS Charity The UHNS Charity is now in its 16th year and the support its gives the Hospital has never been stronger. It has funds valued at more than £4 million and in 2011/12 donations totalled more than £554,000, with a third generated by 1,350 individuals, groups, societies, companies and schools.

In addition, UHNS Charity received £962,000 from legacies – one large legacy has enabled the Trust to buy a PET/CT Scanner that puts the Hospital among a select few in the country.

The Charity worked with clinicians to provide £60,000 to kit out a new cot space to support tiny babies requiring intensive care and provided more than £60,000 for specialist equipment to provide speedy testing of breast cancer biopsies.

It also provided £70,000 for research projects into orthopaedic hip replacement, lung and ovarian cancer and cystic fibrosis.

In total UHNS Charity funded nearly 500 projects proposed by staff to benefit patients. Within this there was still room for £150,000 to be spent on traditional charity favourites such as televisions, comfortable bedside chairs and other extras.

However, in a tougher economic climate UHNS Charity needs to maintain its group of supporters and work harder to meet the needs and expectations of staff and patients.

The forthcoming year will see the Charity launch a strategy to try to increase donations by 10 per cent every year for the next decade.

Stoke City striker Peter Crouch meets a young patient at the Cheethams Children’s Centre.

The Charity has also moved forwards with a new brand, a new website and has embraced the social media sites Facebook and Twitter.

Despite the look towards the future, the Charity will never forget its overriding mission: to improve lives of patients.

University Hospital of North Staffordshire NHS Trust Review of the Year 2011/12

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Finances 2011/12 has been a challenging year for the NHS. This has also been the case for University Hospital with the opening of the new hospital on the City General site.

The Trust has also had to contend with the ongoing service pressures on elective targets, extremely high and increasing levels of emergency activity and the need to continuously improve quality and patient experience.

Having eradicated its historic deficit, the Trust, in conjunction with the local health economy and the SHA, set a financial plan to deliver a planned income and expenditure surplus of £1.6 million and a financial risk of 3 (as measured by the Monitor compliance regime).

In 2011/12 the Trust delivered on all measures with the exception of the A&E four hour target in Quarter 4, which resulted in a penalty of £1 million

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Caring with knowledge, value through quality

being imposed by the Strategic Health Authority and the local health economy.

In spite of this, the Trust has delivered a surplus of £1.1 million compared to the planned £1.6 million, achieving the breakeven statutory duty.

The Trust has invested £270 million in the new PFI Infrastructure on the City General site and during 2011/12 services have been transferring on a phased basis from the Royal Infirmary and Central Outpatient sites.

The new facilities come with a significant financial cost and present a major challenge for the Trust in 2012/13 onward.

The Trust commissioned an independent valuer to carry out a valuation exercise of the estate in March 2012. This resulted in an impairment of £128 million.

Financial outlook for 2012/13 The Operating Framework, Payment by Results (PbR) tariff for 2012/13 and the Annual Operating Plan (AOP) agreement with the CCGs has resulted in the need for the Trust to deliver a £22.2 million cost efficiency target, circa 5.3 per cent of turnover.

The scale of the efficiency target presents an extremely challenging year ahead, as was the case in 2011/12.

For the year ahead the Trust plans to deliver an income and expenditure surplus of circa £2 million, which recognises the increasingly difficult challenge of generating sustainable cost efficiencies, maintaining quality and performance and retaining a financial risk rating of 3.

In the mid-term the strategy is to further reduce and eradicate the recurrent deficit by:

■ utilising and maximising the potential of new PFI facilities ■ continuing to drive clinical and operational efficiency ■ utilising lean management principles and service line management ■ delivering ongoing estate rationalisation with associated recurrent savings and non-recurrent savings from land sale proceeds where appropriate ■ pursuing savings from back office shared services efficiencies ■ management cost reductions

■ effective and flexible use of the workforce ■ transformation of services across the acute and community continuum to deliver clinical pathways that both enhance care and deliver more cost effective services In summary, the Trust’s financial performance continues to deliver to plan and has built on the foundations laid in the previous years. The task ahead over the next five years, as outlined above, will be extremely challenging but is no different to that facing the majority of trusts. With sound financial control and management the Trust is well placed to continue to deliver incremental improvements in the quality of services delivered to patients.

LEARN FROM EXPERIENCE – We reflect when things go right and when they go wrong. This way we can improve where necessary and build on the things we do well.

University Hospital of North Staffordshire NHS Trust Review of the Year 2011/12

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Our Trust Board The Trust Board consists of a non-executive Chairman with six non-executive directors and the chief executive and five executive directors, all of whom have voting rights (in February 2012 the Board approved the Director of Human Resources as a voting member of the Board).

The Trust introduced a revised structure of its Board and sub-committees in April 2011 which was subject to a review in autumn 2011.

The revised Board and sub-committee structure is as follows:

TRUST BOARD

AUDIT COMMITTEE

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EFFICIENCY & INVESTMENT COMMITTEE

Caring with knowledge, value through quality

QUALITY ASSURANCE COMMITTEE

CHARITABLE FUNDS COMMITTEE

REMUNERATION COMMITTEE

WORKING TOGETHER – We put our patients first in everything we do, by reaching out to staff, patients, carers, families, communities and health and social care partners. We put the needs of the patient before the NHS and other organisational bodies.

University Hospital of North Staffordshire NHS Trust Review of the Year 2011/12

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University Hospital of North Staffordshire North Staffordshire Royal Infirmary Princes Road Hartshill Stoke-on-Trent ST4 7LN Tel: 01782 715444 For a full copy of the Annual Report visit www.uhns.nhs.uk