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The Hillingdon Hospitals NHS Foundation Trust
Annual Report and Accounts 2014/15
The Hillingdon Hospitals NHS Foundation Trust
Annual Report and Accounts 2014/15
Presented to Parliament pursuant to Schedule 7, paragraph 25 (4) (a) of the
National Health Service Act 2006.
contents
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01 Introduction from the Chair and Chief Executive
09
02 Strategic Report
28
03 Directors’ Report1
68
04 Remuneration Report
80
05 Quality Report
164
06 Statement of Accounting Officer’s Responsibilities
166
07 Statement of Directors’ Responsibilities in
Respect of the Accounts
168
08 Independent Auditor’s Report
174
09 Annual Governance Statement
193
10 Annual Accounts 2014/15
1. Including the disclosures required in the NHS Foundation Trust Code of
Governance, staff survey, regulatory ratings, and public interest disclosures.
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Introduction from the
Chair and Chief Executive
The Trust has had a mixed experience
in the last year at a time that has
been extremely challenging for the
whole of the NHS.
In terms of successes we have expanded some key
services and, working with our health partners,
made great strides towards providing more
integrated health services in Hillingdon. We have
also seen a couple of significant improvements to
our estate although we recognise that much of it
is in very poor condition and requires substantial
additional investment over the next few years to
bring it up to a more acceptable standard.
Despite our very best efforts, however, we were
not always able to meet the four-hour waiting
targets in A&E simply because of the increased
number of patients coming through the door. We
also exceeded our Clostridium Difficile objective of
16 cases by two. In our recent CQC inspection we
received an overall rating of ‘Requires improvement.’
This is not good enough for a high performing Trust.
We made an absolute commitment to improving
this rating and have made excellent progress in
addressing the key issues that were highlighted.
On the positive side, the CQC rated the Trust
as ‘Good’ for being a caring organisation while
inspectors acknowledged that our staff are
committed to providing high levels of care to
patients.
The Inspection Team also identified areas of good
practice including: our specialist care for children
with diabetes – in particular their outreach work
in schools; good multi-disciplinary team work
supporting ‘one stop’ outpatient clinics; positive
support and mentorship for trainee doctors; and the
24/7 physiotherapy support for critical care patients.
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Overall we continue to provide high levels of care
as evidenced by our good patient outcomes, key
quality performance indicators and positive feedback
from patients themselves. We are also one of
only 16 Acute Trusts in the country with a “lower
than expected” Summary Hospital Level Mortality
Indicator (SHMI) rating.
A major highlight on our estate was seeing the
brand-new £12.3 million Nightingale Centre
come into operation; the first phase of opening
was the new 46-bed Acute Medical Unit which
is transforming the way we manage emergency
admissions. Phase two saw us open a state-ofthe-art Endoscopy Unit which is providing the
same high quality service in a bright new purposebuilt environment.
Over the summer we carried out an extensive
revamp of our Beaconsfield East rehabilitation ward
for elderly patients. More than £845,000 was spent
on transforming it into an impressive dementiafriendly ward with fantastic new spaces and facilities
for patients and their carers to enjoy during their
hospital stay.
We also saw the expansion of our highly-regarded
neuro-rehabilitation service as we opened the
new 16-bed Daniels Ward at Mount Vernon.
And our labour rooms in the maternity unit were
transformed as part of a £1.1 million improvement
programme for maternity services.
The last year also saw us successfully win a
competitive tender to run pathology services
for Ealing.
We strive to provide the best possible care at all
times and our CARES values remain the cornerstone
our approach to patient care. Last year, this saw
the Trust adopt the ‘Hello my name is…’ campaign,
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
01
which ensures that patients always know who is
involved in their care. We also committed to the
national ‘Sign up to Safety’ campaign, which aims
to strengthen patient safety across the whole of
the NHS.
We know there will be new challenges ahead
but are confident in our ability to deal with them
effectively and are grateful to our staff, Governors,
volunteers, and fellow Board members for their hard
work and commitment.
The results of the Friends and Family Test
demonstrate that patients are appreciative of the
services we provide. More than 24,000 responded
to the survey last year and 93% are happy to
recommend our services to their family and friends.
Finally we’d like to thank those who left the Board
this year to pursue new opportunities – executive
directors Karl Munslow Ong and Dr Richard GrocottMason, and the NEDs that reached the end of their
term of office – James Reid, former Interim Chair,
and Craig Rowland who both played a key role in
helping us gain Foundation Trust status in 2011. All
of them made a valuable contribution to the Trust.
We are optimistic but also realistic about the
future; In the year ahead we will be rolling out,
in partnership, a fully integrated care project that
joins up health and social care services to transform
the way that over 65-year-olds are cared for in
the borough. This is the result of many months of
close collaboration with a range of health partners
redesigning the way care is delivered to this patient
group. We will be examining how new models of
care, advocated in NHS England’s Five Year Forward
View, can be applied to wider health and social
care provision in Hillingdon. We are also looking
forward to the next stage of sign-off for the Shaping
a Healthier Future (SaHF) programme that will see
investment in our hospitals and the Trust play an
even greater role in delivering key services across
the North West London region. We will of course
continue to work with local MPs to lobby for the
investment sorely needed to improve our buildings.
Shane DeGaris
Chief Executive
The Hillingdon Hospitals
NHS Foundation Trust
Richard Sumray
Chair
The Hillingdon Hospitals
NHS Foundation Trust
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Key achievements at a glance
Friends and Family Test (FFT)
We received more than 24,000 responses to
the FFT during 2014 and 93% of patients
said they were happy to recommend our
services to their friends and family.
Annual NHS Staff Survey
The number of staff agreeing that patient care
is the Trust’s top priority grew by 7% to 78% –
above the national average of 69%. Our scores
improved in 26 questions and performed better
in 71 questions across all trusts.
Investing in our services
We invested more than £15 million in new and
improved patient services; including opening
the £12.3 million Nightingale Centre housing a
new Acute Medical Unit (AMU) and Endoscopy
Unit; £845,000 on redesigning Beaconsfield
East Ward and £870,000 on new Maternity
Labour rooms.
Expanding services
Patient Safety Thermometer
The Trust’s Patient Safety Thermometer
(Harm Free Care) stood at 95.4% against
a national target of 95% at the year end.
Securing new contracts
The Trust secured a major contract against
tough competition to provide Pathology
Services for Ealing worth £4.9 million per year.
Award winning Paediatrics
Diabetes Team
Our Paediatrics Diabetes Team were awarded
a £50,000 Innovation Challenge Prize for their
schools out-reach work and received three
commendations in the national Quality Care
Programme Awards.
Improved mortality rates
We expanded our highly acclaimed neurorehabilitation service by opening the new 16bed Daniels Ward at Mount Vernon as well as
ambulatory care at Hillingdon Hospital.
We are one of only 16 Acute Trusts in the
country with a “lower than expected” SHMI
band (Summary Hospital Level Mortality
Indicator published by the Health and Social
Care Information Centre).2
Monitor
Improving health care training
The Trust was rated green (compliant)
throughout the year in all but two (A&E
four hour target and C.Diff) of Monitor’s
performance targets.
The Trust was selected to lead the development
of the North West London Excellence Centre
which will provide high quality training for local
healthcare support workers.
2. According to data released at the end of April 2015.
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
02
Strategic report
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Introduction
Overview of the Trust’s strategy
The Hillingdon Hospitals NHS Foundation Trust
was established on 1 April 2011 when Monitor
authorised the organisation as an NHS Foundation
Trust. The Trust provides health services at two
hospitals in North West London: Hillingdon and
Mount Vernon. Hillingdon Hospital is the only acute
hospital in the London Borough of Hillingdon and
offers a wide range of services including accident
and emergency, inpatient care, day surgery,
outpatient clinics and maternity services. The
Trust’s services at Mount Vernon Hospital include
routine day surgery at a modern treatment centre,
a minor injuries unit, and outpatient clinics. The
Trust also acts as a landlord to a number of other
organisations that provide health services at Mount
Vernon, including East & North Hertfordshire NHS
Trust’s Cancer Centre.
The Trust’s Strategy and Business Model
The Trust’s income in 2014/15 was over £220m and
we employed over 3,000 staff. The majority of our
patients live in the London Borough of Hillingdon
but as part of our strategy we are seeking to provide
healthcare to a wider area.
In 2014/15:
• 81,489 attendances were made to our Accident
& Emergency department and Minor Injuries
Unit
• 4,128 babies were born in our Maternity Unit
• 308,180 attendances were made as outpatients
• 25,660 admissions were made for emergency
treatment across all parts of the Trust
• 25,126 admissions were made for planned
operations and day surgery.
The Trust’s Vision and Mission statements were
re-formulated in 2013 as follows:
Vision: To put compassionate care,
safety and quality at the heart of
everything we do.
Mission: To be the preferred, integrated
provider of healthcare for Hillingdon
and the surrounding population, with
a major acute hospital as a hub.
Strategic intent
Our long term strategy (3-5 years) remains focused
on the development of an organisation of sufficient
scale to continue to provide responsive, high quality
clinical care in the most appropriate setting for
patients. Our ambition is to continue to be seen
as both a major acute hospital provider and an
important part of a more integrated health and
social care system. A key part of our longer term
strategy is to obtain capital finance support to
upgrade the estates infrastructure on the Hillingdon
site, in the context of the Shaping a Healthier Future
(SaHF) reconfiguration of healthcare services in
North West London.
We also need to broaden our service offering,
acknowledging that healthcare is unsustainable
based on the current model of care. We will
increasingly see services delivered in community
settings, with a much stronger focus on early
intervention, either as the prime provider or
as part of a network solution.
Our objective is to be the main provider of health
services in Hillingdon, but also to grow our presence
and service offering in neighbouring boroughs.
The medium term strategy (next 1-3 years) is to
continue to deliver safe, high quality services and
be a top quartile performer for small-medium size
acute Foundation Trusts across quality, operational
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
and finance performance indicators. In order
to achieve this, we will transform our current
delivery model, ensuring we increase quality and
safety and drive down cost wherever possible.
Most immediately we are working to address
the quality concerns raised by the Care Quality
Commission (CQC) in its report of February 2015.
We will also support the transition to a more
integrated and affordable healthcare system
through much closer collaboration with Hillingdon
Clinical Commissioning Group (HCCG) – the main
commissioner of our services – and through the
development of strategic partnership arrangements
with other providers.
We have established four strategic priorities for the
future to help deliver our strategic intent and these
remain unchanged since last year’s report:
1. To create a patient centred organisation to
deliver improvements in patient experience
and the quality of care we provide
2. To deliver a clinically led service strategy that
responds to the needs of patients and other
health and social care partners
3. To deliver high quality care in the most
efficient way
4. To develop sufficient sustainable scale to enable
us to improve and grow healthcare services for
our communities.
These priorities are underpinned by more detailed
strategic objectives and actions, which are refreshed
each year, to ensure we deliver our strategic plan.
Further information is available in the Trust’s strategic
and annual plans.
Five Year Forward View
In October 2014 the NHS published its Five Year
Forward View strategy document. We believe there
is a good alignment between the Trust strategy,
local commissioner plans and the recommendations
of the NHS Five Year Forward View, with its core
messages around prevention and integrated care.
Over the coming months, the Trust will work with
commissioners and other local health economy
partners to further explore opportunities for the
integration of health and social care, building upon
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the work of the current Whole Systems Integration
pilot in North West London.
Shaping a Healthier Future
The Shaping a Healthier Future (SaHF) programme
aims to improve NHS services for the two million
people who live in North West London and is a key
driver of strategic change for our Trust. The principal
objectives are to:
• Centralise specialist services, which people need
when they are seriously ill
• Localise the most common services people need
for everyday illnesses and injuries
• Integrate all of these services with others.
On 19 February 2013, the North West London Joint
Committee of Primary Care Trusts (JCPCT) agreed
the following recommendations for service change:
• To adopt the North West London acute and out
of hospital standards, service models and clinical
specialty interdependencies for major, local,
elective and specialist hospitals.
• To adopt the model of care based on five
major hospitals: Hillingdon, Northwick Park,
West Middlesex, St Mary’s, and Chelsea &
Westminster.
• That Ealing should be a local hospital.
• To coordinate implementation of out-of
hospital strategies in conjunction with the
above changes.
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
In the context of this programme, the Trust is a
‘fixed point’ major acute hospital with 24/7 Accident
& Emergency capability, delivering emergency
and elective services over a progressively broader
catchment area, as the changes in the North West
London sector take effect.
With regard to the timing of changes, the Shaping
a Healthier Future programme has recommended to
the Ealing CCG Governing Body that:
• Maternity, neonatal and gynaecology services
close at Ealing Hospital in summer 2015;
• Paediatric A&E and inpatient services close at
Ealing Hospital in summer 2016.
However, before a final decision on the closure
dates is confirmed, NHS England has requested
further assurances around staffing and information
technology preparations. The Trust is supporting the
SaHF team with this work.
Enacting the SaHF changes to maternity services
in Ealing is expected to result in an increase of 800
births per annum at the Trust (to a revised modelled
forecast of 4,800 births per annum). The Trust’s
plans for providing the required physical capacity
to absorb the additional Ealing maternity activity
are based on the reformatting of space within the
Trust’s existing estate. This will enable the following
changes to be implemented:
• Development of a new four bed Maternity
Day Assessment Unit
• Expansion of existing maternity triage provision
• Development of a new four bed Midwifery
Led Unit
• Commissioning of an additional recovery space
• Commissioning of eight new inpatient beds
(six transitional care beds plus two additional
postnatal beds).
Whilst it is proposed that paediatric services should
transition from the Ealing site by 30 June 2016,
NHS England has asked that additional paediatric
capacity is available from winter 2015/16. This
additional capacity for the Trust is expected to cater
for 1,800 additional paediatric A&E attendances
and up to 500 inpatients per annum. In response,
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the Trust plans to create four additional inpatient
paediatric beds together with additional ambulatory
and assessment spaces to support A&E during
2015/16.
Quality strategy
During 2014/15 there has continued to be
increased focus on measuring and monitoring
the quality of our services and the care that is
delivered to our patients and their families. The
Trust’s three-year Clinical Quality Strategy supports
this work and helps us to achieve our vision ‘To
put compassionate care, safety and quality at the
heart of everything we do’. The strategy provides
a structure for ensuring strong clinical governance
and ongoing improvement in the quality and safety
of patient care.
The clinical quality strategy clearly outlines key
strategic enablers that support driving forward the
quality agenda and are central to the delivery of our
strategy. These include having key elements well
organised and resourced, and that there is robust
risk management with systematic processes for
assessing the impact of service changes on quality.
In addition strong clinical leadership, greater patient
involvement in improving services, and a culture
that empowers staff to report incidents and raise
concerns about quality and patient safety in an
open, blame-free working environment are key
components of our strategy.
Further information on the quality of the Trust’s
services and the Board’s priorities for improving
clinical quality is presented in the quality report.
Delivering the strategy
Service developments over the year
Emergency care developments
In December 2014 the Trust opened the doors
of the new 46-bed Acute Medical Unit (AMU).
This was part of a major programme of renewal
of the emergency care facilities funded by the
award of £12.3m Public Dividend Capital from the
Department of Health. The new AMU is adjacent to
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
the existing A&E which will help integrate care for
emergency patients.
The AMU is designed as a short stay unit under the
care of the acute physicians with a focus on rapid
intervention so that patients can return home as
quickly as possible.
The Trust’s Ambulatory Emergency Care unit (AEC)
has also moved to new purpose built premises. The
ambulatory model of care is being developed by the
Trust to prevent hospital admissions and the unit
accepts referrals directly from GPs and the Urgent
Care Centre. Further information on the AMU and
AEC is outlined later in the report.
Developments in endoscopy services
The Trust has completed an extensive programme
of work to enhance the endoscopy facilities on
both the Mount Vernon and Hillingdon sites. In
last year’s report we announced that in January
2014 the endoscopy department at Mount
Vernon moved to a new facility in the modern
Treatment Centre. Subsequently in February 2015
the Hillingdon endoscopy department moved to
a purpose built facility in the Nightingale Centre
(underneath the AMU).
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The new Hillingdon facility has two procedure rooms
and seven individual en-suite patient recovery rooms
offering improved privacy and dignity. The unit is
three times the size of the old department, has been
specifically designed and purpose built, to offer a
superb environment for both patients and staff. As
part of the objective to provide a high quality and
efficient service the department has also increased
staffing. There are plans to increase capacity
throughout 2015, in a measured way, to deliver
further increases in throughput, while maintaining
competitive waiting times.
Refurbishment of the maternity birthing rooms
In 2014 the refurbishment of the maternity birthing
rooms was completed thanks to a £741k award
of Public Dividend capital from the Department of
Health. The ten rooms all have en-suite bathroom
facilities and are decorated to create a soothing
home from home environment for women in
labour. The new facilities have received very positive
feedback from users.
Seven day services
The Trust has made good progress in improving the
provision of seven day services during the year, as
part of a coordinated process across North West
London. The national standards were prioritised for
implementation across North West London by the
Shaping a Healthier Future Clinical Board and the
region has now been chosen as a national
early adopter by NHS England.
During 2014/15 the priorities have been:
• Reducing time to first consultant review
• Diagnostic availability
• Arrangements for transfer to community,
primary and social care;
• Provision for ongoing review, where all patients
in high dependency areas are reviewed by a
consultant twice daily.
The Trust has invested significant additional
resources, with twice daily consultant ward rounds
now occurring seven days per week in the Acute
Medical Unit and paediatrics.
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Further developments planned for 2015/16 include:
• Working collaboratively with another provider
on CT scan reporting, that will free up Trust
radiologist time to allow consultant presence in
radiology seven days per week.
• Additional consultant recruitment to allow for a
separate ITU and anaesthetic rota
• Embedding of the surgical assessment unit
• Increased therapy provision in AMU to allow
multidisciplinary team assessment seven
days per week
• Improvement in multi-disciplinary handover.
Specialist rehabilitation
For some years the Trust has run a well-respected
neuro-rehabilitation service providing 20 beds on the
Alderbourne Rehabilitation Unit at the Hillingdon
Hospital site. In response to increasing demand, this
service has now been expanded with a further 16
beds provided on the Daniels Rehabilitation Ward
at Mount Vernon Hospital. The new unit opened in
July 2014.
The service will continue to take referrals from both
Hillingdon borough and surrounding areas, as well
as the Major Trauma Unit at St Mary’s Hospital in
Paddington and local stroke services.
Ealing GP direct access pathology
Following a successful competitive tender the Trust
took over the contract to provide pathology services
(testing of blood and body tissue samples for
diseases) to GP practices in the borough of Ealing
from October 2014. This means that the Trust now
provides pathology services to GPs in Hillingdon,
Hounslow, Ealing and parts of Buckinghamshire. The
service includes a sophisticated electronic ordering
and results facility to ensure efficient turnaround.
Looking forward, the Trust is engaged in a
pathology modernisation programme to centralise
pathology services across Hillingdon, Imperial,
Chelsea & Westminster and West Middlesex hospital
Trusts. The plan is to develop a hub and spoke
network model which will enhance the quality and
efficiency of pathology provision. The full business
case has now been approved by all four Trusts and a
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joint venture agreement is in development.
Project plans are now well developed with a view
to implementation in 2016.
Upcoming service developments
In addition to the changes to maternity and
paediatric services arising from the Shaping a
Healthier Future programme, the Trust is planning a
number of service developments for next year.
Multidisciplinary tertiary skin centre
Against a background of growth in regional demand
for dermatology services the Board has approved
the creation of a multidisciplinary tertiary skin centre
to provide secondary and tertiary care for patients
in North West London, South Buckinghamshire
and East Berkshire. The new centre will be located
in a brand new facility in Denham and will offer
a comprehensive service integrating appropriate
elements of plastic surgery, maxillofacial surgery,
allergy and dermatology. It is anticipated that the
skin centre will open in early 2016.
The single location and larger facility will allow the
Trust to capitalise on growth opportunities, whilst
also improving clinical quality and operational
efficiency. This will underpin the Trust’s growing role
as the regional dermatology centre.
Emergency eye service
The Trust is developing plans to launch an
emergency eye service that will operate from the
hospital. The intention is to provide patients in North
West London with a convenient urgent treatment to
avoid having to travel into central London. Patients
will be assessed by appropriate specialists and have
access to GPs, optometrists and urgent care services.
The idea will be to effectively see and treat common
problems that require specialist input and ensure
smooth pathways for onward referrals to specialist
clinics, if required.
Paediatric oncology shared care service
The Trust currently runs an effective level 1 paediatric
oncology service (POSCU) covering the catchment
areas of Hillingdon, Ealing and West Middlesex
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
hospitals. However NHS England are currently
reviewing paediatric oncology service provision
across London with plans to reduce the number
of centres from 30 to about 15 so as to improve
efficiency and quality. The Trust is preparing to bid
for the opportunity to run one of the new enlarged
Level 2 or Level 3 centres in North West London
when the NHS England review concludes in the
summer of 2015.
Trends and factors likely to affect the
Trust’s future development, performance
and position
There are three key factors which may negatively
affect the Trust’s future development, performance
and position:
1. The ongoing rise in demand for hospital
care – During 2014/15 there was a large rise
on the previous year in A&E attendance and
non-elective (emergency) admission, peaking
at an increase for both at 17% in September
2014. Although these rises were regarded as
exceptional, there is a trend of increased annual
demand, which places severe pressure on
hospital capacity. As outlined later in the report,
the Trust is working on a range of measures to
reduce demand, in collaboration with Hillingdon
Clinical Commissioning Group (CCG) and other
local health economy partners, such as the Rapid
Response team and Whole Systems Integrated
Care pilot.
2. Recruitment difficulties – The increase in
demand combined with the recommendations
from a range of national reports about safe
staffing levels, such as the Francis report into
care at Mid Staffordshire NHS Foundation Trust,
means that the Trust needs to recruit substantial
numbers of additional clinical staff, across a
range of specialties. The Trust is working with
Health Education North West London to address
resource requirements and devise recruitment
strategies, which in the short term include the
recruitment of overseas doctors and nurses.
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3. Hospital estates – Trust performance and
quality of care is also affected by its ageing
physical estate, as was demonstrated by the
recent report of the Care Quality Commission.
The Trust is seeking significant additional capital
to invest in essential backlog maintenance, so
as to ensure that it can continue to provide care
in an appropriate, safe environment. If capital
funds for this investment are not provided then
the Trust will struggle to maintain high quality
services for patients and meet key targets.
Key commissioning and contractual
relationships
The Trust’s primary commissioning relationship
is with Hillingdon Clinical Commissioning Group
(CCG) who accounted for 61% of total Trust
income in 2014/15. The Trust has a strong working
partnership with Hillingdon CCG, collaborating on
the improvement of patient services, such as the
Whole Systems Integration Pilot, as well as Trust
investment plans. The Trust also has commissioning
relationships with many other CCGs surrounding
Hillingdon, whose patients attend our hospitals.
The relationship with Ealing CCG is becoming
increasingly important in the context of the Shaping
a Healthier Future programme changes.
Certain specialist services are commissioned by NHS
England. For Hillingdon these include neonatal and
HIV services, as well as high cost drugs, and in total
these account for 10% of Trust income.
The Trust acts as landlord to a number of tenants
on the Mount Vernon site, most significantly to
East and North Hertfordshire NHS Trust, for whom
it provides a range of clinical and non-clinical
services. In addition, the Trust provides clinical
services to a number of other NHS organisations,
including the Royal Brompton and Harefield NHS
Foundation Trust, for provision of services to the
Harefield Hospital.
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Significant partnerships and regional and
local alliances to improve patient care
Whole Systems Integration pilot
As part of the North West London (NWL) pioneer
programme, Hillingdon Partners have come
together as an early adopter of ‘Whole Systems
Integrated Care’, with plans to trial and implement
a framework, co-designed by health and social
care organisations, frontline professionals and
service users, across North West London. Hillingdon
Partners is comprised of Hillingdon CCG, The
Hillingdon Hospitals NHS Foundation Trust, Central
and North West London NHS Foundation Trust
as well as GP networks and a voluntary sector
consortium (Hillingdon 4 All).
The initial focus in Hillingdon is on people aged 65
years or over with one or more long term conditions.
The intention is to move to an anticipatory model
of care, whereby older people with risk factors
for increasing dependency and complexity of care
needs are identified early and support put in place to
prevent attendance at health services or appearance
or escalation of need. This will allow support for
people to remain healthy and independent in their
own homes for as long as possible.
The programme went live in April 2015, piloting for
an initial cohort of 1,000 patients. The pilot started
with patients who have a lower level of need, before
adding those requiring higher intensity treatments
later in 2015.
Better Care Fund schemes
The Better Care Fund was established by the Health
and Social Care Act 2012 as a means of expediting
investment in the integration of health and social
care. The Trust has been an active participant in
the development of Hillingdon’s Better Care Fund
schemes as a member of the Hillingdon Health and
Wellbeing Board. Hillingdon’s Better Care Fund (BCF)
plan was approved by NHS England on 6 February
2015 and the focus is now on delivery. The plan
comprises seven schemes:
• Scheme 1: Early identification of people
•
•
•
•
•
•
susceptible to falls, dementia and/or social
isolation
Scheme 2: Better care at the end of life
Scheme 3: Rapid response and joined up
intermediate care
Scheme 4: Seven day working
Scheme 5: Alignment of community services
with emerging GP networks
Scheme 6: Care home initiative
Scheme 7: Care Act implementation – a
new scheme focused on the Council’s new
responsibilities to carers.
Partnerships with other trusts
We continue to develop our relationships with Central
and North West London NHS Foundation Trust, who
are the mental and community health provider in
Hillingdon. This has included collaboration over early
supported discharge, as well as exploring joint bidding
opportunities for services outside Hillingdon.
We have continued to develop our relationship with
the Royal Brompton and Harefield NHS Foundation
Trust (RBHT). In addition to the provision of clinical
support services to Harefield Hospital, the two Trusts
have worked closely with Hillingdon CCG during
the year to refine patient pathways for cardiology in
the borough.
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Performance review
Our performance against key targets
The Trust had strong performance against the majority of targets (exception being A&E four hour standard and
Clostridium difficile) used by Monitor, the regulator of Foundation Trusts, as part of the governance risk rating3:
Performance
in 2013/14
Target in
2014/15
Performance
In 2014/15
2014/2015
Target
Achieved
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
All cancers: 31 days for second or
subsequent treatment (surgery)
100%
94%
100.0%

All cancers: 31 days for second or subsequent
treatment (anti-cancer drug treatments)
100%
98%
100.0%

All cancers: 62 days for first treatment from
urgent GP referral for suspected cancer
90.3%
85%
91.6%

All cancers: 62 days for first treatment from
NHS Cancer Screening Service referral
97.8%
90%
97.8%

All cancers: 31 days diagnosis to first
treatment
99.3%
96%
99.3%

Cancer: two week wait from referral to
date first seen for all urgent referrals (cancer
suspected)
97.9%
93%
98.1%

Cancer: two week wait from referral to date
first seen for symptomatic breast patients
(cancer not initially suspected)
94.7%
93%
95.7%

Maximum time of 18 weeks from point of
referral to treatment – admitted patients
97.1%
90%
95.2%

Maximum time of 18 weeks from point of
referral to treatment – non admitted patients
98.6%
95%
98.5%

Maximum time of 18 weeks from point
of referral to treatment – patients on an
incomplete pathway
97.4%
92%
97.7%

A&E: Total time in A&E less than 4 hours
(Accident & Emergency, Minor Injuries Unit,
Urgent Care Centre)
96.0%
95%
94.1%

Fully
Compliant
Fully
Compliant
Fully
Compliant

Indicator
Clostridium difficile
Self-certification against compliance with
requirements regards access to healthcare for
people with a learning disability
3. Definitions for the indicators are included in Monitor’s ‘Risk Assessment Framework’ (available at https://www.gov.uk/government/
publications/risk-assessment-framework-raf). Information on the risk ratings issued by Monitor is contained on pages 43-45 of this
annual report.
17
02
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Clostridium difficile
The Trust unfortunately saw a sharp increase in the
number of reported Clostridium difficile Infection
(CDI) in 2014/15 with four cases in December 2014
and a further six cases in January 2015. There were
two further cases reported in February and March,
and the Trust breached its nationally set objective
for 2014/15 of 16 with a total of 18 cases reported.
Until December the Trust had been on trajectory
to fully achieve this standard as illustrated by the
graph below.
A detailed Root Cause Analysis (RCA) investigation
was undertaken for each CDI case. The analysis
indicated that there was no evidence of cross
infection in any of the cases. Learning from the
RCAs has shown that the patients affected have
been elderly, acutely unwell and requiring repeated
antibiotic treatment, both within the hospital and
in the community, for acute infections. It has been
concluded that for a few of these cases the use of
these antibiotics is likely to have contributed to the
patients developing CDI. Key learning has indicated
that prescribing practice does not always adhere to
the Trust’s antibiotic guidelines and policy. As a result
there has been an increased focus on prudent use of
This is very disappointing in light of the huge
improvement the Trust has realised in recent years.
Clostridium difficile Trust attributed cases
6
2013-14
2014-15
5
Number of cases
4
3
2
1
0
April
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Month
Clostridium difficile Toxin Positive
200
158
100
0
18
76
2008/09
2009/10
24
25
23
2010/11
2011/12
2012/13
12
2013/14
02
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
broad spectrum antibiotics, which can be seen to be
a contributory factor for CDI.
During quarter 3 the A&E department treated 18%
more patients than the previous year. December
was a particularly challenging month with a 20%
increase in the number of A&E attendances as
illustrated by the graph below.
Referral to Treatment waiting times
All 18 week targets for both admitted and nonadmitted patients were achieved for 2014/15.
The Trust consistently achieves this target and has
been one of the strongest performers in London
for the past three years. The Trust’s continued high
performance meant that it was able to support
national and local programmes to reduce waiting
times further. The Trust also supported other
organisations with delivering their elective 18
week activity.
Additional winter funds were made available to the
A&E department from December through to the
end of April. Extra medical, nursing and phlebotomy
staff were recruited. In addition, onsite senior
managerial support was provided over the weekend.
Unfortunately the activity increase was such that
the physical capacity of the department was
overwhelmed and it was not possible to see these
volumes of patients in the limited physical space in
the department within four hours.
Accident and Emergency (A&E) waiting times
The Trust did not achieve the target for 95% (all
types) of patients to have a total time in A&E of less
than four hours, during quarter 3 and 4. This gave a
mean performance throughout the year of 94.1%
(April 2014 to Mar 2015).
The number of acutely unwell patients continued to
increase throughout the year. Between April 2014
and March 2015, 2,257 ‘blue light’ ambulances
attended the Trust compared to 1,777 for the
same period last year. This represents a 27%
increase (480 attendances). Blue light ambulances
convey the sickest patients to the hospital who
require admission to the A&E resuscitation unit
and intensive support. It takes several hours to
stabilise patients before they can be transferred to
There was strong performance in the first quarter
of the year when the Trust consistently achieved
the required standard. Unfortunately there was a
significant and sustained increase in the number of
patients attending A&E that began early in Quarter 2.
A&E Attendances
A&E (type 1) + UCC (type 3)
12500
2013-2014
12000
2014-2015
11500
11000
10500
10000
9500
9000
8500
8000
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
19
02
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
another location in the hospital. On average 13.1
patients per day are treated in the resuscitation
unit. This often overwhelmed the physical capacity
available and the Trust had to seek diverts for blue
light ambulances to other hospitals to ensure the
continued safety of the department.
Unit (AMU) and into the Ambulatory Care Clinics
(see below). To achieve this, the Trust has invested in
additional medical, nursing and phlebotomy staff in
the A&E department. There is also a senior manager
and nurse on site all day Saturday and Sunday to
support flows out of A&E.
The number of non-elective (emergency) admissions
also increased. During 2014/15 there were 24,926
emergency admissions compared to 23,421 in the
previous year (6.4% / 1505 admissions increase).
3. Safely minimising length of stay
This scheme focuses on maximising the use of the
‘Home Safe’ service, and access to rapid response.
Home Safe is specifically targeted at frail elderly
patients and provides appropriate services in the
community to facilitate a more timely discharge
from hospital. Rapid Response is designed to prevent
patients being admitted to hospital by undertaking
a comprehensive therapy assessment in the A&E
department. Patients that meet the criteria can be
discharged directly from A&E with the appropriate
occupational therapy provided in their home.
The Trust, in conjunction with Hillingdon Clinical
Commissioning Group (CCG) developed a system
wide resilience plan in response to these pressures in
A&E. The plan is sub divided into three sections.
1. Managing demand prior to attendance
at A&E
This scheme, which is being led by the CCG,
includes working with GPs to provide easier
access to health services, encouraging the London
Ambulance Service (LAS) to use alternative pathways
such as community services or rapid response. It
also includes providing more clinical support for care
homes so they can better meet their patients’ needs,
thereby avoiding the need to attend hospital.
Acute Medical Unit
In December the Trust opened a new 46-bed Acute
Medical Unit. The unit is designed to have a 48 hour
maximum length of stay. The average length of stay
on the unit was 32 hours for January and 30 hours
for February and March. 56% of patients admitted
to the unit were discharged home and 44%
admitted to a speciality ward.
2. Managing demand in A&E and avoiding
admissions
This scheme includes ensuring that patients in
A&E have a first assessment by a senior clinician,
streamlines pathways to rapid response and diverts
GP heralded activity directly to the Acute Medical
The new unit also accommodates the Ambulatory
Emergency Care Clinics. During December there
was a stepped increase in the number of patients
attending Ambulatory Care as demonstrated
by the graph below.
400
350
300
250
200
150
100
50
0
Apr
Jun
Aug
2012
20
Oct
Dec
Feb
Apr
Jun
Aug
2013
Oct
Dec
Feb
Apr
Jun
Aug
2014
Oct
Dec
Feb
2015
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
02
all acute providers have been facing, the Trust also
had to manage with unprecedented demand on its
non-elective services throughout the year. Because of
this, the Trust was unable to achieve the underlying
break-even position approved by the Board and
ended the financial year £3.1m worse than plan.
However, when accounting for non-operating
income and non-cash impairments of property,
plant and equipment, the final deficit for the year of
£6.1m was a £2.0m improvement compared to plan.
Cancer performance
The Trust successfully achieved all of the cancer
access targets for the third successive year in a row.
In September a new cancer management system
“Somerset Cancer Register” was introduced which
allows greater oversight of the patient’s pathway
by all members of the multi-disciplinary team
and ensures the Trust has a consistent approach
to recording care and treatment. Furthermore
it facilitates the capture and transfer of data as
stipulated by the national cancer intelligence network.
This powerful tool will support the Trust’s continued
performance against all the cancer access targets.
Access to healthcare for people with learning
disabilities
The Trust continues to fully comply with the
requirements regarding access to healthcare for
people with a learning disability.
Financial review
Overall performance
This is the Trust’s fourth year as a Foundation Trust
regulated by Monitor and it has undoubtedly
been one of the most challenging. Despite this
and as in previous years, the Trust’s continuity of
services risk rating remained at 3 in each quarter.
This demonstrates that the Trust has continued to
successfully manage the operational and financial
risks it has faced.
The financial year proved to be far more demanding
than had originally been planned for. In addition to
the known tight local and national fiscal constraints
Despite the obvious financial pressures on the Trust
it nevertheless still managed to deliver a £15.8m
capital programme for much-needed capital
investment including a new ‘state-of-the-art’
46-bed Acute Medical Unit.
Trading for the year
Excluding non-cash charges for impairments of
property, plant and equipment the Trust ended the
2014/15 financial year with a reduced operating
surplus of £2.9m compared to £5.7m in 2013/14.
The steep increase in non-elective demand and new
service provision were the main reasons operating
income rose by £17.5m, 8.6% for the year. This
also included an additional £2.1m income from
DH to support the Trust’s operational resilience for
the pressures of surges in emergency demand that
occurred frequently throughout the year.
The unprecedented demand on the Trust’s nonelective services resulted in a 16% increase in
occupied bed days for the year. This was equivalent to
60 additional beds that had not been planned for. In
financial terms, this was the main contributing factor
in a £14.5m (11.2%) increase in staff costs and near
trebling of agency staff costs to £13.6m from £4.8m
in 2014/15. In contrast non-pay costs excluding
impairments only increased by £5.8m (8.4%) at a rate
in line with the overall growth in revenue.
Although a significant proportion of the additional
premium cost incurred was recognised with
increased revenue agreed with the Trust’s lead
commissioner, it was insufficient to avoid a
deficit at the year-end.
21
02
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
The deficit was incurred despite the Trust achieving
in full its challenging efficiency savings plan of
£7.5m, equivalent to 3.4% of total annual operating
income. This included a range of new income
generation opportunities the Trust is increasingly
focusing on given the continued financial constraints
within the local health economy. Foremost amongst
these was the award of a five year contract with
Ealing CCG to provide direct access pathology
testing to their GPs. During the year the Trust also
expanded and developed its neuro-rehabilitation
services on the Mount Vernon site.
Cash flow
In November 2014 the Trust agreed a £10m working
capital loan with the Secretary of State for Health.
Its contractually agreed purpose was for the Trust
to reduce its outstanding balance of payables and
in doing so also provide some additional working
capital resilience. The loan is repayable over ten
years at a fixed interest rate of 1.74%.
The Trust generated £11.7m cash during the
financial year from its predominantly direct
healthcare related activities. This was supplemented
by a £10m working capital loan from the
Department of Health. Of this £7.5m was utilised to
service outstanding debt and interest commitments
from loans and leases and to pay Public Dividend
Capital to DH. The £14.2m cash remaining was used
to finance the Trust’s capital investment programme.
The year-end retained cash balance of £5.4m was a
reduction of £0.3m compared to 2013/14 and will
provide some liquidity headroom going forward into
the new financial year.
Capital investment
During the financial year the Trust invested
significantly in a capital programme totalling £15.8m
on the facilities, equipment and technology used by
the Trust to deliver healthcare.
Trust physical estate infrastructure again remained
by far the largest area of investment. This was
targeted toward prioritised risk-based investment to
ensure operational buildings remained safe, fit for
purpose, and compliant with statutory legislation.
The 46-bed acute medical unit was completed
and ready for operational use in December 2014
followed early in the New Year by the relocation and
expansion of a new build endoscopy suite.
Apart from the physical infrastructure, the Trust
also continued to invest in updating its medical
equipment impacting on a wide range of
clinical services and on information technology
infrastructure and capability. Of most significance
was a major project to implement a wireless
network throughout the Trust; a key next step
on the Trust’s pathway to becoming a ‘paper-lite’
organisation.
Looking ahead
Given the overall 2014/15 deficit position of the NHS
in England and acute providers in particular, 2015/16
was always going to be extremely financially
challenging. Despite the £2bn of additional resource
announced in the 2014 Autumn Statement all
providers of NHS commissioner requested services
will continue to have to manage with a reduced
national tariff that will embed an efficiency saving
requirement of 3.5% merely to standstill.
In addition to the overall harsh economic context,
the Trust will face its own specific pressures. These
result from the unprecedented bed pressures faced
22
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
02
Finally, given its age and condition, managing the
Trust’s estate infrastructure is an ever increasingly
difficult and expensive task. For this reason the Trust
has made a first stage business case for £99m of
capital investment in the clinical facilities on the
Hillingdon Hospital site as an integral part of SaHF.
This investment is critical to supporting the capacity
required for the Trust to undertake the significant
amount of activity and in particular maternity
services planned to be transferred from Ealing
Hospital. However, until major new investment is
secured, the cost of maintaining current facilities to
meet compliance standards and service requirements
remains high.
The impact of this on Trust finances is that a cash
deficit of £4.4m will be planned for in the 2015/16
operational year.
over the last 12 months that will take some time
and considerable management effort to contain.
As a consequence of this the Trust’s agency
costs almost tripled over the last financial year so
addressing this with a focused recruitment and
retention programme is both essential and a major
challenge in its own right.
Added pressure on operating costs will also arise
from the Trust rectifying the compliance issues
highlighted in the Care Quality Commission
inspection in October 2014.
There are also further financial risks posed by the
transition path to the Trust’s Shaping a Healthier
Future (SaHF) post reconfiguration end-state as a
major acute hospital. The Trust will lose significant
activity and associated revenue well in advance
of gaining from services transferring from Ealing
Hospital in 2017/18. As a direct implication of this
the Trust will continue to require transitional funding
from NWL commissioners so it can continue to cover
its fixed costs and remain financially viable until full
reconfiguration implementation is complete. This
transition process began in 2013/14, was continued
in 2014/15 and sustained in 2015/16.
One positive however, is the increase in allocated
resources available to the Trust’s lead and local
commissioner, Hillingdon CCG. Because of its
distance from its target allocation it benefited
significantly in 2015/16 from an uplift of 7.63%.
This compared nationally to the minimum national
increase of 1.94% and the average increase of
3.74% and was nearly £11m more than it had
expected.
This will clearly benefit the local health economy in
the medium-term as it will assist Hillingdon CCG
in clearing its long-term historic deficit faster than
planned. It should also mean that from 2016/17
commissioner savings plans can be reviewed with
the expectation they will be less onerous on the
Trust whilst still achieving out of hospital aspirations.
The additional resources will also help the CCG meet
its obligations in respect of the Better Care Fund,
again with the prospect that it will have less financial
impact on the Trust than would have been the case.
It is hoped therefore, the deficit incurred in 2015/16
will be short-term and that the Trust can return to
financial balance and sustain this from 2016/17
onwards. It will be working with health economy
partners during the current financial year toward this
objective.
23
02
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
The Trust will remain committed to realising the
benefits from information and communications
technology and 2015/16 will see the start of the
development of the Trust’s own digital healthcare
record. The benefits will mainly come from risk
reduction, quality improvement, more efficient
clinical practice and business processes. More
widespread access and use of digital and online
technology will enhance patient care and be
delivered through a series of planned changes to a
‘paper-lite’ then largely paperless environment. For
this reason, investment in digital technology will
remain a priority.
Comparative financial performance
Compared to the Foundation Trust sector as a
whole, this is how the Trust performed on a range
of key financial performance indicators for the first
three quarters of the 2014/15 year.4
The
Hillingdon
Hospitals
NHSFT
Sector
Average
Operating Revenue –
Medium Acute Trusts*
£162m
£278m
Net Surplus(Deficit) –
Medium Acute Trusts
(£1.6m)
(£6.3m)
EBITDA5 Margin –
Medium Acute Trusts
5.8%
2.3%
Cost Improvement
Programmes –
Medium Acute
Trusts**
2.1%
2.7%
Capital Expenditure as
a % of Depreciation
186%
154%
4.The table is based on the Regulator, Monitor’s most
recent available review of the Foundation Trust sector
of 149 Trusts, of which 83 were acute, as at quarter 3
2014/15. To enable a direct comparison, the THH figures
also reflect performance as at end of quarter 3 2014/15.
5. Earnings Before Interest, Taxes, Depreciation, and
Amortisation.
* Monitor defines a medium acute Trust as having total
revenue of between £200m and £400m per annum.
** This excludes income generation schemes that brought
Trust total Q3 savings to 3.4%.
24
Going concern
After making enquiries, the Directors have a
reasonable expectation that the Foundation Trust
has adequate resources to continue in operational
existence for the foreseeable future and they
continue to adopt the going concern basis in
preparing the accounts. There is a degree of
uncertainty however, regarding outcomes, which
may affect incoming resources to the Trust. The
Annual Governance Statement later in the annual
report provides more detail on these financial risks
and uncertainties.
The financial statements have been prepared under
a direction issued by Monitor under the National
Health Service Act 2006.
Equality, diversity and
human rights
The Trust as a public health authority is ‘listed’
under Schedule 19 of the Equality Act 2010 and is
therefore required to comply with the equality duties
under Section 149 and Regulations 2011.
This means that when staff are delivering services
and carrying out the Trust’s functions, they must
consciously think about and pay due regard to
the three aims of the general equality duty as an
integral part of the decision making process. Details
of the equality duty aims and the Trust’s statement,
documenting how the Trust is meeting the duty,
have been published on the Trust’s website.
The specific duties require public bodies to:
• Publish relevant, proportionate information
demonstrating their compliance with the general
equality duty by 31 January each year.
• Set and publish specific, measurable equality
objectives by 6 April each year.
On 31 January 2015, the Trust published its
Service Equality Compliance Report and Workforce
Equality Compliance Report on its public website.
Both reports include actions and initiatives taking
place within the Trust to meet the Public Sector
Equality Duty, and the areas that continue to need
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
addressing and are being addressed via the four year
objectives set in April 2012. The Trust published an
update of its four year objectives in May 2015.
The breakdown of the number of male and female
Directors, other senior managers and employees at
31 March 2015 is shown below.6
Male
Female
Directors
8
6
Other senior
managers
15
18
Employees
742
2,315
Social, community and
environmental issues
The Trust is committed to acting as a good
corporate citizen. All Trust tenders include a section
for prospective suppliers to provide narrative on
environmental, sustainability, and ethical issues
relating to their offer. This includes information
on the suppliers’ adherence to environmental
standards and policies; information on carbon
reduction initiatives; and evidence that the supplier’s
procurement is conducted in an ethical manner
that is compliant with current legislation and takes
account of relevant environment and sustainability
standards. The Trust’s contracts with suppliers
contain clauses relevant to these issues.
02
The Trust will be refreshing its Sustainable
Development Management Plan in order to
minimise the organisation’s impact on the
environment. A key element of the Sustainable
Development Management Plan is to reduce
the Trust’s energy use. The Carbon Reduction
Commitment Energy Efficiency Scheme (often
referred to as ‘the CRC’) is a mandatory scheme
aimed at improving energy efficiency and cutting
emissions in large public and private sector
organisations. The scheme features a range of
reputational, behavioural and financial drivers, which
aim to encourage organisations to develop energy
management strategies that promote a better
understanding of energy usage.
Despite increased electrical demand from rising
clinical activity, the electricity consumption for the
period 2014/15 dropped to 57,557 Gigajoules
(GJ) from 60,209 GJ in 2013/14, a reduction of
almost 4.5%. These savings arose as a result of
a number of schemes that were implemented as
part of Estates Capital Programme. These projects
have helped to significantly lower the demand for
electrical heating. However due to unreliability of
the site contracted-out incinerator in October 2014,
our gas consumption by backup boilers went up and
consequently total gas consumption for the year
rose by 6.6% against 2013/14 figures.
The Trust continues to make progress in its
commitment to realising the benefits arising from
carbon management, reducing harmful impacts to
the environment, improving efficiency and resilience
in the way that we operate our hospitals, and
promoting health and well-being of staff and local
population.
6. ‘Directors’ refers to those listed in the remuneration report as the Directors who regularly attend Board meetings;
‘other senior managers’ relates to the direct line reports
of these Directors; ‘employees’ includes fixed term and
permanent employees.
25
02
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
The table below summarises the Trust’s energy use in Gigajoules (GJ):
2009-10
2010-11
2011-12
2012-13
2013-14
2014-15
Electricity
61,173
59,851
58,518
56,703
60,209
57,557
Gas
89,369
89,327
66,806
87,551
64,164
68,389
Steam
(incinerator)
79,990
79,991
79,991
69,990
70,000
64,166
Total
230,532
229,169
205,315
214,244
194,373
190,112
The Trust’s contract with SRCL to operate the
incinerator based on the Hillingdon Hospital site
ensures our clinical waste travels a minimal distance
before entering the incinerator process. It helps
minimise the impact on the environment in that
the steam created from burning clinical waste is
used to provide 70% of the energy needed to heat
the radiators and provide hot water at Hillingdon
Hospital, therefore significantly reducing our
need for energy sources such as gas and oil. The
incinerator takes all waste from Hillingdon, and
clinical waste from Mount Vernon.
Waste reduction and minimisation
The Trust’s Waste Group has met on a regular basis
during the year. Part of its role is to ensure waste
is segregated, managed, recycled and disposed of
effectively in line with the Department of Health
publication ‘Safe Management of Healthcare Waste’
and the Department for Environment, Food & Rural
Affairs’ ‘Waste Hierarchy’.
The Facilities waste & recycling service provides
the safe collection, management and disposal of
materials from our sites. This has been a challenge
over the past year as the significant building
programme at Hillingdon has led to departments
using the opportunity to clear storage areas of
large numbers of unwanted or obsolete items for
waste disposal. Alongside this there has been a high
volume of occupied beds over the past year and
this too has generated an increase in clinical and
domestic waste.
There was 19.9% growth in recorded waste
created, collected and disposed of in comparison to
the previous year. During the year there has been
26
a large focus on improving waste segregation and
processing and in the coming year’s programme
there will be an increased drive to improve our
recycling and reduce landfill working in partnership
with both the local authority and our incinerator
operating company.
2012/13
2013/14
2014/15
Total waste
generated
at Hillingdon
and Mount
Vernon
Hospitals
1,363
tonnes
1,476
tonnes
1,881
tonnes
Waste
recycled
351
tonnes
(26%)
437
tonnes
(30%)
441
tonnes
(23%)
Clinical waste
incinerated
to produce
steam that
generated
heat and
hot water at
Hillingdon
Hospital
545
tonnes
(40%)
537
tonnes
(36%)
574
tonnes
(31%)
Waste sent to
landfill
467
tonnes
(34%)
502
tonnes
(34%)
866
tonnes
(46%)
Green travel
The Trust has continued to promote green travel
for staff and service users. There were small surveys
undertaken at the Trust looking at how people
access the site and park and the Trust had some
success in locating and leasing off-site parking
spaces for staff. In line with the planning consent
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
for the Deck Car Park, a Travel Plan Co-Ordinator
is being appointed this year and further surveys
will be undertaken to update the Green Travel Plan
in partnership with the local authority. The Trust
will also be creating more cycle spaces either in
bicycle racks or lockable bicycle bins, as part of our
encouragement of cycling in the year ahead.
Looking ahead
On its energy efficiency journey, the Trust is keen
to work with the Carbon and Energy Fund (CEF),
a £300 million plus fund to support projects in the
NHS. Leveraging CEF’s expertise based on their work
with 50 hospitals, the Trust will be able to upgrade its
energy infrastructure at no net cost. The benefits of
this approach would be in the way of implementing
turnkey projects via simplified procurement, access
to technical and legal documentation and skilled
advisors at reduced costs, 15/25 years funding
options and guaranteed savings.
The projects being considered include, but are not
limited to:
• Feasibility of a Combined Heating and Power
plant
• Provision of new standby generators and
participating and benefiting from National
Grid’s Short Term Operating Reserve (STOR)
programme
• Lighting upgrades
• Electrical system enhancements
• Building Management Systems improvements
• Metering strategy and associated energy
monitoring and targeting software.
02
Looking ahead: principal risks and
uncertainties
The following summarise the key strategic risks
affecting the delivery of the Trust’s strategy:
• Failure to maintain operational performance and
quality of patient services
• Failure to maintain patient safety
• Failure to carry on as a going concern
• Failure to maintain safe staffing
• Failure to provide premises that are fit for
purpose
• Failure to plan appropriately to meet future
healthcare needs.
Further information on the risks facing the Trust and
the approach to managing these is outlined in the
Annual Governance Statement later in the report.
Shane DeGaris
Chief Executive
28 May 2015
These initiatives will not only help the Trust become
a more efficient user of energy and thereby lower
its associated carbon emissions, but also go a long
way in improving operational resilience. In addition,
the Trust will benefit from a reduction in both direct
energy costs and non-energy charges in the form of
lower carbon levies, operational, maintenance, and
service costs.
The Trust will also be developing a comprehensive
Travel Plan.
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Directors’ report
28
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Quality reporting
The Quality Report contains a comprehensive review
of the quality of the Trust’s services, and the priorities
for quality improvement. The following summary
outlines some key points of note.
Clinical quality and governance
The following information provides an outline
of some of the arrangements that are in place in
relation to governance and leadership structures
that support the Trust in ensuring that the quality
of care is routinely monitored across all services
and that poor performance or variation in quality
is challenged:
• There is monthly reporting to the Board via
•
•
the quality and performance report; this
highlights quality issues and improvement
through narrative information and performance
indicators. Each quarter the Quality and Risk
Committee (QRC) of the Board receives a more
detailed Quality and Patient Safety Report. It
includes information on the key quality indicators
that feature on the Trust’s quality dashboard in
more depth and other information on quality
such as patient feedback from NHS Choices.
Any external / peer reviews, and a summary of
performance against KPIs in the annual Quality
Report are also reported at this Committee with
escalation to the Board where required. The
Committee also receives a detailed quarterly
overview of complaints in terms of themes and
lessons learned and actions taken; claims and
litigation data; incident numbers, severity and
themes by clinical division; and medium and high
risks and actions being taken to address these.
Clinical divisions review their quality data in
relation to patient safety, patient experience
and clinical effectiveness on a monthly basis at
their divisional governance boards; a divisional
exception report is received by the Clinical
Governance Committee and any concerns on
quality are escalated via this Committee to the
Quality and Risk Committee.
There are regular clinical area reviews as part
of the ‘Clinical Fridays’ initiative and the mock
•
•
03
Care Quality Commission (CQC) inspection
programme. In addition the Director of Patient
Experience & Nursing and the Chief Executive
undertake regular ward visits which provide
the opportunity to talk to staff and patients
about their experience and to review the care
environment.
There is a robust framework to ensure that
all service changes have a Quality Impact
Assessment (QIA) which is reviewed by the
Medical Director. Any schemes where there
are quality concerns are reviewed at a multiprofessional Clinical Assurance Panel (CAP), with
the project leads presenting the scheme and
the actions being taken to mitigate any risks to
quality associated with the scheme.
There are a range of opportunities to support
patients in providing feedback and raising
their concerns. This is welcomed by the Trust
as a learning organisation which is always
striving for quality improvement. Patients can
complete local patient experience surveys,
provide feedback via the Trust website, via
NHS Choices, in person directly to department
managers and matrons or via the PALS/
Complaints offices. There is also opportunity for
patients and members of the public to attend
the Trust’s People in Partnership (PiP) meetings
and there are also specialty-based focus and
support groups, where again patient feedback
can be obtained. The Board receives patient
stories as part of understanding the patient
experience; this ensures that the voice of the
patient and their families/carers is heard first
hand by Board members.
The Trust recognises that in line with emerging
best practice and national quality improvement
initiatives there are key strategic enablers that will
truly support driving forward the quality agenda
and are central to the delivery of our clinical quality
strategy. These include ensuring there is robust
risk management with systematic processes for
assessing the impact of service changes on quality.
Strong clinical leadership and greater patient
involvement in improving services are also key
components of our strategy.
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
The arrangements in place to govern service quality
and to monitor the quality of services are discussed
in more detail in the Annual Governance Statement
and the Quality Report, later in the Annual Report.
Monitor Quality Governance Framework
In 2013/14 the Trust conducted a self-assessment
against the Monitor Quality Governance Framework
which highlighted the Trust’s position in relation to
the key four areas: strategy; capabilities and culture;
processes and structure; and measurement. This was
followed by an independent assessment by KPMG
who reported that overall the quality governance
systems and processes at the Trust appeared to be
strong, and in particular, the strength of challenge
at Trust Board and in sub-committees was robust
and appropriate, and that this extended into
other meetings that are not formally part of the
governance structure. In addition, they noted that
across all meetings and observations there was
a general sense that the culture amongst senior
staff and the Board was one of openness, where
problems are accepted and the focus is on finding
solutions – as opposed to a culture of defensiveness
and self-protection.
KPMG recommended that the Board sustains
its intentions in maintaining strong governance
arrangements in the face of pressures arising from
the estate, funding constraints, and Shaping a
30
Healthier Future. The Trust developed an action plan
to address the report’s recommendations during
the latter part of 2013/14. This has supported this
year’s work programme to strengthen governance
arrangements and delivery of the Trust’s overall
strategy and the clinical quality strategy. This plan has
been reviewed quarterly at the QRC and the majority
of recommendations have been addressed. Alongside
delivering on the quality governance framework
action plan the Trust has driven forward its annual
clinical quality strategy action plan, which the clinical
divisions integrated to their divisional business plans.
Progress with the divisional plans is scrutinised by the
Executive Team at quarterly divisional performance
reviews, whilst the overarching clinical quality strategy
action plan is reviewed quarterly at the QRC.
A further review was conducted by KPMG during
2014/15 to examine the Board’s operation and
effectiveness more widely. The outcomes of this
review are discussed separately in the governance
section of the Annual Report.
Care Quality Commission (CQC)
The Trust was inspected by the CQC in October
2014 as part of its planned and more detailed
inspection regime. The final reports were published
on 10 February 2015, following the ‘Quality
Summit’ held on 4 February. The Trust was rated
as ‘Requires Improvement’ overall.
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
The Trust was issued with formal warning
notices against:
• Regulation 10 – Assessing and Monitoring
the Quality of Service Provisions
• Regulation 12 – Cleanliness and Infection
Control.
The Trust was also issued with five Compliance
Notices against:
• Regulation 13 – Management of Medicines
• Regulation 15 – Safety and Suitability of Premises
• Regulation 16 – Safety, Availability and Suitability
of Equipment
• Regulation 20 – Records
• Regulation 22 – Staffing.
The Trust was also issued with 21 ‘Must’ and 11
‘Should’ do actions of which seven were not directly
addressed by the Warning or Compliance Notices.
The Trust had already flagged several of the strategic
challenges and key quality concerns identified by
the CQC via its Board Assurance Framework and
the corporate risk register. These included concerns
on safer staffing, the condition of the Trust’s estate,
the quality of record keeping, training compliance
in safeguarding and infection control, and expired
policies and clinical guidelines.
The concerns raised by the CQC in relation to the
systems to assess and monitor the quality of service
provision with robust and effective processes to
ensure there was minimal risk to patient safety were
of immediate concern to the Board. Some specific
areas highlighted such as assurance on theatre
ventilation standards and the management of
medicines with regard to storage and security were
unexpected. The findings provided a real impetus to
ensure our assessment of the quality of services fully
encompasses the review of systems and processes
that our staff are following, in addition to achieving
key quality indicators and positive patient outcomes.
03
improvements. The Board has been clear that it
believes our hospitals have staff who are committed
to the highest possible standards of care for patients
and has welcomed the very positive feedback
received from both patients and staff in the CQC’s
report. It is also clear that the gaps in process
identified by the CQC, especially in relation to the
safety rating, must be addressed as a priority. It has
been considered that most of the required actions
are deliverable within agreed timeframes. A minority
will take longer and may need external support.
The Trust appointed an Interim Director of
Compliance and the improvements are managed
through a robust governance structure with
Executive Directors as accountable leads for each of
the Regulations being addressed. Improvements are
monitored at twice-weekly ‘Sit-Rep’ meetings, at
a weekly Steering Group, and at regular Executive
Briefings. A detailed improvement plan provides a
summary of the urgent actions required for each
of the main areas of concern and outlines the
arrangements for making the improvements and
demonstrates our progress against the plan. The
Trust will set out longer-term plans to maintain
progress and ensure the actions lead to measurable
improvements in the quality and safety of care for
patients. This will be informed by a ‘root cause
analysis’ overseen by the Board that will examine
how the situation identified by the CQC arose.
The reporting in the Annual Governance Statement
and Quality Report are consistent with the CQC’s
findings. The Trust’s quarterly submissions to
Monitor have also reflected the CQC’s inspection
findings. However, the Trust did not declare a risk
of non-compliance with the CQC’s registration
requirements in the Corporate Governance
Statement submitted to Monitor in May 2014.
The Board have considered the overall rating
(‘Requires Improvement’) to be fair; all of the
recommendations have been accepted and
the Board is determined to make the necessary
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
The new approach to training has been extremely
well received by staff from across the Trust. Staff
have fed back examples of how they have used the
training in day-to-day situations, such as offering
help to patients who are not sure where they are
going, ensuring they speak calmly and clearly, and
above all being friendly and reassuring, which has
benefitted all our patients.
“Barbara’s Story” has proved so popular that we are
planning to use other episodes in the more detailed
training we are developing for clinical staff.
Tissue viability
Developments in patient care
Dementia awareness training
Dementia awareness training has been included in
the new starters induction programme at the Trust
for a number of years, with the focus on clinical
staff. We recognise however that all staff should be
dementia-aware and understand the huge impact
our attitude and actions have on the experience of
those affected by dementia.
Since October 2014 all staff must attend dementia
awareness training. When our Clinical Nurse
Specialist took up post in October approximately
25% of staff had attended awareness training; by
the end of March 2015 it had reached 85%.
Not only have we increased the number of staff
attending training, we have also revised its format
to be more person-centred, which has increased
its impact. The awareness session is based around
the first episode of the acclaimed DVD programme
“Barbara’s Story” which was developed by Guy’s
and St Thomas’ NHS Foundation Trust to raise
awareness of how it can feel to be a patient with
dementia. The film follows the journey of an older
person with dementia, allowing the audience to
experience care through her eyes. Although it is
highly emotive, it is also inspirational.
32
The Tissue Viability Nurse (TVN) has continued to
work closely with frontline staff to provide support
and specialist expertise on all wards across the
Trust. There has been a particular focus on bringing
education and awareness to the bedside this year.
The TVN provides 15 minute teaching slots and
reality based sessions at the patient’s bedside to
assist the nursing team in the identification of grade
2 pressure ulcers. In addition, the TVN uses every
opportunity to enhance the skills and confidence of
ward based nurses in the management of complex
wounds by encouraging nurses to shadow her whilst
undertaking wound assessments and dressings.
A new visual alert magnet to identify patients
who are at risk of pressure damage has been
implemented across the Trust on the new bedside
information boards. The ‘SSKIN’ mnemonic on
a green hand is used to prompt nursing staff to
consider five key interventions to reduce pressure
damage: regular Skin inspection, ensuring that
the patient is nursed on the correct Surface, Keep
turning – ensuring that the patient is repositioned
regularly, and managing Incontinence and Nutrition.
The TVN has worked collaboratively with
procurement colleagues to review heel pressure
relieving devices. This has led to a number of wards
using heel protectors with a view to implementing
these more widely.
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Core nursing care plans
A number of core nursing care plans have been
developed and introduced this year. The care plans
developed with frontline nursing staff and specialist
nurses include a number of common key actions
that should be considered/undertaken following
assessment of the patient and identification of
nursing needs. Each care plan is designed to
incorporate space for any individualised actions
required to meet patients’ specific needs. New core
care plans currently under development relate to
caring for a patient with dementia and care at the
end of life.
Admission standard
An admission standard has been developed and
implemented to ensure there is a consistent
approach to safely admitting both elective and
emergency patients and settling them into the
ward routine and environment. The standard
was developed with Senior Sister/Charge Nurse
involvement and includes actions clustered under
the headings associated with our aim of keeping
patients safe, comfortable, informed and involved.
03
Healthcare assistant education and
training pathway
Following on from the Francis report into Mid
Staffordshire NHS Foundation Trust and the
Cavendish review, the Induction Care Certificate
has been successfully piloted within the Trust for
both new starters and current healthcare assistants
(HCA). It is now being rolled out nationally, and the
Care Quality Commission (CQC) will expect every
healthcare assistant to have the care certificate as
part of the induction process. All healthcare assistants
that have started in the Trust since August have had
their care certificate induction; this involves a two day
induction following on from the corporate induction.
The healthcare assistant then has a workbook to
complete in practice to ensure that they are providing
high quality, compassionate patient care.
Our existing healthcare assistants have also been
offered the opportunity to complete the care
certificate, through a shorter course that provides
an overview of the care certificate, the Francis
report and the importance of whistleblowing and
raising concerns.
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
In 2015 there will be a pathway for healthcare
assistants who would like to develop themselves
within their role. There will also be the opportunity
to gain formal qualifications and progress towards
a nursing degree. The first cohort of the Essential
Care Certificate began in February 2015 with
good feedback and enthusiasm from all learners.
At the end of the course they will achieve a level
2 Qualifications and Credit Framework (QCF) or
intermediate apprenticeship. The Higher Care
Certificate will begin in summer 2015 and there
will be an option to make this an advanced
apprenticeship with QCF level 3 if required.
Another course which is in early development is the
progressive care certificate; this course is aimed at
bridging the gap between level 3 QCF and the Level
6 nursing degree programme. It will provide the
healthcare assistant with interview skills, reflective
practice and focuses on the academic requirements
of a career in nursing. Ultimately the pathway
will help the healthcare assistant to progress
academically but essentially they will be able to
deliver highly skilled, compassionate care to patients.
Preceptorship and Transition Programme
for newly qualified nurses
The Professional Development Pathway for newly
or recently registered nurses and nurses who have
previously worked in nursing homes has been
designed to meet the professional development
needs within the Trust. This post-registration,
educationally led pathway, contributes to the
national emphasis on workforce planning and
quality of service delivery. The programme aims
to help make the transition of staff from student
to staff nurse as easy as possible to support their
learning and development needs.
The pathway is 12-18 months based on the NHS
Knowledge and Skills Framework Foundation
Gateway. The purpose of the Foundation Gateway
is to check that individuals can meet the basic
demands of their post. The pathway period time
is deemed appropriate to allow the opportunity to
test-out, consolidate and have verified a measurable
level of competence required of a registered nurse.
34
Delivery of quality targets agreed
with the Trust’s commissioners and
other key healthcare targets
Commissioning for Quality and Innovation (CQUIN)
is a national framework for locally agreed quality
improvement schemes. It links a proportion of
healthcare income to the achievement of local quality
improvement goals. CQUINs are divided between
those that are set nationally for all hospitals, those
which are set regionally, and those are agreed locally
between the Trust and commissioner.
In 2014/15 there were eight CQUIN schemes
relating to the Trust’s acute services, five of which
were locally derived by Hillingdon CCG. At the time
of writing, there is potential achievement of 86% of
the maximum possible CQUIN income, compared to
79% that was achieved in 2013/14. This will equate
to around £3.1m of income in 2014/15 compared
with £2.8m in 2013/14. Detail on these schemes
and the Trust’s performance against these is included
in the Quality Report.
Patient public and stakeholder
engagement
Improvements following patient feedback
The Trust has a number of approaches to gathering
patient feedback. The Friends and Family Test (FFT)
is now implemented across inpatients, the accident
and emergency (A&E) department, maternity,
paediatric areas, day care and outpatient services.
In 2014/15 over 31,000 responses were received
to the FFT or one of our local surveys, providing
valuable feedback about patients’ experience.
Results and comments from all surveys are reviewed
alongside other feedback such as compliments,
complaints, NHS Choices feedback, and national
patient survey results.
One of our primary aims has been to ensure that
our patients should always be safe, comfortable,
informed and involved. Many of the measures
undertaken this year were planned with this aim
in mind.
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Comfort at night campaign
A ‘Comfort at night’ campaign was launched last
year, with the aim of creating the right conditions to
reduce sensory overload and enhance comfort
at night.
This year the Trust introduced comfort packs that
are available to patients on all wards. The contents
of the packs help us to provide dignified care for
patients through provision of a basic set of toiletries;
non-slip slipper socks which are both for comfort
and help prevent falls; a pen and small note pad;
ear plugs; and an eye mask. The packs are especially
helpful to those patients who do not have family or
friends close by or are admitted as an emergency.
Bedside information boards
New bedside information boards have
been designed to incorporate some of the
recommendations of the Francis report into Mid
Staffordshire NHS Foundation Trust. The boards
include the name of the consultant responsible for
the care of the patient and the name of the nurse
caring for the patient on each shift. The boards
also have a space to include the patient’s preferred
name, and information about what matters most
to them. A range of magnets have also been
purchased with the boards. These provide a visual
03
alert about risks of harm and are used with the
patient’s consent. The boards are currently being
installed across the wards.
Patients with Parkinson’s disease
Following a concern about Parkinson’s medications
being given on time, the Trust has designed and
implemented a new visual alert magnet for the
bedside information boards.
To raise greater awareness about caring for patients
with Parkinson’s disease a series of workshops open
to all Trust staff were delivered by a Parkinson’s
specialist nurse. These were very well attended and
evaluated by the multi-disciplinary attendees and the
plan is to schedule further workshops in 2015/16.
Admission standard
An admission standard has been developed and
implemented to ensure there is a consistent
approach to safely admitting both elective and
emergency patients and settling them into the ward
routine and environment.
Raising worries or concerns
A number of approaches to raise awareness of who
to speak to about worries or concerns have been
undertaken. Members of the PALS (Patient Advice &
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Liaison Service) team proactively visit wards; posters
with the name of the ward sister and matron
are displayed prominently outside each ward;
and matrons carry mobile phones. New patient
information reinforcing this information has been
implemented.
Hello, my name is…
Some patients have told us through the Friends and
Family Test that they do not always know the names
or roles of staff providing care to them.
Dr Kate Granger championed a national campaign
urging hospital staff to introduce themselves by name
to patients. It followed her personal experience as a
terminally ill patient in Bristol; her stark observation
was that many staff did not introduce themselves.
We have supported the national Hello, my name is…
initiative with the launch of a local campaign.
Staff have been encouraged to show their support
for the campaign by committing to a number of
simple actions, including:
• Wearing a name badge in a visible position
• Making eye contact
• Introducing themselves by name and role to
patients and explaining what they are there to do
• Asking patients for their preferred name and
remembering to use it.
These acts demonstrate openness and
compassion, help to set the tone for what patients
can expect, and provide the first step in building a
trusting relationship.
To help embed the message the ‘hello, my name is’
logo is also incorporated on our bedside information
boards and updated each shift so that the patient
and their family and carer know the name of the
nurse responsible for their care on each shift.
Pharmacy improvements
Following a complaint the Pharmacy Team
developed an action plan to improve the experience
of patients using the Outpatients Pharmacy. Key
changes include:
• Improved seating in the waiting area including
foldaway seating to improve wheelchair access
• A texting service and the use of a local buzzer
system to give patients the choice to call back for
their medication when it is ready
• A lead pharmacist is now responsible for clear
communication with the team and prompt
escalation when there is greater demand
• Waiting times are now monitored on a regular
basis.
To promote a culture of learning and continuous
improvement pharmacy staff are given time to sit in
the waiting area to see the pharmacy through the
patient eyes and an experience survey is also used.
Feedback from both of these approaches influences
actions on the improvement plan.
Complaints
In 2014/15 the Trust received 397 complaints, of
which 99.2% were acknowledged within three
working days. As the investigation period is typically
30 working days, the number of complaints on
which responses were due during the financial year
differs because of investigation time overlap at the
beginning and end of the year.
The number of complaints due for response year by
year is shown in the table below, together with the
performance, which indicates how many of these
were responded to within the agreed timeframe.
The improved response rate in 2014/15 reflects
the impact of tighter controls implemented from
January 2014.
Complaints
Due for response
Performance
36
2011/12
2012/13
2013/14
2014/15
370
503
405
419
83.5%
76.1%
73.6%
88.5%
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
03
This has been achieved against a backdrop of a
reduced timeframe for responding to complaints.
For more than half of 2013/14 the default time set
for a complaint response was 45 working days.
In contrast, in 2014/15, 85% of complaints were
targeted for investigation within 30 working days,
with only those meeting the criteria set out within
the Complaints Policy being set for a longer period
of investigation. Just six complaints (1%) required an
extension to the deadline.
After completion of local resolution, a number
of complainants will take their complaint to the
Parliamentary & Health Service Ombudsman (PHSO).
In 2014/15 15 complaints were accepted for
investigation by PHSO. Four of these investigations
have been completed; one was upheld, the others
not. In addition, we have received a draft final
report on a further case, on which the proposal is
to uphold in part, with the potential for significant
compensation to be assessed.
These performance improvements have been
achieved through a combination of the following:
We also received final reports on six other
investigations that had been underway at PHSO
since 2012. Two of these were upheld on poor
complaints handling, two were upheld on the
substance of the complaint (with compensation paid
on both) and the remaining two were not upheld.
• Full implementation of control measures within
•
•
•
the Complaints Management Unit (CMU) to
monitor timeliness and quality of responses from
divisions
Closer working relationships with the divisions to
produce the best investigation outcome for the
complainant
The Division of Medicine appointing a lead
matron to co-ordinate all divisional complaint
responses and act as the principal point of
contact with CMU
Provision of ad hoc training by the Complaints
Manager to emphasise the importance of
upholding the Ombudsman’s Principles.
Last year we reported that the investigation reports
and complaint response letters were being more
closely scrutinised by the Complaints Manager to
ensure they address the complaints that have been
raised. It was anticipated that the benefits of this
approach would become more evident over time
and should reduce the number of complaints that
return to us to be reopened for further investigation.
This has indeed been borne out with the result that
only nine complaints were reopened during the year,
the last of which was in October 2014. In contrast,
32 complaints were reopened in 2013/14. Eight
of the reopened complaints were answered; the
ninth had to be closed without a response after four
months to enable the complainant to approach the
Ombudsman.
Improvements in patient and carer information
Providing high quality and clear information is
central to the patient experience.
During 2014/15 the Trust’s Patient Information
Review Group continued to work with staff across
the hospital to develop new patient and carer
information, and to refresh existing information.
Our Readers Panel which includes public governors
and service users supports Trust staff to ensure that
the information we produce is clear, jargonfree and
user friendly. Our Patient Transport Group which
includes public representation has worked with our
Patient Transport Manager to develop an eligibility
criteria poster for patients and our paediatric leaflets
are reviewed by children/parents prior to publication.
Each ward has a resource folder containing
information sheets about clinical conditions, and
access to specialist services and support groups. This
information is available to patients and carers. During
2014/15 the Trust benefited from the appointment
of a dementia clinical nurse specialist who is available
to support carers of patients with dementia.
The Trust has developed a guide for mothers
and families who lose a baby in early pregnancy
explaining the different options for funeral
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
arrangements. The guide was developed in response
to feedback from a mother who was not aware that
she could arrange a private funeral.
on the reconfiguration of health services in North
West London –‘Shaping a Healthier Future’ – by the
Trust and Hillingdon Clinical Commissioning Group.
The Trust’s Carers’ Strategy 2012-2015 outlines the
Trust’s commitment to working in partnership with
all carers and families by listening, learning and
responding to feedback. Our vision is to provide
support and information to all carers ranging from
breastfeeding mothers through to carers’ needs at
the end of people’s lives.
A selection of public engagement activities
undertaken during the year are outlined below:
Consultation and engagement
The Trust is committed to involving and consulting
with members, patients and the local community in
the planning of service provision, the development
of proposals for change, and decisions about how
services operate. The Trust will continue to engage
and consult with service users, public and the wider
local community in decisions about general service
delivery (such as any transfer of services to an ‘out of
hospital’ location).
The Governors and members will clearly have an
important role in any consultation and engagement
on major service changes. However the Trust will seek
to ensure that such engagement reaches beyond our
membership, particularly where a group that is underrepresented in our membership is affected.
The Trust encourages and facilitates linkages
between the Council of Governors and groups
and organisations which represent patients, public
and the wider community. The Membership
Development & Engagement Strategy approved
by the Board outlines the Trust’s policy on the
involvement of members, patients and wider public,
including a statement on the Trust’s approach
to consultation, and addressing the overlap and
interaction between the Governors and other
consultative and representative groups. Further
information on membership development and
engagement is outlined later in the membership
section of the Annual Report.
The Trust did not undertake any formal consultations
in the past year. Members of the public are updated
38
• Members of the Board attended Hillingdon
Council’s External Services Scrutiny Committee
on three occasions during 2014/15.
• The Trust continues to hold bi-monthly meetings
of its ‘People in Partnership’ forum (with the
September meeting replaced by the Annual
Members’ Meeting). The forum enables the
Trust to listen to the views and opinions of the
communities we serve, share information about
what the Trust is doing and planned future
developments, and provides an opportunity
for members to meet and communicate with
staff, governors and fellow members. People
in Partnership meetings are organised by the
Lead Governor and Head of Patient and Public
Engagement, and chaired by a public or staff
governor. Meetings are rotated between a
hospital and community setting with some of
the meetings held during the day which has
attracted new members and raised a number of
different issues.
• Governors, members, patients and the public
are offered the opportunity to get involved in
projects and groups such as: Patient Transport,
Fighting Infection Together, Maternity Services
Liaison Committee, People Improving Cancer
Services, Readers Panel and the Patient-led
Assessment of the Care Environment (PLACE).
A focus group of public members was held
in November 2014 to help develop the Trust’s
patient safety and quality priorities for 2014/15
which are set out in the Quality Report.
• Over the last year and following engagement
with user representatives there has been an
increase in volunteer applications from younger
volunteers and from minority communities. This
highlights our commitment to involve users
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
which in turn adds value to our services and
provides an opportunity for individuals to gain
valuable work place skills prior to pursuing a
career in health and social care.
• Since 2011, Age UK Hillingdon has conducted
unannounced visits to ward areas to provide an
informed view of the standards of care specifically
related to nutrition, dignity and compassion
towards the elderly. The visits are currently
planned quarterly and an overview of the results is
presented to the Quality & Risk Committee.
• The Trust has continued to work in close
partnership with Healthwatch Hillingdon and
appreciates the valuable contribution the
organisation provides. Representatives from
Healthwatch regularly attend focus groups and
committees and are regular attendees at our
People in Partnership meetings. This year the
Trust has worked closely with Healthwatch on
the consultation for the priorities for the Quality
Report, PLACE inspections and follow up action
plans. Healthwatch Hillingdon have direct access
to the Chief Executive and regularly meet with
the Chief Executive and Director of Patient
Experience & Nursing to discuss health care
issues. Healthwatch Hillingdon and Healthwatch
Ealing attend a quarterly quality meeting, and
Healthwatch representatives have also been
involved in senior appointments at the Trust.
• The Trust has a number of regular patient
support groups providing information and
improving awareness on:
– Age related macular degeneration
–Glaucoma
– Care of the colon (semicolon group)
–Psoriasis
– Cardiac care
– Skin Cancer awareness.
The sessions are delivered by clinicians and
are organised both in the hospital and in the
community. • The Trust’s Head of Patient & Public Engagement
manages the Foundation Trust Office and
03
has a central role in coordinating the Trust’s
relationship with third party voluntary
organisations such as the Hillingdon League of
Friends, the Mount Vernon Comforts Funds,
Hillingdon Diabeticare, Hospital Radio Hillingdon
and Hospital Radio Mount Vernon. The Trust
has a further 150 volunteers who represent the
local community by volunteering on wards and
in departments at both Hillingdon and Mount
Vernon Hospitals.
Our staff
Staff consultation and engagement
The Trust takes a partnership approach when
consulting and engaging with staff and staff side
(trade union) colleagues. To assist with this the
Trust has three main forums to work with the
unions that represent staff: the Terms & Conditions
Committee, the JNCC (Joint Negotiating &
Consultative Committee) and the JLNC (Joint Local
Negotiating Committee). Each committee is made
up of management and union representatives. The
latter two committees are attended by members
of the Executive Team. These committees allow for
an open and consultative approach to discuss and
agree matters which affect terms and conditions
of employment, or will have an impact on staff.
At these meetings, staff side colleagues provide a
valuable input into the decision making process.
In addition to these groups committees, it is not
uncommon for further sub-committees or working
groups to be set up to consider specific issues.
Examples include on-call payments, the personal
development review (PDR), and overseas recruitment.
Seven members of the Council of Governors are
elected by staff; and a further Governor is appointed
by the JNCC in recognition of the importance of
partnership working between the unions and Trust
management.
In addition to these more formal mechanisms, the
Trust communicates and engages directly with staff.
There are regular written team briefings from the
Chief Executive on key matters such as the Trust’s
performance and strategic developments; a weekly
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
General Information Bulletin to communicate other
information such as upcoming events or policy
changes; plus the Chief Executive holds regular open
briefing sessions at both hospitals.
The magazine for staff and public members of
the Foundation Trust, ‘The Pulse’, is distributed
throughout the Trust’s hospitals and online
of the Trust’s staff responded to this national
confidential survey, which disappointingly was below
the national average and also last year’s response
rate. However, more positively, in the responses
received, engagement overall was better than the
national average and an increase on last year’s score.
The Trust also ranked 13 out of 135 acute Trusts
for staff engagement, as listed in the ‘Listening into
Action’ analysis of the 2014 staff survey data.
Staff survey
The NHS staff survey provides the Trust with valuable
feedback on the views of our staff. In 2014, 29%
40
The following tables summarise the Trust’s
performance in the 2014 staff survey:
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Response Rate
2013/14
Response rate
2014/15
Trust
National
Average
Trust
National
Average
45%
49%
29%
49%
03
Improvement /
Deterioration
16% lower
Top four ranking scores
The Trust appears in the top 20% of all Trusts in 23 questions, and ranks 13 out of 135 Trusts in overall engagement.
2013/14
2014/15
Top four ranking
scores
Trust
National
Average
Trust
National
Average
Trust Improvement/
Deterioration
Overall Engagement
3.77
3.68
3.84
3.68
0.07 better than 2013
0.16 better than other Trusts
8g. Satisfaction with the
extent to which the Trust
values your work?
45%
40%
51%
40%
6% better than 2013
11% better than other Trusts
5a. Staff look forward to
going to work
60%
52%
62%
51%
2% better than 2013
11% better than other Trusts
11b. Effective
communication between
senior managers and staff
38%
34%
44%
35%
6% better than 2013
9% better than other Trusts
7d. Able to make
improvements
58%
53%
61%
53%
3% better than 2013
8% better than other Trusts
Bottom four ranking scores
The Trust appears in the bottom 20% of all Trusts in six questions.
Bottom four ranking
scores
2013/14
2014/15
Trust Improvement/
Deterioration
Trust
National
Average
Trust
National
Average
20c. Reported last
experienced violence
64%
62%
63%
69%
1% lower than 2013
6% lower than other Trusts
22. Trust acts fairly with
career progression
81%
59%
82%
87%
1% lower than 2013
5% lower than other Trusts
21c. Reported last
experienced abuse
47%
44%
43%
47%
4% lower than 2013
4% lower than other Trusts
23a. No experience of
discrimination from
patients or public
91%
95%
91%
95%
Equal to 2013
4% lower than other Trusts
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Action plan
An action plan has been drafted in response to the
national survey results which is specifically focused
on key priority areas to ensure actions are achievable
and not over-ambitious. Key priority areas for
2015/16 are:
• Communicating results of the staff survey and
increasing future response rates
• Improve rate of reporting of incidences – errors,
violence, harassment and abuse
• Perception of fairness with development and
career progression
• Quality of performance and development reviews.
The action plan was reported to the Board in
March 2015 and is available on the Trust’s website.
A summary of the actions and the measures for
evaluating their impact is outlined below.
This work will report into the Experience and
Engagement Group, which includes representation
from across the Trust and staff and public governors.
Policies in relation to disabled employees
and equal opportunities
The Trust seeks to adhere to the commitments
of the ‘two ticks’ disability symbol and as part of
this guarantees interviews to all applicants with
a disability who meet the minimum criteria for a
job vacancy. Later in 2015 the Trust will undertake
an annual audit to ascertain how closely we are
adhering to this commitment, and then implement
improvements as appropriate.
Survey outcome
Action required
Measures of success
Communications about
the results of the 2014
staff survey and the
provision of divisional
reports
• Summarise in staff Bulletin
• Link to data on intranet
• Cascade via department managers during team
• Completion and delivery of
•
•
42
Further directorate and staff group analysis has
and will be undertaken to be shared with divisional
leads. This will enable targeted local action,
including celebrating notably high performance, and
communicating key messages about improvements
to be made and best practice. For example, the local
survey undertaken in the Women’s and Children’s
Division last year focused on pressure of work,
and the results were used to inform the design of
bespoke workshops.
meetings
Further analysis to be carried out to enable
divisions to see their local results
Local results to be delivered and discussed at
divisional and departmental meetings
analysis
• Cascade of information
•
to staff demonstrated by
future feedback
Completion of divisional
action plans
Failure to report:
• Errors
• Physical violence
from the public
• Abuse from
colleagues
• Communication campaign (eg staff bulletin,
Career progression and
fairness including link
between discrimination
and career progression
• Conduct desktop analysis of existing data
• Facilitate focus groups if more exploration is
• 2015 Staff survey results
• Take up of development
Appraisals
• Review analysis of divisional differences to
• Identification of local needs
• Simplified PDR process for
•
• Improved scores in the
intranet front page, management briefs)
• Increased response in
• Training targeted to workgroups
•
needed
determine if action is required locally or
corporately
Provide further training in creation of objectives
and delivering good quality appraisals
2015 staff survey to the
question on those knowing
procedure
Reduction in the number of
reports of errors
programmes
2014
2015 Staff Survey
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
03
The Trust provides onsite Occupational Health
support including access to an Employee Assistance
Programme for all staff (see below). HR Consultants
and Business Partners work closely with managers
in supporting and re-enabling staff who are or
become disabled. This includes making reasonable
adjustments, such as adjustment to PCs and work
equipment, and redeployment to a role more suited
to their condition. We also provide flexible working
opportunities for staff who are disabled or have
caring responsibilities.
2012 which established a system whereby
Monitor licences providers of NHS services.
The Trust provides a range of mandatory training,
career development and promotional opportunities
to our disabled employees. This includes making
reasonable adjustments to our equipment and
training facilities to make them accessible. In terms
of promotion and career development, the Trust
seeks to meet the commitments of the two ticks
symbol meaning that our employees will be offered
an interview for a new role where they meet the
minimum post requirements. The Trust will audit
compliance with respect to the existing workforce
as part of the annual audit that will be undertaken
later in 2015, referred to above.
The financial risk rating was based on a range of
metrics across four areas: achievement of plan,
underlying performance, financial efficiency, and
liquidity. The governance risk rating was based on
a combination of: service performance (measured
on the Trust’s performance against key performance
indicators selected by Monitor from the Department
of Health’s Operating Framework); the views of
third parties such as the Care Quality Commission
and the NHS Litigation Authority; the provision of
the mandatory services that Foundation Trusts were
required to provide; and other instances where
the Board had failed to accurately certify on their
performance or governance. In addition, Monitor
had the discretion to amend the governance risk
rating should a Foundation Trust fail to meet the
statutory requirements of other bodies.
Occupational Health and sickness
absence data
The Trust’s Occupational Health department
provide advice on how to protect individuals
from harm, help identify aspects of health which
affect employees’ capacity to work efficiently, and
improve employees’ quality of life in a safe working
environment. The Employee Assistance Programme
(EAP) offers a free confidential helpline that can
provide advice and support on a range of issues
such as financial difficulties, workplace difficulties,
and health and wellbeing. Information on sickness
absence is contained in note 6.5 to the accounts.
Until 30 September 2013 Foundation Trusts (FTs)
were subject to Monitor’s ‘Compliance Framework’
under which FTs were given:
• A financial risk rating (rated 1-5, where 1
represents the highest risk and 5 the lowest);
and
• A governance risk rating (rated red (highest risk),
amber-red, amber-green or green (lowest risk)).
Regulatory ratings
For the period of 2013/14 in which the
Compliance Framework was in place, the Trust
had a financial risk rating of 3, and a green
governance rating. This was consistent with the
ratings expected by the Board in the Trust’s Annual
Plan. This performance was also consistent with
the performance during 2012/13. The green
governance rating reflected the Trust’s strong
performance against the required performance
targets including those relating to healthcare
associated infections and access to services.
Monitor, the independent Regulator of Foundation
Trusts, assigns Foundation Trusts two risk ratings
each quarter. During 2013/14 Monitor introduced
a revised regulatory regime to take account of the
changes introduced by the Health & Social Care Act
From 1 October 2013 the ‘Risk Assessment
Framework’ replaced the Compliance Framework.
As part of these changes the financial risk rating was
replaced by a continuity of services rating and the
nature of the governance rating changed.
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Whereas the financial risk rating was intended to
identify breaches of FTs’ terms of authorisation on
financial grounds, the continuity of services risk
rating identifies the level of risk to the ongoing
availability of key services. The continuity of services
risk rating incorporates two measures of financial
robustness:
a. liquidity: days of operating costs held in
cash or cash-equivalent forms, including
wholly committed lines of credit available for
drawdown; and
b. capital servicing capacity: the degree to which
the organisation’s generated income covers its
financing obligations.
A rating of 1 to 4 is given for each of these two
areas and the overall continuity of services rating is
the average of the two measures, rounded up. A
rating of 4 is the lowest risk, whilst 1 indicates the
highest level of financial risk.
As before, the governance risk rating continues to
be generated by Monitor considering a range of
information about an FT. From 1 October 2013 this
information covers the following areas:
• Performance against national access and
outcomes requirements
• Care Quality Commission judgements
• Third party information
• Quality governance indicators
• Continuity of services and aspects of financial
governance.
Monitor can also consider any other relevant
information when calculating the governance
risk rating.
Where there are no grounds for concern at a Trust,
Monitor will assign a green rating. Where Monitor
has identified a concern at a Trust but not yet taken
action, it will provide a written description stating
the issue at hand and the action it is considering. A
red rating will be assigned when Monitor has begun
enforcement action.
The Trust retained its green governance risk rating
for the first half of the 2014/15 financial year. As
44
outlined earlier in the report, the Care Quality
Commission’s (CQC) inspection of the Trust rated
the Trust as ‘Requires Improvement overall’ with an
‘Inadequate’ rating for safety, with two warning
notices issued. Therefore Monitor changed the
Trust’s governance risk rating to ‘under review’
for quarter three. In making this change, Monitor
advised that the risk rating would remain ‘under
review’ until the CQC had concluded a follow-up
inspection of the warning notices.
The Trust maintained a continuity of services risk
rating of 3 as planned in each quarter of the
2014/15 financial year. A full quarter by quarter
breakdown of the Trust’s risk ratings in 2013/14
and 2014/15 is presented below.
There have been no formal interventions by Monitor
at the Trust.
Financial and other public interest
disclosures
Research and development
The Trust is committed to the NHS Research &
Development (R&D) agenda and supports clinical
trials which help to establish if new treatments are
safe, have any side effects, and are better than
those already available. All of our research activity
is scrutinised for quality and compliance to the
standards expected by the Research Governance
Framework. In addition we work to comply with the
Department of Health National Institute of Health
Research (NIHR) objectives.
The majority of the Trust’s research and development
activities are NIHR portfolio adopted multi-centre
studies where the Trust acts as a recruiting site on
behalf of the lead centre. Our research portfolio is
a balance of observational and treatment studies
across many clinical areas including cancer, stroke,
haematology, cardiology and many of the general
medicine and surgical specialities. In 2014/15 we
significantly increased the number of NIHR portfolio
adopted commercial and non-commercial trials
in Ophthalmology, with eight trials open and a
further four trials set-up. The Trust employs a 0.4
03
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Annual Plan
2014-15
Q1
Q2
Q3
Q47
Continuity of service rating
3
3
3
3
3
Governance rating
Green
Green
Green
‘Under
Review’
‘Under
Review’
Q3
Q4
Annual Plan
2013-14
Q1
Q2
Under the Compliance Framework
Financial risk rating
3
3
3
Governance risk rating
Green
Green
Green
Under the Risk Assessment Framework
Continuity of Service rating
4
3
Governance rating
Green
Green
7. The Q4 risk ratings are based on the Trust’s submission to Monitor at the end of April 2015: the Trust does not have Monitor’s
confirmed Q4 ratings at the time of finalisation of the report (May 2015).
WTE Ophthalmology Research Physician and two
Ophthalmology Trial Coordinators to support this
work. The Trust also supports a small number of
studies undertaken by our own staff and students
from the local universities undertaking PhD and
Masters courses.
The R&D Team based at Hillingdon Hospital inform
patients about research that is relevant to them and
offer, to those who choose to, the opportunity to
take part in clinical trials. Participation in research
and development enables patients to access new
treatments that would not have otherwise been
available and supports our clinicians to stay abreast
of the latest treatments whilst helping to improve
the quality of care provided.
Cost allocation and charging
requirements
The Hillingdon Hospitals NHS Foundation Trust has
complied with the cost allocation and charging
guidance issued by HM Treasury. There is no
additional charge for material made available to
meet the needs of particular groups of people, eg in
Braille or other languages.
The standard fee of £10, as set by the Information
Commissioner’s Office, is charged for Subject Access
Requests made under the Data Protection Act. Fees
for copies of medical records are set at a maximum
of £50.
The Trust does not impose any fees for responding
to requests under the Freedom of Information Act
unless the amount of information requested exceeds
the appropriate limit as defined in section 12 of the
Freedom of Information Act.
Policies and procedures in relation to
countering fraud and corruption
The Hillingdon Hospitals NHS Foundation Trust will
not tolerate any form of fraud, bribery or corruption
by, or of, its employees, associates, or any person or
body acting on its behalf.
The Trust is committed to ensure that the number
of offences is kept to a minimum and that all
allegations will be investigated thoroughly and the
strongest sanctions including criminal sanctions will
be taken against those found to have committed a
fraud, bribery or corruption offence.
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
The Trust engages TIAA (The Internal Audit Agency)
as its Local Counter Fraud Specialist (LCFS) in
accordance with Secretary of State Directions to
support its work in this area.
from 2013/14. Nineteen of these incidents were
reportable to the HSE under RIDDOR (Reporting
of Injuries, Diseases and Dangerous Occurrence
Regulations).
The Trust’s Audit & Assurance Committee agrees
the annual work-plan for the LCFS and receives sixmonthly reports on progress against its delivery. The
Committee has agreed the Trust’s policy for dealing
with suspected fraud, bribery and corruption.
Non-NHS income
Health and safety
Through its Health & Safety Strategy the Trust
continues work towards best practice standards of
health and safety for all our staff in the workplace,
for members of the public, patients, and others who
come into our premises.
In February 2015 the Health & Safety Executive (HSE)
issued the Trust with an improvement notice for
failing to implement the Health and Safety (Sharps
Instruments in Healthcare) Regulations 2013 in a
timely manner. To meet the regulations fully the
Trust must substitute all traditional unprotected
medical sharps with a ‘safer sharp’ where it is
practicable to do so by 29 May 2015.
Section 43(2A) of the NHS Act 2006 (as amended
by the Health and Social Care Act 2012) requires
that the Trust’s income from the provision of
goods and services for the purposes of the health
service in England must be greater than its income
from the provision of goods and services for any
other purposes. In 2014/15, the Trust met this
requirement, with 96.3% (£214m) of the Trust’s
income generated by activities for the purpose of
the health service in England.
As the vast majority of Trust income is categorised
as generated by activities for the purpose of the
health service in England, it is the Board’s view that
other income does not detract from NHS provision
to any material extent. Where other income is
generated it supports the Trust to make optimum
use of its assets and is used to directly support
principal patient care activities.
Financial risk management
Health and safety governance: The Health and
Safety Committee has met quarterly and the Board
has received quarterly reports on health and safety
issues and performance throughout the year.
Following an internal audit review of health and
safety that gave an opinion of ‘limited assurance’, a
review of the Trust’s Health and Safety Committee
has taken place. New terms of reference and
committee membership have been implemented to
ensure that the focus remains on the Trust’s health
and safety strategy, implementation and planning.
Training: All new members of staff receive health
and safety training during their corporate induction.
Fire safety training has been comprehensively
reviewed, which has resulted in increased attendance.
Performance: In 2014/15, 1508 incidents were
reported, a 6% (85) increase in incidents reported
46
In relation to the use of financial instruments,
an indication of the financial risk management
objectives and policies of the Trust and the exposure
to price risk, credit risk, liquidity risk and cash flow
risk can be found in note 1.35 of the accounts.
Employee benefits
Accounting policies for pensions and other
retirement benefits are set out in note 1.10
of the accounts. Details of senior employees’
remuneration can be found in the remuneration
report.
Payment of creditors
The Trust aims to comply with the Better Payment
Practice Code which is that 95% of invoices in
terms of numbers and value are paid by the due
date of payment. Details of the Trust’s compliance
in this matter can be found in note 7.1 of the
accounts.
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
03
The Trust paid out £9k in 2014/15 for interest on
late payments under the Commercial Debts (Interest)
Act 1998 (£4k in 2013/14).
• Provide leadership to the Foundation Trust
Trust’s auditors
•
The Council of Governors has appointed Deloitte
as the Trust’s external auditors. Further information
is contained later in the report in the section on the
Audit & Assurance Committee.
The Board confirms that for each individual who was
a Director at the time that this report was approved
(27 May 2015):
• so far as the Director is aware, there is no
relevant audit information of which the NHS
Foundation Trust’s auditor is unaware; and
• the Director has taken all the steps that they
ought to have taken as a Director in order to
make themselves aware of any relevant audit
information and to establish that the NHS
Foundation Trust’s auditor is aware of that
information.
Important events affecting the
Foundation Trust occurring since
the end of the financial year
The Board confirmed at its meeting on 27 May
2015 at which this Annual Report and accounts
were approved, that there were no events that
required disclosure.
Directors’ statement on the annual report
and accounts
At the time of approval (27 May 2015) the Directors
consider 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
Foundation Trust’s performance, business model
and strategy.
•
•
•
•
within a framework of processes, procedures
and controls which enable risk to be assessed
and managed
Ensure the Foundation Trust complies with its
Licence; its Constitution; requirements set by
Monitor; and relevant statutory and contractual
obligations
Set the Foundation Trust’s vision, values and
standards of conduct
Set the Foundation Trust’s strategic aims and
ensure that the necessary human and financial
resources are in place to deliver these
Ensure the quality and safety of the healthcare
services provided by the Foundation Trust
Ensure that the Foundation Trust exercises its
functions effectively, efficiently and economically.
The Board undertakes these responsibilities through
a set business cycle that includes approving strategic
documents such as the forward plan and other
strategies, and receiving monitoring reports on areas
such as key risks, financial, operational, and quality
performance.
The Board has approved a Scheme of Reservation
and Delegation which outlines the decisions that
must be taken by the Board and the decisions that
are delegated to the management of the hospital.
For example, contracts or investment proposals
over a certain financial value must be approved by
the Board, whereas the approval of lower value
contracts is delegated to management.
Board Directors collectively and individually have a
legal duty to promote the success of the Trust so
as to maximise the benefits for members and for
the public. They also have a duty to avoid conflict
of interests, not to accept any benefits from third
parties and declare interests in any transactions that
involve the Trust.
Our governance
Who does what
The Trust is headed by the Board of Directors
(often referred to as ‘the Board’). The Board’s key
responsibilities are to:
The Council of Governors is responsible for
representing the interests of the Foundation
Trust members and partner organisations in the
governance of the Foundation Trust. The Council
of Governors is responsible for providing feedback
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
from the membership and stakeholders on strategic
developments at the Trust, including for example
on the Trust’s strategic plans, and in turn, should
keep members and stakeholders informed about
developments at the Trust.
This role is encapsulated in the Council of
Governors’ two statutory duties: (a) to hold the
Non-Executive Directors individually and collectively
to account for the performance of the Board of
Directors; and (b) to represent the interests of the
members of the corporation (Foundation Trust)
as a whole and the interests of the public.
The Council of Governors has a number of statutory
powers to assist them to discharge these duties.
The Council of Governors’ statutory powers are to:
• Appoint, and if appropriate, remove the Trust
Chairman
• Appoint, and if appropriate, remove the
Non-Executive Directors
• Decide the remuneration and terms and
conditions of office of the Chairman and the
Non-Executive Directors
• Approve the appointment of the Chief Executive
• Appoint, and if appropriate, remove the
Foundation Trust’s external auditor
• Receive the Foundation Trust’s annual accounts,
any report of the auditor on them, and the
annual report
• Approve a ‘significant’ transaction8
• Approve any proposal to increase the proportion
of total income earned from non-principal
purpose activities by 5% or more (eg from 2%
to 7% of the Trust’s income)
• Approve any proposal for the merger,
acquisition, separation or dissolution of the Trust
• Vote on whether the Trust’s income from nonprincipal purpose activities will significantly
interfere with the Trust’s principal purpose or its
ability to perform its other functions.
8. A ‘significant’ transaction is defined in the Trust’s
Constitution.
48
The Council of Governors and the Board of Directors
must both approve any amendments to the Trust’s
Constitution.
Whilst the Council of Governors is responsible
for holding the Board, and in particular the NonExecutive Directors, to account and ensuring that
the Board is acting in a way that means the Trust
will meet its obligations, it continues to remain the
Board’s responsibility to oversee the running of
the hospital.
A formal procedure is in place should there be
a dispute between the Board and Council of
Governors. This comprises three stages. The first
stage is informal discussion between the relevant
Directors and Governors, coordinated by the Chair
(or the Senior Independent Director if the dispute
involves the Chair). The second stage would be
a resolution meeting open to all members of the
Board of Directors and Council of Governors.
The Chair may decide to appoint an independent
facilitator to assist in reaching an agreement at the
meeting. If the resolution meeting fails to resolve
the issue to the satisfaction of the representatives
of the Council of Governors and Board of Directors
present, then the third and final stage would be for
a subsequent meeting of the Board of Directors to
make the final decision on the disputed issue. This
would not however replace the requirement set
out in the Constitution for certain decisions to have
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
the approval of the Council of Governors, nor the
ability of the Council of Governors to refer an issue
to Monitor or the Independent Panel for advising
Governors, in certain circumstances. In the four years
since the Trust’s authorisation as a Foundation Trust
no issues have required escalation to this process.
Further information on the Board of Directors and
Council of Governors is outlined below.
Board of Directors
As at 31 March 2015 the Board comprised six NonExecutive Directors, a Non-Executive Chairman and
six Executive Directors. Details of Board members
as at 31 March 2015 are outlined below.
Richard Sumray: Trust Chair
Appointed in November 2014, Richard brings a
wealth of hands-on experience from across a range
of public bodies, which encompass health, sport,
policing, education, and the arts, as well as the
voluntary sector. Richard is an experienced Chair
in the NHS, having chaired NHS Haringey (Primary
Care Trust – PCT) for ten years from 2001 to 2011,
a member of the London Health Commission until
October 2008, and chaired the Joint Committee
of all London PCTs that led the consultation on the
significant reforms of stroke and trauma services
in London. In September 2012 he was appointed
to chair Health Education South London. Richard
has been a magistrate since 1984 and for more
than 20 years has been a chair of youth and
family proceedings courts in inner London. He
has previously been Chief Executive of London
International Sport, and more recently has been the
Chair of the London 2012 Forum, working with
the London Organising Committee of the Olympic
Games. He also chairs Alcohol Concern. Richard is
Chair of the Trust’s Charitable Funds Committee and
the Board of Directors Nominations Committee.
Richard’s term of office expires on 31 October 2017.
Katey Adderley: Non-Executive Director
First appointed in December 2010, Katey is a
former Director and Partner of Charterhouse Capital
Partners, one of Europe’s largest private equity
companies, where she worked for 11 years. In her
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early career Katey worked in strategy consulting
and as a financial analyst at Procter and Gamble. As
well as bringing up a young family, Katey is a NonExecutive Director of BPP University and is active in
local voluntary work. She has a first class Honours
degree in Economics from Cambridge University
and a Masters degree in Economic Evaluation in
Healthcare. She is also a Chartered Management
Accountant. Katey is Chair of the Trust’s Audit &
Assurance Committee. Katey’s term of office expires
on 30 November 2016.
Carol Bode: Non-Executive Director
First appointed in April 2012, Carol is an
organisational development specialist with 30 years’
experience in retail, customer services, financial
services, health and education. Previous roles have
included Non-Executive Chairman of Southern
Health NHS Foundation Trust, Trustee on the
Foundation Trust Network Board, and a Corporate
Board Director with a General Motors Company.
Carol is an Associate Consultant with both the
Foresight Centre for Governance at GE Healthcare
Finnamore, QGI, and NHS Providers, and a Senior
Advisor to Newton Europe. Carol is also a Magistrate
in North Hampshire, and a Director of The Costello
School (an Academy Trust) in Basingstoke. Carol
is Chair of the Board’s Quality & Risk Committee.
Carol’s term of office expires on 31 March 2018.
Professor Soraya Dhillon MBE: Non-Executive
Director
Appointed in February 2014, Soraya is a clinical
academic and Dean of School of Life and Medical
Sciences at the University of Hertfordshire. Soraya
has a PhD in clinical pharmacology and has held a
number of key senior academic posts. Her research
interests are in chronic disease management,
prescribing, medicines optimisation and patient
safety. Soraya is the former Non-Executive Chairman
of Luton and Dunstable Hospital NHS Foundation
Trust and is currently a member of the General
Pharmaceutical Council. Soraya is a fellow of the
Royal Pharmaceutical Society and was awarded
an MBE for her contribution to health services in
Bedfordshire. Soraya brings expertise in strategic
leadership, academia and patient safety to the
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Board. Soraya is a member of the Board’s Audit &
Assurance Committee. Soraya’s term of office expires
on 31 January 2017.
Professor Elisabeth (Lis) Paice OBE: Non-Executive
Director
Appointed in February 2014, Lis trained as a doctor at
Trinity College Dublin and Westminster Medical School
before being appointed as a Consultant Rheumatologist
at the Whittington Hospital. For 15 years Lis was
Dean Director of London Deanery, overseeing the
postgraduate training of doctors. As Chair of the Inner
and Outer North West London Care Programmes
and Co-Chair of the Integrated Care Programmes Lis
currently has a leading role in developing integrated
care in North West London and has special responsibility
for encouraging partnerships with people using health
and social care services. Lis holds the ILM Diploma in
Executive Coaching and Leadership Mentoring, and
was named NHS Mentor of the Year 2010. In 2011 she
received an OBE for services to Medicine. Lis is a Fellow
of the Royal College of Physicians. Lis’ term of office
expires on 31 January 2017.
Pradip Patel: Non-Executive Director – also Deputy
Chair and Senior Independent Director
First appointed in August 2011, Pradip qualified with
a First Class Honours degree in Pharmacy from the
London School of Pharmacy and has an MBA from
Nottingham University. He has worked for Boots
for over 34 years, of which the last 18 years have
been at senior and Board levels. He was Managing
Director for Boots Opticians and Executive Chairman
following its merger with Dolland and Aitchison,
and is currently Director of Healthcare Strategy for
Walgreens Boots Alliance. He is a Fellow of the
Chartered Institute of Management and a Member
of the Royal Pharmaceutical Society of Great Britain.
Pradip is also the Trust’s Deputy Chair and Senior
Independent Director, and is Chair of the Board of
Directors Remuneration Committee and Transformation
Committee. Pradip is a member of the Board’s Audit &
Assurance Committee. Pradip’s term of office expires
on 31 July 2017.
Richard Whittington: Non-Executive Director
Appointed in 2014, Richard is a chartered accountant
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(FCA) who was a senior Partner at KPMG where
he was latterly in charge of the Infrastructure,
Government and Healthcare Audit Group which
provided audit services to the health and public
sectors and building and construction companies.
During his time at KPMG he had clients who were
developers, contractors and builders. Richard is
currently Chair of The Magstim Company Limited, a
high-tech business in the neuro-science field, and a
Non-Executive Director at ISG plc, an AIM-listed £1.2
billion turnover, international construction services
group. In addition to his business experience Richard
holds a number of board and trustee roles with
educational and charitable organisations, including
Chair of Governors and Director of the Gordon’s
School Academy Trust Limited. Richard brings
senior financial, audit and corporate governance
experience to the Board, together with estates and
capital investment expertise. Richard’s term of office
expires on 30 September 2017.
Shane DeGaris: Chief Executive
First appointed as the Trust’s Deputy Chief
Executive & Chief Operating Officer, in May 2012
Shane was appointed as the Trust’s substantive
Chief Executive following a period as Acting Chief
Executive. Shane is an experienced NHS Director
having worked in a number of London Trusts in
senior management roles including as Director of
Operations at Barnet & Chase Farm Hospitals NHS
Trust and as Deputy Chief Executive at Epsom & St
Helier University Hospitals NHS Trust. Australian by
birth, he began his healthcare career in 1990 after
training as a Physiotherapist in Adelaide, South
Australia. Shane has been appointed by the Board
as the Trust’s Director of Imperial College Health
Partners, and is also a Board member of the North
West London Local Education & Training Board
(a sub-committee of Health Education England),
which is a non-executive role.
Dr Abbas Khakoo: Medical Director
Appointed as Medical Director on a job-share
basis in January 2013, and the Trust’s sole Medical
Director from October 2014, Abbas is a Consultant
in Paediatrics and the care of newborn babies.
Abbas also runs a children’s allergy service at
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Hillingdon Hospital and at St Mary’s Hospital, part
of Imperial College Healthcare NHS Trust. Since
October 2010 Abbas has been the Clinical Director
of Paediatrics (Honorary) at NHS London, and
chairs both the NHS London Paediatric Emergency
Clinical Panel and the North West London Paediatric
Clinical Implementation Group. Prior to taking up
the position of Medical Director at THH he was the
Trust’s Clinical Director for Quality and Safety.
Professor Theresa Murphy: Director of the
Patient Experience & Nursing
Theresa joined the Trust in May 2013 having
been the Director of Nursing at North Middlesex
University Hospital NHS Trust. Theresa qualified
in general nursing in 1987, before specialising in
Neuroscience and Critical Care nursing. Theresa has
also held a number of clinical and managerial posts
in both teaching and general hospitals. Theresa
was awarded the Florence Nightingale leadership
scholarship for 2012, and is an Honorary Professor
for the City of London University, and has an LLB.
Theresa holds Board level responsibility for nursing,
governance and risk management, infection
prevention and control, safeguarding people, patient
experience and engagement.
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2015, Joe was previously the Trust’s Director
of Operational Performance. Joe has over 20
years senior managerial healthcare experience,
including Deputy Chief Operating Officer at
Royal Bournemouth and Christchurch Hospitals
NHS Foundation Trust and Director of Service
Improvement at Epsom and St Helier University
Hospitals NHS Foundation Trust. Joe holds Board
level responsibility for the management of the
clinical divisions, emergency planning, the QIPP
programme (Quality, Innovation, Productivity
and Prevention), and ensuring the Trust meets
and exceeds all national and local patient access
standards.
Paul Wratten: Finance Director
Appointed in 2000, Paul is a member of the
Chartered Institute of Public Finance and
Accountancy, and has spent almost all his
working life within the NHS, including working
in performance management for the NHS in
London. Paul also holds Board level responsibility
for purchasing and supplies; the Trust’s information
services and information technology functions,
which includes the clinical coding team; health and
safety; and is the Trust’s Senior Information Risk
Owner (SIRO).
David Searle: Director of Strategy & Business
Development
Appointed in 2007 from a 20 year career in the Royal
Navy as a Fleet Air Arm pilot, where senior roles
included second in command of a major Air Defence
warship and the Commanding Officer of a large
front line Naval Air Squadron, David subsequently
worked in the aerospace and defence industries
where he held senior positions in procurement,
commercial management, business development and
marketing. He was latterly Director, Wider Markets
in the Defence Aviation Repair Agency before
joining the Trust. He is a Chartered Director, and has
Board-level responsibility for estates and facilities,
business development, strategy, business planning,
communications and marketing.
In attendance at Board meetings:
Joe Smyth: Chief Operating Officer
Appointed as Chief Operating Officer in March
The following also served as Board members
during the 2014/15 year.
Claire Gore: Director of People
Claire joined the Trust in 2010 as Director of People,
and attends Board meetings in a non-voting
capacity. Claire is a Fellow of the Chartered Institute
of Personnel and Development (FCIPD) and has
worked at a senior level in human resources and
training and development in a number of public
sector organisations including the London Borough
of Brent and the Metropolitan Police Service.
Claire has Board level responsibility for human
resources (including recruitment, employee relations
and temporary staffing), occupational health,
nurse training, and workforce and organisational
development.
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Dr James Reid: Non-Executive Director and
Interim Chair
First appointed in February 2008, James is a former
Chief Executive of a privately owned oil refining and
trading company, with extensive risk management
experience within the oil and gas industry. He has
a PhD in Mathematics from Edinburgh University,
and worked for Shell for many years holding
senior management positions in Shell’s trading and
shipping organisation. James was the Trust’s Interim
Chair from 1 April 2014 to 31 October 2014, after
which he resumed his position as a Non-Executive
Director until 31 December 2014. Whilst a Board
member of the Trust, James was also a NonExecutive Director of West Indies Oil Company.
Craig Rowland: Non-Executive Director
First appointed in October 2006, Craig’s second
term of office ended on 30 September 2014. Craig
is a qualified accountant and former Managing
Director of BT Group’s UK Business Division. Prior
to his career at BT, Craig worked for Coopers &
Lybrand (now PricewaterhouseCoopers – PwC)
where he qualified as a Chartered Accountant.
Whilst a Board member of the Trust, Craig was also
a Board member of the Christian charity Tearfund,
and a member of the Trust’s Audit & Assurance
Committee and Chair of the Transformation
Committee.
Dr Richard Grocott-Mason: Medical Director
(job-share)
Appointed as Medical Director on a job-share basis
in January 2013 with Dr Khakoo, Richard left the
position in October 2014 to join the Royal Brompton
& Harefield NHS Foundation Trust as the Divisional
Director of Harefield Hospital’s Heart Division.
Karl Munslow Ong: Chief Operating Officer
After joining the Trust as Director of Operational
Performance, Karl was appointed as the Trust’s
substantive Chief Operating Officer in October 2012
following a period as Acting Chief Operating Officer.
Karl left the Trust at the end of February 2015 to
become the Chief Operating Officer at Chelsea &
Westminster Hospital NHS Foundation Trust.
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The Constitution states that the Council of
Governors will appoint one of the Non-Executive
Directors as the Deputy Chairman, whilst the Board,
in consultation with the Council of Governors
appoints the Senior Independent Director. In April
2013 the Council of Governors appointed Pradip
Patel as the Trust’s Deputy Chair. This appointment
was not explicitly time limited and therefore runs
until the remainder of his term of office, unless
revised by the Council of Governors.
In April 2014 the Board appointed Pradip Patel as
the acting Senior Independent Director (SID) given
that the existing SID James Reid was taking on the
Interim Chair role. Having consulted the Governors,
in November 2014 the Board agreed that Pradip
would continue to hold the SID in addition to being
Deputy Chair. With the support of the Council
of Governors, in May 2015 the Board extended
Pradip’s appointment as Senior Independent Director
until the end of his term of office.
Statement on the balance, completeness
and appropriateness of the membership
of the Board
The Board of Directors Nominations Committee
is responsible for reviewing the structure, size
and composition of the Board and makes
recommendations to the Council of Governors
on the skills required for any upcoming NonExecutive Director appointments. As outlined in
the biographies of Board members, the Board
comprises individuals with senior level experience
in the public and private sectors, across a range
of disciplines including clinical and patient care;
health service leadership; commercial development;
business transformation and change management;
finance; governance; risk management; and human
resources. The appointment of a new Chair and
Non-Executive Director brought extensive NHS
Board leadership and audit and construction/
development experience to the Board. The Board
therefore confirms that the current composition is
considered to be appropriate. This is supported by
the conclusions of the Board governance review
undertaken in 2014 by KPMG.
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Taking account of the NHS Foundation Trust Code
of Governance published by Monitor, the Board
considers the current Chairman and all of the
Non-Executive Directors to be ‘independent’. Two
non-executive Board members who served during
the year, Craig Rowland and James Reid, were first
appointed to the Board of The Hillingdon Hospital
NHS Trust more than six years ago (in October 2006
and February 2008 respectively); the Board’s view
is that both Directors retained an independent
viewpoint, and ability to challenge and scrutinise
management.
Board members’ other commitments and
Register of Interests
Company directorships and other significant
commitments held by Board members are outlined
above. Board members are required to enter their
relevant interests in the Register of Directors’
Interests which is formally reviewed by the Board at
least annually. The full register is available from the
Trust Secretary on 01895 279976.
Richard Sumray, Trust Chair is also Chair of Health
Education South London, Chair of Alcohol Concern,
a Magistrate, and on the Boards of International
Broadcasting Trust, Lee Valley Leisure Trust and
Echo Ventures C.I.C. Whilst Interim Chair from 1
April 2014 to 31 October 2014 James Reid was
also a Non-Executive Director of the West Indies
Oil Company and an independent oil industry
consultant.
Appointment and removal of Board
members
In accordance with the requirements of the NHS
Act 2006, the Foundation Trust Constitution
outlines the respective responsibilities of the
Directors and Governors in appointing and
removing Board members.
The Council of Governors is responsible for
appointing, and if necessary, removing the Chairman
and Non-Executive Directors. The Council of
Governors Nominations & Remuneration Committee
has been established to make recommendations
to the Council of Governors on the appointment
03
and remuneration of these positions, including
identifying suitably qualified candidates for
appointment. At the start of the recruitment process
the Board of Directors Nominations Committee
makes recommendations to the Council of
Governors Nominations & Remuneration Committee
on the capabilities required for these appointments
in light of the current Board composition and the
challenges facing the Trust.
When considering the appointment and
remuneration of Non-Executive Directors, the
Council of Governors Nominations & Remuneration
Committee consists of the Trust Chair (who
chairs the Committee), three Public Governors,
one Staff Governor and one Appointed or Staff
Governor. When considering the appointment and
remuneration of the Chairman, the Committee
consists of three Public Governors, one Staff
Governor, one Appointed or Staff Governor, and one
Non-Executive Director (who chairs the Committee
on these occasions – this was Pradip Patel as Senior
Independent Director in 2014/15). The Chief
Executive and Director of People are invited to attend
to provide advice to the Committee.
Should any such circumstances arise, the Council
of Governors Nominations & Remuneration
Committee is responsible for investigating the
grounds for any resolution to remove the Chairman
or a Non-Executive Director, and preparing a
report on this issue with recommendations for the
consideration of the Council of Governors. Removal
of the Chairman or a Non-Executive Director
requires the approval of three-quarters of the
members of the Council of Governors.
The Chief Executive is appointed by the Board of
Directors Nominations Committee which comprises
the Chair (Committee Chair) and all of the NonExecutive Directors. The appointment must be
approved by the Council of Governors. The Board of
Directors Nominations Committee is responsible for
agreeing the removal of the Chief Executive should
this be required – any such decision does not require
the Council of Governors’ approval.
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
The Board of Directors Nominations Committee
is responsible for appointing and removing the
Executive Directors. The Chief Executive is also a
member of the Committee when it is considering
the appointment and removal of the Executive
Directors. The Director of People is invited to attend
the Committee to provide advice as required.
The Trust Secretary provides secretarial support to
the Board of Directors Nominations Committee
and the Council of Governors Nominations &
Remuneration Committee.
Performance evaluation of the Board, its
Committees, and Board members
The Board usually reviews its performance annually.
In 2013/14 the Trust commissioned KPMG to
undertake a review of the Trust’s position against
Monitor’s Quality Governance Framework. The
review’s conclusions were positive with KPMG
concluding that overall the quality governance
systems and processes at the Trust appeared to be
strong, and in particular, the strength of challenge
at Trust Board and in sub-committees was robust
and appropriate.
Further to this review, the Trust commissioned
KPMG to undertake a follow-up piece of work
to examine the effectiveness of the Board more
generally and to review the Council of Governors.
The review took into account the requirements
of Monitor’s and the Care Quality Commission’s
(CQC) ‘well-led’ framework and sought to provide
background to the Board’s future commissioning of
a tri-annual review under Monitor requirements.
The review encompassed three areas:
• Assessing the effectiveness of the Board
• Assessing the Board Committee structure and
the flow of information
• Assessing the effectiveness of the Council of
Governors.
The review was undertaken in June and July 2014
and included observation of a number of meetings
at the Trust (such as Board, Board Committee
and Council of Governors meetings); interviews
54
with Board members and Governors; surveys of
Board members and Governors; and an extensive
document review.
As with the quality governance review, the
overall position was positive, with a number of
areas identified to further strengthen the Trust’s
governance. The review concluded that the Trust’s
governance arrangements are:
‘…well designed, operating effectively
and provide good governance, effective
control and sound decision making
processes for the Trust. The component
parts of the governance arrangements
work well together with mature
understanding of respective roles and
responsibilities, particularly within the
Board of Directors and its subcommittees.
Individuals within the governance
structure are reflective and engaging
in their approach to challenge and
ensure they are positively fulfilling their
governance responsibilities.’
An action plan was developed in response to the
report, with progress overseen by the Board.
Subsequent and unrelated to the governance
review, KPMG also provided a consultant to support
the Trust in relation to development of the Physician
Associate role in the NHS.
The findings of the Care Quality Commission (CQC)
inspection in October 2014 raised issues around the
assurance processes in place at the Trust and the
Board’s oversight of aspects of standards. A learning
review into the outcomes of the inspection is being
undertaken, and the resulting actions to be taken to
strengthen governance from ward to Board will be a
key priority for early 2015/16.
Board members are subject to an annual individual
performance appraisal.
• The Chair’s appraisal is led by the Senior
Independent Director, whilst the Chair leads
the appraisal of the Non-Executive Directors.
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
•
The Council of Governors, through the Council
of Governors Nominations & Remuneration
Committee, feed in their views to these
appraisals and the full Council of Governors is
formally briefed on the outcomes. The outcomes
of the 2013/14 appraisals, including the 2014/15
objectives, were considered at the July 2014
Council of Governors meeting.
The Chief Executive undertakes the appraisal
of the Executive Directors, and the Chair
undertakes the appraisal of the Chief Executive.
The Board of Directors Remuneration Committee
oversees the Chairman’s monitoring and
evaluation of the Chief Executive’s performance,
and the Chief Executive’s monitoring and
evaluation of the Executive Directors’
performance. The Committee provides input into
this process midway through the year and at the
end of the year.
Nominations Committee meetings
in 2014/15
Board of Directors Nominations Committee
The Committee met five times in 2014/15. The
Committee reviewed the composition of the Board
and in light of this and the challenges facing the
Trust, made recommendations to the Council of
Governors Nominations & Remuneration Committee
on the person specification and job description for
the appointment of the new Chair and a NonExecutive Director (the position filled by Richard
Whittington). Having reviewed the composition of
the Board and in light of this and the challenges
facing the Trust, the Committee also recommended
that Katey Adderley and Carol Bode were
reappointed for second terms of office.
In relation to Executive Director appointments,
the Committee appointed Dr Abbas Khakoo as
the Trust’s sole Medical Director following the
resignation of his job-share partner Dr Richard
Grocott-Mason. The Committee also agreed the
person specification and job description for the
appointment of a new Chief Operating Officer, and
at the end of the appointment process agreed the
candidate to be appointed – Joe Smyth.
03
In line with its terms of reference, the Committee
also reviewed talent management and succession
planning at the Trust, and commented on draft
organisational design principles.
Council of Governors Nominations &
Remuneration Committee
The Committee met six times during 2014/15.
The Committee’s main two areas of work during the
year were to oversee the appointment processes for
the Trust Chair and to the Non-Executive Director
(NED) position created by Craig Rowland’s retirement.
The Committee engaged the executive search agency,
Gatenby Sanderson, to assist with these processes.
The process was largely similar for both roles.
The Committee agreed a person specification
and job description for the roles drawing on
the recommendations of the Board of Directors
Nominations Committee. The positions were then
externally advertised with Gatenby Sanderson
assisting with the search process. The Committee
met to agree a long-list of candidates who were
invited for an initial interview by Gatenby Sanderson;
a Governor member of the Committee also
participated in these interviews for the Chair role. In
light of these interviews, the Committee agreed a
short-list of candidates to attend the final stage of
the appointment process in September 2014.
For the Chair role, this involved a presentation to an
audience of stakeholders, and a series of interviews.
For the NED position, the final stage involved an
interview with members of the Committee. The full
Committee then met to agree a recommendation
to the Council of Governors on the candidate
to be appointed to each of these roles. These
recommendations were accepted by the Council
of Governors who appointed Richard Sumray as
the Trust Chair and Richard Whittington as NonExecutive Director.
The Committee also considered the
recommendations from the Board of Directors
Nominations Committee on the reappointment of
Katey Adderley and Carol Bode for second terms of
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
office as NEDs, and recommended the Council of
Governors agree these reappointments.
The Committee also commented on the appraisals
of the Interim Chair and the NEDs.
The Committee’s work in relation to non-executive
remuneration is outlined in the remuneration report.
Audit & Assurance Committee
As at 31 March 2015, the Trust’s Audit & Assurance
Committee comprises four Non-Executive Directors,
two of whom (including the Committee Chair)
have recent and relevant financial experience. The
Committee is usually attended by the internal
and external auditors, the Finance Director, and
the Director of Patient Experience & Nursing as
the Executive Director responsible for clinical and
corporate governance. The Local Counter Fraud
Specialist attends at least two meetings a year, and
other Directors and senior managers attend when
invited by the Committee. The Trust Secretary is the
Committee Secretary.
The Committee is responsible for providing an
independent and objective review of the Trust’s
systems of internal control (both financial and nonfinancial) and the underlying assurance processes in
place at the Trust. The Committee is also responsible
for ensuring that the Trust has in place independent
and effective internal and external audit functions.
The Committee’s work in undertaking these
responsibilities is outlined in an annual report to
the Board. Key elements of the Committee’s work
include reviewing the Board Assurance Framework,
and reviewing the findings of the Trust’s internal and
external auditors and Local Counter Fraud Specialist.
The Committee is responsible for reviewing the
annual financial statements, with particular focus
given to major areas of judgement and changes
in accounting policies, the basis of the Board’s
determination that the Trust remains a going
concern, and the draft Annual Report including the
annual governance statement. The Committee also
reviews the assurance in place in respect of data
quality. In addition to its own annual self-evaluation,
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the Committee reviews the performance of internal
audit, external audit, and the Local Counter Fraud
Specialist each year.
External audit
The Audit & Assurance Committee (AAC) is
responsible for making recommendations to the
Council of Governors on the appointment and
removal of the external auditor. In October 2013
the Council of Governors reappointed Deloitte
as the Trust’s external auditors for a three year
period starting with the 2013/14 audit with an
option for two one-year extensions (bringing five
years in total). This followed a tendering process
that involved a ‘mini-competition’ in which the 11
audit providers on the Government Procurement
Service (GPS) Framework Agreement were invited
to participate. The framework agreement included
all of the firms who would be expected to bid for
the service, and by using the framework the Trust
was able to benefit from the economies of scale of
working across Government.
In line with the Code of Governance this
reappointment is subject to annual review. This
annual review involves the Audit & Assurance
Committee (AAC) members completing a structured
review of external audit against the areas of work set
out in Monitor’s Audit Code:
• Financial statements
• Annual governance statement
• The Trust’s arrangements for securing economy,
efficiency and effectiveness in the use of
resources; and
• The quality report.
Plus review of external audit against 46 criteria across
the following domains:
• The audit partner
• The audit team
• The audit approach – planning and then execution
• Communications by the auditor to the AAC
• External audit’s support to the work of the AAC
• Insights and adding value
• Formal reporting by the auditors.
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
03
The Chair of the AAC then presents a report to
the July meeting of the Council of Governors on
the outcomes of this review and whether external
audit’s appointment should be confirmed.
The Head of Internal Audit reports to the Committee
and is managed by the Finance Director. The Head
of Internal Audit has a right of direct access to
Committee members.
The audit fee for 2014/15 was £76,200 for the
financial statement audit and £17,160 for work
on the quality report. These figures are inclusive of
VAT but do not include any additional expenses or
disbursements.
Key issues considered by the Committee
At their meeting in October 2013 the Council
of Governors agreed an updated policy on the
engagement of the external auditors to undertake
additional services, which had been reviewed and
recommended by the working group established to
oversee the tendering of the external audit service.
Under the policy, the Council of Governors has
delegated to the Audit & Assurance Committee
the authority for commissioning additional services
from the external auditor. Any such work will then
be reported to the Council of Governors. No such
additional work was commissioned in 2014/15.
Internal audit
The Trust’s internal audit service is provided by TIAA
(The Internal Audit Agency).
The scope and work of the Trust’s internal auditors,
which is consistent with public sector internal
audit standards, is set out in a charter approved by
the Audit & Assurance Committee. Internal audit
provides an independent and objective opinion
on risk management, control and governance by
measuring and evaluating the effectiveness by which
organisational objectives are achieved. Through
detailed examination, evaluation and testing of the
Trust’s systems, internal audit play a key role in the
Trust’s assurance processes.
The Audit & Assurance Committee agree a work
plan for internal audit at the start of each financial
year, taking account of the risk assessment
undertaken by internal audit. The Committee review
the findings of internal audit’s work against this plan
at each quarterly meeting.
In addition to the presumed risk of management
override of controls, as part of audit planning process
external audit identified three specific audit risks for
the Trust: recognition of NHS revenue; valuation of
property assets; and the Trust’s continuation as a
‘going concern’ in the context of the Trust’s increasing
deficit and risk in delivery of cost improvement plans.
At its meeting in January 2015 the Committee
approved the external audit plan which focused on
these issues. At this meeting, external audit advised
that the Care Quality Commission (CQC) inspection
findings would be added as a further audit risk and
the audit would consider whether the inspection
raises issues relevant to the auditor’s exception report
on the Trust’s arrangements for securing value for
securing economy, efficiency and effectiveness in its
use of resources.
The Committee reviewed external audit’s findings on
these risks at its meeting on 26 May 2015.
At its meeting in April 2015, the Committee
reviewed the draft accounts, with a focus on
consistency with the management information
reported to the Board during the year and the
financial information reviewed by the Committee
such as provisions and the impact of the property
valuation. The Committee reviewed the draft annual
report and accounts to ensure the information
contained within was consistent with that reviewed
by the Committee during the year and that
presented to the wider Board. This supported the
Directors’ confirmation that the document is fair,
balanced, and understandable and provides the
information necessary for stakeholders to assess the
Trust’s performance, business model and strategy. In
addition to this overall review, the Committee also
scrutinised key compliance disclosures in the annual
report including the position around ‘off payroll’
engagements and the Trust’s compliance with the
Foundation Trust Code of Governance.
57
03
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Over the year, the Committee reviewed in depth
the Trust’s response to internal audit reviews that
received an opinion of ‘limited assurance’.
Following KPMG’s governance review, the
Committee oversaw a number of changes to the
Board Assurance Framework (BAF) to enhance
its use to the Board. The document has been
refocused on a smaller number of risks which
more crisply articulate the key strategic risks to the
Trust, with the number of controls and assurances
also refined. A ‘RAG’ rating has been added to
the risks to assist the Board’s focus on the areas of
concern. The Committee has continued to review
the assurance in place in relation to data quality at
the Trust, including reviewing the outcomes of the
Trust’s internal audits of the data that underpins key
performance indicators reported to the Board.
• The Board of Directors Remuneration Committee,
which comprises all of the Non-Executive Directors,
is responsible for agreeing the remuneration
and terms of service for the Chief Executive and
Executive Directors. Further information on the
Committee is outlined in the remuneration report.
• The Charitable Funds Committee assists the
Trust in its role as corporate trustee for The
Hillingdon Hospitals NHS Foundation Trust charity
and has been established to make and monitor
arrangements for the control and management of
the Trust’s charitable funds.
• The Quality & Risk Committee provides assurance
and makes recommendations in matters relating
to clinical quality and standards, and to ensure
that risks to the delivery of the Trust’s services are
identified and addressed.
Other Board committees
In addition to the Nominations Committee and
Audit & Assurance Committee, the following Board
Committees are in place. Each of these is chaired by
a Non-Executive Director.
58
• The Transformation Committee assists the Board
with the shaping, review and challenge of the
Trust-wide transformation programme, including
the strategy for developing the Trust’s services.
12 of 12
9 of 12
11 of 12
11 of 12
3 of 3
9 of 9
9 of 11
9 of 12
9 of 12
11 of 12
9 of 9
5 of 6
9 of 12
1 of 1
4 of 5
6 of 6
11 of 12
Katey Adderley
Carol Bode
Shane DeGaris
Soraya Dhillon
Richard Grocott-Mason
Abbas Khakoo
Karl Munslow Ong
Theresa Murphy
Lis Paice
Pradip Patel
James Reid
Craig Rowland
David Searle
Joe Smyth
Richard Sumray
Richard Whittington
Paul Wratten
(12 meetings)
Board of
Directors
2 of 2
2 of 3
4 of 5
5 of 5
5 of 5
Audit &
Assurance
Committee
(5 meetings)
2 of 4
3 of 3
3 of 3
4 of 4
6 of 6
5 of 6
4 of 6
6 of 6
5 of 6
5 of 6
Board
Nominations
Committee
(6 meetings)
3 of 5
4 of 4
4 of 4
5 of 5
8 of 8
7 of 8
5 of 8
6 of 8
8 of 8
Board
Remuneration
Committee
(8 meetings)
3 of 3
1 of 1
1 of 3
3 of 3
3 of 3
Charitable
Funds
Committee
(3 meetings)
2 of 3
2 of 3
1 of 1
4 of 5
4 of 5
3 of 5
4 of 5
1 of 3
4 of 5
5 of 5
2 of 2
1 of 1
1 of 3
3 of 3
3 of 4
4 of 5
3 of 5
3 of 5
4 of 5
1 of 5
1 of 3
5 of 5
(5 meetings)
(5 meetings)
4 of 4
Transformation
Committee
Quality & Risk
Committee
The following table outlines Board members’ attendance at Board and Committee meetings during 2014/15 against the total possible number of meetings for which an
individual was a member. Committee attendance is shown in relation to those Committees of which a Director was formally a member.
Attendance at Board and Board Committee meetings
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
03
59
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Council of Governors
The role and powers of the Council of Governors are outlined earlier in the report. The composition of the
Council of Governors is outlined in the Trust’s Constitution.
As at 31 March 2015 there were 24 positions on the Council of Governors: 13 elected to represent the public
members, seven elected to represent the staff members, and four appointed by partner organisations (Hillingdon
Council, Hillingdon Clinical Commissioning Group, the London Ambulance Service, and the Trust’s Joint
Negotiating & Consultative Committee).
The members of the Council of Governors who served during 2014/15 are outlined below:
Name
Date took office and
method (see key below)
Term of office
expires
Graham Bartram
01/04/2014 (CE)
31/03/2017
Ian Bendall
01/04/2014 (CE)
31/03/2017
David Bishop
01/04/2014 (CE)
31/03/2017
Tony Ellis
01/04/2014 (CE)
31/03/2017
Harkishan Chander
01/04/2014 (CE)
31/03/2017
Donald Dakin
01/04/2014 (CE)
31/03/2017
Neil Fyfe
01/04/2014 (CE)
Resigned 31/12/14
Roger Shipton
01/04/2014 (CE)
31/03/2017
John Coleman
01/04/2014 (CE)
31/03/2017
Keith Saunders
01/04/2014 (CE)
31/03/2017
Doreen West
01/04/2014 (CE)
31/03/2017
Rekha Wadhwani
01/04/2014 (CE)
31/03/2017
Colette Murphy
01/04/2014 (UE)
Resigned 6/5/2014
Doctors & Dentists (1)
Alvan Pope
01/04/2014 (UE)
31/03/2017
Nurses, Midwives, Healthcare
Assistants (3)
Sheila Bacon
08/04/2014 (UE)
31/03/2017
Sheila Kehoe
08/04/2014 (UE)
31/03/2017
Amanda O’Brien
01/04/2014 (UE)
31/03/2017
Allied Health Professionals (1)
Graham Coombs
01/04/2014 (CE)
31/03/2017
Support Staff (2)
Paul Cornford
01/04/2014 (UE)
31/03/2017
Jack Creagh
01/04/2014 (UE)
31/03/2017
Hillingdon Clinical Commissioning
Group (1)
Dr Mayur Nanavati
01/04/2014 (A)
01/04/2017
London Borough of Hillingdon (1)
Mary O’Connor
01/04/2014 (A)
01/04/2017
London Ambulance Service (1)
Pauline Cranmer
01/04/2014 (A)
01/04/2017
Joint Negotiating & Consultative
Committee (1)
Lesley Dixon
01/04/2014 (A)
Rachel Hyman
01/12/2014 (A)
Retired from the
Trust on 30/11/2014
31/03/2017
Public Governors
North (4)
Central (4)
South (4)
Rest of England (1)
Staff Governors
Appointed Governors
Key: CE – contested election
60
UE – uncontested election
A – appointed by partner organisation
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
03
Elections for the Rest of England vacancy were
held in September 2014 for which no nominations
were received. The election process for this vacancy
and that for the Public Governor for the Central
Constituency commenced in May 2015 following a
deferral for the general election purdah period.
Governors are required to declare any relevant
interests which are then entered into the publicly
available Register of Governors’ Interests. The
Register is formally reviewed by the Council of
Governors annually and is available from the Trust
Secretary on 01895 279976.
In 2014/15 the Council of Governors formally met
five times. Governor attendance at these meetings
is outlined below. Where a Governor was not in
office for all five meetings, the maximum possible
attendance is shown.
Lead Governor
Governor
Meetings
attended
Graham Bartram (Public)
5 of 5
Ian Bendall (Public)
4 of 5
David Bishop (Public)
4 of 5
Tony Ellis (Public)
4 of 5
Harkishan Chander (Public)
4 of 5
Donald Dakin (Public)
4 of 5
Neil Fyfe (Public)
2 of 4
Roger Shipton (Public)
4 of 5
John Coleman (Public)
5 of 5
Keith Saunders (Public)
5 of 5
Rekha Wadhwani (Public)
4 of 5
Doreen West (Public)
5 of 5
Colette Murphy (Public)
0 of 1
Alvan Pope (Staff)
5 of 5
Sheila Bacon (Staff)
4 of 5
Sheila Kehoe (Staff)
5 of 5
Amanda O’Brien (Staff)
4 of 5
Graham Coombs (Staff)
5 of 5
Paul Cornford (Staff)
5 of 5
Jack Creagh (Staff)
4 of 5
Dr Mayur Nanavati (Appointed)
4 of 5
Mary O’Connor (Appointed)
4 of 5
Pauline Cranmer (Appointed)
3 of 5
Lesley Dixon (Appointed)
4 of 4
Rachel Hyman (Appointed)
1 of 1
In line with Monitor’s Code of Governance, the
Council of Governors elects one of the Public
Governors to be the ‘Lead Governor’. The main
duties of the Lead Governor are to:
• Act as a point of contact for Monitor should
the Regulator wish to contact the Council of
Governors on an issue for which the normal
channels of communication are not appropriate
• Be the conduit for raising with Monitor any
Governor concerns that the Foundation Trust
is at risk of significantly breaching its Licence,
having made every attempt to resolve any such
concerns locally
• Chair such parts of meetings of the Council
of Governors which cannot be chaired by the
Trust Chair or Deputy Chair due to a conflict
of interest in relation to the business being
discussed.
In April 2014 the Council of Governors appointed
John Coleman as Lead Governor for the 2014/15
year. The Council of Governors reappointed John
as Lead Governor for the 2015/16 year at their
meeting on 5 May 2015.
The Board’s liaison with Governors
and members
All Board members have a standing invitation to
attend Council of Governors meetings to help
ensure they understand the views of Governors and
members. Throughout the year the aim has been to
increase the role of the NEDs at the meeting, in order
to facilitate the Council of Governors undertake their
statutory duty to hold the Non-Executive Directors
(NEDs) to account for the performance of the Board.
As part of this, the Council of Governors meetings are
now usually held in the week after a Board meeting,
to enable the Council of Governors to ask the Board,
in particular the NEDs, about the action being taken
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
by the Board. A task and finish group was established
to consider the findings of the KPMG governance
review and made recommendations to the February
2015 Council of Governors meeting. Following this
group’s recommendations, with effect from the
May 2015 Council of Governors meeting two NEDs
will provide an overview of their work followed by
questions from the Governors to each Council of
Governors meeting.
The Board and Council of Governors meet jointly
at least annually as part of enabling the Governors
to input into the Trust’s strategic plans and also
to discuss any other matters of joint concern. In
2014/15 this meeting was held in January 2015 to
provide an opportunity for Governors to comment
on the development of the Trust’s strategy and
strategic issues affecting the Trust’s forward
planning. Board and Council of Governors meetings
are held in public and there is an opportunity
for members of the public and Governors to ask
questions of the Board members present. Members
of the Board also attend the Trust’s People in
Partnership meetings and Annual Members Meeting
to liaise with members and Governors.
Attendance by Board members at the five meetings
of the Council of Governors and the joint meeting
between the Board and Council of Governors in
2014/15 is outlined below:
Board Member
62
No of Council of Governor meetings
attended in 2014/15 (including joint
Board/Governor meeting)
Katey Adderley (Non-Executive Director)
4 of 6
Carol Bode (Non-Executive Director)
3 of 6
Shane DeGaris (Chief Executive)
5 of 6
Soraya Dhillon (Non-Executive Director)
4 of 6
Richard Grocott-Mason (Joint Medical Director)
0 of 3
Abbas Khakoo (Joint Medical Director)
2 of 6
Karl Munslow Ong (Chief Operating Officer)
2 of 6
Theresa Murphy (Director of the Patient Experience & Nursing)
3 of 6
Lis Paice (Non-Executive Director)
3 of 6
Pradip Patel (Deputy Chair, Senior Independent Director & NonExecutive Director)
5 of 6
James Reid (Interim Chair & Non-Executive Director)
4 of 4
Craig Rowland (Non-Executive Director)
0 of 3
David Searle (Director of Strategy & Business Development)
1 of 5
Joe Smyth (Chief Operating Officer)
0 of 0
Richard Sumray (Chair)
2 of 2
Richard Whittington (Non-Executive Director)
0 of 3
Paul Wratten (Finance Director)
2 of 5
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
During 2014/15 the Council of Governors did not
exercise its formal power under paragraph 10C
of schedule 7 of the NHS Act 2006 to require one
or more of the Directors to attend a Governors’
meeting for the purpose of obtaining information
about the Foundation Trust’s performance of its
functions or the Directors’ performance of their
duties (and deciding whether to propose a vote on
the Foundation Trust’s or Directors’ performance).
Governor development
The Trust has undertaken a range of initiatives to
support Governors develop their effectiveness in
their role. Induction was provided to Governors on
taking office, plus briefing sessions were held on a
number of key issues affecting the Trust. The Trust
commissioned the Foundation Trust Network (now
known as NHS Providers) to deliver a development
day in June 2014 based on their ‘Governwell’
programme. This led to the identification of a
number of actions to develop the Governors’
effectiveness including refocused Governor meeting
agendas and reports, and Governor only pre-meets
prior to the main Council of Governors meetings
which have helped build relationships amongst
Governors. Following on from this, NHS Providers
will be delivering a session on questioning and
challenge in June 2015 to further support Governors
in their role.
03
Constitution includes two further disqualifications
on public membership.9
Staff membership
The staff constituency is a single constituency
divided into the following classes:
• Doctors and dentists
• Nurses and midwives (including health care
assistants)
• Allied Health Professionals
• Support staff.
Staff membership is open to all those employed by
the Trust on a permanent basis, those who have a
fixed term contract of at least 12 months, and those
who have been working at the Trust for at least 12
months. These staff are automatically members of
the Staff Constituency unless they ‘opt-out’ from
membership. In addition, those working at the Trust
through the temporary staffing ‘bank’ become staff
members providing they have been registered on
the Trust’s bank for at least 12 months and continue
to be registered. So far no staff have opted out from
being a member of the Foundation Trust.
Staff membership will cease at the point that the
member leaves the service of the Trust. Anyone
eligible to be a staff member of the Foundation Trust
cannot be a public member.
Membership
Public Membership as at 31 March 2015
The Foundation Trust membership is divided into two
categories: public membership and staff membership.
As at 31 March 2015, the Trust had 7,040 public
members. The table below illustrates the number of
public members for each constituency compared to
the total population.
Public membership
There are four public constituencies, which are
collectively known as the Public Constituency. The
majority of the public members are drawn from
the three public constituencies which cover the
electoral wards in Hillingdon borough together with
several neighbouring electoral wards. The fourth
public constituency covers all other electoral areas
in the rest of England. Public membership is open
to individuals aged 16 years or over living within
the Public Constituency, who are not eligible to
be a staff member of the Foundation Trust. The
9. An individual may not become or remain a member of
the Trust if during the five years prior to their application,
they have demonstrated aggressive or violent behaviour at
any hospital or towards any person working for a health
service body and following such behaviour has been excluded from any hospital or other health service body under
either the Trust’s or other health service body’s policy for
withholding treatment from violent/aggressive patients, or
equivalent. Nor can anyone become or continue as a member of the Trust if they have been confirmed as a ‘vexatious
complainant’ in accordance with the Trust’s complaints
handling policy.
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
31st March 2015
% of membership
Population Base
% of area
Central
2,653
37.7
190,180
39.8
North
1,395
19.8
103,151
21.6
South
2,750
39.1
184,883
38.7
242
3.4
0
0
7,040
0
0
0
Rest of England
Total
During 2014/15, the Foundation Trust recruited 208
new public members and lost 254 public members
due to bereavement, members moving away
without providing a new address or cancelling their
membership. This has contributed to the Trust not
meeting the target of 7,200 members agreed by the
Board in April 2014. The majority of members who
have been removed from our membership database
are those who have moved away or provided
incorrect contact details when they completed their
membership form.
The Trust established a Council of Governors
Membership Development and Engagement Group
in April 2014 to develop Governors’ involvement
in a programme of focused recruitment and
engagement with members. Key actions agreed by
the group included setting up Governor surgeries in
the hospital, identifying community events for the
Governors to attend, redesigning the welcome letter
sent to new members from the Governors, and
encouraging Governors to suggest content for The
Pulse Foundation Trust magazine.
64
Staff Membership as at 31 March 2015
As at 31 March 2015 the Trust had 2,945
staff members. The following table provides
a breakdown by staff group. Each staff group
includes bank staff who meet the Trust’s eligibility
criteria for staff membership:
Staff Class
Number of
members
Doctors and Dentists
311
Nurses, Midwives & Healthcare
1,229
Allied Health Professionals,
Scientific and Technical
433
Support staff
972
Total
2,945
Membership Development and
Engagement Strategy 2012-2015
The Board approved a three year Membership
Development and Engagement Strategy in
February 2012. The Strategy describes the Trust’s
objectives for the membership and the approach
to ensure the Trust develops and engages with a
representative membership. It outlines our plans for
raising awareness about membership and for the
recruitment, retention and involvement of members.
It also defines how we will measure the success of
the strategy. The strategy was produced with the
guidance and input of the Council of Governors.
A high level action plan to deliver the Membership
Development and Engagement Strategy has been
developed each year with progress periodically
reported to the Council of Governors and the Board.
The Trust with the Council of Governors is in the
process of updating the Membership Development
and Engagement Strategy.
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
03
The Hillingdon Hospitals NHS Foundation Trust is
committed to recruiting members from the diverse
population served by the Trust. Membership is open
to all those eligible to be a member regardless of
gender, race, disability, ethnicity, religion or any other
groups covered under the Equality Act 2010.
• Encouraging Governors and members to sign up
The membership base is regularly reviewed to ensure
that the membership is representative of those
eligible to be members. Specific groups that appear
to be under-represented are targeted in recruitment
campaigns in order to seek to increase membership
representation in these areas, such as young people
between the ages of 16 and 45.
•
The Board agreed a reduced target of 7,200 public
members for 2014/15 at its meeting in April 2014,
with a view to focusing on maintaining the current
level of membership, address areas of underrepresentation and focus on engagement rather
than growth.
Key actions to grow membership and improve
engagement include:
• Attending local groups (eg Resident Associations)
•
•
•
•
•
and local community events (May Day Fair, RAF
Northolt Centenary celebration, Ruislip Manor
Fun day)
Attending local community and voluntary group
meetings such as AGMs, conferences
Providing membership forms to local care
providers and clinical community staff to distribute
to clients and patients such as Carers Trust
Thames, Parkinson’s nurse specialist and local
pharmacies
Attending joint public engagement meetings with
Hillingdon Clinical Commissioning Group, Central
and North West London NHS Foundation Trust,
Healthwatch Hillingdon and the London Borough
of Hillingdon, such as Hillingdon Disabled Tenants
and Residents Group and Meet the CCG meetings
Attending carer events, hosted by Hillingdon
Carers and the Council
Promoting membership at Trust engagement
events, such as armed forces, BME focus groups
and patient support groups
•
•
•
•
•
•
family, friends and members of the public
Inviting ex-staff, their family and friends to
become public members
Attending careers events for students studying
health related subjects at local universities and
colleges
Promoting membership through the Brunel
University Student Placement and Careers Centre
and voluntary services office
Encouraging student nurses studying at Bucks
New University to become members
Promoting membership to students attending
the Trust to undertake work experience
Exploring the benefits of social media to reach
out to the younger eligible membership
Making membership forms available in local
libraries and shopping centres.
Engagement between Governors
and members
The Trust organises ‘People in Partnership’ meetings
which enable the Governors, particularly the Public
Governors, to engage with the members they
represent. The meetings are held at a variety of
locations and times during the year and are chaired
by a Governor. They are preceded by an opportunity
for members and Governors to meet over
refreshments. The Trust encourages and facilitates
linkages between the Council of Governors and
groups and organisations which represent patients,
public and the wider community. During 2014/15,
Public Governors attended Residents’ Association
meetings across the Borough and various
community events throughout the year, including
the May Fair in West Drayton, a local ‘Carnival
in the Park’, a wellbeing day for older people, a
wellbeing day for people who are housebound and
a World War I celebration for local residents living in
the borough. Governors also held three Governor
surgeries, two at Hillingdon Hospital and one at
Mount Vernon Hospital, as well as attending the
Hillingdon Disabled Tenants and Residents Group.
Governors were able to communicate with local
residents and public members at these events and
report back to the wider Council of Governors in
order to ensure that the Council of Governors are
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03
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
aware of public comments and concerns which have
been raised.
The Trust provides Governors with information on
the Trust’s strategy and performance at various
meetings such as the formal quarterly Council of
Governors meetings, monthly informal meetings
with the Chair and Chief Executive, and the
joint meetings between the Board and Council
of Governors. Governors can then feed this
information back to the members and organisations
they represent. These meetings also provide the
opportunity for Governors to feed back issues of
concern raised by members. During 2014/15 such
issues included car-parking at the Hillingdon site,
staffing, and the estate.
Governors are also able to communicate with
members through the quarterly members’
magazine– ‘The Pulse’ which regularly features a
Governor article.
The Membership Development & Engagement
Strategy approved by the Board outlines the Trust’s
policy on the involvement of members, patients
and wider public, including a statement on the
Trust’s approach to consultation, and addressing the
overlap and interaction between the Governors and
other consultative and representative groups. The
strategy is available on the Trust’s website.
The Trust Board received and discussed a report
on membership recruitment, actions taken by the
Trust to develop the membership and an outline of
potential recruitment and engagement activities in
April 2014. A similar report was presented to the
Board in April 2015.
Contacting Directors and Governors
Directors and Governors can be contacted through
the Foundation Trust Office:
• Email: [email protected]
• Phone: 0800 8766953
• Post: Foundation Trust Office, Hillingdon
Hospital, Pield Heath Road, Uxbridge, UB8 3NN.
66
Compliance with the NHS
Foundation Trust Code of
Governance
The Hillingdon Hospitals NHS Foundation Trust has
applied the principles of the NHS Foundation Trust
Code of Governance on a comply or explain basis.
The NHS Foundation Trust Code of Governance,
most recently revised in July 2014, is based on the
principles of the UK Corporate Governance Code
issued in 2012.
The Board has identified that the Trust is currently
non-compliant with the following provisions of the
updated Code.
• Provision A.1.1: The Trust is compliant with
this provision in that the Trust’s Scheme of
Reservation and Delegation includes a schedule
of matters reserved for the Board and a
statement on the roles and responsibilities
of Governors. This document was reviewed
and updated in February 2014 and again
in February 2015. The Trust is however not
fully compliant with this provision in that the
procedure for how conflicts between the Board
and Council of Governors are contained in a
separate document that covers the engagement
between the Board and Council of Governors.
This is felt to be a more suitable location within
the Trust’s governance documents. The Trust’s
arrangements are consistent with the principles
of the Code in that a clear written dispute
resolution process is in place and regularly
reviewed.
• Provision A.3.1: The Trust is currently compliant
with this provision, and has been since 1
November 2014 when the current Chair took
up the role. However, from 1 April 2014 to 31
October 2014 the Trust could potentially be
viewed as non-compliant with this provision as
James Reid, Interim Chair, was on the Board of
the Trust for six years (albeit only three of these
were on the Foundation Trust Board). James
retained his ‘independent’ mindset as evidenced
by an ability to challenge. Furthermore this
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
was always only a short-term arrangement for
which the need arose following an unsuccessful
recruitment for a substantive Chair.
• Provision B.4.2: The Trust is not currently
fully compliant with this provision which states
that ‘the chairperson should regularly review
and agree with each Director their training
and development needs as they relate to their
role on the Board.’ The Trust is compliant with
this provision in relation to the Non-Executive
Directors and Chief Executive; however it is
not technically fully compliant in relation to
the Executive Directors. The Chair, through the
Remuneration Committee provides feedback
with the other Non-Executive Directors on
Executive Directors’ performance, which includes
areas for Executive Directors’ development
both in terms of their role on the Board and
their functional management role. However,
this is fed back to individual Executive Directors
by the Chief Executive rather than the Chair
as there is not a separate appraisal in relation
to Executive Directors’ Board role. The Board
development programme in 2015 will assist in
the identification of how Directors individually
and collectively can be more effective and
the outputs of this work will assist the Chair
in agreeing development needs with Board
members individually and collectively.
03
James Reid, had served more than six years on the
Board of the Foundation Trust and predecessor
NHS Trust. As noted above, it is the Board’s view
that evidence from Board meeting discussions
demonstrated that both retained an independent
mindset and ability to challenge; and as such the
Trust complied with this provision.
The disclosures required by the Code of Governance
in relation to the Board, Council of Governors,
Nominations Committees, Audit Committee, and
membership are included in the governance section
of the Directors’ report. The disclosures required
by the Code in relation to the Remuneration
Committee are contained in the remuneration
report that follows this section.
In addition, the Board has identified that the Trust’s
compliance with the Code could be strengthened
in relation to the Governors’ consultation and
engagement with the membership (provision B.5.6).
Whilst the Trust currently provides a number of
mechanisms to support Governors to engage with
their members as outlined in the membership section
of the annual report, it is acknowledged that this is an
area where practice, and therefore compliance with
the Code, could be strengthened. The Council of
Governors have in 2015 agreed targets for measuring
this engagement, which will be monitored at the
Council of Governors’ quarterly meetings.
In relation to provision B.1.1, two Non-Executive
Directors during 2014/15, Craig Rowland and
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Remuneration report
68
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Annual statement on
remuneration
The Board of Directors Remuneration Committee
undertook a thorough review of Executive
remuneration in March 2014 and agreed the 2014/15
pay awards within the agreed pay policy. In November
2014 following the resignation of Karl Munslow Ong
the Committee considered the remuneration range
for a new substantive Chief Operating Officer at the
start of the recruitment process. The Committee
agreed this should be the same benchmarked range
from the review in March 2014 which applied to the
decisions for 2014/15. At its meeting in February
2015 the Committee agreed the remuneration within
this range for the appointee to this role (Joe Smyth) in
line with the agreed pay policy.
No other adjustments were made to the executive
remuneration in-year.
At its meeting in March 2015 the Committee
considered the executive remuneration for 2015/16.
The Committee received updated benchmarking
information that had been provided by Hay Group,
and also a report on the remuneration of the tier of
senior management who report to the Executives,
and also of the highest paid Consultants. The
Committee also considered information from
recruitment consultants on the pay for recent
Executive appointments in the London area.
The Committee noted that the pay to the senior
managers on Agenda for Change band nine
exceeded that paid to two Executive Directors.
The Committee therefore agreed to amend the
executive pay policy with effect from 1 April 2015
to include a statement that executive remuneration
will as a minimum be set at the equivalent of the
top of Agenda for Change band nine, including
the high cost area allowance. This will increase the
remuneration for two of the Executive Directors
with effect from 1 April 2015. The Committee
then considered whether further adjustments
should be made to the Executives’ remuneration
based on the factors in the pay policy, drawing on
the remuneration benchmarking report, personal
performance and broader contribution to the
04
Trust. Where this was in line with the pay policy,
changes were made to executive remuneration with
effect from 1 April 2015. In recognition of the wider
remuneration context in the Trust and broader public
sector, the Committee agreed to phase increases
across two years, with the second stage of the uplift
awarded from 1 April 2016, subject to continued good
performance.
Pradip Patel
Chair of the Board of Directors Remuneration
Committee & Non-Executive Director
Senior managers’ remuneration
policy
The executive pay policy for 2014/15 agreed by the
Remuneration Committee was as follows:
“The pay policy is to set executive remuneration
between the median and upper quartile of comparator
Trusts when individuals have a demonstrable track
record of high performance against agreed objectives
and in their overall contribution to the Trust over
a sustained period of time. In making decisions on
executive remuneration the Remuneration Committee
will also consider the organisation’s performance, and
the individual’s experience, marketability and likelihood
of moving elsewhere. Executive remuneration does
not currently include provisions for bonus payments
linked to the delivery of performance targets.”
Under this policy the Committee considers individual
and overall Trust performance when determining
executive remuneration.
No material changes were made to the remuneration
policy for 2014/15, with the following added to the
policy for 2015/16:
“Executive remuneration will as a minimum be set at
the equivalent of the top of Agenda for Change band
nine, including the high cost area allowance.”
Remuneration for staff not covered by the
Remuneration Committee is determined by nationally
defined terms and conditions.
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
The remuneration for the Chair and Non-Executive
Directors is set by the Council of Governors,
drawing on the recommendations from the
Council of Governors Nominations & Remuneration
Committee. The Council of Governors has agreed
that the Chair position is remunerated at £45k per
annum, whilst Non-Executive Director positions
are remunerated at £13k per annum. There are no
other additional fees payable to the Chair or NonExecutive Directors, or other items that could be
considered to be remuneration in nature.
The Executives and Non-Executives are able to claim
reimbursement of certain expenses incurred in their
role. Details of these are outlined below.
In the event that a Director is overpaid any sums,
the Trust will recover this payment from the monthly
payment that the Director receives. Should the sums
involved be high, then the payroll department will
liaise with the appropriate Director to negotiate a
payment plan.
Service contracts and payments for loss
of office
Neither the Chief Executive nor the Executive
Directors are currently appointed for fixed term
contracts. The Board believes that such contracts
would make it harder to attract and retain highquality Executives in a competitive recruitment
environment, and can lead to uncertainty affecting
service delivery towards the end of the contract.
The Trust’s policy on notice periods and termination
payments for Executive Directors is six months, in
line with generally accepted practice at this level in
the NHS. Any decision to allow an Executive Director
to leave the Trust’s employment without this full
notice period is subject to a risk assessment by the
Board of Directors Nominations Committee, in line
with the Code of Governance. This risk assessment
will include consideration of the individual’s
performance and the succession planning
arrangements in place.
Non-Executive appointments are not within the
jurisdiction of Employment Tribunals and there is
no entitlement for compensation for loss of office
70
through employment law. The expiry of the terms of
office for the Chair and Non-Executive Directors are
outlined earlier in the annual report in the section
relating to the Board. The Chair and Non-Executive
Directors can resign at any time by giving three
month’s written notice.
All Executive Directors are entitled to sick pay in line
with the following table:
Length of NHS
Service
Full Pay
Half Pay
During the first year of
service:
1 month
2 months
During the 2nd year of
service:
2 months
2 months
During the 3rd year of
service:
4 months
4 months
During the 4th and 5th
years:
5 months
5 months
After 5 years service
6 months
6 months
In terms of loss of office, all Executive Directors will
be entitled to the same redundancy terms associated
with Agenda for Change (AfC) and Medical &
Dental (M&D) staff ie after two years qualifying
service, the entitlement for redundancy pay will be
one month’s salary for each year’s service, capped
at 24 months payment. This may change in light of
recently published contractual changes to AfC and
M&D staff terms and conditions of employment,
which would mean for the purposes of redundancy,
salary will be capped at £80K for the determination
of a redundancy payment. Furthermore, all Executive
Directors will be entitled to any annual leave which
has been accrued and not taken at the point of a
loss of office. Where more annual leave has been
taken than already accrued, the Director will need to
pay this back to the Trust (payment will be recovered
through monthly pay). As mentioned earlier, all
Executive Directors will be entitled to a six months’
notice period in relation to a loss of office, the only
exception to this would be an immediate dismissal,
whereby notice periods would not be applicable.
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
04
Payments made to Directors at the point when there
will be a loss of office would in usual circumstances
be in line with contractual rights ie redundancy,
annual leave etc. Any payments outside of these
would be subject to the relevant approval process,
which may include Monitor.
remuneration policy. However, staff are represented
on the Council of Governors (through the elected
Staff Governors and the Appointed Governor for the
Joint Negotiating & Consultative Committee) which
is responsible for agreeing the remuneration for the
Chair and Non-Executive Directors.
Non-Executive Directors are not entitled to
redundancy pay, holiday pay or sick pay, as they are
‘Office Holders’, and not employees of the Trust.
The benchmarking report considered by the
Remuneration Committee in March 2014 included
benchmarking information taken from Foundation
Trust annual reports for 2012/13. The report to the
Committee in March 2015 included information on
published salaries in 2013/14 annual reports in a
sample of Foundation and non-Foundation Trusts.
Consideration of employment conditions
elsewhere in the Foundation Trust
The Board of Directors Remuneration Committee
reviews the pay of the first layer of management
beneath the Board and that of the highest paid
consultant staff to ensure that (a) the level of
differential between the Executives and other
senior staff within the organisation is appropriate
and (b) that there is assurance on the rationale for
this differential. This information was presented
to the Committee in March 2014 (in relation to
2014/15, and March 2015 in relation to 2015/16).
The Committee’s standard approach is to award
the cost of living increases that are awarded to
staff on Agenda for Change terms and conditions
to the Executives.
As highlighted above, this information highlighted
to the Committee in March 2015 that the salaries
for several of the direct reports to the Executive
Directors had overtaken, or would in future
overtake, those paid to the Executive Directors.
This was due to the fact that staff on Agenda for
Change terms and conditions receive incremental
pay awards, whilst the Executives were subject to
‘spot salaries’ determined by the Remuneration
Committee. To ensure that the seniority, challenges
and responsibilities of the Executives are recognised
in remuneration, the Committee agreed to amend
the pay policy as outlined above. Also, as outlined
above, the Committee agreed to phase Executive
pay increases over two years in recognition of the
remuneration conditions elsewhere in the Trust.
The Remuneration Committee has not consulted
with staff when preparing the executive
Annual report on remuneration
Details of the service contract and notice period for
the Executives are outlined above. The expiry dates
of the Non-Executives’ terms of office are outlined
in the Board section of the annual report. As stated
above, Non-Executives may resign from office prior
to this by providing three months notice.
Board of Directors Remuneration
Committee
The Board of Directors Remuneration Committee
comprises all of the Non-Executive Directors
and is chaired by the Deputy Chair. The Chief
Executive and Director of People are invited to
attend to provide professional advice, except
when the Committee is considering these
individuals’ remuneration and/or performance.
The Trust Secretary attends to take minutes of the
Committee’s meetings.
Attendance at Remuneration Committee meetings
in 2014/15 is outlined earlier in the governance
section of the Directors’ Report.
At its meeting in October 2014 the Committee
agreed to commission remuneration consultants
to provide benchmarking information as it
would provide evidence on the appropriateness
of the Executive remuneration when compared
to other Trusts. The Committee delegated to
the Committee Chair the authority to agree the
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
remuneration consultants to undertake this work.
Hay Group were subsequently commissioned to
provide a benchmarking report for the Committee
which benchmarked the executive remuneration
at the Trust against other Foundation Trusts. The
Committee considered the report in March 2015
with respect of the remuneration to be paid for
2015/16. To ensure independence and objectivity,
neither the Chief Executive nor Director of People
were present whilst the Committee discussed their
respective remuneration. Hay Group’s services
were limited to providing the benchmarking report
for the Committee and representatives from
the Group did not attend any meetings of the
Remuneration Committee.
Council of Governors Nominations &
Remuneration Committee
The Council of Governors is responsible for agreeing
the remuneration of the Chair and Non-Executive
Directors. As outlined above, in making decisions
on Non-Executive remuneration, the Council of
Governors draws on the recommendations of the
Council of Governors Nominations & Remuneration
Committee.
The Committee met six times in 2014/15. As
outlined earlier in the report the Committee’s
key area of work was the Chair and various NonExecutive Director appointments undertaken during
the year. The Committee also agreed updated
expense rates for the Chair and Non-Executive
Directors to bring these in line with changes to the
rates for staff on Agenda for Change terms and
conditions (see below). At its meeting in October
2014 the Committee agreed to commission the
remuneration consultants that would be reporting
on executive remuneration to also report on
non-executive remuneration. The Committee will
consider the implications of this review for 2015/16
remuneration at its meeting in June 2015 and
any decisions of the Council of Governors will be
reported in the 2015/16 annual report.
The fee for the two aspects of Hay Group’s report
was £5,500 plus VAT.
72
Attendance at the Committee’s six meetings in
2014/15 is outlined below.
Name
Number of
meetings
attended
James Reid (Interim Chair)
4 of 5
Pradip Patel (Deputy Chair and
Senior Independent Director)
4 of 4
John Coleman (Public Governor)
6 of 6
Jack Creagh (Staff Governor)
6 of 6
Tony Ellis (Public Governor)
6 of 6
Mary O’Connor (Appointed
Governor)
6 of 6
Roger Shipton (Public Governor)
5 of 6
Directors’ remuneration in 2014/15
For the purposes of the remuneration report, the
Chief Executive has confirmed that the definition of
senior manager covers the members of the Board
plus the Director of People who attended Board
meetings throughout the year, in line with the
definition in Monitor’s Annual Reporting Manual
that senior managers are ‘those persons in senior
positions having authority or responsibility for
directing or controlling the major activities of the
Foundation Trust.’
0
100
95-100
120-125
David Searle,
Director of
Strategy & Business
Development
Paul Wratten,
Finance Director
6
0
5-10
Joe Smyth, Chief
Operating Officer
5
0
105-110
Theresa Murphy,
Director of the
Patient Experience
and Nursing
4
0
100-105
Karl Munslow Ong,
Chief Operating
Officer
3
0
175-180
Abbas Khakoo,
(Joint) Medical
Director
2
0
85 – 90
Richard GrocottMason, (Joint)
Medical Director
200
100-105
Claire Gore, Director
of People
1
0
£s
£000s
165-170
(To the
nearest
£100)
Taxable
Benefits
2014/15
(Note 11)
(bands of
£5000)
Salary and
fees 2014/15
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
£000s
(bands of
£5000)
Annual
Performance
Related
Bonuses
2014/15
Current Year Ending 31 March 2015
Shane DeGaris,
Chief Executive
Executive Directors
Notes
NAME AND TITLE
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
£000s
(bands of
£5000)
Long Term
Performance
Related
Bonuses
2014/15
17.5-20
5-7.5
2.5-5
40-42.5
20-22.5
0
10-12.5
N/A
32.5-35
£000s
(bands of
£2500)
Pension
Related
Benefits
2014/15
140-145
105-110
10-15
150-155
125-130
175-180
100-105
100-105
200-205
£000s
(bands of
£5000)
Total
Remuneration
2014/15
115-120
95-100
N/A
80-85
100-105
170-175
155-160
100-105
160-165
£000s
(bands of
£5000)
Salary and
fees 2013/14
100
0
N/A
0
0
0
0
200
0
£s
(To the
nearest £100)
Taxable
Benefits
2013/14
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
£000s
(bands of
£5000)
Annual
Performance
Related
Bonuses
2013/14
(excluding
social security
costs)
Previous Year Ending 31 March 2014
Table 1– Senior Managers (The Chair, Executive and Non-Executive Directors) Remuneration
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
£000s
(bands of
£5000)
Long Term
Performance
Related
Bonuses
2013/14
7.5-10
10-12.5
N/A
15-17.5
17.5-20
47.5-50
5-7.5
N/A
30-32.5
£000s
(bands of
£2500)
Pension
Related
Benefits
2013/14
125-130
110-115
N/A
100-105
120-125
220-225
165-170
100-105
195-200
£000s
(bands of
£5000)
Total
Remuneration
2013/14
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
04
73
74
200
0
0
0
0
0
0
0
10-15
10-15
10-15
10-15
10-15
5-10
5-10
Katey Adderley,
Non-Executive
Director
Carol Bode, NonExecutive Director
Soraya Dhillon, NonExecutive Director
Lis Paice, NonExecutive Director
Pradip Patel, NonExecutive Director
Richard Whittington,
Non-Executive
Director
10
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
£000s
(bands of
£5000)
Annual
Performance
Related
Bonuses
2014/15
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
£000s
(bands of
£5000)
Long Term
Performance
Related
Bonuses
2014/15
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
£000s
(bands of
£2500)
Pension
Related
Benefits
2014/15
5-10
5-10
10-15
10-15
10-15
10-15
10-15
15-20
25-30
£000s
(bands of
£5000)
Total
Remuneration
2014/15
Notes on Table 1
Annual and Long Term Performance Related bonuses have not been paid by the Trust and are not applicable (N/A)
Pension Related Benefits have been calculated using the HMRC method advised by Monitorin the Annual Reporting Manual.
Craig Rowland,
Non-Executive
Director
9
8
15-20
James Reid, Interim
Chair / NonExecutive Director
7
Richard Sumray,
Chair
£s
£000s
0
(To the
nearest
£100)
Taxable
Benefits
2014/15
(Note 11)
(bands of
£5000)
Salary and
fees 2014/15
Current Year Ending 31 March 2015
25-30
Non Executive Directors
Notes
NAME AND TITLE
N/A
10-15
10-15
0-5
0-5
10-15
10-15
N/A
10-15
£000s
(bands of
£5000)
Salary and
fees 2013/14
N/A
0
0
0
0
0
0
N/A
0
£s
(To the
nearest £100)
Taxable
Benefits
2013/14
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
£000s
(bands of
£5000)
Annual
Performance
Related
Bonuses
2013/14
(excluding
social security
costs)
Previous Year Ending 31 March 2014
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
£000s
(bands of
£5000)
Long Term
Performance
Related
Bonuses
2013/14
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
£000s
(bands of
£2500)
Pension
Related
Benefits
2013/14
N/A
10-15
5-10
10-15
10-15
10-15
10-15
N/A
10-15
£000s
(bands of
£5000)
Total
Remuneration
2013/14
04
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
2.5-5
2.5-5
Karl Munslow Ong, Chief
Operating Officer
Theresa Murphy, Director of
the Patient Experience and
Nursing
Joe Smyth, Chief Operating
Officer
David Searle, Director
of Strategy & Business
Development
Paul Wratten, Finance
Director
3
4
5
6
0-5
0-5
5-10
5-10
0-2.5
0-2.5
2.5-5
45-50
20-25
20-25
30-35
15-20
45-50
45-50
25-30
£000s
(Bands of
£5000)
Total accrued
pension at age
60 at 31 March
2015
135-140
65-70
65-70
100-105
40-45
135-140
140-145
25-30
£000s
(Bands of
£5000)
Lump Sum at
age 60 related
to accrued
pension at 31
March 2015
765
421
348
522
153
821
826
252
£000s
Cash Equivalent
Transfer Value
at 1st April 2014
51
32
43
59
26
34
51
38
£000s
Real Increase in
Cash Equivalent
Transfer Value
837
464
400
595
183
877
899
297
£000s
Cash Equivalent
Transfer Value
at 31 March
2015
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Employer’s
contribution
to stakeholder
pension
Notes on Table 2
The Trust is a member of the NHS Pension Scheme which is a defined benefit Scheme, though accounted for locally as a defined contribution scheme. The Trust does not operate nor contribute a stakeholders pension scheme. This is therefore shown as not
applicable (N/A) Non Executive Directors are not members of the Trust pension scheme. Claire Gore, Director of People, is not a member of the Trust’s pension scheme.
5-7.5
5-7.5
0-2.5
0-2.5
Abbas Khakoo, (Joint)
Medical Director
2
2.5-5
0-2.5
£000s
£000s
0-2.5
(Bands of
£2500)
Real increase in
pension lump
sum at age 60 at
31 March 2015
(Bands of
£2500)
Richard Grocott-Mason,
(Joint) Medical Director
Shane DeGaris, Chief
Executive
Executive Directors
Real increase in
pension at age
60 at 31 March
2015
1
Notes
NAME AND TITLE
Table 2– Senior Managers’ Pension Entitlements
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
04
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Table 3– Fair Pay Multiple
2014/2015
2013/2014
Band of Highest Paid Director’s Total Remuneration (£000)
200-205
220-225
Median Total Remuneration
30,206
30,845
Ratio
6.70
7.20
Notes on Table 3
The HM Treasury Financial Reporting Manual (FReM), requires the Trust to disclose the median remuneration of the Trust staff and the ratio between this and the
mid-point of the banded total remuneration of the highest paid director. The calculation is based on full-time equivalent staff of the Trust at 31 March 2015 on an
annualised basis. In 2014/15 and 2013/14 no employee received remuneration in excess of the highest-paid Director.
There was a slight decrease from 7.20 to 6.70 in the ratio this year. Due to how pension related benefits are calculated, the previous highest paid director in
2013/14 received no pension related benefits in 2014/15, which has resulted in a lower total remuneration for the highest paid director in 2014/15. There was
also a slight decrease in median income. Given the Trust employs over 3000 staff this slight reduction in the median could be down to a combination of factors;
however likely factors include the increase in the overall staffing numbers and the impact of staff turnover
It should also be noted that the fair pay multiple has been recalculated from that reported in the 2013/14 annual report as the figures for pension related benefits
are now available which contribute to Executive Directors total remuneration.
Notes
Changes in Office Holders 2014/15
1 Richard Grocott-Mason, Joint Medical Director, left office 12 October 2014
Clinical work in band of £35k – £40k, Director work in band of £50k to £55k
Recharges out to Royal Brompton and Harefield NHS Foundation Trust not included in above
Included in salary was a Clinical Excellence Award in band of £15k to £20k which was Trust funded.
2 Abbas Khakoo became sole Medical Director following Dr Grocott Mason’s resignation
Clinical work in band of £65k – £70k, Director work in band of £110k to £115k
Recharges out to NHS Central London CCG and Imperial College not included in above
Included in salary was a Clinical Excellence Award in band of £25k to £30k which was funded by the NHS Commissioning Board CCG.
3 Karl Munslow Ong, Chief Operating Officer, left office 28 February 2015
4 Theresa Murphy joined the Trust on 30 May 2013
5 Joe Smyth Chief Operating Officer, from 1 March 2015
6 Prior to 1 July 2014 David Searle was Director of Corporate Development. Disclosure covers both roles.
7 James Reid, Interim Chair, 1 April 2014 to 31 October 2014 then reverted to being a Non-Executive Director 1 November 2014 to 31 December 2014
8 Richard Sumray, Chair, from 1 November 2014
9 Craig Rowland, Non-Executive Director, left office 30 September 2014
10 Richard Whittington Non Executive Director, from 1 October 2014
Other Notes
11 Taxable Benefits relate to p11d taxable travel costs paid.
The above tables include the payments made to current and former senior managers in 2014/15 that require
disclosure under the Foundation Trust Annual Reporting Manual. No Executive Director currently serves as a NonExecutive Director of another organisation.
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Governor and Director expenses
04
Governors and Directors are entitled to claim for certain expenses incurred whilst undertaking their role at the Trust.
The rates payable to Governors are approved by the Board of Directors, whilst the rates payable to the Chair and
Non-Executive Directors are approved by the Council of Governors. These are both based on the rates payable to the
Trust’s staff on Agenda for Change Terms and Conditions. The Chief Executive and Executive Directors are eligible to
claim expenses under the rates payable to staff employed on the Agenda for Change terms and conditions.
The table below outlines the expenses paid to members of the Board of Directors and Council of Governors in
2013/14 and 2014/15 as required by the Foundation Trust Annual Reporting Manual.
2014/15 Actual
2013/14 Actual
Total number of Directors in office in the reporting period
18
19
Number of Directors receiving expenses in the reporting period
11
10
Total value of expenses paid to Directors in the reporting period
£7,243
£5,213
Total number of Governors in office in the reporting period
25
27
Number of Governors receiving expenses in the reporting period
2
0
Total value of expenses paid to Governors in the reporting period
£91
£0
Reporting of ‘off-payroll’ engagements
It is the Trust’s policy that off-payroll or non-standard contract employment arrangements should only be
considered by exception and where there is no practical alternative to the Trust employing directly. Before any offpayroll engagements are agreed with an individual a tax status questionnaire must be completed and sent to the
Director of People before any engagement is finalised.
Where the contract would be with an agency or a limited company this questionnaire is not required but any
engagement must comply with the HM Treasury rules set out in the following paragraph.
All off-payroll engagements must be governed by a Trust contract and contain clauses that allow the Trust to seek
assurance from the individual, partnership or limited company that they have complied with their tax obligations.
It is the responsibility of the Director of People to approve all off-payroll engagements or non-standard contract
employment arrangements prior to commencement.
The following information is presented in accordance with the requirements of the NHS Foundation Trust Annual
Reporting Manual.
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Table 1: For all off-payroll engagements as of 31 March 2015, for more than £220 per day
and that last for longer than six months
No. of existing engagements as of 31 March 2015
31
Of which...
No. that have existed for less than one year at time of reporting.
7
No. that have existed for between one and two years at time of reporting.
7
No. that have existed for between two and three years at time of reporting.
4
No. that have existed for between three and four years at time of reporting.
6
No. that have existed for four or more years at time of reporting.
7
All existing off-payroll engagements, outlined above, have at some point been subject to a risk based assessment
as to whether assurance is required that the individual is paying the right amount of tax and, where necessary, that
assurance has been sought.
Table 2: For all new off-payroll engagements, or those that reached six months in
duration, between 1 April 2014 and 31 March 2015, for more than £220 per day and that
last for longer than six months
No. of new engagements, or those that reached six months in duration, between
1 April 2014 and 31 March 2015
11
No. of the above which include contractual clauses giving the trust the right to request assurance
in relation to income tax and National Insurance obligations
6
No. for whom assurance has been requested
4
Of which...
No. for whom assurance has been received
0
No. for whom assurance has not been received
4
No. that have been terminated as a result of assurance not being received.
0
In five cases the Trust has made engagements without including clauses allowing the Trust to seek assurance
as to their tax obligations. These are staff that have been engaged at relatively short notice due to very pressing
operational service needs and to deal with waiting list issues. Where relevant, the Trust is still in the process of
putting contracts in place with the required clauses and of seeking the required assurances.
78
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
04
Table 3: For any off-payroll engagements of board members, and/or, senior officials with
significant financial responsibility, between 1 April 2014 and 31 March 2015
No. of off-payroll engagements of board members, and/or, senior officials with significant
financial responsibility, during the financial year.
0
No. of individuals that have been deemed “board members and/or senior officials with
significant financial responsibility” during the financial year. This figure should include both
off-payroll and on-payroll engagements.
18
Shane DeGaris
Chief Executive
28 May 2015
79
05
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Quality Report 2014/15
80
Putting Compassionate Care, Safety and
Quality at the Heart of Everything we do
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
contents
05
About the Trust’s Quality Report82
Executive summary82
Part 1
Statement from the Chief Executive85
Part 2
Priorities for improvement and statements
of assurance from the board Key Quality Achievements for 2014/15
2.1 Looking back…
Quality priorities for improvement 2014/15 – How did we do?
88
88
89
89
Looking Forward…
101
Quality priorities for improvement in 2015/16
102
2.2 Formal statements of assurance from the Board 109
Provision of NHS Services Participation in clinical audit 109
Participation in research 114
Lessons learned from Serious Incidents 115
Goals agreed with our commissioners 118
Care Quality Commission registration 119
Data quality 120
Information governance toolkit 120
Clinical coding error rate 109
120
2.3 Performance against Core Quality Indicators 2014/15 Part 3
Other key quality improvements we have made in 2014/15 126
120
Annex 1 Statements from our stakeholders 144
Statement from Hillingdon Clinical Commissioning Group (CCG)
144
Statement from our local Healthwatch 147
Statement from External Services Scrutiny Committee 150
The Hillingdon Hospitals NHS Foundation Trust response
to the consultation
151
Independent Auditor’s Report 152
Annex 2 Statement of Directors’ responsibilities in respect of
the Quality Report 155
Glossary
156
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
About the Trust’s Quality Report
What is the Quality Report?
The Quality Report is produced for the public by
NHS healthcare providers, to inform them about
the quality of services they deliver. All NHS providers
strive to achieve high quality care for their patients,
and the Quality Report provides the Trust an
opportunity to demonstrate its commitment to
quality improvement, and show what progress we
have made in 2014/15 against our quality priorities
and national requirements. The Quality Report is a
mandated document which is laid before Parliament
before being made available on the NHS Choices
website and our own website – (www.thh.nhs.uk).
What is included in the Quality Report?
The Quality Report is a statutory document that
contains specific, mandatory statements and
sections. There are also three categories mandated
by the Department of Health (DH) that give
us a framework in which to focus our quality
improvement programme. These are patient
safety, patient experience and clinical effectiveness.
The Trust undertook extensive consultation and
engagement in developing this report to ensure that
the quality improvement priorities reflect those of
our patients, our staff, our partners and the local
community.
Part 2 of the report highlights the Trust’s quality
priorities and includes:
• The areas identified for improvement in 2014/15;
• How we performed against these improvement
•
targets; and
What this means for our patients.
There is also a section in Part 2 on the quality
priorities that have been identified for improvement
projects in 2015/16.
A glossary is available at the back of the report
which lists the abbreviations and terms in the
document.
82
Executive summary
The Quality report is a summary of our performance
during 2014/15 in relation to our quality priorities
and national requirements. The detail of our
key quality achievements and improvements are
outlined in the main body of the report. Overall,
the Trust has performed very well across a wide
range of core quality indicators during this past year
which has resulted in us maintaining the quality
governance requirements of our foundation Trust
status with Monitor.
Particular successes include the Trust achieving
measurably low patient mortality rates being one of
only 15 acute Trusts in the “lower than expected”
Summary Hospital-level Mortality Indicator (SHMI)
band. The Trust’s Patient Safety Thermometer
(Harm Free Care) currently stands at 95.4% against
a national target of 95% and we received more
than 24,076 responses to the Friends and Family
Test (FFT) during 2014 and 93% of patients are
happy to recommend our services to their friends
and family. We have also performed well in other
areas including increasing our uptake of statutory
and mandatory training in infection prevention
and control and safeguarding and achieved the
requirements of the National Specification for
Cleaning across the Trust as part of the CQC
improvement programme.
However 2014/15 has been a challenging year for
the Trust. We have seen increased patient activity and
throughput with 90 additional beds open through
the majority of the year. This has put pressure on our
internal systems and has stretched our manpower
resources during a very challenging staffing market
nationally. It has therefore been difficult to realise
some of the stretching quality targets that we set
ourselves at the beginning of the year.
Some examples of our achievements and progress
against the key priority areas are listed below:
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Quality priority
How did we do?
05
Accessible and Responsive Services – Continuing to improve the outpatient experience
Local outpatient experience survey overall satisfaction
Achieved 91% against a target of 88%
Percentage of clinics cancelled with six weeks’ notice
target 1.5%
Not achieved, but clinic utilisation has improved to
87% from 85.6%
Improving inpatient care project
Ambulatory care pathway – to see more than 200
patients per month
The Ambulatory Care Service assesses and treats more
than 270 patients per month
Patients leaving hospital with positive experience
Achieved 90.1% against a target of 72%
Improving patient safety in Emergency and Maternity care
Consultant physician presence at weekends in
Medicine
This was only achieved during the winter months
however it facilitated the timely review of patients and
supported safe discharge during extreme pressures.
All patients seen by a Consultant within Medicine,
Surgery, Paediatrics and Gynaecology within 12 hours
Not achieved, some specialties have realised greater
improvement than others with investment in
consultant rotas
Introducing and embedding patient care bundles/pathways
Implement the Acute Kidney Injury (AKI) Pathway and
show some improvement
Achieved
Catheter Care Bundle compliance
Achieved 97% against a target of 95%
To reduce all falls (rate, per 1000 bed-days) by 20%
Achieved reduction to 4.38 against a target of 3.98
Improve responsiveness to patient need
FFT response rate – Accident and Emergency
Achieved 20.6% against a target of 20%
FFT response rate – Inpatients
Achieved 36% against a target of 30%
Improvement in compassionate care indicator
Achieved 86% against a target of 90%
Some elements of improvement work in the key
priority areas have not been realised and the clinical
teams will continue to drive forward improvement
during 2015/16 to ensure improvement targets
are achieved. In addition the Trust has developed a
detailed improvement plan based on the findings of
its CQC planned inspection in October 2014 where
an overall rating of ‘Requires Improvement’ was
given to the Trust. The full report can be viewed at:
http://www.thh.nhs.uk/media/index.php. The Trust’s
improvement plan can be viewed at: www.thh.nhs.uk.
The Trust continues to invest in its services, opening
the Nightingale Centre housing a new Acute
Medical Unit (AMU) and Endoscopy Unit, a redesign
of Beaconsfield East Ward into a dementia friendly
environment, new Maternity labour rooms and
opened the new 16-bedded Daniels rehabilitation
ward at Mount Vernon Hospital.
We have set out our quality priorities for 2015/16
and the targets we aim to achieve are as follows:
• Safeguarding – ensuring the safety of vulnerable
•
•
•
and older people;
Improving the safety of medicines management
and the experience of people requiring
medicines in the inpatient and outpatient
settings;
Improving maternity services; and
Improve communication with our patients.
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05
84
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
During 2014/15 there has continued to be increased
focus on measuring and monitoring the quality of
our services and the care that is delivered to our
patients and their families. The Trust’s three-year
Clinical Quality Strategy supports this work and helps
us to achieve our vision: ‘To put compassionate care,
safety and quality at the heart of everything we do’.
The mandated statements/sections within this
Quality Report include information on our
participation in national audits and our research
activity during 2014/15. In addition, information is
provided on our registration as a healthcare provider
with the Care Quality Commission (CQC) and the
results of our announced visit in October 2014.
The SaHF programme and findings from the
investigation into the maternity services at University
Hospitals of Morecambe Bay NHS Foundation Trust
have further influenced the priorities, especially as
the Trust is expecting an increase in births due to
the transfer of maternity services from Ealing in the
summer of 2015.
This Quality Report and the priorities for 2015/16
are presented as a result of consultation and
engagement with our Foundation Trust members,
our Governors, People in Partnership, our staff,
Healthwatch and our Commissioners.
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
05
Part 1
Statement from the Chief Executive
This Quality Report provides the Trust with an
opportunity to demonstrate our commitment to
delivering high quality care. It outlines our quality
improvement work and the progress we have made
in 2014/15. It also aims to give a balanced view and
to highlight the areas that we know we need to
focus on to make our services even more safe and of
a higher quality.
It has been challenging for the Trust during the later
part of the year after the findings of an announced
CQC inspection in October 2014 were announced.
The Trust was given an overall rating of ‘Requires
Improvement’ in January 2015 and issued with 2
Warning Notices against:
• Regulation 10 – Assessing and Monitoring; and
• Regulation 12 – Cleanliness and Infection
Control.
It was also issued with 5 Compliance Notices
against:
• Regulation 16 – Safety and Suitability of
•
•
•
•
Equipment;
Regulation 15 – Premises;
Regulation 13 – Medicine Management;
Regulation 20 – Records; and
Regulation 22 –Staffing.
The Board considers the overall CQC rating to be
fair and it is determined to make the necessary
improvements. I am pleased with the examples of
good practice highlighted in the report and welcome
the very positive feedback provided by patients and
staff. The quality status for governance with regard
to Monitor’s risk rating system is under review from
the green achieved last year by the Trust.
The Trust has, however, performed well in
many areas:
• The Trust continues to maintain its high
performance across the Referral to Treatment
waiting times and is achieving the highest level of
achievement in the North West London Sector;
• Key cancer performance indicators are being
well maintained for all the national waiting times
standards, achieving performance better than
the London and national average;
• The Trust has measurably low patient mortality
figures achieving one of only 15 Acute Trusts
in the “lower than expected” SHMI band
(Summary Hospital Level Mortality Indicator
published by the Health and Social Care
Information Centre);
• The Trust’s Patient Safety Thermometer (Harm
Free Care) currently stands at 95.4 per cent
(YTD) against a national target of 95 per cent;
• We have received over 24,076 patient responses
to the Friends and Family Test (FFT) during 201415 with 93% of patients recommending our
wards and emergency department to family and
friends. Where problems were highlighted we
have looked to address these. An example of this
is our local campaign on the ‘Hello…my name
is’ national initiative which encourages staff
to always introduce themselves by name and
role. This has been recognised as a very positive
outcome on action taken as a result of feedback
from the FFT; and
• In the annual NHS staff survey (2013), reported
in 2014, the number of staff agreeing that
patient care is the Trust’s top priority grew by
7% to 78% above the national average of 69%.
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05
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
In addition 64 questions showed improvement
from the previous year and in 71 questions our
responses were better than the national average.
We have also performed well in other areas
including increasing our uptake of statutory and
mandatory training in all subjects to above targets
and achieved the National Specification for Cleaning
standards across the Trust as part of our CQC
Improvement programme.
We have continued to invest in our services, some
exciting areas include:
• More than £15 million in new and improved
•
•
•
patient services;
Opening the £12.3 million Nightingale Centre
housing a new Acute Medical Unit (AMU) and
Endoscopy Unit;
A further £845,000 on redesigning Beaconsfield
East Ward and £870,000 on new Maternity
labour rooms; and
Expanding our highly acclaimed
neuro-rehabilitation services into a new 16
bedded Daniels Ward at Mount Vernon Hospital.
I am proud that we have also received national
recognition in several areas including:
• Awarding winning Paediatrics Diabetes Team –
•
our Paediatrics Diabetes team won a £50,000
Innovation Challenge Prize for their schools
out-reach work and received three commendations
in the national Quality Care Programme Awards.
The Trust will lead the development of the
‘The National Skills Academy for Health (NSA
Health’) North West London Excellence Centre to
improve the quality and accessibility of training
for England’s healthcare support workforce.
Within North West London the ‘Shaping a Healthier
Future’ (SaHF) programme outlines a five year
strategy which places the Hillingdon Hospital site
as one of the five major hospitals for providing a
full range of 24/7 emergency care in the region.
The SaHF programme places an emphasis on the
provision of a wider range of out-of-hours primary
86
and urgent care, and we are working closely with
our General Practitioners, commissioners and other
providers to ensure that across the healthcare
community patient care is provided in the right place
at the right time. Currently we have implemented
new community pathways in the Musculoskeletal,
Urology and Gynaecology specialties.
This April will see the launch of a comprehensive
pilot project with a wide range of partners that
will bring about a step change in the way care is
delivered to our most vulnerable elderly patients.
Hillingdon’s Whole Systems Integrated Care
project (WSIC) is a new care model targeted at
over 65 year-olds with complex health needs. The
new system has been designed collaboratively
throughout 2014 by clinicians from the Trust and
key health partners. It aims to join-up services across
organisations and care settings. Overall more care
will be delivered in the community and in people’s
homes rather than in acute hospitals. This approach
will deliver better value for money by freeing-up
hospital beds but more importantly will provide a
far better patient experience as more services are
accessed closer to home. The project is part of the
government’s wider agenda to fully integrate health
and social care by 2018. The 12-month pilot begins
in the North of the borough, before being rolled
out across the rest of Hillingdon.
The hospital has also been working with the SaHF
programme to support the proposed transition of
Maternity services. The new service configuration for
maternity and neonatal care for North West London
will see birthing units and labour ward activity
concentrated across six sites in upgraded facilities,
with expectant mothers able to choose between
midwife-led or obstetric-led units. For our Hillingdon
Hospital we now have plans in place to undertake
transition from June 2015 once the official decision
is made.
I am clear that our hospitals have staff who are
committed to the highest possible standards of
care for our patients. This Quality Report confirms
our commitment to you to achieve ongoing
improvements in the quality for our services to
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
patients and ensures that we always put our
patients at the forefront of service development
and improvement. In this report you will read of the
extensive quality improvement work that has been
taking place across our hospitals to support this
ethos, and the elements of clinical care and service
delivery that we aim to further improve to provide
the safe and high quality care that our patients
expect and deserve.
During 2014/15 there has been an increased focus
on how we measure and monitor quality at the
Trust due to the CQC findings. Our Clinical Quality
Strategy continues to underpin our key aims and
objectives for quality improvement as it was informed
by a review of our quality performance against
national and regional quality data and referenced
local feedback from both staff and patients.
In developing our quality priorities for 2015/16 we
have made reference to our CQC report, national
best practice and reviewed our current quality
performance in line with local, regional and national
performance. The report includes a consultation
with a wide group of stakeholders, including our
Governors, Commissioners, People in Partnership
and our local Healthwatch.
05
cases, data reported reflects clinical judgement
about individual cases, where another clinician
might have reasonably have classified a case
differently.
• National data definitions do not necessarily
cover all circumstances, and local interpretations
may differ.
• Data collection practices and data definitions
are evolving, which may lead to differences
over time, both within and between years. The
volume of data means that, where changes
are made, it is usually not practical to reanalyse
historic data.
The Trust’s Board and management have sought to
take all reasonable steps and exercise appropriate
due diligence to ensure the accuracy of the data
reported, but recognises that it is nonetheless
subject to the inherent limitations noted above.
Following these steps, to my knowledge, the
information in the document is accurate with the
exception of the matters identified in respect of the
18 week referral to treatment incomplete pathway
indicator as described on pages 129 and 130.
Yours sincerely
I hope that this Quality Report provides you with a
clear picture of how important quality improvement
and safety are to us at The Hillingdon Hospitals NHS
Foundation Trust.
There are a number of inherent limitations in the
preparation of this Quality Report which may impact
the reliability or accuracy of the data reported. These
include:
Shane Degaris
Chief Executive
The Hillingdon Hospitals NHS Foundation Trust
28 May 2015
• Data is derived from a large number of different
systems and processes. Only some of these are
subject to external assurance, or included in
internal audits programme of work each year.
• Data is collected by a large number of
teams across the Trust alongside their main
responsibilities, which may lead to differences in
how policies are applied or interpreted. In many
87
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Part 2
Priorities for improvement and
statements of assurance from
the board
In this part of the report we tell you about the quality of our services and how we have performed in the areas
identified for improvement in 2014/15. These areas are called our quality priorities and they fall into the three
areas of quality as mandated by the Department of Health (DH): patient safety, patient experience and clinical
effectiveness, and we are required to have a minimum of one priority in each area.
Firstly, the information below provides an overview of some of our key quality achievements in 2014/15. These
are important indicators for the public and our key stakeholders to provide assurance on the quality of care and
services that are delivered at the Trust:
Key Quality Achievements during 2014-15
Award winning Paediatrics
Diabetes Team
Our Paediatrics Diabetes team won a
£50,000 Innovation Challenge Prize for
their schools out-reach work and received
three commendations in the national
Quality Care Programme Awards.
Friends and Family Test
We received more than 24,076 responses
to the FFT during 2014 and 93% of
patients are happy to recommend our
services to their friends and family.
Improved mortality rates
We are one of only 15 acute Trusts (out of
137 Trusts) in the “lower than expected”
SHMI band (Summary Hospital Level
Mortality Indicator published by the Health
and Social Care Information Centre).
88



Annual NHS Staff Survey 2013
The number of staff agreeing that patient
care is the Trust’s top priority grew
by seven per cent to 78% above the
national average of 69%. Trust scores
improved in 26 questions and performed
better than the average in 71 questions.
Patient Safety Thermometer
The Trust’s Patient Safety Thermometer
(Harm Free Care) currently stands at
95.4 per cent (YTD) against a national
target of 95 per cent.


The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
LOOKING BACK
j
05
timely responses from consultants at the Trust to
GP’s about clinical queries. We also established a
hotline for GP practices to contact our booking
agents about general administrative queries. Staff
members have been empowered to challenge
areas of poor practice which has resulted in better
communication especially around clinic delays.
Part 2.1
Quality priorities for improvement
2014/15 – How did we do?
PRIORITY 1
The work to reduce the percentage of clinics
cancelled with less than six weeks’ notice is yet to
see any measureable benefit. We know that on
average we cancel 119 clinics every month with
less than six weeks’ notice. This represents 2.3%
of all the clinics we run. We set a target to reduce
this to 1.5%, 80 clinics a month – a reduction of
40 late cancelled clinics a month. However, clinic
utilisation has improved to 87% from 85.6% in
the previous year.
Accessible and Responsive Services –
continuing to improve the outpatient
experience
We said:
The Trust’s outpatient productivity scheme
highlighted areas in appointment management
that would benefit from further service redesign.
In addition, our patients told us that they continue
to experience some difficulties with the booking of
their appointments and communication with the
hospital.
In order to achieve this target we have now
introduced a new process for managing late clinic
cancellations and moved the management of
these from the central patient administration team
to the outpatient appointment centre. This change
has allowed greater scrutiny around requests and
better tracking of patient appointment changes.
Furthermore we have richer data about late
cancellation of clinics which allows us to challenge
practices not aligned with the Trust’s leave policy.
We said we would reduce the percentage of
clinics cancelled with less than six weeks’ notice
and improve the utilisation of outpatient slots.
Furthermore we said we would achieve an overall
improvement in the satisfaction of patients using
our services.
How did we do?
We have been successful in improving the
overall patients’ satisfaction percentage from
87% to 91%. Much of this success is due to the
engagement with our stakeholders especially
General Practitioners (GP’s). During 2014 we
set up a GP advice service which is run via the
outpatient appointment centre and ensures
What does this mean for our patients?
These changes mean that our patients now
experience a service where they have seen positive
changes in staff attitude, communication, respect
and dignity. In addition with the further work
to reduce clinic cancellations patients will see a
reduction in changes to their hospital appointments.
Annual Quality Report Projects KPI
Dashboard 2014/15
2013-14
2014-15
2014-15
Target
Percentage of clinics cancelled with six
weeks’ notice target 1.5%
2.3%
2.3%
1.5%
Local outpatient experience survey overall
satisfaction
87%
91%
88%
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
PRIORITY 2
effective and timely discharge management.
Improving Inpatient Care project
We said:
We wanted to reduce the length of stay further for
our inpatients acknowledging the work that has
already taken place in recent years. We advised that
we wanted to remove all unnecessary waits and
support our patients to return to their homes safely
and be supported in the community as soon as
clinically appropriate.
How did we do?
The specific goals we set for the project and the
performance are outlined below.
Re-admission rates
We have seen a very slight reduction overall in Trust
re-admissions. Re-admissions for planned episodes
of care for surgical patients have fallen by 0.1% but
have increased by 0.2% for our emergency cohort
of patients.
Re-admissions for emergency medical patients
have increased by 0.4% but have fallen by 0.3%
for planned admissions, although this group of
patients represents a small percentage of the total
number of patients treated at the Trust. The Trust
has experienced increased activity with regard to
emergency admissions during this last year which
has impacted severely on our internal systems and
has stretched our manpower resources – this has
put pressure on clinical staff with regard to ensuring
Annual Quality Report Projects KPI Dashboard
2014/15
Ambulatory care
The Ambulatory Care Service now assesses and treats
> 270 patients per month and treats a far broader
range of clinical conditions than it did in 2013/14.
With the opening of the new Nightingale building
Acute Medical Unit (AMU) in December 2014,
patients and clinical staff have been able to benefit
from a comfortable, fit-for-purpose environment
that facilitates rapid assessment and treatment. The
improved physical space and additional facilities
allows for ‘point of care’ testing where blood samples
can be taken and analysed in the unit. This serves to
improve the patient experience by reducing waits.
Further expansion has been hampered due to
the challenges in recruiting. However, senior
2013-14
2014-15
2014-15
Target
8.0%
7.8%
<8.0%
200/month
>200/250 per
month
>200/
month
Number of patients screened for Home Safe CGA
N/A
1,651 Q4 = 512
>300/Q3
> 450/ Q4
Reduced length of stay for patients aged >65yrs (days)
7.0
7.9
Reduce by
0.5 days
23.2%
23.1%
>/=25%
N/A
90.1%
>/= 72%
Reducing re-admissions (28 day re-admissions)
Ambulatory care pathway patients
Patients discharged before midday
Patients leaving hospital with positive experience
90
Work is currently underway to track individual
re-attendances in order to understand the
reasons for re-admission, to learn lessons where
the re-admission has been assessed as avoidable
and to change practice where indicated. Further
improvement work will continue during 2015/16,
this includes introducing a re-admission risk
stratification tool. This will allow us to target
appropriate interventions in a timely manner
and, together with our colleagues in primary and
community services, support patients with a higher
risk of re-admission more directly in their transition
between spheres of care.
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
05
appointments have recently been made that will
facilitate extension to the hours of operation with a
concurrent increase in the numbers of patients that
can be treated via ambulatory care.
Surgical Assessment Unit (SAU) and specialty based
wards the aim is to further facilitate efficient ways
of working for the benefit of the patient so that
discharge home can take place earlier in the day.
Early supported discharge workstream
The ‘Home Safe’ team has gone from strength to
strength during the course of the year evidenced by
the increasing numbers of patients that have been
able to be discharged at an early stage of the patient
clinical pathway.
Initiatives such as the ‘Perfect Week’ saw the
mobilisation and deployment of a cross section of all
types of staff to clinical areas to provide additional
support to help with patient flow, facilitate
discharge and to unblock barriers to efficient delivery
of care. Lessons learned during these extraordinary
weeks will be taken forward in 2015/16.
A total of 1,651 patients over the age of 65 have
been screened by the multidisciplinary ‘Home Safe’
team. Of these patients, 925 were eligible patients
for the comprehensive geriatric assessment, and
of this number, 580 patients were discharged early
(within 48 hours), remaining under the care of the
‘Home Safe’ team for up to 10 days post discharge.
Targeted therapy and care support overseen by a
consultant geriatrician has allowed some of our
most frail patients to reduce the length of time
spent in hospital, thereby encouraging a swift return
to independent living.
Review of the service has been overwhelmingly
positive demonstrated by the following comments:
“Care was excellent – Improvement not necessary.”
“I couldn’t believe how speedily everything was
in place and how caring and understanding they
were.”
The ‘Home Safe’ team has to date concentrated
their efforts at the front end of the hospital, working
from the AMU. Patients benefitting from the service
have demonstrated an average length of stay of
1.04 days with 42% being assessed, treated and
discharged on the day of admission. This positive
work will continue during 2015/16.
Leaving Hospital Improvement project
During 2014/15 23.1% of patients were discharged
before midday. We have therefore not been able to
achieve the 25% target that we set ourselves for
the year. With the inception of the new AMU, the
By the end of 2014/15, 90.1% of patients providing
a response have told us that they have had a positive
experience of leaving hospital. Work on areas such
as the time for patients to receive their take-home
medicines and for final reviews by members of the
multidisciplinary team continue in 2015/16.
In January 2015 we opened the 14-bed SAU on
Fleming Ward. This unit and the implementation of
new pathways of care will allow surgical patients
to be assessed in a timely manner with earlier
decisions being made about their treatment. Using
ambulatory care pathways will mean that more
surgical patients will not have to be admitted to
hospital unless it is absolutely necessary. One of the
biggest challenges over the next year is to try and
ensure that the flow of patients through the SAU is
maintained, even when the hospital is experiencing
peaks in emergency admissions.
What does this mean for our patients?
Reducing the length of stay for our patients means
they spend less unnecessary time in hospital. Also
reducing readmissions to hospital means that
patients are able to continue to remain in the
community to receive their ongoing care. These
are two areas where the Trust will continue to drive
improvement. The transforming patient care project
for 2015/16 will continue to build on schemes to
increase the use of ambulatory care pathways, to
improve the quality of the patient experience whilst
in hospital and to standardise discharge processes
with the overarching aim of reducing length of stay.
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
PRIORITY 3
Improving patient safety in Emergency
and Maternity care
We said:
We said we would achieve consultant physician
(senior level doctor) presence at weekends in
Medicine 12 hours a day and that all patients would
be seen by a Consultant within Medicine, Surgery,
Paediatrics and Gynaecology within 12 hours of
admission. We also stated that our goal was to
deliver access to earlier diagnostic radiology and
reporting by working toward the London Health
Programme Emergency care Standards.
How did we do?
This work formed part of the wider North West
London Seven Day Services Programme pilot.
This has focused on four of the London Health
Programme (LHP) Standards which include time
to first consultant review, diagnostics, transfer to
community and on-going review of patients in high
dependency care. In 2014/15, good progress was
made with three of the four standards, the exception
being the time to first consultant review.
With the additional 90 beds being open in the Trust
during the winter there was a consultant physician
present for 12 hours at weekends during October,
November and December with a second consultant
on site 0800-2000hrs on top of the already
established two-session day at weekends (6 hours)
for the AMU. This greatly facilitated the timely review
of patients and supported safe discharge.
Unfortunately the Trust was unable to achieve the
required targets for the consultant review within 12
hours in each specialty. In order to obtain up to date
performance in this key area in 2014/15, an audit
was undertaken of admissions for September and
October 2014. The results for first consultant review
within 12 hours by specialty are as follows:
• Paediatrics 70%
• Medicine 64%
• Surgery 32%
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Paediatrics and Medicine have had investment to
improve their rotas and this is reflected in their
better results than in surgery. However much of this
additional staff investment has taken place after the
audit was undertaken.
Future audits in 2015/16 will collect and analyse data
separately for general surgery and orthopaedics to
give greater clarity as these specialities have separate
consultant rotas. The impact of the additional
staffing in Medicine and Paediatrics will also be
assessed.
Current plans are also focussing on improving data
collection as in the audit there were a number of
cases in which there was no time or consultant
name documented. These details are included in the
medical admissions proforma and Paediatrics plan
to include these details in their admission proforma
in the near future. A new sticker is being developed
for use in surgical specialities to ensure that the
appropriate information is documented at the time
of first consultant contact.
With regard to earlier diagnostic imaging and
reporting the demand for all radiological services
has increased throughout the year, seeing increases
in demand of 9% for CT, 20% for MRI and 3% for
X-rays. Against this increase in demand we have
made significant improvements in the turnaround
times for CT and ultrasound reporting for patients
attending Accident and Emergency and in-patients.
However we know further changes are needed
in MRI and plain film reporting. The radiology
department prioritises emergency work for inpatients and accident and emergency patients
through the normal working day with an on-call
team outside these hours. X-ray and CT access
is immediate for A&E patients and the audit of
reporting performance confirmed a reporting time of
less than one hour for all head injury patients for CT.
Average reporting delays are 20 days for A&E and 23
days for in-patients.
The performance against these targets is included in
the table below.
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Annual Quality Report Projects KPI Dashboard
2014/15
05
2013/14
2014/15
Consultant physician presence at weekends in Medicine
n/a
Achieved during
winter months
only
12hrs/day
All patients seen by Consultant within Medicine, Surgery,
Paediatrics within 12 hours of admission
64%
Improved
performance in
some specialities
but targets not
achieved
Within 12
hours (%
achieved)
No target set
See narrative
No target set
Access to earlier radiology diagnostics and reporting
within a specified timeframe
What does this mean for our patients?
The time for first consultant review is seen as a key
indicator to reduce mortality and improve the quality
of patient care, especially at weekends. The Trust
will continue to work with the sector to improve
performance in these key quality areas. The plan in
2015/16 is to permanently recruit to extend the hours
in which consultants are on-site at weekends, which
will enable twice daily review of all patients on the
AMU. We will continue to work with our consultant
staff to move to a vital and necessary seven day
service to reduce mortality rates at this time of
constantly increased admissions.
Further developments within our radiology
department will be implemented during the spring/
summer of 2015 including voice recognition reporting
which will shorten our reporting times. We have
developed new working patterns for our radiologists
as well as recruiting more consultants and this will
provide a longer working day and include consultant
presence in the radiology department seven days a
week.
We are opening an additional CT facility further
improving access and flexibility for emergency
patients in July 2015. This is the most commonly
requested complex investigation for emergency
patients. We are also planning to develop daytime
access to MRI on site at the weekends.
2014/15
Target
PRIORITY 4
Introducing and embedding patient care
bundles/pathways
We said:
As part of improving the standard and safety
of clinical care we said we would introduce and
embed certain patient care bundles/pathways
during 2014/15. These are tools that include a
collection of healthcare interventions can be used
to manage the quality of care that is delivered by
standardising care processes. They promote more
organised and efficient patient care based on
evidence-based practice, whereby locally agreed
standards help a patient with a specific condition
or diagnosis receive a consistently high standard
of care.
Our aims for 2014/15 were:
• Implement the Acute Kidney Injury (AKI)
•
•
•
•
Pathway, in line with a London wide AKI
pathway and show some improvement
Sepsis Care Bundle to achieve =/> 70%
compliance
FAIR assessment completed for >90% of elderly
patients per quarter
To achieve a 20% reduction in falls without
harm
Catheter Care Bundle to achieve =/> 95%
compliance
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
• Improvement against the NHS Safety
• Agreement with the Urgent Care Centre
How did we do?
Implement the Acute Kidney Injury
(AKI) Pathway
The Trust has invested in an increased resource
for the renal team during 2014/15 which, as
a result, has ensured that patients with an AKI
are reviewed by a specialist in renal care. There
are approximately 3-5 new patients on average
with AKI that are highlighted to the renal team
by the biochemistry department on a daily basis.
These patients are reviewed by a renal physician
on a twice weekly basis until their discharge
form hospital. The renal physician liaises with the
medical team looking after the patient to ensure
there is agreement on the management plan for
the patient and that the appropriate treatment
is delivered to correct the AKI. All patients with
a diagnosed AKI are followed up by the renal
physician in the out-patient clinic once they are
discharged from hospital.
•
Thermometer with focus on pressure sores – to
realise a 25% reduction, from a baseline of
3.2% to a final value of 2.4%.
Sepsis care bundle
It is disappointing to report that we did not
achieve the target compliance we set ourselves for
2014/15. The Trust achieved a compliance of 38%
against a target of 70%. The A&E department has
experienced increased activity and pressures during
this past year and alongside some recognised
barriers such as wait times for assessment and
the increased use of agency staff to deal with the
increased activity this has affected an improved
performance in this area. There is a detailed action
plan now being taken forward within the A&E
department to ensure that there is early recognition
and action taken for patients attending the hospital
with signs of sepsis. This includes:
• Regular teaching sessions for junior doctors
•
94
regarding sepsis and its treatment
Agreement with the London Ambulance Service
so that they will accentuate suspicion of sepsis
on handover to the nurse in charge
•
•
(UCC) to ensure all patients with suspicion of
sepsis are streamed on UCC triage to ED so
they can get the treatment needed as soon as
possible
Cards with sepsis recognition criteria provided
to each member of the nursing team; upon
receiving their card a short teaching session is
provided about the sepsis protocol. Cards are
also given to agency staff.
Two teaching sessions per week organised by
the Outreach team about sepsis (a teaching
session about neutropenic sepsis is being
organised for the nursing team)
A4 posters about recognition of sepsis and
actions to be taken are now displayed in each
area of the A&E department.
In addition, an electronic system to support the
information requirements associated with the
care bundle is currently being explored. This
will be able to provide evidence of interventions
taken within agreed timescales.
FAIR assessment will be completed for >90%
of elderly patients per quarter
The FAIR assessment (Find, Assess and
Investigate, Refer) is one of the indicators of
the national dementia CQUIN and applies to
patients over 75 years of age admitted as an
emergency, with a length of stay 72 hours
or more. The “find” component relates to
case-finding, where patients are screened for
early signs of dementia by way of a nationally
set question. The CQUIN also requires that
this question is asked within 72 hours of
admission. Those who answer positively are
then asked more specific questions (“assess and
investigate”); should there still be indications
of potential dementia, the patient’s GP is
notified so that ongoing specialist review can be
arranged in the community (“refer”).
We found screening and assessing all relevant
patients challenging. Disappointingly we did
not achieve the target 90% for either of these
in the first half of the year (79% and 68.4%
05
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
respectively). However, following the appointment
of a Clinical Nurse Specialist for Dementia in
October, we did achieve our target for “find” in
both quarter three and four, and for “assess and
investigate” in quarter four.
Patients who were identified as needing ongoing
review were consistently referred to their GP,
this component being achieved throughout the
year. The graphs below illustrate percentage
performance per month and quarter:
Figure 1 FAIR performance per month
100
80
60
40
20
Find
Refer
Assess and Investigate
March
Feb
Jan
Dec
Nov
Oct
Sept
Aug
July
Jun
May
Apr
0
Target
Figure 2 FAIR performance per quarter
100
80
60
40
20
0
Quarter 1
Find
Quarter 2
Refer
Quarter 3
Assess and Investigate
Quarter 4
Target
95
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Falls prevention
We said we wanted to achieve a 20% reduction in
falls. The rate of falls is calculated per thousand beddays; this method is used by most NHS organisations
as well as the National Patient Safety Agency as it
enables performance to be monitored across time/
organisation irrespective of differences in level of
activity. The 20% reduction target required the falls
rate to be no greater than 4 per 1000 bed-days.
these indicators which were both achieved. Table
1 shows annual performance in both these areas
over the last three years; Graph 1 and 2 show
monthly performance for overall rate of falls and
falls resulting in fracture respectively.
A falls working group is continuing to drive
improvement in this area to ensure we achieve a
further reduction in the number of inpatient falls in
the forthcoming year. Their efforts will be supported
by the work of the Sign up to Safety campaign.
It was acknowledged from the start of the year
that this target would prove challenging, given
the improvements already made in preceding
years. The target was narrowly missed, with the
overall rate for the year being 4.38. Although the
target set was not achieved, we did again improve
on the previous year’s performance as shown in
Table 1 below. In addition to the overall rate of
falls we also monitor the rate of falls resulting in
harm and more specifically those that result in the
patient sustaining a fracture. Targets were set for
Catheter care
The Urinary Catheter care bundle was devised as part
of the Department of Health ‘Saving Lives’ campaign,
which incorporated several High Impact Interventions
(HII) the aim being to reduce healthcare acquired
infections. Urinary catheter care featured as HII
no.6 and the Trust created a care bundle (Catheter
Monitoring Chart – CMC) to incorporate areas that
needed addressing as well as measuring compliance.
Table 1: Falls rate performance
Annual Quality Report Projects KPI Dashboard
2014/15
2014/15
2013/14
2012/13
All Falls (rate per 1000 bed-days)
4.38 (Target = 3.8)
5.0
5.8
Falls resulting in harm rate per 1000 bed-days)
1.2 (Target = 1.3)
1.4
1.6
Falls resulting in fracture (actual number)
7 (Target = < 11)
8
13
Figure 3 Falls rate per 1000 bed-days
8
7
6
5
4
3
2
1
Trust Target 2014/15
Trust Rate 2014/15
Trust Rate 2012/13
96
NPSA Average (2010)
Trust Rate 2013/14
ar
M
b
Fe
n
Ja
c
De
v
No
ct
O
pt
Se
g
Au
l
Ju
n
Ju
ay
M
Ap
r
0
05
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Figure 4 Falls resulting in fracture
4
3
2
1
2014/15
2013/14
The use of the CMC and monthly audit have
continued during 2014/15, with the infection
control team undertaking validation audits in areas
that may not be performing as well as expected or
have a cause for heightened surveillance.
ar
M
Fe
b
n
Ja
De
c
No
v
O
ct
pt
Se
Au
g
Ju
l
Ju
n
ay
M
Ap
r
0
2012/13
helping nurses to collect information about four
different harms. It measures performance at the
point of care demonstrating the proportion of
patients who receive harm free care. Four ‘harms’
are assessed: pressure ulcers, falls resulting in
harm, venous thromboembolism and urinary tract
infections (UTI) in those with a urinary catheter.
Every month senior nursing staff survey patients
at the bedside through review of documentation,
discussion with the allocated nurse and the patient
and if required examination of the patient. The data
is collated to identify the proportion of patients on
each ward who have received harm free care.
Compliance is now at 97% which is an
improvement on our position from last year of
93% and a marked improvement from when we
started assessing against the bundle several years
ago when compliance was just 80%. The tool has
been reviewed in line with updated guidance and
will continue to be used in the forthcoming year to
ensure current performance is maintained and that
effective catheter care is being delivered.
In 2014/15 we saw an increase in the proportion
of patients who received harm free care, exceeding
the national aim of 95%. The graph below shows
the year on year increase since the Trust started to
collect this information:
Safety thermometer
The Safety Thermometer is a survey tool that
provides a ‘temperature-check’ on the system,
Proportion of patients receiving harm free care
96%
95.5%
95%
94.5%
94%
93.5%
93%
92.5%
92%
95.4%
94.5%
93.4%
2012/13
2013/14
National target set at 95%
2014/15
THH performance
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
The safety thermometer measures all pressure
ulcers, both new (acquired in the hospital) and old
(admitted with) and our target for reduction was
based on the combined total of both new and old.
Whilst the Trust did not achieve the desired 25%
reduction of all pressure ulcers (November to March)
we did achieve a 27% reduction in hospital acquired
pressure ulcers over the full year period:
• Hospital acquired pressure ulcers reduced
•
by 27% (April 2014 to March 2015) when
compared with 2013/14 – from 33 in 2013/14
to 24 in 2014/15;
Over the same period, there was no change
in the overall number of community acquired
pressure ulcers – 140 in 2013/14 and 139 in
2014/15.
In 2015/16 we will ensure that the improvement
work continues to further reduce hospital acquired
pressure ulcers. A robust training programme
is currently being delivered and detailed root
cause analysis investigation of why patients
have acquired grade 3 and 4 pressure ulcers is
supporting learning to make further changes to
our practice.
What does this mean for our patients?
AKI Pathway – the additional resource that has
been put in place in 2014/15 to support the review
of patients with AKI by a renal physician has really
supported the effective management and treatment
plans for these patients and ensured that there is
reduced risk of deterioration in their medical status
related to AKI. This supports their overall care so
that their primary and presenting medical condition
that resulted in their admission to hospital (which
may/may not have been AKI at that time) can be
effectively managed.
Sepsis care bundle – Anyone can develop sepsis
after an injury or minor infection, although some
people are more vulnerable. If sepsis is detected
early and has not yet affected vital organs, it
may be possible to treat the infection easily and
most people who have sepsis detected at this
stage will make a full recovery. This is why it is
important to identify early and treat quickly. Some
people however with severe sepsis may need very
intensive therapy to support them, but again early
detection and treatment will improve the outcome
for the patient.
How did we do overall?
Annual Quality Report Projects KPI Dashboard
2014/15
98
2013/14
2014/15
2014/15
Target
Implement the Acute Kidney Injury (AKI) Pathway and
show some improvement
N/A
Achieved
THH to join
AKI network
Sepsis Care Bundle compliance
N/A
38%
=/> 70%
Dementia FAIR assessment – Find
74%
79%
=/>90%/
quarter
Dementia FAIR assessment – Assess/Investigate
67.5%
68.4%
=/>90%/
quarter
Dementia FAIR assessment – Refer
100%
100%
100%
To reduce all falls (rate, per 1000 bed-days)
4.98%
4.40%
3.98%
Catheter Care Bundle compliance
93%
97%
=/>95%
Improvement in the NHS Safety Thermometer, focus on
pressure sores
3.2%
3.2%
2.4%
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Dementia FAIR assessment – whilst it is not
always possible or appropriate to make a confirmed
diagnosis of dementia during an acute illness,
admission to hospital does provide a valuable
opportunity for screening and, where indicated,
referral for follow up post discharge. Achieving this
quality priority plays a key role in ensuring those with
dementia receive a formal diagnosis, enabling them
to access appropriate treatment, therapy and support
and to be actively involved in decisions regarding
their future, with associated improved quality of life
for those living with dementia and their carers.
Reducing patient falls – we have achieved
improvement in reducing patient falls through
introducing a number of practice changes with, this
year, a particular focus on preventative measures for
high risk patients. To ensure consideration is given
to a breadth of potential risk factors, a new care
plan has been implemented which addresses these
and references interventions to support reducing
the risk of falls. The care plan supports working in
partnership with individual patients and carers as
it promotes discussion when planning care. A falls
prevention information leaflet has been introduced
to further promote patient involvement.
The decrease in the rate of falls means that our
patients have a lesser risk of sustaining harm during
their stay, as evidenced by the decreased number of
fractures resulting from falls.
Catheter Care – by embracing the urinary catheter
care bundle and using the CMC staff are ensuring
patients are put at less risk of coming to further
harm or risk of acquiring a HCAI as many elements
are addressed furthermore, like any device if it is
not needed it should be removed at the earliest
opportunity.
Harm free care (Patient Safety Thermometer)
– the numbers of our patients who have received
harm free care in our Trust has risen significantly in
the Trust since 2012. There has been year-on-year
improvement and the 95% target was achieved for
2014/15. This means that patients are receiving safer
care in our hospitals.
PRIORITY 5
05
Improve responsiveness to patients’
needs
We said:
We recognise that patient experience is a key
element in delivering high quality care and
understanding how patients experience their care is
fundamental to delivering high quality services.
We wanted to continue with the scheduled
implementation of the Friends and Family Test (FFT)
across other services and improve the response rates
for the inpatient and emergency department FFT
survey. We were also aiming for an increase in the
Net Promoter Score for inpatients and patients seen
in the emergency department.
The NHS Constitution explains that compassionate
care is central to the care that we provide, and
responding with kindness to patients needs and
making time for patients and their families is a
core value for all NHS organisations. In line with
the Constitution we planned to identify small
things that we could do to support a culture of
compassionate care.
How did we do?
Following the FFT schedule set out by NHS England,
we have rolled out the FFT survey to many other
services during 2014/15, including: day care and
outpatient services across both the Hillingdon and
Mount Vernon sites, paediatric services and the
Minor Injuries Unit at Mount Vernon.
We are also about to commence a pilot in a number
of outpatient clinics using electronic devices to
collect FFT feedback, this will enable the staff in
these areas to monitor responses and access results
in real time. Following an evaluation of the pilot we
will be aiming to implement this system across all
outpatient clinics and day care services.
In July 2014 and following a lengthy consultation a
change in the way that the FFT results are presented
was announced by NHS England. It was decided to
do away with the Net Promoter Score methodology
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Annual Quality Report Projects KPI Dashboard
2014/15
2013/14
2014/15
2014/15
Target
Improvement in compassionate care indicator
(baseline to be calculated from Q1 result)
Q1 2014/15 =
88%
86%
90%
FFT response rate – Accident and Emergency
18.3%
24.9%
=/>20% by Q4
FFT response rate – Inpatients
40%
32.8%
=/>30% in Q4
Accident and Emergency net promoter score
+54
Indicator changed
during 2014/15
+62
Inpatient net promoter score
+65
Indicator changed
during 2014/15
+75
CARES – Customer Care training
35%
10.4%
50% of
remaining staff
which was poorly understood and replace it with
a more simple scoring system. The new approach
counts the proportion of positive responses
(extremely likely and likely to recommend) and the
proportion of negative responses (extremely unlikely
and unlikely to recommend).
Our aim for 2014/15 was to improve the Net
Promoter Score of FFT in inpatients and A&E.
However, as the net promoter score methodology
has been discontinued and replaced with the new
approach, our improvement is shown through
comparison of the proportion of positive responses
(extremely likely and likely to recommend) for A&E
and inpatients in 2013/14 and 2014/15.
In line with the Care Quality Commission monitoring
framework, we ask the same two questions taken
from the national survey of inpatients to assess
compassionate care:
• Do you feel you got enough emotional support
•
from hospital staff during your stay?
Did you find someone to talk to about worries or
concerns?
The result of these two questions was below
target. Going forward into 2015/16 we plan to
continue to focus on ensuring that our patients
receive compassionate care and feel informed
and involved as much as they want to be. We will
continue to learn from patient feedback and we
100
will look at new initiatives to support improvement
in this area of care.
The Trust will be rolling out more customer care
training from June 2015 which will ensure our
staff develop improved communication skills and
that they develop an improved understanding of
the needs of our patients with regard to emotional
support and being able to talk through their
concerns. This will be targeted at the remaining
existing staff who did not receive the training in
2014 and staff new to the Trust. The Trust will
be running 12 days of workshops spread over six
months with three sessions a day. Each session will
be for a cohort of 30 participants.
What does this mean for our patients?
A number of initiatives specifically aimed at
improving patient experience in these key areas
were implemented during 2014/15.
These include:
• Supporting the national ‘Hello, my name is …’’
•
•
work with the launch of a local campaign
Introducing a Working Together Leaflet that
explains who patients can talk to about worries
and concerns, it also sets out a clear escalation
process if they are not happy with the response
or wish to speak to someone else
Designing and implementing a poster for each
ward that clearly shows the name of the Sister/
Charge Nurse and Matron who has responsibility
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
•
for the ward and inviting patients or families to
speak to them if they have worries
Introducing a proactive Patient Advisory and Liaison
Service (PALS) approach. This involves members of
the PALS team visiting wards to enable patients/
family members to speak to someone unconnected
to the ward.
LOOKING forward
Our Clinical Quality Strategy
f
During 2014/15 there has continued to be increased
focus on measuring and monitoring the quality of our
services and the care that is delivered to our patients
and their families. The Trust’s three-year Clinical Quality
Strategy supports this work and helps us to achieve our
vision ‘To put compassionate care, safety and quality at
the heart of everything we do’. The strategy provides
a structure for ensuring strong clinical governance and
ongoing improvement in the quality and safety of patient
care. Key principles that support this are outlined within
our strategy. These have been key recommendations
from national investigations and include:
• Always putting the patient first
• Clearly understood fundamental standards of care
•
and measures of compliance
Openness, transparency and candour throughout
our organisation
Improved support for compassionate and
committed nursing
Strong and patient centred leadership
Accurate, useful and relevant information.
05
Clinical divisions developed their own local quality
actions plans based on the overarching Trust action
plan. These formed part of their business plans and
were used to monitor progress at their divisional
performance reviews.
The concerns that the Care Quality Commission
(CQC) raised in its planned inspection of October
2014 in relation to assessing and monitoring
were viewed extremely seriously by the Board. An
assessment of systems and processes that staff
follow alongside reviewing and achieving key
quality indicators and positive patient outcomes has
commenced and will continue into 2015/16.
The clinical quality strategy outlines key enablers
that support the quality agenda and that are central
to the delivery of our clinical quality strategy. These
include having key elements well organised and
resourced, and that there is robust risk management
and systematic processes for assessing the impact
of service changes on quality. Indeed several of
the strategic challenges and key quality concerns
identified by the CQC such as concerns on safer
staffing, the condition of the Trust’s estate, training
compliance in safeguarding and infection control
and the quality of record keeping were already
identified via its Board Assurance Framework and
the corporate risk register.
The Strategy aims to ensure that the ethos of a
clinically-led, quality and patient-focused organisation
is strengthened and that the Trust Board is provided
with robust and detailed information on quality so
that it can be assured that the clinical quality agenda is
being appropriately identified, assessed, monitored and
addressed.
The framework of the clinical quality strategy
supports the detailed improvement plan that has
been developed to address each of the main areas
of concern. The clinical quality strategy also outlines
the responsibilities of Trust staff and is supported
by our culture and values framework, CARES
(Communication, Attitude, Responsibility, Equity and
Safety) which embraces a culture that empowers
staff to report incidents and raise concerns about
quality and patient safety in an open, blame-free
working environment. This is now supported by
the statutory Duty of Candour and best practice
guidance such as ‘Freedom to Speak’.
During 2014/15 a clinical quality strategy action plan
was developed and was reviewed on a quarterly basis
at the Quality and Risk Committee (Board committee).
The clinical priorities outlined in the Strategy reflect
the quality priorities outlined in this year’s Quality
Report. The full Clinical Quality Strategy is available
•
•
•
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
via our website at: http://www.thh.nhs.uk/patients/
safety/index.php
Quality priorities for improvement
in 2015/16
In this section of the report, we tell you about the
areas for improvement in the next year in relation
to the quality of our services and how we intend
to assess them. As last year, these are called our
quality priorities and they fall under the three
Respondent
Category
domains of patient safety, patient experience and
patient outcomes.
To develop these priorities, the Trust held an
engagement exercise with key stakeholders
(Foundation Trust members, HealthWatch,
Governors, local voluntary organisations) on 24th
November 2014. This event included a review of
our current position against this year’s priorities
and a discussion on the quality priorities for the
forthcoming year. Results from the discussions on the
Quality Priority Topic 2015/16
Patient Safety
Staff
Healthwatch
Governors and
FT members
• Staffing levels in terms of number and quality of staff
• Clarity of communication re medication especially in outpatients and on discharge of
•
inpatients)
Difficulty for visually impaired to navigate the Trust
Clinical Effectiveness
Staff
Healthwatch
Governors and
FT members
• Senior (Consultant) involvement at earliest opportunity
• Availability of Consultant to see the patients’ family
• Consistency of information given to patients
• Discharge information
• Electronic patient record
• Electronic prescribing
• Confidentiality
Patient Experience
Staff
Healthwatch
Governors and
FT members
• Clear communication between staff and patient
• Better presence of PALS i.e. Main Reception who could provide contact information both
•
•
•
•
•
•
•
•
•
•
•
•
•
102
in the hospital and outside agencies
Strengthen volunteer services in the hospital
Enable better access for motorised wheelchairs and guide dogs
Designated space required for wheelchair users in outpatients
Privacy, dignity, confidentiality– real-time feedback and encourage openness
Visually impaired cannot see number called. Use interactive communication
Ensuring vulnerable patients are supported (appointment and follow-up)
Avoid cancellation of treatments
Ensure psychological / emotional support
Pharmacy dispensary presence in outpatients
Improve patient experience in Pharmacy – notifying via mobile/bleeper when prescription
is ready
Have a prescription ‘in desk’ and ‘collection desk’
Improve presence of pharmacists in all areas across all times especially weekends
Improve ‘patient entertainment’ (TVs and availability of magazines/books to maintain
stimulation.
05
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
day show that some areas of improvement that we
have focussed on during 2014/15 still need further
work which include the First Contact Project to
improve the outpatient experience and the Improving
Inpatient Care Project, especially the ‘leaving hospital’
experience. It was recognised that this work will
continue outside of the priorities identified in this
year’s Quality Report as there are working groups
that continue to focus on these improvement areas
An outline of the key results from the consultation is
included in the table above.
In addition, the Trust triangulated data from several
sources to identify themes and recurring trends.
Over the last year there has continued to be active
engagement with our local Healthwatch including
its members on several of our Trust working groups.
The Trust has also met with Healthwatch on a
quarterly basis to review quality and patient safety
data and the progress on the quality report priorities.
This engagement has proved invaluable in being
able to hear the feedback that Healthwatch receives
from people with which it engages.
The Board has considered all of the suggestions put
forward and the review of data and the priorities
below have been recommended for inclusion in
the Quality Report for 2015/16. These have been
identified as falling under the three domains of
safety, clinical effectiveness and patient experience
as follows:
No.
Priority
Safety
1
Safeguarding – ensuring the safety of vulnerable and
older people
✔
2
Improving the safety of medicines management and
the experience of people requiring medicines in the
inpatient and outpatient settings
✔
3
Improving Maternity Services
✔
4
Improving Communication with our patients
✔
Clinical
Effectiveness
Patient
Experience
✔
✔
✔
✔
✔
✔
The Trust has also signed up to the new National Patient Safety campaign that was announced in March 2014 by
the Secretary of State for Health. ‘Sign up to Safety’ is a campaign to strengthen patient safety in the NHS. Its three
year objective is to reduce avoidable harm by 50% and save 6,000 lives. The Trust is developing a plan outlining
what we will do to reduce harm and save lives and this is aligned with the Trust’s clinical quality strategy and its
quality priorities.
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PRIORITY 1
Safeguarding – ensuring the safety of
vulnerable and older people
This includes working with social care and
community colleagues on improved discharge
management, identifying improvements for people
with disabilities and the frail elderly in hospital and
for those people who may lack the capacity to
consent or who lack advocacy.
Why is this one of our priorities?
This element of care has been identified by our
key stakeholders as requiring improvement and
concerns also referenced via our complaints service
in the feedback we get from patients and their
families/carers. It was also a key area of practice
that the CQC raised in a Warning Notice from their
planned inspection in October 2014 as requiring
strengthening.
How are we doing so far?
Improving care for patients who lack mental capacity
or who lack advocacy
The Trust now delivers enhanced Mental Capacity
Act and Deprivation of Liberty Safeguards MCA/
DoLS training to all relevant staff. This is delivered
by a solicitor in Healthcare Law and by a Consultant
Psychiatrist. This training covers:
• identifying those patients that may lack capacity
•
•
•
to make decisions about their care and treatment
and longer term health and social care needs;
equipping staff to support patients in the
decision-making process, making sure the best
interests of the patient are always maintained;
highlighting the importance of accessing
the wider health and social care team and it
promotes advocacy;
ensuring that the patient, where possible, is
always involved in the decision-making and
where this is difficult that those nearest to the
patient are included in discussions.
The training also ensures that staff have knowledge
of the law in relation to deprivation of liberty and
104
ensures that staff are trained in what actions to take
should they have any concerns. This area of practice
was identified by the CQC as requiring improvement
and in response to this more staff have now received
this training. Safeguarding vulnerable adults training
is also delivered as mandatory training for all of our
staff and the Trust has achieved >90% compliance
in accordance with its target of 80%.
Improvements for patients with disabilities
As part of our consultation on the quality priorities,
our stakeholders and members acknowledged the
work undertaken by the Trust to support patients
who had a learning disability or dementia and
recommended that in 2015/16 the Trust should
focus on patients with other disabilities.
Over the last year, the Trust has engaged with
several local stakeholders to listen to their feedback
on facilities/services for disabled people. Some
improvements have been implemented across the
Trust including signage, height and style of tables
in the dining room and installation of hearing
loops in some public areas to support patients
with a hearing disability. The Trust has purchased
additional wheelchairs which are available for
patients in main reception and outpatients. Car
parking remains an issue for some disabled users
however with the proposed improvements being
made during the summer of 2015 disabled car
parking should be improved.
We recognise that further work is required and the
Trust has set an equality objective for next year to:
‘Listen to the views of people with a physical or
sensory disability to understand greater insight into
the issues/concerns of this protected group with a
view to developing specific measurable actions for
improvements’.
The Trust is planning to create a task and finish
group involving service users and Healthwatch
Hillingdon to look at current facilities for patients
and public with a disability and to identify
improvements required.
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Improving discharge management for the frail
elderly and most vulnerable
The discharge team has complex mechanisms in
place to ensure the safety and wellbeing of all the
elderly/ vulnerable on completion of their discharge.
The disciplines involved in this process are multiple
and can include Social services, CNWL and outside
agencies i.e.: psychiatry, police, and housing.
Our aims for 2015/16 are:
Our discharge team work in partnership to plan,
agree and implement a procedure to ensure
discharges are jointly agreed, that they are timely,
safe and offer choice and ensure a good outcome
for patients. The discharge team currently:
•
• Screen and assess for Continuing Health Care
•
•
•
•
•
•
eligibility in accordance with the Delayed
Discharges (Continuing Care) Directions 2013.
Screen cases and see who is appropriate for
specific sections of the discharge process
Give updated feedback from ward rounds and
MDT to Social Care
Update Social Care regarding change of
circumstances using the change of circumstances
form
Ensure that a Mental Capacity Assessment/Best
Interest Assessment has been undertaken when
appropriate
Identify the responsible commissioner.
This process includes notification of complex cases
e.g. those with symptoms who appear to be in need
of an in depth multi-disciplinary input/assessment
both in hospital and upon discharge.
A key principle is to reach a joint agreement
between health and social care about the next
step regarding discharge destination and care
requirements of the patient. Moving forward a
weekly ‘situation report’ meeting is to be held
between Social Care and Trust service managers
to discuss patient cases, especially where there is a
threatened or actual delay in discharge, in order to
find solutions and minimise delays for patients. This
will include patients who are the most vulnerable
and/or very complex cases.
05
• Establish a baseline on the number of referrals
•
•
•
to the Independent Mental Capacity Advocacy
(IMCA) service and realise an increase in these
numbers
Establish a baseline on the number of referrals to
the Disablement Association Hillingdon (DASH)
service and realise an increase in these numbers
Further increase the number of staff receiving
the enhanced MCA/DoLS training – >80% for
relevant staff
Establish an Equality and Diversity steering group
with representation from people with different
disabilities
Improve our facilities for those people with
physical and sensory disabilities, such as
increased number of hearing loops in use,
improved signage and improved access to
interpreting services, especially British Sign
Language
Improve the engagement with people who
have a disability by attending local groups for
people with disabilities (DASH and the Hillingdon
Disabled Tenants and Residents Group).
PRIORITY 2
Improving the safety of medicines
management and improve the
experience of people requiring medicines
in the inpatient and outpatient setting
Why is this one of our priorities?
The Trust is committed to ensuring that patients
are able to continue to take their medicines safely
after leaving the hospital. Allowing patients to
continue to take their medicines themselves (selfadministration) whilst they are in hospital (where
they are able to do so) is an important element of
medicines adherence and compliance. Maintaining
independence in this way means that there is a
reduced risk of readmission to the hospital due to
medicines-related reasons.
In addition the Trust is committed to optimise the
safe use of medicines and central to this is to ensure
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
that learning from most errors/near misses of no
harm are applied to reduce the risk of errors/near
misses occurring that may cause harm.
How are we doing so far?
The Trust’s policy for self-administration was recently
updated to improve its use in practice by patients
and this is now in the process of being trialed on
one of our medical wards.
The Trust recently established a Medication Safety
Committee comprised of doctors, nurses and
pharmacists. It is tasked with supporting improved
frequency and learning from medication incidents
that have been reported.
Our aims for 2015/16 are:
• Pilot the use of the revised patient self•
•
•
administration of medicines policy and roll out its
implementation across the Trust
Develop survey and receive qualitative feedback
from staff and patients on self-administration
of medicines in hospital and demonstrate
evidence of changes to the process based on this
feedback
Increase the reporting of medicines errors, via
our incident reporting system, that constitute
no/low harm incidents so that learning from
these can avoid more harmful incidents from
occurring. Trust performance stands at 7.1%
with a national average of 11% of incidents
reported*. The Trust aim will be to improve on
current performance to achieve the national
average.
Develop a pharmacy services patient
questionnaire, establish a baseline, audit
quarterly and realise improvement for 2015/16
on the baseline.
PRIORITY 3
Improving Maternity services
Why is this one of our priorities?
As part of Shaping a Healthier Future (SaHF)
transitional planning Ealing maternity services
will be re-provided across several other maternity
units in North West London, including Hillingdon.
This means a substantial increase in activity (from
4,100 up to a maximum of 5,000 deliveries per
year) which requires in-depth planning and robust
implementation to ensure a safe and effective
service. This will involve the implementation of new
service models such as a birthing centre, ambulatory
pathways a new community team and a transitional
care unit. We expect these changes to improve the
quality of care and choice for women choosing to
have their baby with us.
How we are doing so far?
The service currently receives positive feedback
through the Friends and Family Test (FFT) across
all our services. The challenge so far has been the
limited number of respondents from service users in
the community following the delivery of their baby.
A lot of work has been undertaken to increase the
number of responses in order to obtain adequate
feedback to help shape our services. Following this
work there has been a steady increase the number
of respondents providing feedback. We have started
displaying ‘you said, we did’ posters based on the
feedback received from FFT, NHS Choices, verbal
feedback and complaints. We will continue to
encourage responses and act on feedback going
forward. All complaints have an action plan, where
concerns have been identified and learning from
the investigations is shared with all staff groups to
further improve the quality of the service.
Our aims for 2015/16 are:
The Trust wants to ensure that all of the women
will have a positive experience in relation to their
care and treatment. Key aims we want to achieve in
relation to the women’s experience:
*National reporting and Learning System: Organisation
Patient Safety Incident Report for incidents reported
between 01 April 2014 to 30 September 2014.
106
• A 10% reduction in the complaints received on
the maternity triage service once this has moved
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
•
•
•
to its new clinical environment
A very positive experience for women in the new
birth centre monitored via the Friends and Family
Test – target of >/=88% extremely likely/likely to
recommend
Very positive feedback from women on the new
neonatal transitional care model – target of
>/=88% extremely likely/likely to recommend via
the FFT
Maintain current numbers of Hillingdon Borough
women choosing to continue to use the
Hillingdon Hospital service, despite the increase
in Ealing women accessing the maternity services
at Hillingdon.
PRIORITY 4
Improving communication with our
patients
Why is this one of our priorities?
Key stakeholders (our staff, our Governors,
Healthwatch) advise us that we need to ensure that
there is focus on improving the patient experience
and how they are delivered, are truly responsive to
individual patient needs. Feedback from a variety of
sources including our complaints service, indicate
that communication from the healthcare team to
the patient and their family/carers, as a key patient
experience element, still needs to improve. We have
also heard that this needs to improve at different
points of the patient’s pathway e.g. at discharge
from the A&E department and from inpatient
episodes when patients are going home. We also
need to effectively communicate in a way that
meets the patient’s individual needs as part of our
drive to deliver compassionate care.
How we are doing so far?
The Trust participates in the annual national patient
survey programme and in addition a number of
local patient surveys have also been developed and
implemented. The Friends and Family Test has also
been fully rolled out to all patient areas. During
2014/15 over 26,600 took up this opportunity and
answered the FFT question. Listening to feedback
enables our staff to gain a real insight into the
05
patient’s experience of care. Results from our
local surveys and the FFT can be seen in Part 3 of
this report; also included are some of the themes
from the feedback which include elements of
communication and what we have done to improve
on this. Customer care training will be rolled out
again from June 2015 to ensure more of our staff
are better equipped to enhance communication
with our patients and their families.
The comments below relate to communication and
highlight the areas where improvement is required:
‘To have more confidence in my treatment by more
explanation’
‘More communication if there is a long delay for
operations’
‘Better communication between myself and the
doctors and consultants’
‘I would have liked to have more information on
what I should expect for the next two to three
weeks after my operation’
‘Communicate better with family; listen to what
they have to say as they know the person best’
Analyses of our comments and survey results related
to communication indicate that there are specific
actions that our staff should always do to enhance
involvement and communication.
These include:
• Taking time to explain what is happening and
•
•
•
•
what is planned
Checking the patient/families understanding of
information given
Keeping patients informed if there are delays
Involving patients in decisions about care and
treatment and offering choice
Providing more information about what to
expect following surgery.
In 2015/16 we will focus on initiatives and actions
that will make a difference to these areas.
With regard to written communication on the
care patients have received we have seen an
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
improved performance during the last quarter
of 2014/15 with regard to completion of patient
discharge summaries for both our inpatients
and A&E attendances – this supports improved
communication with our patients and their GPs
about the treatment and care they have received.
However there is further improvement that needs
to be realised in this forthcoming year in this area
with regard to turnaround times and quality of the
information provided.
that is provided, monitored with our
commissioners
– Improvement on the communication and
information provided to patients whilst they
are in A&E (performance was 74% for 2014
in National Patient Survey) – local quarterly
survey to be undertaken to improve on this
indicator to achieve a performance of 80%
– Copy of discharge summary to be provided
to patients attending the A&E department
before they leave
Our aims for 2015/16 are:
•
Improve communication from the A&E
department:
– Quarterly audit of the quality of the A&E
discharge summary, demonstrating an
improvement in the standard of information
• Discharge summaries from inpatient episodes
will be completed within 24 hours – >80%
target
• Improvement in the results of the local quarterly
patient experience survey in the following areas:
Question
Source
2014/15
2015/16 Target
Stretch
Involved as much as you wanted to be
Local inpatient survey
86.8%
89%
2%
Nurses – Clear answers to questions
Local inpatient survey
88.4%
90%
2%
Doctors – Clear answers to questions
Local inpatient survey
88.2%
90%
2%
If waiting more than 20 mins, informed
and updated of waiting times
Local outpatient survey
68%
80%
12%*
*This stretch target has been set higher because there is greater scope for improvement and quarterly scores have been up as high as 74%.
Our quality priorities will be monitored by the individual clinical and management teams, through their divisional
performance reviews and quarterly through reports to the Board or Board Committee and the results will be
reported in the 2014/15 Trust Annual Report.
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Part 2.2
Formal statements of assurance
from the Board
05
Participation in clinical audit
National audits
During 2014/15, 28 national clinical audits
and 3 national confidential enquiries covered
NHS services that The Hillingdon Hospitals NHS
Foundation Trust provides.
Information for our regulators
Our regulators need to understand how we are
working to improve quality so the following two
pages are specific messages they have asked us to
provide:
During that period The Hillingdon Hospitals NHS
Foundation Trust participated in 83% of national
clinical audits and 100% of national confidential
enquiries for which it was eligible to participate in.
Provision of NHS Services
During 2014/15 The Hillingdon Hospitals NHS
Foundation Trust provided medicine, surgery, clinical
support services and women’s and children’s NHS
services. The Hillingdon Hospitals NHS Foundation
Trust has reviewed all the data available to them
on the quality of care in all of these relevant health
services. The income generated by these relevant
health services reviewed in 2014/15 represents 100%
of the total income generated from the provision
of the relevant health services by the Hillingdon
Hospitals NHS Foundation Trust for 2014/15.
The national clinical audits and national confidential
enquiries that The Hillingdon Hospital NHS
Foundation Trust was eligible to participate in
during 2014/15, and for which data collection
was completed during 2014/15, are listed below
alongside the number of cases submitted to each
audit or enquiry as a percentage of the number of
registered cases required by the terms of that audit
or enquiry.
Audit
Participated
Cases submitted
Acute Myocardial Infarction
Yes
100%
Adult Community Acquired Pneumonia
Yes
Data submission in progress
Adult Critical Care Case Mix Programme
No
N/A. Trust is participating from 1st
April 2015
National Bowel Cancer Audit Programme
Yes
100%
National Adult Diabetes Audit includes National Foot
Ulcer audit
Partial
Participation in NADIA only – 35
patients included in the audit. The
trust is reviewing National Adult
Diabetes Audit requirements with a
view to participate fully in the future.
National Pregnancy in Diabetes Audit
Partial
The Trust participated in the Pregnancy
in Diabetes Audit; Trust is planning to
participate in the National Foot Ulcer
Audit from July 2015; Participation in
the National Adult Diabetes Audit is
under review.
National Paediatric Diabetes Audit (Royal College of
Paediatric and Child Health)
Yes
100%
Elective Surgery (National Patient Reported Outcome
Measures (PROMS) Programme)
Yes
Percentages unavailable, numbers are:
Hip replacements -263
Yes
100%
Knee replacements – 394
Yes
100%
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Audit
Participated
Cases submitted
Groin hernia – 145
Yes
100%
Varicose veins – 51
Yes
Expected 75%
Epilepsy 12 Audit (Royal College of Paediatrics and
Child Health) National Childhood Epilepsy Audit
Yes
100%
Falls and Fragility Fractures Audit Programme including
National Hip Fracture Database
Yes
100%
Fitting Child (Care in Emergency Departments)
Yes
100%
Head and Neck Oncology (Data for Head and Neck
Oncologists)
Yes
100%
Inflammatory Bowel Disease (Biologic Audit)
No
Trust has registered to participate in
this audit from 2015 onwards.
National Lung Cancer Audit
Yes
100%
Major Trauma: The Trauma Audit & Research Network
Yes
29.9%
Mental Health (Care in Emergency Departments)
Yes
100%
National Audit of Intermediate Care
No
Trust not eligible to participate in
2014, as ‘Homesafe’ service newly
established.
National Cardiac Arrest Audit
Yes
100%
National Chronic Obstructive Pulmonary Disease
(COPD) Audit Programme
Yes
31%
National Comparative Audit of Blood Transfusion:
Audit of Transfusion in Children and Adults with Sickle
Cell Disease
Yes
100%
National Emergency Laparotomy Audit (NELA)
Yes
47 patients submitted, percentage
figure not available
Heart Failure Audit
Yes
74%
National Joint Registry
Yes
Hillingdon: 58%
Mount Vernon Treatment Centre: 91%
Yes
100%
National Prostate Cancer Audit
Yes
100%
National Neonatal Audit Programme
Yes
100%
National Oesophago-gastric Cancer Audit
Yes
100%
Older people (care in emergency departments)
Yes
100%
Rheumatoid and early inflammatory arthritis
No
N/A
Sentinel Stroke National Audit Programme
Yes
100%
Yes
100%
Clinical Outcome Review Programmes
Maternal, New-born and Infant Clinical Outcome
Review Programme (MBRRACE-UK)
110
Lower Limb Amputation (National Confidential Enquiry Yes
into Patient Outcome and Death (NCEPOD)
50%
Gastrointestinal Haemorrhage (NCEPOD)
80%
Yes
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
05
The reports of 14 national clinical audits were reviewed by the provider in 2014/15 and The Hillingdon Hospitals
NHS Foundation Trust intends to take the following actions to improve the quality of healthcare provided.
Audit
Actions
National Comparative
Audit of Blood Transfusion
– Audit of Patient
Information & Consent
A procedure specific consent form for long term blood transfusion patients has
been introduced.
To improve provision of written information there is wider availability of leaflets for
blood transfusion patients.
Training provision is being reviewed and the Lead Nurse for Blood Transfusion is
providing training as part of the junior doctor programme.
National Comparative
Audit of Blood Transfusion
– Audit of the Use of
Anti-D
The Trust is fully compliant with all of the relevant recommendations in this audit,
for example, all rhesus negative women receive a leaflet about anti-D, staff receive
regular training.
Falls and Fragility Fractures
Audit Programme
including National Hip
Fracture Database (NHFD)
Alongside the existing Trust mortality process, there is a separate multi-disciplinary
process for all hip fracture patients. The multi-disciplinary team includes Care of the
Elderly Consultant, Trauma Lead Consultant, Trauma Nurse.
Early Supported Discharge has been extended to Kennedy Ward, our Orthopaedic
Ward – this process being in place should help to reduce patient length of stay
following a hip fracture.
National Neonatal Audit
Programme
The requirement to give mothers antenatal steroids is slightly below the required
standard. This area for improvement has been shared at various forums and a
specific obstetric audit will be added to the 2015/16 work plan to understand why
not all mothers are given antenatal steroids.
Confirmation of review and documenting of senior consultation is being checked
on the ward rounds, plus a process is being put in place to ensure this data is
included and checked in the patient discharge summary.
Sentinel Stroke National
Audit Programme
A new proforma has been introduced for use at the Multi-Disciplinary Team
Meeting to improve documentation. We have also introduced new stroke specific
admission and discharge checklists. A Stroke Strategy Group is in the process of
being set up, with our Director of Patient Experience and Nursing as an attendee.
Hip Fracture Anaesthesia
Sprint Audit Project (ASAP)
The Anaesthetic Trauma Lead Consultant is currently working on the development
of a local guideline to support hip fracture anaesthetic practice.
National Audit of Inpatient
Care for Adults with
Ulcerative Colitis
Specialist Inflammatory Bowel Disease (IBD) Nurse is now in post. This nurse will be
available to provide advice, support patient education and help improve the IBD
service.
National Paediatric
Diabetes Audit
Three Paediatric Diabetes Specialist Nurses (PDSNs) have been employed since June
2013 to support children and young people with Diabetes (CYPD). PDSN’s reach
out to contact and engage CYPD with high HbA1c and those that do not attend
hospital clinics. The entire diabetes team undertook training in health coaching
to encourage engagement and self-management. A CYPD Facebook page has
recently been launched to promote YPD and carers engagement. The team
motivates CYPD to aim for new agreed blood glucose targets. The 24/7 helpline
together with all the above team strategies has drastically decreased the number of
DKA readmissions.
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Audit
Actions
National Audit of the Care
of the Dying
The provision of specialist palliative care service is Monday to Friday. Referrals
have doubled in the last five years. A business case has been submitted for
a new palliative care clinical nurse specialist post to adequately deal with the
Monday to Friday case load. There is no plan at present to extend to seven day
working. Training for care of the dying is not mandatory, and current attendance
to voluntarily attended sessions is poor. An End of Life Care Committee is in the
process of being set up with our Director of Patient Experience and Nursing as
the Chair and we have an identified Non-Executive Director member. An area for
improvement is to have a lay member to be part of this committee.
The Individual Care Plan for Excellent Care in Last Days of Life has been developed
by the Specialist Palliative Care Team. This document incorporates the five Priorities
of Care (Leadership Alliance for Care of Dying People 2014) for dying patients:
recognise, communicate, involve, support, plan and do. This is yet to be fully
implemented at THH.
British Thoracic Society
Paediatric Bronchiectasis
Audit
Following this audit we have developed a bronchiectasis admission pathway which
details all the steps required for children admitted with chest exacerbations. This is a
multi-disciplinary document. We have also developed a records system with details
of investigations/ diagnosis/ microbiology/ key events/ contact details for all out
patients
British Thoracic Society
Paediatric Asthma Audit
An area for improvement was to increase the use of the discharge checklist.
Training sessions are being used to highlight the existence of the discharge checklist
and embed in practice. Examples of Paediatric Asthma training are: induction for
new paediatric and A&E doctors and nurses; nursing staff attend an annual training
session. We are currently developing an integrated asthma service across primary
and secondary care.
National Epilepsy 12 Audit
The Paediatric team are in the process of submitting a business case to employ a
part time Epilepsy Nurse Specialist.
Trauma Audit and
Research Network (TARN)
A Major Trauma Booklet has been introduced in the Emergency Department, which
is improving documentation for relevant patients. To help improve our participation
rates in TARN, ‘i-reporter’ now identifies eligible patients for inclusion in the TARN
database.
NCEPOD Tracheostomy
Care
A tracheostomy training programme has been established and the first session has
been run, with further dates booked. A Tracheostomy policy is in development.
This will include competencies needed for staff to safely care for patients with a
tracheostomy. The tracheostomy care bundle and revised patient passport will
be added to the policy and will be issued to all relevant wards to be used and
embedded in practice. A Tracheostomy Box, which is a portable, essential box of
equipment to be moved around with the patient, is now in place.
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
05
The reports of 84 local clinical audits were reviewed by the provider in 2014/15 and examples of The Hillingdon
Hospitals NHS Foundation Trust actions to improve the quality of healthcare provided are as follows:
Audit
Actions
Re-admissions Audit
A rolling process of audit of re-admissions is being put in place. This new audit
process will make it 'business-as-usual' for an in-depth clinical investigation to
occur every time a patient is readmitted within 30 days of a previous discharge.
The daily review system uses technology to create readmission alerts. Investigations
are completed in as real-time as possible and aim to capture both the medical
and, critically, the patient's perspective as to the causal factors leading to the
readmission. All results are electronically stored in a central database to enable
further trend analysis.
Controlled Drug Audit
An additional controlled drug book for recording patients own controlled drugs has
been introduced. To embed local processes, the medicines management induction
training session, for nursing and midwifery, now includes hospital specific controlled
drug processes, for example, use of the additional controlled drug book, pharmacy
requirement to have staff members sample signature.
Audit of Quality of
Emergency Department
Discharge Letters
In January 2015 the Trust went live with an upgrade to the Patient Administration
System (PAS) which enabled A&E doctors to enter more specific and detailed
information to provide to GPs as ‘free text’.
Doctors were given training in the use of the modified system and were
encouraged to use the free text option to provide detailed information to GPs, such
as:
• Details about the history/mechanism of injury
• Outcomes of investigations, and
• Information regarding follow-up advice.
Interventional Radiology
Patient Safety Checklist
The lead nurse verifies full completion of the interventional radiology patient safety
checklist at the end of each relevant procedure.
A list of all procedures requiring the checklist has been produced and is displayed in
the relevant clinical room.
WHO Surgical Safety
Checklist Audit
To improve use of the WHO Surgical Safety Checklist, there was a continued
drive and an awareness programme within all theatre environments in the Trust.
Following this the Trust undertook regular auditing to review and maintain
compliance.
A further snapshot audit is due to take place in April 2015 to ensure processes are
embedded within Theatres.
Static Mattress Audit
All failing mattresses and covers were replaced at the time the audit was
undertaken
Audit of Baby Early
Warning Score (BEWS)
Charts on the Postnatal
Ward
Introduction of BEWS poster on the postnatal ward, which includes bleep numbers
and quick action algorithm.
Refresher/induction training, for midwifery staff, dates have been agreed and
commenced.
Process is being put in place for Neonatal SHOs to confirm which babies on BEWS
monitoring on the postnatal ward at each shift handover.
Audit Paediatric Casualty
Cards at Minor Injuries
Unit Mount Vernon
Hospital
The Emergency Nurse Practitioners in Minor Injuries Unit have been reminded
both verbally and by e-mail that all children who fit the criteria for referral to the
Paediatric Liaison Health Visitor should have a referral made and that all sections of
the Paediatric Assessment proforma are to be completed by the responsible ENP.
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Audit
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Actions
Do Not Actively Resuscitate A revised DNACPR form has been introduced across the hospital. Following this,
(DNACPR) re-audit
DNACPR induction training programmes and all resuscitation training programmes
have been amended to include use of the updated proforma.
Regular snapshot audit is taking place to ensure compliance with use of the
DNACPR form is improved.
Clinical Record Keeping
Standards Audit
A poster to highlight the Trust record keeping standards has been produced and
issued around the hospital.
The Trust is making sure all clinical staff are provided with a stamp to improve
identification of the person writing in the notes.
Supporting Carers of
People with Dementia
The Lead Nurse for Dementia is now in post, which has resulted in a significant
improvement in the number of surveys completed. This nurse is there to explain/
deal with any concerns or queries about the survey.
A dementia resources folder is now available on all inpatient wards, alongside the
Alzheimer’s Society ‘This is Me’ document.
Mortality Audit Process
The mortality audit process has continued during 2014/15 with an increased
percentage of notes audited. The Division of Medicine have introduced a regular
meeting to present overall data and specific cases, for learning, to the multidisciplinary team. Every quarter the overall figures and summary of cases presented
are reported in the Patient Safety and Quality Report to our Quality and Risk
Committee.
Re-audit of Staff Survey
of Caring for Vulnerable
Patients including those
with a Learning Difficulty
This annual audit has highlighted the need for the continuous promotion of the
patient passport and action card. This takes place at the Safeguarding Adults
mandatory training and where other opportunities arise for the Head Nurse for
Safeguarding.
Re-audit of Staff
Awareness and knowledge
of the Mental Capacity Act
(MCA) and Deprivation of
Liberty Safeguards (DOLS)
Following this audit and subsequent CQC inspection a training needs analysis has
been developed to identify those senior clinical staff who are priorities for enhanced
Mental Capacity Act and Deprivation of Liberty Safeguard training. The training
programme is in place and dates are available at both hospital sites. Mandatory
training has been revised to include more detailed MCA and DOLS training.
Commitment to research as a driver for
improving the quality of care and patient
experience
The number of patients, receiving relevant
NHS health services provided by The Hillingdon
Hospitals NHS Foundation Trust in 2014/15 that
were recruited during that period to participate in
research approved by a research ethics committee
was 779.
The Hillingdon Hospitals NHS Foundation Trust has a
good research track record for a hospital of its size.
Our main research activity is recruiting patients into
high quality National Institute for Health Research
(NIHR) portfolio adopted multi-centre trials. We
participate in commercial research funded by the
114
pharmaceutical industry and non-commercial
research which is funded from the Department
of Health via the NIHR North West London (NWL)
Clinical Research Network (CRN). In 2014/15 we
received £437,483 from the NWL CRN for this work.
The funding enables the Trust to employ research
nurses and data managers to support the clinicians
in this work.
Our Strategic Aims for 2014 to 2019 are:
1. To expand the number of patients recruited into
high quality clinical trials
2. To expand the number of Specialties that are
actively participating in clinical trials
3. To adapt to the changing National and Regional
organisation of clinical research and funding.
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
This has enabled us to offer a greater number
of patients, from different clinical areas, the
opportunity to participate in research. In 2014/15
we significantly increased the number of NIHR
portfolio adopted commercial and non-commercial
trials in Ophthalmology, with 8 trials open and a
further 4 trials in set-up. The Trust employs a 0.4
WTE Ophthalmology Research Physician and 2
Ophthalmology Trial Coordinators to support this
work.
Participation in clinical research demonstrates
The Hillingdon Hospitals NHS Foundation Trust’s
commitment to improving the quality of care
we offer and to making our contribution to the
Nation’s wider health improvement. This also allows
clinical staff to stay abreast of the latest treatment
possibilities giving patients access to new treatments
that they otherwise would not have.
The Trust has an extensive research portfolio
with a balance of observational and treatment
trials across many clinical areas including cancer,
stroke, haematology, paediatrics, and many of
the general medicine and surgical specialities. In
2015/16 we plan to become more research active in
Reproductive Health and Childbirth.
We also support PhD and Masters Students from the
local universities giving them access to our patients
and staff for their projects.
05
During 2014/15 we had 63 NIHR Portfolio Studies
open or in follow-up. We recruited 779 patients into
40 trials. We supported two grant applications to
the NIHR Research for Patient Benefit programme
(RfPB) and two Masters Student studies.
All of our research activity is scrutinised for quality
and compliance to the standards expected by the
Research Governance Framework. In addition we
work to comply with the Department of Health
NIHR objectives.
Lessons learned from Serious Incidents
During 2014/15, the Trust reported 63 ‘Serious
Incidents’ and two ‘Never Events’ in accordance with
the national Serious Incident reporting framework
and categorisation of serious incident cases. These
cases include ambulance delays, unexpected
admissions to neonatal care, grade 3 or 4 pressure
ulcers and categories such as delayed diagnosis,
drug incidents, surgical error etc. 14 of these cases
have been Non-Executive/Executive Director led
panel investigations.
Protecting patients from avoidable harm is
something to which there is universal agreement
and the Trust has clearly defined processes and
procedures to follow to help avoid these events
occurring. Lessons learnt through investigation of
some of these Serious Incidents include:
Area
Division
Summary
Enhanced Recovery Programme for
colorectal surgery
Surgery
Review of the Enhanced Recovery Programme (ERP)
document
Specialist training for staff
Surgery
Need for training sessions for surgical ward staff re: ERP
and signs and symptoms of complications of bowel
surgery
Record keeping
All divisions
Staff require further training on standards of record
keeping and medical notes audit programme
Epidural monitoring guidelines
Surgery
Ward nurses to receive training on new epidural
management guidelines and audit of epidural pathway
according to the revised guideline
Standards of monitoring according
to local guidelines
Surgery
The expectation of nursing staff to follow monitoring
guidelines strictly as per the guidance
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Area
Division
Summary
Drug extravasation guidelines
Paediatrics
The paediatric extravasation guideline expanded to an
all-encompassing guideline to include drug (chemical)
injuries
Medicines Policy review
All divisions
An addition to the Medicines Policy on escalation
process and steps taken on suspecting a defective drug
Staff training on drug defects
All divisions
Unexpected medicine defects awareness in relevant
teaching and induction programme for medical staff
Medical gas administration
All divisions
Use of medical air rotometers restricted Trust wide
ensuring they are only connected to outlets when in
use and removed immediately after use*
Medical gas outlets
All divisions
Signage and wording of oxygen/medical air outlet
ports reviewed Trust wide to ensure consistency*
A&E Resus Environment
Medicine
Review of environment and equipment in resus in line
with best practice and Hospital Technical Memorandum
(HTM)*
Clinical leadership
Medicine
Clarity on clinical lead overseeing acute management
of patient in A&E resus with a scribe appointed in acute
cases needing intensive management*
Availability of senior surgical staff
Surgery
Senior surgical medical staff must be available for
surgical emergency reviews and there should be no
delay in seeking their input
Staff training on Abdominal Aortic
Aneurysm (AAA)
Medicine
Junior medical staff and nursing staff within the A&E
to receive training on recognising and diagnosing
abdominal aneurysm
AAA guideline
Surgery
AAA screening map is to be used for all patients in the
outpatient setting
Clinical documentation review
Medicine
Review of the Early First Assessment process in A&E
Emergency Lighting
Health and
Safety
A&E Resus and majors areas must have suitable levels
of emergency lighting
Internal incident procedures
Health and
Safety
Awareness training of internal incident plan activation
procedures/communication process to be understood
by all key/senior staff
Communication channels
Health and
Safety
Alternative means of communication to counteract
areas of poor mobile reception
Major incident loggist training
Health and
Safety
Additional Loggist training to key night staff so that
there is always one available when required
Intravenous drug administration
policy review
All divisions
Two members of staff to sign for administration
of intravenous drugs – intravenous drug policy
amendment
Allergy status and drug
administration
All divisions
Prescribers should refer to the Trust’s Penicillin Allergy
Poster and clinical staff to ensure that allergy box on
drug chart is completed and patients are not prescribed
a medicine to which they are allergic
Antibiotic guideline
All divisions
Review of antibiotic guideline to include guidance on
history of previous administration of antibiotic without
adverse reaction despite penicillin allergy
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
05
Area
Division
Summary
Lumbar puncture (LP)
documentation
All divisions
The LP form must be updated to ensure clear
documentation and added to the intranet as a related
document to the LP guidelines
Neurological review of patients
Medicine
Patients admitted with neurological signs and
symptoms must have the benefit of a neurological
opinion, face to face or by phone, within 24 hours if
required
Multidisciplinary Team working
Medicine
A review of multidisciplinary handover processes,
including continuity and communication to ensure that
this is an effective process
Radiology Operating Policy
Radiology
Diagnostic staff must inform referring clinician if
imaging is difficult to ensure all patients are offered
sedation or pain relief where required
Clinical guideline review
Maternity
Streamlining of main transfusion guideline and Major
Obstetric Haemorrhage guideline
Baby Early Warning Score (BEWS)
Maternity
Embed the use of BEWS system in practice on the
postnatal ward
Airway intubation training
Maternity
Intubation training workshop for neonatal trainees and
nurses
Communication between specialist
teams
Maternity
Anaesthetic team to alert neonatal team when opiates
given to a mother immediately prior to delivery so that
reversal agent can be considered for baby if required
Neonatal simulation training
Maternity
Learning from serious incidents to be incorporated into
rolling neonatal simulation programme for staff
WHO checklist and wrong site
surgery
Surgery
To make all surgeons aware that there is always a risk
of wrong site surgery even with the WHO checklist in
place and that the WHO checklist should be reviewed
for each sub-specialty*
Communication / information in
Theatres
Surgery
To mandate the use of the whiteboard in Theatres to
display the procedure site for oral surgery*
Surgical pre-operative review
Surgery
The Lead Surgeon should always see the patient before
surgery to confirm the procedure site*
Tooth extraction protocol
Surgery
A service agreed protocol/checklist for tooth extraction
is to be written to assist new staff, as an induction
guide to ensure that correct steps and appropriate
preventative measures are followed*
*Learning/actions from the two never event investigations
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Serious incident and never event actions plans
based on the learning from investigations are
implemented and monitored via clinical divisional
governance boards until fully completed. Directorled panel investigation reports and action plans are
approved and reviewed by the Trust Board until fully
completed. As part of our duty in being open and
honest with patients and their families, the findings
from serious incident investigations are shared with
them and information is provided on the learning
and the actions that the Trust is taking forward to
prevent reoccurrence.
Goals agreed with our commissioners (CQUINs)
The key aim of the Commissioning for Quality
and Innovation (CQUIN) framework is to secure
improvements in the quality of services and better
outcomes for patients, whilst also maintaining strong
CQUIN Targets 2014/15
financial management. In 2014/15 there were nine
National and Local Acute CQUIN schemes agreed,
five of which were locally derived by Hillingdon
Clinical Commissioning Group. In 2014/15 we
have achieved 86% of our acute CQUIN target
demonstrating a material improvement on 2013/14
in which we achieved 78.6%.
The CQUIN framework supports improvements in
the quality of services and aims to provide better
outcomes for patients. It enables commissioners
to reward excellence, by linking a proportion of
healthcare providers’ income to the achievement of
local quality improvement goals. Having fully and
partially achieved eight out of the nine CQUINs for
2014/15 will mean that the quality of our services
and the care that we deliver to our patients has
improved.
Achievement
Commentary
Improving the experience of both
patients and staff (measured using
the Friends and Family Test)
Partial (60%)
achievement
The Trust fully achieved its targets for rollout of
the FFT to staff and to outpatient departments
but, whilst succeeding in achieving an increase in
response rates for both inpatients and AE, it did
not quite achieve the stretch target for inpatient
participation.
Promoting ‘harm free’ care for
patients (as measured using the
Patient Safety Thermometer Nov
2014 to March 2015)
Not achieved
Whilst the Trust did not achieve this year’s target
of a further 25% reduction in both hospital and
community acquired pressure ulcers (between Nov
2014 and Mar 2015) it did achieve a 27% reduction
in the total number of hospital acquired pressure
ulcers over the full year period.
Improving services for patients with
dementia
Partial (55%)
achievement
The Trust fully achieved its targets to provide
complete monthly carers’ surveys and to implement
staff training.
A further requirement was to find, assess, investigate
and refer 90% of elderly patients admitted through
emergency methods. Whilst the Trust did not
achieve this earlier in the year, it has fully achieved
since January 2015.
National Schemes
Local & Regional Schemes
Providing ‘recovery at home’
for appropriate elderly patients
(HomeSafe)
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100%
achievement
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Providing timely specialist advice
and guidance to local GPs
50% achievement
Improving the speed and quality
of communications between the
hospital and local GPs
100%
achievement
Reducing hospital admissions for
emergency conditions that do not
require hospitalisation (Ambulatory
Emergency Care)
85% achievement
Improving services for patients with
kidney damage
100%
achievement
A proportion of The Hillingdon Hospitals NHS
Foundation Trust’s income in 2014/15 was
conditional on achieving quality improvement and
innovation goals agreed between The Hillingdon
Hospitals NHS Foundation Trust and any person
or body we entered into a contract, agreement
or arrangement with for the provision of relevant
health services, through the Commissioning for
Quality and Innovation payment framework.
Total CQUIN income for 2014/15, is expected to be
£2,960,913 for National and Local schemes and
£119, 422 (91% of potential available income) for
Specialised CQUIN ~Schemes. In the previous year
(2013/14) total income was £2,591,456 (78.6% of
potential available income) for National and Local
schemes and £234,314 (91% of potential available
income) for Specialised Commissioning.
Further details of the agreed goals for 2015/16 are
available electronically at: www.thh.nhs.uk.
Care Quality Commission registration
The Hillingdon Hospitals NHS Foundation Trust
is required to register with the Care Quality
Commission and its current registration status is
that it is registered without conditions. As a result of
the CQC announced visit in October 2014 the Trust
05
The Trust had a target to answer 95% of e-mail
enquiries from GPs within 24hrs.
This was particularly challenging for specialties with
few consultants and a small number of enquiries
were answered beyond the 24hr target.
There were numerous different targets relating
to this CQUIN. Some of those achieved include
a reduction in non-elective admissions, the
introduction of point-of-care testing, and provision
of information about the service to patients and GPs.
The two aspects that were not achieved this year
were provision of a 7-day advice line for GPs and
extended hours access to endoscopy.
received two Warning Notices and five Compliance
Notices against seven regulations. The Trust set out
an action plan to close the gaps in compliance and
this action plan was submitted to the CQC with
further updates on progress.
As a result of the Trust actions against the Warning
Notices the Trust has increased compliance rates
for staff training for all statutory and mandatory
training; adopted the National Specification for
Cleaning standards (NSC) and has met or exceeded
the NSC targets across all clinical areas during the
period of audit from 9th February and 8th March;
appointed a Lead Nurse for Infection Prevention
and Control and Lead Nurse for Child Safeguarding;
undertaken significant work to upgrade the
ventilation systems in main theatres; completed its
first NHS Protect medicine security self-assessment
for wards, theatres and A&E; progressed the
centralisation of all clinical equipment for quality,
maintenance and supply purposes; increased
compliance against medical record keeping and
concluded a third of the oversees recruitment visits
to attract nursing staff to the Trust whilst reducing
the turnover of nurses.
The CQC re-visited the Trust on 5th and 7th May.
Pending further information requests and the
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
approval of the CQC Board, the inspectors will likely
recommend:
• The de-escalation of the Warning Notices against
regulations 10 and 12;
• Regulation 10 likely to be removed completely
• Regulation 12 likely to have some follow up
compliance actions
• Recommend the review of the four red
‘inadequate’ ratings in the safety domain
against A&E, Medicine, Surgery and Services for
Children.
subject to the inherent limitations outlined within the
statement from the Chief Executive Officer on page
99 of the report.
Information Governance Toolkit
The Hillingdon Hospitals NHS Foundation Trust’s
Information Governance Assessment Report overall
score for 2014/15 was 80%. This is termed as
satisfactory (green) with all requirements level 2 or
above.
The inspectors fed back that they observed many
areas of excellent practice which they will detail in
their report.
Clinical coding error rate
The Hillingdon Hospitals NHS Foundation Trust was
not subject to the Payment by Results Clinical Coding
Audit during 2013/14 by the Audit Commission.
Moving forward, the Trust’s processes for CQC
compliance monitoring are being reviewed in light
of the inspection findings and a programme of
internal and peer review has been created.
Action taken to improve data quality
The Hillingdon Hospitals NHS Foundation Trust will
be taking the following actions to improve data
quality:
Data quality
The Hillingdon Hospitals NHS Foundation Trust
submitted records during April 2014 to January
2015 to the Secondary Uses service for inclusion in
the Hospital Episode Statistics which are included in
the latest published data.
• Continue the comprehensive monitoring
•
The percentage of records in the published data:
• which included the patient’s valid NHS number
was:
– 98.7% for admitted patient care
– 99.8% for out-patient care and
– 96.8% for accident and emergency care.
• which included the patient’s valid General
Medical Practice Code was:
– 100% for admitted patient care;
– 100% for out-patient care; and
– 100% for accident and emergency care.
The Trust's Board and management seek to take
all reasonable steps and exercise appropriate due
diligence to ensure the accuracy of the data reported
in relation to the quality indicators outlined in the
Quality Report, but recognises that it is nonetheless
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•
•
programme for data quality across the
organisation through divisional based groups led
by the Director of Operational Performance.
The quality of elective waiting time data in
particular will continue to be reviewed monthly at
the elective performance meeting and divisional
data quality groups, ensuring all elective lists are
managed and assessed on electronic systems.
NHS Number coverage on clinical systems – the
programme to integrate information systems is
continuing to address this with seven remaining
systems identified for 2015/16.
Trust Board Indicators assurance – regular review
and local auditing.
Part 2.3
Performance against Core Quality
Indicators 2014/15
In this part of the report the Trust is required to report
against a core set of national quality indicators to
provide an overview of performance in 2014/15. The
following page provides information which has been
obtained from the recommended sources and is
presented in line with the detailed Monitor guidance.
25.4%
2: the percentage of patient deaths with palliative care
coded at diagnosis
12 Cases
(9.5 Cases
per 100,000
beddays)
95.2%
0.095/3.372
0.438/10.388
0.32/7.123
62%
66%
5255 (8.9%)
58 (1.1%)
Fully Compliant
5: Clostridium difficile
6: Venous Thromboemolism (VTE)
7: PROMS (Health Gain), Groin Hernia, EQ-5D Index/VAS
8: PROMS (Health Gain), Hip Replacement, EQ-5D
Index/VAS
9: PROMS (Health Gain), Knee Replacement, EQ-5D
Index/VAS
10: Friends and Family Test question 12d – ‘If a friend
or relative needed treatment I would be happy with the
standard of care provided by this organisation’
11: Trust’s responsiveness to personal needs of our
patients
12: [a] The number, and where available, rate of patient
safety incidents reported within the period, and;
[b] the number and percentage of such patient safety
incidents that resulted in severe harm or death
13: Self certification against compliance with
requirements regarding access to healthcare for people
with a learning disability
4: Emergency readmissions to hospital within 28
days of discharge from hospital: Adults of ages 16+
[Standardised] (Crude)
3: Emergency readmissions to hospital within 28 days
of discharge from hospital: children of ages 0-15
[Standardised] (Crude)
0.87 (Lower
Than Expected)
1: Summary Hospital-Level Mortality (SHMI)
2013/14
Performance
Fully
Compliant
n/a
n/a
n/a
n/a
n/a
n/a
95%
16 Cases
(Absolute)
n/a
n/a
2014-15
Target
Fully Compliant
5679 (9.2%)
47 (0.8%)
63.4%
Q1 - 77%, Q2 76%, Q3 - 65%,
Q4 - 74%
0.157/3.938
0.305/9.167
0.068/3.0
92.6%
18 Cases
(12.3 Cases
per 100,000
beddays)
24.7%
0.88 (Lower
Than Expected)
2014-15
Performance
n/a
3.5%
0.5%
n/a
Not available
n/a
n/a
n/a
96.0%
14.4 Cases
per 100,000
beddays
n/a
n/a
London Trusts
HSCIC
HSCIC
Benchmark
Source
Oct-2013 to
Sep-2014
Oct-2013 to
Sep-2014
Benchmark Period
The Whittington Hospital NHS
Trust 0%
Medway Nhs Foundation Trust
1.1982 Higher Than Expected
Lowest Performing Trust
n/a
3.5%
0.5%
n/a
Q1 75%,
Q2
- 75%,
Q3 55%,
Q4 - not
available
0.328/
6.369
0.442/
12.162
0.081/0.397
96.1%
17.3
Cases
per
100,000
beddays
n/a
NPSA
n/a
Apr-2014 to
Sep-2014
n/a
2014
NHS
England
n/a
Apr-2014 to
Sep-2014
Apr-2014 to
Sep-2014
Apr-2014 to
Sep-2014
Apr-2014 to Dec
2014 (National/
London)
Oct-2014 to
Dec-2014
(Lowest/Highest
Performers)
2013/2014
HSCIC
HSCIC
HSCIC
NHS
England
PHE
n/a
doncaster and bassetlaw hospitals
nhs foundation trust (0.02%)
doncaster and bassetlaw hospitals
nhs foundation trust (82.9%)
n/a
Q1 - 46% - London Ambulance
Service Nhs Trust Q2 - 41% - Devon
Partnership Nhs Trust Q3 - 38%
(EST) - not known
0.055
University College London Hospitals
Nhs Foundation Trust
-10.167
Walsall Healthcare Nhs Trust
0.191
Kettering General Hospital Nhs
Foundation Trust
-2.583
Bolton Nhs Foundation Trust
-0.017
Ashford And St Peter’s Hospitals Nhs
Foundation Trust
-12.786
Barts Health Nhs Trust
81.2% - Cambridge University
Hospitals Nhs Foundation Trust
University College London Hospitals
had 99 Trust aportioned Cases (37.1
cases per 100,000 beddays)
HSCIC will not be publishing updates for this Indicator for this Year
25.1%
n/a
National
n/a
northern devon healthcare nhs trust (7.5%)
Dorset County Hospital Nhs Foundation Trust,
George Eliot Hospital Nhs Trust, The Dudley
Group Nhs Foundation Trust (0%)
n/a
Q1 - 99% - Papworth
Hospital Nhs Foundation Trust
Q2 - 98% - The Clatterbridge Cancer Centre
Nhs Foundation Trust, The Walton Centre Nhs
Foundation, The Robert Jones And Agnes Hunt
Nhs Foundation Trust Q3 - 92% - not known
Q4 - not available
0.532
Aintree University Hospital Nhs Foundation Trust
24.167
University Hospital Southampton Nhs Foundation
Trust
0.765
Southend University Hospital Nhs Foundation
Trust
27.875
Luton And Dunstable University Hospital Nhs
Foundation Trust
0.273
The Rotherham Nhs Foundation Trust
6.675
Mid Essex Hospital Services Nhs Trust
100.0% - Royal National Orthopaedic Hospital
Nhs Trust (+8 other trusts)
Following Trusts had Zero Cases of Cdiff in
2014/2015:
Royal National Hospital for Rheumatic Diseases
Birmingham Women’s
Moorfields Eye Hospital
Salford Royal Nhs Foundation Trust 49.4%
The Whittington Hospital NHS Trust 0.5966 Band
3 (Lower Than Expected)
Highest Performing Trust
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
05
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Data inconsistencies
A number of indicators are showing changes to
2014/15 data that was published in last year’s
Quality Report. There are several reasons for this as
follows:
1. The statutory timescale within which the
Quality Report is published is very tight. Not all
of the latest data was available at the time of
publication last year and so the Trust has taken
the opportunity to update 2013/14 indicators
with full year updates which are now available.
2. National Indicators based on statistical methods
by definition require re-basing (e.g. standardised
readmissions, HSMR, SHMI).
3. Data quality or data completeness issues may
have affected last year’s indicators. If these have
been identified then they have been rectified in
this year’s report.
Supporting information about the indicators
required in accordance with the Quality
Account regulations Update
The Hillingdon Hospitals NHS Foundation Trust
considers that this data is as described for the
following reasons:
Indicator 1: SHMI
National reporting shows the Trust to be within
the ‘lower than expected’ range for the latest
benchmark period July 2013-June 2014. This has
been a stable performance with a ‘lower than
expected’ range overall in 2014/15 with a rate of
0.87% compared to a rate of 0.90% in 2013/14.
The Trust intends to take the following actions to
further improve on this indicator and so the quality
of its services:
• Continue to reduce the variation between
•
weekdays and weekends by driving forward the
implementation of the London Quality Standards
Work with Dr Foster to examine specialty outliers.
Indicator 2: Palliative Care Coding
The Trust has sustained its improved performance
on palliative care coding during the past year and is
reporting above the national average and marginally
122
under the London average. It must be noted that
there continues to be significant variation in coding
rates across Trusts. The Trust intends to take the
following actions to maintain and further improve
performance on this indicator and so the quality of
its services:
• Monitor performance via the quality dashboard
(reviewed monthly by the Board) and continue
to ensure that reporting systems are robust and
efficient through audit.
Indicator 5: Clostridium difficile
The Trust was unsuccessful in meeting its
Clostridium difficile objective in 2014/15 – exceeding
by 2 cases (n=18). The Trust reported a marked
increase in incidence in December 2014 and January
2015. Learning from the RCAs showed that the
patients affected have been elderly, acutely unwell
and requiring antibiotic treatment, both within the
hospital and in the community, for acute infections.
Key learning has indicated that prescribing practice
does not always adhere to the Trust’s antibiotic
guidelines and policy. The Trust intends to take the
following actions to further improve performance on
this indicator and so the quality of its services:
• Strict application of the Trust antibiotic policy
•
•
•
by the multidisciplinary team, with increased
support and review from the Medical Director,
the Microbiologists, the infection control
team, the anti-microbial pharmacist and ward
pharmacists
The antibiotic policy and guidelines have been
reviewed to ensure that there is more restricted
use of broad spectrum antibiotics and this will
remain under review
Performance on prescribing practice is being
monitored by the Infection Control Committee
and Antimicrobial Stewardship Group
Enhanced Infection Control surveillance to be
undertaken across the Trust: the Lead Nurse
for IPC has reviewed practice on the wards
where affected patients have been nursed
and some changes in local practice have been
recommended to ensure there is no risk of cross
infection. The Lead Nurse has also set out clear
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
instructions for all ward areas to ensure high
standards of IPC practice are adhered to.
Indicator 6: Venous Thromboembolism
The Trust has not reached the target for venous
thromboembolism (VTE) risk assessment compliance,
having been 100% compliant with the CQUIN
requirements in the previous year 2013/14. The
VTE risk assessment forms part of the Patient Safety
Thermometer measured monthly and the shortfall has
been registered on this. There has been a root cause
analysis (RCA) of reasons for this shortfall to elucidate
the obstacles to VTE assessing and reporting. As
a result an action plan has been developed and is
monitored within the Trust clinical governance system
up to Quality and Risk Committee.
The Trust intends to take the following actions to
further improve performance on this indicator and
so the quality of its services:
• Improve staff education including junior
•
•
•
•
•
doctors during their induction and nursing staff
during education on documentation and drug
administration
Improve documentation with checklists including
VTE in medical notes
Increase awareness of levels of reporting by
weekly communication to senior doctors
Involvement of ward pharmacists as part of the
multidisciplinary team to draw attention to any
omissions on drug charts
Consideration of modification of the drug chart
to aid in ease of VTE risk assessment
The Medical Director has communicated to all
relevant clinical staff his expectation that no
patient will be admitted to the ward without VTE
risk assessment completed.
05
– September 2014 demonstrates that our
participation rates have improved slightly to 37.6%
but the post-operative issue rate (questionnaires
sent to patients) for groin hernia has unfortunately
decreased. There has been a slight increase in health
gain for groin hernia for both the EQ-5D Index and
Visual Analogue scale compared with the previous
12 month period.
The Trust intends to take the following actions to
further improve performance on this indicator and
so the quality of its services:
• The Surgical Service Manager and Pre-Operative
•
Assessment Sister are working on ways of
improving both the pre-operative issue rate by
reviewing the current process.
They will also be aiming to improve the postoperative response rate by ensuring patients are
aware of the fact they will be sent further postoperative questionnaires and encouraging them
to return these.
Indicators 8 & 9: Patient Reported Outcome
Measures – Hip and Knee Replacements
The issue rate for pre-operative hip and knees
questionnaire is very good and this is due to the
questionnaire being administered at the ‘joint
school’ which patients attend before their surgery.
The latest published PROMs results have been
reviewed and also discussed with the company
(Quality Health) that collects and analyses the
PROMs data on our behalf.
Meanwhile, patients are provided with appropriate
treatment for prophylaxis against VTE. Staff remain
vigilant and RCA of identified hospital acquired VTE
continue with learning shared with clinical teams.
It has not been possible to fully evaluate the
associated health gain as Quality Health have
reported that they have yet to upload the results
returned to them for this period. This information
is due to be uploaded on 16th May 2015 and until
then the results cannot be reviewed. The Trust
is exploring this further with Quality Health and
with other hospitals who have managed to report
outcomes in a more timely manner.
Indicator 7: Patient Reported Outcome
Measures – Health Gain Groin Hernia
The latest data published for the period April
The Trust intends to take the following actions to
maintain performance on this indicator and so the
quality of its services:
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
• A diagnostic assessment of the Rapid Recovery
Programme (which has been in place for
approximately eight years) for patients having
hip and knee replacements has been undertaken
and the report is due imminently. The findings
of this report will be reviewed by the Clinical
Speciality Lead and the multidisciplinary team
and an action plan devised to optimise the
patient’s pathway from pre admission to post
discharge.
• Being involved in decisions about your care and
•
•
•
•
treatment
Finding someone to talk to about worries and
concerns
Being given enough privacy when discussing
your condition and treatment
Informing patients about medication side effects
to watch out for after going home
Knowing who to contact if worried about
condition or treatment after leaving hospital
Indicator 10:
The Staff Friends and Family Test (FFT) is a quarterly
two-part question staff survey which takes place
every quarter except quarter three when the annual
staff survey is run. For the for the three quarters in
which the Staff FFT operates, the results show an
average of 75% of staff are ‘likely’ or ‘very likely’ to
recommend the Trust as a place in which to receive
treatment (the highest percentage being ‘very
likely’ – 31% – to recommend the Trust as a place to
receive care in the last quarter).
The Trust did undertake some focused improvement
work related to finding someone to talk to about
worries or concerns and knowing who to contact if
worried after leaving hospital (see patient experience
commentary for further details). The Trust intends to
take the following actions to improve performance
on this indicator and so the quality of its services:
An average of 67% of staff are ‘likely’ or ‘very likely’
to recommend the Trust as a place to work (The
highest percentage being ‘very likely’ – 28% – to
recommend the Trust as a place to work in the last
quarter).
embedded and consistently applied across all
inpatient wards
The Transforming Inpatient Care Project includes
four work streams which are aimed at improving
efficiency and patient experience specifically in
relation to discharge processes. Implementation
of these will have an impact on this indicator.
The Trust intends to take the following actions to
maintain and further improve performance on this
indicator and so the quality of its services:
• Support the easy accessibility of the
questionnaire to increase the participation rate
• Promote action taken as a result of feedback
provided by staff through the Bulletin, intranet,
staff meetings and team briefings
• Continue timely reporting of feedback to the
Divisions and relevant departments
• Continue to implement the staff engagement
initiatives detailed in the strategy
• Continue to engage clinical Divisions in retention
and engagement work streams
Indicator 11: Responsiveness to personal needs
of our patients
This is a composite score from 5 questions taken
124
from the 2014 national survey of inpatients:
• To ensure that these initiatives are fully
•
Indicator 12: Patient Safety Incidents
The Trust’s rate of reporting for patient safety
incidents has increased from 8.9% (per 100
admissions) to 9.2% from the previous year of
2013/14. This is a positive improvement as part of
an improved patient safety culture.
Comparative data from the National Reporting and
Learning Service shows that the Trust increased
its reporting rate from 8.33 per 100 admissions (1
April 2013 – 30 September 2013) to 9.00 per 100
admissions (1 October 2013 and 31 March 2014).
This is compared to a median reporting rate for
the cluster of medium acute organisations of 7.82
incidents per 100 admissions. The Trust is in the
highest 25% of reporters – organisations that report
more incidents usually have a better and more
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
effective safety culture. It is well recognised that you
can’t learn and improve if you don’t know what the
problems are.
The number of patient safety incidents that resulted
in severe harm or death has decreased from the
previous year by 0.3%. This is despite an increase of
over 400 incidents reported from the previous year.
The Trust intends to take the following actions to
improve further on this key patient safety indicator
and so the quality of its services:
05
The NRLS has changed its reporting approach and
the comparative reporting rate will now be recorded
as rate per 1,000 bed days and the comparative
organisation type will be acute (non-specialist)
organisation as opposed to medium sized acute
organisations; this will be reported as such in next
year’s quality report.
**Excluding Pressure Ulcers Internal Transfers (PUIT)
and Pressure Ulcers Admitted With (PUADM)
• Continue to raise awareness of the importance
Definitions of the two mandated indicators
for substantive sample testing by the Trust’s
auditors are:
•
1. Percentage of patients receiving first definitive
treatment for cancer within 62 days of an urgent
GP referral for suspected cancer.
2. Referral to Treatment Time waiting times –
18 week pathway
of incident reporting and in particular near
misses and no/low harm incidents (this will
ensure learning to avoid the more harmful
incidents from occurring)
Continue to ensure there is thorough
investigation of all severe/death reported
incidents to support learning and changes in
practice.
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Part 3
Other key quality information
and improvements we have
made in 2014/15
In this part of the report we have included other
key quality indicators which have been selected
by the Board in consultation with stakeholders.
They represent those indicators that are of national
importance that patients will want to know about
and they include targets used by Monitor as part of
Monitor’s Risk Assurance Framework. The indicator
set includes patient experience, patient safety and
clinical effectiveness indicators. The indicators
covered in this year’s report are consistent with
those from last year’s Quality Report. Narrative
has been provided on some of these indicators to
outline our performance.
Indicator 1 – Hospital Standardised
Mortality Rate
Based on bench-marking data available from Dr
Foster (historically re-based annually), the Trust
2014/15 aggregate hospital standardised mortality
ratio (HMSR) of 97.3 (YTD 2014/15 reported up
to Dec 14) is below the national level of 100 but is
above the London average of 86.3. Trust weekday
and weekend HSMRs have fluctuated above and
below the national benchmark throughout the year.
The HSMR for weekdays is currently lower than
the national benchmark at 95.9 and the HSMR
for weekends is above the national benchmark at
107.0. The Trust is tracking the HSMR monthly and
has a robust mortality review process in place for
all deaths occurring in hospital.
Indicator 2 – Re-admissions to hospital
within 28 days
In recent months the Trust has been working
towards rolling out an innovative new audit process
that will make it ‘business-as-usual’ for a ward-based
126
investigation to be undertaken every time a patient is
re-admitted within 30 days of a previous discharge.
Investigations are completed in as real time as
possible and aim to capture both the medical and,
critically, the patient’s perspective as to the causal
factors leading to the re-admission. Results are
captured in a central database, a proportion of
which are then selected for deeper in-depth
review by clinical specialists.
Key themes identified have been in relation
to palliative care, substance abuse, respiratory
conditions and diabetes. Results to date have found
the majority of re-admissions to be unavoidable
but there are indications that some re-admissions
may possibly be avoided through initiatives aimed
at improving access to, and local take-up of,
appropriate community-based services. We are also
working with a nurse from a local hospice on a
project to look specifically at reducing re-admissions
among palliative patients, in an aim to provide the
best possible care for patients who are either on,
or approaching, an end of life pathway.
Concurrently, the Trust is in the early stages of
implementing PARR-30, a risk stratification tool
developed by the Nuffield Trust, which will enable
us to proactively identify those patients at greatest
risk of re-admission whilst they are still inpatients on
our wards. This will allow us to target appropriate
interventions in a timely manner and, together with
our colleagues in primary and community services,
support patients with a higher risk of re-admission
more directly in their transition between spheres
of care.
0%
95%
99.3%
100.0%
100.0%
90.3%
97.8%
96.9%
97.1%
98.6%
97.4%
92.6%
96.0%
92.1%
0.85%
0.0%
83.1%
5: Cancer: 31 day maximum wait from diagnosis to first
treatment
6: Cancer: 31 day maximum wait from diagnosis to
subsequent treatment, drug or surgery
7: Cancer: 62-day maximum wait from referral by GP/
screening service/consultant upgrade to treatment
8: Referral to treatment waiting times - admitted
9: Referral to treatment waiting times - non admitted
10: Referral to treatment waiting times - Incomplete
11: Fractured neck of femur emergency patients in
theatre within 36 hours
12: Total time in A&E: 4 hours or less (All Types/ Type 1)
13: Number of last minute elective operations cancelled
for non clinical reasons
14: Percentage of patients not treated within 28 days of
having operation cancelled for non-clinical reasons
15: Percentage of women in the relevant PCT population
who have seen a midwife or a maternity healthcare
professional, for health and social care assessment of
needs, risks and choices by 12 weeks and 6 days of
pregnancy
0.8%
95%
95%
90%
92%
95%
82.8%
2.92%
0.69%
94.1%
84.2%
86.4%
97.7%
98.5%
95.2%
87.70%
8.07%
0.76%
87.9%
92.6%
n/a
92.0%
95.5%
86.9%
96.1%
5.30%
0.85%
90.4%
93.6%
n/a
93.3%
95.5%
88.9%
Apr-2014 to Feb-2015
Apr-2014 to Feb-2015
Apr-2014 to Feb-2015
NHS England
NHS England
NHS England
NHS England
Apr -2014 to Dec 2014
Apr- 2014 to Dec 2014
Apr-2014 to Mar-2015
Local Indicator n/a
UNIFY2
UNIFY2
UNIFY2
Oct-2014 to Dec-2014
NHS England
83.8%
93.8%
90.0%
81.6%
90.8%
93.1%
92.2%
97.8%
98.7%
85%
90%
n/a
90%
Oct-2014 to Dec-2014
Oct-2014 to Dec-2014
Oct-2014 to Dec-2014
Apr- 2014 to Mar 2015
NHS England
NHS England
NHS England
NHS England
Apr-2014 to Sep-2014
Apr- 2014 to Dec 2015
Benchmark Period
99.7%
96.0%
97.8%
94.0%
92.9%
0.10%
Dr Foster
Dr Foster
Benchmark
Source
99.8%
96.1%
97.7%
95.4%
95.4%
0.30%
100
100
86.3 (84.9 87.7)
100.0 (99.4 100.8)
National
London Trusts
100.0%
100.0%
99.3%
98.0%
95.7%
0.00%
109.9 (105.8 114.1)
97.3 (89.2 106.0)
2014-15
Performance
97%
94%
96%
93%
93%
97.9%
94.7%
4: Cancer: Two week wait from GP referral to seeing a
specialist (suspected cancer)/(breast symptoms)
<100
0.0%
105.5 (102.6 - 108.6)
2: Readmissions to hospital within 28 days
<100
2014-15
Target
3: Non clinically justified single sex accommodation breach,
0.02%
rate per 1,000 finished consultant episodes
97.4 (90.0 - 105.2)
1: In Hospital Standardised Mortality Ratio
2013/14
Performance
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Apr -2014 to Jun 2014
05
127
128
95%
97.2%
99.6%
16: Percentage of women in the relevant PCT population
who have seen a midwife or a maternity healthcare
professional, for health and social care assessment of
needs, risks and choices by 12 weeks and 6 days of
pregnancy (excluding late Referrals)
17: Stroke patients: Percentage of Patients that have spent
at least 90% of their time on the stroke unit
>/=87%
94%
73.6%
23: Independent assessment of cleanliness of hospital*
– Very High Risk areas
– High risk areas
24: Percentage of complaints responded to within agreed
timescale
n/a
n/a
97%
97%
88.5%
n/a
n/a
n/a
1.8 Cases
per 100,000
beddays
n/a
London Trusts
88%
91%
90%
0.7 Cases per
100,000 beddays
100%
98.2%
97.4%
2014-15
Performance
Definitions for the indicators are included in Monitor’s ‘Risk Assessment Framework’ (available on http://www.monitor.gov.uk/raf).
90%
95% 95%
92%
>/= 88%
86%
>/= 88%
91%
20: Inpatient Experience Programme (local survey results)
22: Maternity Experience Programme (Local survey results)
0
0.8 Cases per 100,000
beddays
19: Meticillin-Resistant Staphylococcus Aureusis (MRSA)
21: Outpatient Experience Programme (local survey results) 87%
n/a
100%
18: Stroke patients: Percentage of high risk Transient
Ischaemic Attack (TIA)/mini stroke patients who are treated
within 24 hours
80%
2014-15
Target
2013/14
Performance
n/a
n/a
n/a
n/a
n/a
1.1
Cases per
100,000
beddays
n/a
National
n/a
n/a
n/a
n/a
n/a
PHE
Local Indicator
Local Indicator
Local Indicator
Benchmark
Source
n/a
n/a
n/a
n/a
n/a
Ceased Qtr 4 2012/2013
Ceased Qtr 4 2012/2013
n/a
Benchmark Period
05
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Outcomes of both the Daily Review of Readmissions and the Risk Stratification are
contributing to the definition and development
of a 2015/16 CQUIN, jointly owned with our local
community-based service provider, CNWL. By
working collaboratively, and dovetailing into the
Whole Systems Integration Strategy and the Better
Care Fund initiative, we aim to establish effective
admission and re-admission avoidance schemes,
ensuring that finite local resources are appropriately
targeted to further improve the quality and
consistency of our patients’ care.
Already, we have seen a substantial reduction in the
rate of re-admissions in the second half of 2014/15,
from 8.4% in Q1 and Q2 to 7.6% in Q3 and 7.7%
in Q4.
Indicators 4-7 – Cancer performance
Cancer performance is being well maintained
for all the national waiting times standards. The
quality of services is monitored annually via the
national peer review programme. Tumour specific
work programmes also reflect areas for service
development.
Indictors 8-10 – Referral to treatment
waiting times
The Trust is required to report performance against
three indicators in respect of 18 week Referral-toTreatment targets. For patient pathways covered by
this target, the three metrics reported are:
• ‘admitted’ – for patients admitted for first
treatment during the year, the percentage who
had been waiting less than 18 weeks from their
initial referral;
• ‘non-admitted’ – for patients who received
their first treatment without being admitted,
or whose treatment pathway ended for other
reasons without admission, the percentage for
the year who had been waiting less than 18
weeks from the initial referral; and
• ‘incomplete’ – the average of the proportion
of patients, at each month end, who had been
waiting less than 18 weeks from initial referral,
as a percentage of all patients waiting at
that date.
05
The measurement and reporting of performance
against these targets is subject to a complex
series of rules and guidance published nationally.
However, the complexity and range of the services
offered by the Trust mean that local policies and
interpretations are required, including those set
out in the Trust Access Policy. The Trust receives a
limited number of referrals from other providers.
Under the rules for the indicators, the Trust is
required to report performance against the 18 week
target for patients under its care, including those
referred on from other providers. Depending on
the nature of the referral and whether the patient
has received their first treatment, this can either
“start the clock” on a new 18 week treatment
pathway, or represent a continuation of their
waiting time which begun when their GP made an
initial referral. In order to accurately report waiting
times, the Trust therefore needs other providers to
share information on when each patient’s treatment
pathway began. Dermatology represents the vast
majority of referrals from other providers, and are
by and large for continuation of treatment (i.e. the
first definitive treatment has already been provided).
Therefore these patients will be on closed pathways
and will already have had their clock stopped.
Some providers do not always provide the
information required under the national RTT
rules. There is a standard defined Inter Provider
Administrative Data Transfer Minimum Data Set to
facilitate sharing the required information. If this
happens the Trust will contact the referring provider
to obtain the clock start date. In the majority of
cases the Trust is able to obtain the appropriate
information and accurately record the clock
start date.
This means that for a few patients each month the
Trust will not be able to know definitively when
their treatment pathway began. The national
guidance assumes that the “clock start” can be
identified for each patient pathway, and does not
provide guidance on how to treat patients with
‘unknown clock starts’ in the incomplete
pathway metric.
129
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
The Trust’s approach in these cases, where
information is not forthcoming after chasing the
referring provider, is to treat a new treatment
pathway as starting on the date that the Trust
receives the referral for the first time.
RTT pathways. The outputs of the audit have been
factored in to the programme for the coming year
and there will be a renewed focus on providing
more guidance to staff on appropriate use of clock
start dates.
This approach means that all patients are included
in the calculation of the reported indicators, but
may mean that the percentage waiting more
than 18 weeks for treatment is understated as we
cannot take account of time spent waiting with
other providers which has not been reported to us.
However given the low volume of patients referred
from other providers where the Trust has not been
able to establish the correct start date, there would
be no noticeable impact on the performance
indicator even if every one of these patients
breached.
Clinicians will be re-trained on the appropriate use
of outcome forms to ensure accurate recording of
clock stops.
The Trust continues to maintain its high
achievement across the RTT and is at the highest
level of achievement in the North West London
sector. We plan to monitor this closely through
our waiting list meetings and will continue to drive
performance.
An external audit undertaken by Deloitte reported
a high error rate on recording data on incomplete
pathways. Incomplete pathways remain under
continuous scrutiny and on-going validation by
Trust management and a number of the errors
found during the audit would have been picked up
through the on-going validation processes put in
place.
The Trust has undertaken an exercise on the
impact the high error rate would have on reported
performance. With the exception of one month
the errors identified in the audit would not have
compromised the RTT incomplete target. Further
validation and analysis of performance will be
undertaken to inform the Trust’s position.
There is an on-going training programme led by
the Director of Operational Performance, for all
staff associated with recording and delivering the
130
The Trust will undertake a comprehensive
re-training programme for all staff to cover
appropriate management of all RTT pathways.
Indicator 11 – Fractured neck of Femur
The Trust recognises that in 2014/15 there has
been a drop in the performance related to ensuring
patients that have sustained a fractured neck of
femur attend for surgery within 36 hours.
Each individual patient that breaches the 36 hour
target is currently discussed at the multi-disciplinary
trauma meeting and the patient’s pathway is
reviewed to identify delays and whether these could
have been avoided.
In many cases the delay in taking a patient to
theatre is due to the patient having co-morbidities
and requiring medical stabilisation prior to surgery.
However there are situations where the time of
admission and the volume of trauma cases can
result in delays.
The full year data is currently being reviewed and
is due to be presented at the Orthopaedic Audit
morning in June 2015 and further discussion at this
meeting will generate a list of actions that the Trust
can take to optimise performance.
Indicator 12 – Accident and Emergency
(A&E) waiting times
The year-end performance of A&E was 94.1%.
Overall, demand exceeded expectations throughout
2014/15 with a 9% growth in emergency
attendances and a 6% growth in emergency
admissions.
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Winter proved extremely challenging with
unprecedented numbers of emergency attendances
of greater than 16% during quarter 3.
The higher levels of activity coupled with the
complexity of the inpatient cohort has necessitated
utilisation of all escalation capacity for the
preceding 11 months. This has at times impacted
on patient flow creating an ‘exit block’ for patients
waiting in A&E to be admitted to an inpatient bed.
The Trust is undertaking a comprehensive
programme of work to transform the patient
pathway. The streams of work include expanding
the scope and capacity for ambulatory care in all
specialties, eliminating unnecessary waits during an
inpatient episode and expanding early supported
discharge.
In addition, the Trust has committed to undertake
a detailed diagnostic piece of work with Hillingdon
CCG to better understand demand for A&E
services. This piece of work will review the whole
of the patient pathway from attendance to the
department through to discharge from an inpatient
bed.
Indicator 13 – Number of last minute
elective operations cancelled for
non-clinical reasons
The Trust had less cancelled operations in 2014/15
compared to 2013/14 and performed within the
target range. Cancelled operations continue to
be a key focus for the organisation and we aim
to continue to decrease the number of operations
cancelled.
Indicator 15 – Percentage of women
who have seen a midwife or maternity
healthcare professional within 12 weeks
and six days of pregnancy
There is a continued drive to work with Hillingdon
CCG and Public Health Hillingdon to explore
ways of increasing awareness in the community
to encourage women to access maternity services
in a timely manner. Reducing the proportion
of Hillingdon women who access services late
05
continues to be a challenge. However we remain
committed to achieving this by working with our
partners in the CCG and Public Health, building
on the plans laid out in 2014-15. Once women
have made contact with the maternity service,
we continue to provide access to care within the
appropriate time frame. This data is shared with our
partner organisations periodically so as to inform
the delivery of the improvement plan.
Indicator 21- Outpatient local patient
experience survey
There continues to be detailed analysis of the FFT
and local patient experience survey provided by
patients attending outpatient departments. Current
feedback indicates that patients would like to be
seen at their allocated clinic time and if this is not
possible then to be notified by nursing staff of delay
time and reason for delay.
Actions which are being driven by the outpatient
matrons feature a feasibility project reviewing a
new piece of software that uses an application on
a smart phone allowing patients greater freedom
to interact with outpatient services. The system is
a free downloadable mobile app for smart phone
users or an automated voice and keypad for
non-smart phone users. Through the app patients
can be reminded of their pending appointment.
There is also a function where the patient can
alert outpatients’ reception if they are running late
for their appointment. This function is reciprocal
allowing enabling reception staff to notify patients
if their clinic is running late and give them the
option of waiting in a coffee shop or area of their
choice rather than in the outpatient waiting area.
Patients are contacted via their phone when their
appointment time is pending and asks them to
proceed to outpatients for their clinic appointment.
In conjunction with this new development matrons
continue to liaise with service managers to ensure
clinic capacity and templates are set correctly to
reduce delays occurring as routine.
During April outpatient departments commenced
a pilot to capture FFT feedback electronically.
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Patient experience trackers capture real time patient
feedback which facilitates greater flexibility to
review and disseminate results.
Indicator 22 – Maternity local patient
experience survey
The work with hard-to-reach groups remains
a priority for us with plans to engage with
the travelling and polish communities in
the forthcoming year. Feedback from these
communities during their interaction with our
services highlighted that they have different
expectations of maternity services. Friends and
Family Test in maternity has been in place for
over a year and we aim to increase the number
of respondents as the feedback gained from this
is invaluable to our engagement agenda. The
solutions implemented in response to comments
is displayed in each of the ward areas (You Said,
We did) to demonstrate how comments are acted
upon. Other engagement events have included
participation in the public open events such as the
May Fayre on The Green in West Drayton. Our
Home Birth team also set up a stand, weekly, at
the Bulls Bridge Tesco in Hayes sharing information
about services we provide. The results of the Picker
Institute national patient experience survey showed
a marked improvement in women’s experience of
the Hillingdon maternity services, placing us as one
of the top services in the sector. This survey was
repeated in February 2015 as part of the biannual
cycle and we expect to receive the results later in
the year.
the following scores: VHR 98% (meets target) and
HR 97% (exceeds target).
Indicator 24 – Percentage of complaints
responded to within agreed timescales
In 2014/15 the Trust received 397 complaints, of
which 99.2% were acknowledged within three
working days. As the investigation period is typically
30 working days, the number of complaints on
which responses were due during the financial year
differs because of investigation time overlap at the
beginning and end of the year.
The response rate for the year was 88.5% which
means that 371 of the 419 complaints were
answered within the timescale agreed with
the complainant. This represents a significant
improvement (14.9%) on the previous year and
reflects the impact of tighter controls implemented
from January 2014. The monthly performance
ranged from a low of 79.4% at the start of the year
through to 100%.
These performance improvements have been
achieved through a combination of the following:
• Full implementation of control measures within
•
•
Indicator 23 – Independent assessment of
cleanliness of hospital
The domestic technical cleaning scores for 1 April
2014 – 8 Feb 2015 are Very High Risk (VHR) areas
97% against the target of 95%; and High Risk (HR)
97% against a target of 92%. There is no available
benchmarking data as this has been a local cleaning
indicator. From 9 February 2015 we adopted
the NSC targets (as per CQC report) and audit
processes in their entirety and the VHR target rose
to 98% and the HR target to 95%. For the 7-week
period between 9 February 2015 and 31 March
2015 – against the new targets – the Trust achieved
132
•
the Complaints Management Unit (CMU) to
monitor timeliness and quality of responses from
Divisions.
Closer working relationships with the Divisions
to produce the best investigation outcome for
the complainant.
The Division of Medicine appointing a lead
Matron to co-ordinate all divisional complaint
responses and act as the principal point of
contact with CMU.
Provision of ad hoc training by the Complaints
Manager to emphasise the importance of
upholding the Ombudsman’s Principles.
Improving Patient Safety
During 2014/15 the Hillingdon Hospitals NHS
Foundation Trust joined the Imperial College Health
Partners (ICHP) Patient Safety Collaborative (PSC).
This is one of 15 new PSCs set up to help improve
the safety of patients and ensure continual learning
sits at the heart of healthcare in England. As the
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Academic Health Science Network (AHSN) for
North West London, ICHP will work with its partner
organisations and service users to focus on specific
areas of local clinical need. Its vision is to support
its partners to embed safety in every aspect of their
work. This means that:
• Patient and carer views are obtained and heard
•
•
•
at all levels as a critical indicator of safety;
There is a strong ethic of team working and
shared responsibility for patient safety;
Effective safety measurement and monitoring
systems are in place in all clinical settings; and
Clinical processes, practices, equipment and
environment ate standardised and simplified
Our PSC is forging ahead and making great progress
with a number of initiatives already underway.
The Hillingdon Hospitals NHS Foundation Trust is
involved in these key patient safety programmes of
work and these specifically are as follows:
• Foundations of Safety – a forum comprising
of leaders and patients from across NWL who
will be part of a two year programme being
developed in partnership with Ashridge Business
School. The programme will promote and foster
best practice from within the NHS and other
industries, and will be an opportunity to share
learnings and develop new initiatives across
NWL. The programme has over 45 members and
was launched on 24 March. The Trust has three
senior leaders attending this programme who
will share best practice and learning from the
collaborative leadership working across North
West London.
• Patient Safety Champion Network – a
network of service users, carers and citizens
from across NWL who want to get involved in
improving patient safety across NWL. In addition
to champions supporting the work, the ICHP
is keen to identify opportunities within partner
organisations for champions to get involved
in safety improvement projects. The Trust is
currently engaging with patients in our Sign up
to Safety campaign.
05
• Measuring and monitoring safety – The
ICHP is working with West London Mental
Health NHS Trust and West Middlesex Hospitals
NHS Trust, to test a measuring and monitoring
framework that aims to answer the question:
‘How safe is your organisation?’ The first
workshop for clinicians, managers and service
users was held on 20 March. This work will
be shared with ICHP with regard to roll out
across NWL. The Trust will actively participate in
its review of patient safety data based on the
proposed framework.
• Prescribing Improvement Model – This is
a pilot programme to improve pharmacists’
provision of feedback to doctors on their
prescribing errors – this aims to support better
communication between pharmacists and
doctors. The Trust’s pharmacy services are
actively engaged in this work.
ICHP are also engaging with key stakeholders on
developing a detailed strategy that will incorporate
locally identified priorities for improving medicines
optimisation including: visibility of patient journey
to all staff; staff capability development, funding
and resource.
Sign up to Safety campaign
The PSC programme of work is also aligned
with and supports the national Sign up to
Safety campaign which the Trust signed up to in
September 2014.
The Sign up to Safety campaign mission is to
strengthen patient safety in the NHS and make it
the safest healthcare system in the world. Sign up
to Safety aims to deliver harm free care for every
patient, every time, everywhere. It champions
openness and honesty and supports everyone to
improve the safety of patients.
The overall goal of the national campaign is to
reduce avoidable patient harm by 50 per cent and
save 6,000 lives over three years. These aims align
comfortably with the overall safety goals the Trust
already has in place.
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
The Trust has committed to: listen to patients,
carers and staff, learn from what they say when
things go wrong and take action to improve
patients’ safety. We want to give patients
confidence that we are doing all we can to ensure
that the care they receive will be safe and effective
at all times. The Trust has drawn up a Sign up to
Safety action plan to respond to the five key Sign
up to Safety campaign pledges listed below:
• Put safety first – commit to reduce avoidable
•
•
•
•
harm in the NHS by half and make public the
goals and plans developed locally.
Continually learn – make organisations more
resilient to risks, by acting on the feedback
from patients and by constantly measuring and
monitoring how safe their services are.
Honesty – be transparent with people about
their progress to tackle patient safety issues and
support staff to be candid with patients and their
families if something goes wrong.
Collaborate – take a leading role in
supporting local collaborative learning, so that
improvements are made across all of the local
services that patients use.
Support – help people understand why things
go wrong and how to put them right. Give staff
the time and support to improve and celebrate
the progress.
Four priorities have been identified as areas of
focus for the Trust as part of the campaign – these
are aligned to the priorities that are already set
out in the Trust’s overall strategy, the Clinical
Quality Strategy and with the menu of national
patient safety priorities. Some of these contribute
significantly to the numbers of incident reports
that are generated via the Trust’s incident reporting
system:
• Medication Errors
• Pressure Ulcers
• Patient Falls
• Acutely Ill Older People.
134
The Trust has formed a steering group with
key clinical leads who will support the safety
improvement work moving forward. A very
important part of the campaign will be to identify
safety champions in our workforce and our
patient groups.
Infection Control Prevention and Control
Meticillin Resistant Staphylococcus aureus
(MRSA)
The MRSA bacteraemia national target of zero
continues to be breached with one MRSA blood
stream infection (BSI) being reported for the Trust
for the month of July 2014 (Table 1). This continues
to be a challenge with a high turnover of patients
attending the Trust as both elective and emergency
cases. MRSA screening for elective is 100% and
emergency is 91.2% by the end of Q4.
Clostridium difficile infection (C diff)
There have been eight C diff cases reported for Q4,
taking the total for 2014/15 to 18; two cases over
the threshold. This equates to seven more cases than
when compared to the same Q4 period of 2013/14
(see Table 2).
The Trust has exceeded the national threshold and
monitor target. Root Cause Analysis (RCA) has
been undertaken on each case and further infection
control measures are being taken in order to
minimise the risk of further C diff infections. Isolate
typing has shown that there was no evidence of
cross infection. Learning from the RCAs has shown
that the patients affected have been elderly, acutely
unwell and requiring several courses of antibiotic
treatment, both within the hospital and in the
community, for acute infections.
NHS England has recently published the C diff
objectives for NHS organisations in 2015/16
and guidance on sanction implementation.
C diff objectives have been calculated using the
same methodology as for 2014/15. The Trust’s
05
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
new objective for 2015/16 is eight C diffs; this
calculation is based on C diff cases reported
during an indicative baseline period (Dec-2013 to
Nov-2014).
for 2015/16 which will be implemented in
the next financial year.
Meticillin Sensitive Staphylococcus aureus
(MSSA)
In Q4 one case of MSSA was attributed to the Trust,
taking the total reported to seven MSSA cases.
There is no mandated threshold for MSSA.
A meeting was held in March with the Deputy
Director of Infection Prevention and Control (IPC),
the Lead Nurse (IPC) and our commissioners to
discuss and agree the reporting and review protocols
Trust attributed MRSA bloodstream infections
3
2014-15
Number
Number
of casesof cases
3
2013-14
2014-15
2
2013-14
2
1
1
br
ua
ry
Fe
y
ar
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br
nu
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ar
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r
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r
r
m
ve
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er
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r
be
er
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be
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be
em
Se
pt
3
Trust attributed MSSA
r
st
sSt
ep
t
Au
Au
gu
y
Ju
l
ne
Ju
M
ay
ril
0
Ap
gu
ly
Ju
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ay
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Ap
ril
0
2014-15
2013-14
2014-15
2
2013-14
2
1
1
ua
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ar
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ry
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br
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y
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r
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m
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ay
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ay
ne
ril
Ap
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0
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Number
Number
of casesof cases
3
135
05
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Patient Experience –
listening to our patients
We aim to be a listening and learning organisation,
in which concerns that are raised by patients are
understood, shared and responded to. Listening to
feedback enables our staff to gain a real insight into
the patient’s experience of care. We use a number
of different approaches, all of which provide us
with information about what we are doing well and
where we need to improve.
• National and local surveys
• Friends and Family Test
• Compliments/Complaints
• PALS concerns
What our inpatients have told us:
95% for treating patients with
dignity and respect
88% for communication,
involvement and information
93% for confidence and Trust in
our doctors and nurses
89 % for meeting physical needs




Source: 2014/15 local inpatient survey (accessed 13.4.15,
based on responses from 2095 inpatients)
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
How we have responded to patient experience feedback
Complaint
• Pharmacy environment
•
•
and waiting times
Improved seating in the
waiting area
Introduction of a texting
and local buzzer system
to give patients the
choice to call back for
their medication when
its ready
Friends and
Family Test
• ‘The staff don’t always
introduce themselves to
me’
• Supported the national
Hello my name is....
initiative with a
local campaign that
encourages staff to
always introduce
themselves by name
and role
05
National and local
inpatient surveys
• Patients were unsure or
•
•
couldn’t find someone
to talk to about worries
or concerns
Name of the sister
and matron displayed
prominently outside
each ward and Matrons
now carry mobile
phones
A Working Together
booklet is given to
every patient has been
implemented, this sets
out who the patient/
family member can
talk to and includes an
escaltion process
Learning and continuously improving
National Patient Survey
A survey of inpatients is part of the annual
mandatory survey programme for acute Trusts;
this assists organisations to find out about the
experience of patients when receiving care and
treatment at their hospitals. The results of the 2014
survey are based on responses from 312 patients
who completed the survey, giving a response rate of
38%, the average response rate of all Trusts
was 47%.
Based on the patients’ responses to the survey the
Trust scored ‘About the Same’ as most other Trusts
that took part in the survey in nine out of the eleven
grouped sections and in the ‘worst performing
Trusts’ for two sections.
There is one question where the Trust has a score
that is significantly higher than the 2013 score:
• Staff explaining how the operation or procedure
had gone
And eight questions where the Trust has a score
that is significantly lower than the 2013 score:
• Length of time on the waiting list
• Admission date changed by the hospital
• Sharing sleeping area with the opposite sex
• Cleanliness of toilets and bathrooms
• Feeling threatened by other patients and visitors
• Getting answers that you can understand
from nurses
• Written information about what you should
or shouldn’t do after leaving hospital
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
• Hospital staff discussing whether additional
equipment or adaptions needed in home after
leaving hospital.
In comparison with others the Trust has been rated
as worse than most other Trusts in six questions
• How much information given about condition or
treatment in A&E
• Given enough privacy when being examined or
treated in A&E
• Cleanliness of room or ward
• Cleanliness of bathroom and toilets
• Clear answers to questions from nurses
• Nurses talking in front of you as if you weren’t
there?
There were no questions where the Trust scored
‘better’ than most other hospitals.
The CQC adult inpatient survey provides a helpful
annual check of our inpatients’ experience and
enables the Trust to compare our performance
with that of other Trusts. Overall the 2014 survey
results show that there are a number of areas
where patients have reported a worse experience
compared to the previous year.
138
Friends and Family Test
The Friends and Family Test (FFT) provides a
simple and standardised way of collecting patient
experience feedback. The FFT question asks patients
to consider their recent experience in the hospital
ward/department or clinic and rate how likely they
would be to recommend the area to a friend or
family member.
New guidance related to the FFT was published on
the 21st July 2014. This is following an extensive
review that we, along with many other Trusts
contributed to.
One of the main changes concerns the presentation
of results. The review demonstrated that the Net
Promoter Score (NPS) was not well understood by
either staff or patients and that alternative measures
would work better. It was felt that using a simpler
scoring system will increase the relevance of the
FFT data for frontline staff. The more transparent
scoring system will count likely and extremely likely as
positive. In future the proportion of positive responses
(extremely likely and likely to recommend) and the
proportion of negative responses (extremely unlikely
and unlikely to recommend) will be published.
The survey results have been triangulated with other
sources of feedback to help identify the themes
that should be our focus for improvement during
2015/16. There are a number of transformational
programmes underway that have links to the
areas for improvement to some of the themes set
out above including Transforming Inpatient Care
and workforce transformation. Improving patient
experience is identified as a positive outcome from
these programmes.
Patients should be given the opportunity to complete
an FFT survey; during 2014/15 over 26,600 took up
this opportunity and answered the FFT question. Our
results for this period are set out below.
Improving communication and involvement with
patients is embedded in priority four on this report,
we will be scoping out specific initiatives and actions
that will make a difference to these areas. The local
survey programme will enable the Trust to monitor
progress on any initiatives and report into the
Experience and Engagement Group.
Response rate and percentage of positive
and negative results for A&E
How do our FFT results compare
with others?
The graphs below show the FFT results and response
rate for A&E and inpatients for January 2015 (the
most recently published data).
The response rate for A&E in January is lower than
the England and London rate, focused work by the
A&E team has seen an improvement in February.
We do significantly better than England and
London in relation to the percentage of people
who recommend and do not recommend.
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Inpatient
92%
Positive
Responses
Inpatient
2%
Negative
Responses
Outpatients
94%
Outpatients
1.6%
Maternity
90%
Maternity
1%
A&E
92%
A&E
2%
Paediatrics
99%
Paediatrics
0%
Daycare
94%
Daycare
1.2%
Minor injuries
95%
Minor injuries
0%
Friends and Family Test: A&E
Data: Jan 15
94.6%
100.0%
88.1%
90.0%
87.0%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
5.8%
10.0%
0.0%
22.4%
20.1%
18.4%
6.6%
1.6%
England
Response Rate
London
Percentage Recommended
THHFT
Percentage Not Recommended
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05
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Friends and Family Test: Inpatient
Data: Jan 15
100.0%
94.9%
94.2%
90.0%
91.8%
80.0%
70.0%
60.0%
50.0%
40.0%
37.1%
35.8%
37.3%
30.0%
20.0%
10.0%
0.0%
1.8%
England
Response Rate
3.3%
0.5%
London
Percentage Recommended
THHFT
Percentage Not Recommended
Response rate and percentage of positive and negative results for Inpatients
The response rate for inpatients in January was very similar to the London rate and slightly higher than the England
rate. We have the lowest percentage of patient who would not recommend in relation to London and England. The
percentage of people who would recommend is very similar to the England score and higher than the London score.
What patients have told us is good about their experience
The doctor took time to listen
to my concerns and quickly
acted upon my symptoms of
dehydration. I am very grateful to
her and her team of nurses who
did their best to make my visit
comfortable and pain free.
140
The triage department
was great – made me
feel at ease and explained
everything. The midwives
and staff in the activity
suite were outstanding
but very firm when
needed. The support
throughout it all was
fantastic.
I attended ENT outpatients with
my 6 year old daughter. I was
extremely impressed with the
experience. I was made to feel
welcome in reception and shown
where to go. Examination and
treatment excellent. The staff in
clinic very friendly, professional
and competent. Many thanks for
a first class service
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
What patients have told us could be improved
05
It was good, except for the long
wait.
Action
We are investigating the use of a pager system that could
be offered to patients whose clinic may be delayed, this will
enable them to leave the department and go for a walk or
coffee and then receive a message when it is near to their
consultation time.
I have been given lots of
appointments which is good.
However, would be nice if the
appointments were all in the
same children’s centre
Action
There is work underway throughout the service to
coordinate the outpatient appointments to minimise the
disruption for the women who have challenging health
conditions needing multidisciplinary team care.
The care and staff on the ward
were brilliant, however it’s so
disorganised the communication
between staff overlaps and is
sometimes forgotten
Action
The Trust has a standard operating procedure for shift
handovers, Sisters and Charge Nurses were reminded that
they should be following the procedure. Further work will
be undertaken during 2015 to improve the quality of shift
handovers.
Staff Survey Headlines
The Trust appears in the top 20% of all Trusts
in 23 questions. This compares with last year’s
performance in which we ranked in the top 20% for
5 questions.
Of all the survey’s questions, 64 of them showed
improved results on last year’s. Ten questions were
static and our results were worse than last year’s in
14 questions. There are significantly more improved
than declining scores for 2014.
When compared with the national average, 71
of the questions showed better results than the
national average. We were at the average in 5
questions, and worse than the national average in
18 questions. There are significantly more superior
than inferior scores for 2014.
Our engagement score has risen every year for the
past 5 years and this year were ranked 13th out
of 135 Trusts in overall engagement. The overall
engagement score (out of 5) is 3.84 – better than
national average of 3.68 which has not increased
since 2013 and an increase on our last year’s score
of 3.77.
The top four ranking scores are –
• satisfaction with the extent the Trust values
•
•
•
people’s work
staff look forward to coming to work
there is effective communication between senior
managers and staff
staff feel able to make improvements
141
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
The Trust’s 3 most improved scores are –
1. Staff receiving equality and diversity training (up
by 16% to 72% at the time of survey)
2. Staff receiving health and safety training (up
12% to 78%)
3. Percentage of staff feeling pressure of work
(down 5% to 21%)
The results for ‘Patient Care being seen as the
Trust’s top priority’ put the Trust in the top 20%
of all Trusts, with 78% of staff agreeing (9%
above the national score of 67%) and only 6%
disagreeing (7% below the national score of 19%).
The remaining 16% include those who omitted to
answer the question, or responded ‘neither agree
nor disagree’.
Equality and Diversity
More than 90% of staff have completed equality
and diversity training and remain compliant with
refresher training. In response to the staff survey
results on limited career development and job
relevant training, we –
• Implemented new development programmes
for Agenda for Change Bands 3-5 and 6-7,
previously not included in internal Leadership
Programme, and rolled out the Leadership 100
programme to additional cohorts at Bands 8 and
above
In response to experiences of discrimination, the
Trust is embarking on a variety of projects including:
• Collaboration with national NHS project
involving one corporate and 5 clinical
representatives to explore race and
discrimination
• Cleansing of existing electronic staff record (ESR)
system data and the collection of more in-depth
data enabling monitoring and targeted analysis
• Commissioning external trainers to train
HR and managers in unconscious bias and
how to minimise it, as well as other training
opportunities
• Working across divisions to create an equality
impact analysis toolkit developing the method
for collecting learning and developing learner
142
•
statistics on uptake to ensure equal access to
training opportunities
Promoted “Ready Now” NHS Leadership
Academy programme for black and minority
ethnic communities (BME) staff.
Shaping a Healthier Future will increase work in
specific areas, including an increase in women from
Ealing attending for births, and new pathology
work, with the resulting expectation of staffing
levels increasing, with patients and service users
attending from communities with slightly different
profiles from Hillingdon.
There has been a 6% increase in our workforce
which is also increasing in diversity. The Trust is
committed to creating a working environment in
which its employees are treated fairly, feel valued
and are engaged. It is working hard to promote
equality in everything it does by embedding its
CARES values of which ‘equity’ is one.
Over the last three years, the percentage of
employees from the ‘White’ ethnic backgrounds
has fallen by 6%. This indicates a growing BME
workforce further increasing the balance and
diversity of our workforce.
The Staff survey results enable us to compare
metrics for the responses from white and BME staff
as follows:
For Key Finding 18 – the percentage of staff
experiencing harassment, bullying or abuse from
patients, relatives or the public in last 12 months is
27% for white staff and 28% for black staff.
For Key Finding 19 – the percentage of staff
experiencing harassment, bullying or abuse from
staff in last 12 months is 21% for white staff and
22% for black staff.
For Key Finding 27 – the percentage believing
that Trust provides equal opportunities for career
progression or promotion is 88% for white staff
and 71% for black staff. We have promoted the
NHS London Leadership Academy BME leadership
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
programme “Ready Now” across the Trust and
continue to monitor access to development
opportunities and equalities data.
Action Taken
• Data: Work is ongoing at improving our data
collection and reporting. This work has been
integrated in the action plan in the Workforce
Compliance Report.
• Apprenticeships: Over the last year the Trust has
invested in the expansion of its apprenticeship
scheme in clinical areas. The apprentices have
the opportunity to progress on to qualified
professional pathways at the end of their
apprenticeship. Further development is
expected this year with the extension of our
apprenticeship scheme to non-clinical areas.
These new roles will be created in hard to recruit
roles and enable succession planning in areas
where there are impending skills shortages thus
providing a talent pipeline for the future.
• Disability: Following an audit of our “two
ticks” symbol, it was recognised that recruiting
managers need to be made more aware of the
symbol.
• Workforce patterns: With respect to identified
patterns of workforce inequality (above),
05
further investigation is required through
baseline data validation. This will form part
of the action plan included in this report
with corresponding KPIs for monitoring as
appropriate over the next two years.
• Bullying and Harassment: The Trust has
prioritised work to tackle this issue and has
committed resources to this work. Results
from the 2014 staff survey have shown a slight
percentage shift in this area however this work
is long term and requires a whole cultural shift
to enable significant improvements in outcomes.
Work has included a Trust wide anti bullying and
harassment campaign.
• This campaign is further supported with training
for our CARES Ambassadors who will provide a
listening ear to staff who wish to report incidents
of bullying and harassment. Alongside this has
been investment in an independent initiative,
‘Speak In Confidence’ which will enable staff to
raise concerns to senior managers anonymously.
The response rate has reduced from 45% to 29%
which is disappointing and requires a campaign
of communication to reassure staff of their
confidentiality, and assure employees that we are
keen to address their concerns demonstrated by
the results.
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Annex 1 – Statements from our stakeholders
Statement from Hillingdon Clinical Commissioning Group (CCG)
12th May 2015
Hillingdon CCG
Boundary House, 2nd Floor
Cricket Field Road
Uxbridge
Middlesex
UB8 1QG
Shane DeGaris
Chief Executive
The Hillingdon Hospitals NHS Foundation Trust
Pield Heath Road
Uxbridge
UB8 3NN
SENT BY EMAIL ONLY ([email protected])
Dear Shane,
The Hillingdon Hospitals NHS Foundation Trust Quality Report 2014-15
Please find below the Lead Commissioner statement in relation to the 2014-15 Draft
Quality Report. We note that not all of the data and sections of the report were complete
at the time of our comments.
The Hillingdon Clinical Commissioning Group welcomes the opportunity to provide this
statement on The Hillingdon Hospitals NHS Foundation Trust Quality Report 2014-15.
We confirm that we have reviewed the information contained within the Report and
checked this against data sources where this is available to us as part of existing
contract/performance monitoring discussions and is accurate in relation to the services
provided.
We have reviewed the content of the Quality Report and confirm that this complies with
the prescribed information, form and content as set out by the Department of Health.
We believe that the Account represents an open, fair and robust summary of the
overview of the quality of care at the Trust for the services covered in the report.
We are encouraged by the Trusts achievements during 2014-15, including the
improved mortality rate, the 95.4% Harm Free Care and the results of the friends and
family test. We also note that despite the Trust not achieving their target for the number
of falls per 1,000 bed days, they have seen an overall reduction in the numbers, which
we hope the Trust will continue to see during 2015-16.
We acknowledge the progress made to date on specific goals for 2014-15 and the
areas of underperformance but would like to emphasise that these still remain areas
of focus and priority in the forthcoming year. In particular reduction in the number of
outpatient clinics cancelled, a reduction in the length of stay for patients over 65 years
and compliance with the Sepsis Care Bundle. We aim to see Home Safe being
Chair: Dr Ian Goodman
Chief Officer: Rob Larkman
COO: Ceri Jacob
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
05
expanded and effective and increased use of ambulatory care pathways and the
Surgical Assessment Unit which would prevent unnecessary admissions. The timely
management of patients with a fracture neck of femur has been acknowledged, and
having noted a recent dip, we would hope that the Trust would aspire to achieve the
xcellent standards they have done in the past.
We would like to commend the stable performance with a lower than expected range
of SHMI and are encouraged by the continued focus to reduce the variation between
weekdays and weekends.
We agree with the Trusts priorities for improvement for 2015-16 and welcome the focus
on improving the quality and safety of the health service they provide for the local
population.
We acknowledge the Trust are setting priorities in response to local and national
influence via Shaping a Healthier Future and the lessons from the University Hospitals
of Morecombe Bay NHS Foundation Trust. We agree with the continued focus on
Maternity care, particularly with the pending closure of Ealing Hospital’s maternity unit
and the increased activity the Trust will see following this.
Despite the increase in the uptake of the Friends and Family Test with 93% of patients
happy to recommend services to family and friends, we would aim to see improvement
in the compassionate care indicator moving forward. Further work is required by the
trust to improve the numbers of staff attending the CARES – customer care training
during 2015/16.
We note the improved response times to complaints, which we are sure will remain a
focus.
We are encouraged by the increased patient safety incident reporting rate which is
above the peer incident reporting rate and we support the continued focus the Trust
has to report patient safety incidents and ensure learning occurs as a result of the
severe incidents reported.
Hillingdon CCG continue to support the Trust’s focus on Quality by the continued
development of the Trust Clinical Quality Strategy. We support the Quality priorities for
2015-16 and are very happy to continue to work collaboratively with you to continue to
shape how the quality agenda continues to develop and moves forward both from a
commissioner and provider perspective.
We acknowledge the Trust underwent a CQG inspection in-year and we request the
Trust make every area highlighted by the CQC a priority, in particular;


Regulation 10 – Assessing and Monitoring;
Regulation 12 – Cleanliness and Infection Control.
Chair: Dr Ian Goodman
Chief Officer: Rob Larkman
COO: Ceri Jacob
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Hillingdon CCG will continue to work with you to monitor the progress of your action
plan following the inspection. We will be particularly interested in your progress in
relation to the the 5 compliance notices issued:





Regulation 16 - Safety and Suitability of Equipment;
Regulation 15 - Premises;
Regulation 13 - Medicine Management;
Regulation 20 - Records;
Regulation 22 - Staffing.
Overall we welcome the vision described within the Quality Account, agree on the
priority areas and will continue to work with the Trust to continually improve the quality
of services provided to patients and the local population.
We look forward to receiving the final version which will include an easy read format.
Yours sincerely,
Dr Ian Goodman
Chair Hillingdon CCG
C.c.: Theresa Murphy, Director of Nursing, The Hillingdon Hospitals Foundation NHS
Trust
Ceri Jacob, Chief Operating Officer, Hillingdon CCG
Carole Mattock, Joint Interim Director of Nursing and Patient Safety, BHH
Federation of CCGs
Pauline Johnson, Joint Interim Director of Nursing and Patient Safety, BHH
Federation of CCGs
Chair: Dr Ian Goodman
Chief Officer: Rob Larkman
COO: Ceri Jacob
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
05
Healthwatch Hillingdon’s response to The Hillingdon Hospitals NHS Foundation Trust
(the Trust) Quality Report 2014/15
Healthwatch Hillingdon’s response to The Hillingdon Hospitals NHS Foundation Trust (the
Trust) Quality Report 2014-2015
Introduction
Healthwatch Hillingdon wishes to thank the Trust for the opportunity to comment on the
Trust’s Quality Report for the year 2014-2015.
Healthwatch Hillingdon has a close working partnership with the Trust. We welcome their
continued commitment to engage with us and the value the Trust places upon our
relationship. We meet regularly with The Chief Executive Officer, the Chair and Director of
Nursing of the Trust. We are lead assessors for the Patient Led Assessment of the Care
Environment, and Healthwatch representatives sit on a number of important groups to
monitor patient experience and quality.
Through the effective communication mechanisms that are in place Healthwatch Hillingdon
are able to feedback patient experiences directly in a timely manner and provide support for
residents and their families in receipt of services at the Trust.
During our work we have witnessed and acknowledge the Trust’s commitment to improve
the quality of the services they provide and their desire to have a positive impact upon the
experiences of their patients.
This year the Trust has set up a quarterly quality meeting with Healthwatch Hillingdon
where we meet to check on the progress of existing priorities and receive insight into how
the Trust is performing against a number of quality indicators.
Healthwatch Hillingdon are also directly consulted during the process of setting each year's
priorities.
Quality Report
We must congratulate the Trust again this year that the Quality Report is well set out,
logical and easy to read. We would especially like to thank the Trust for acting on our
recommendations from last year by presenting quality priority achievements in a clearer
fashion, without ambiguous labels. This has added to the clarity of the report. We still feel
that it is not fully in a format that makes it easily assessable to a public audience. But we do
understand that the content of the report is determined by Monitor's technical guidance, and
the information NHS trusts are required to submit in their annual quality accounts.
We are again pleased that the Trust has been candid in its reporting and has acknowledged
where targets have not been met, as well as highlighting the areas which they have shown
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Registered Office: Healthwatch Hillingdon, 20 Chequers Square, The Pavilions Shopping Centre, Uxbridge UB8 1LN
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
an improvement. As last year we see the report as an honest and balanced assessment of the
Trust’s performance on the quality of their services.
We know how disappointed the Trust was following the results of the Care Quality
Commission’s (CQC) visit and we have seen the work which is being done to make the
necessary improvements.
In general there has been a good effort to meet the 2014-15 quality priorities. The Friends
and Family Test (FFT) scores are excellent and the response rates are equally impressive.
The Trust should also be congratulated on its improved mortality rates, patient safety
thermometer scores and its improvement in the NHS Staff Survey results.
The FFT score is a positive reflection of the care provided within the hospital and this is
further endorsed by survey results on compassion and the CQC care rating of good. This is
particularly pleasing when we consider the challenging year the Trust has had, with record
numbers of attendees at A&E and the record numbers of patients being admitted, with 3
additional wards open throughout the year.
We note that again this year there is only a 2 year comparison of performance in the Quality
Report and would recommend that where the priorities are part of a long term programme
that all previous years are also shown. This will show the general public a performance over
time which would demonstrate continuous improvement.
Quality Priorities 2015-16
We support the Trust in their choice of 2015/16 quality priorities and thank them for taking
into account the views of Healthwatch Hillingdon and the wider public membership.
We are especially pleased to see the following elements, which have been highlighted to us
by service users, carers and their families in the experience data we have gathered:
Improved discharge management, identifying improvements for people with physical
disabilities and the frail elderly in hospital and for those people who may lack the
capacity to consent, or who lack advocacy
Review the location of outpatient pharmacy and assess options to improve the patient
experience
The timely sharing and quality of A&E discharge summaries
With this work stream Healthwatch Hillingdon would ask that a copy of the summary is also
made available for patients at discharge from A&E. This has been raised by many patients
since electronic discharge was introduced and patients stopped receiving their copy.
 01895 272997 |  [email protected] | www.healthwatchhillingdon.org.uk
Registered Office: Healthwatch Hillingdon, 20 Chequers Square, The Pavilions Shopping Centre, Uxbridge UB8 1LN
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
05
Another area we would recommend the Trust adds to this work stream is timely notification
to GP’s of the results of outpatient appointments. This is area which we have reported to
the Trust that patients tell us is indifferent.
Improving maternity services
This will be a very important priority due to the possible closure of Ealing Hospital’s
maternity department under Shaping a Healthier Future. Healthwatch Hillingdon will be
carrying out some extensive engagement during this year with residents and will share its
results with the Trust.
One area which was not taken forward after the consultation was relocating the PALS office
to a more prominent position within the Trust for easier access for the public. We would like
to see the Trust consider this option outside of the quality priorities.
Conclusion
Next year is likely to be a pivotal year for The Trust. Changes are expected in maternity,
paediatric care and gynaecology within the Trust under the Shaping a Healthier Future
programme; the integrated care initiatives will start in earnest and there is a possibility
more acute services will be delivered in the community by the Trust.
The Trust is committed to improving the patient and carer’s experience of care and
Healthwatch Hillingdon looks forward to working closely with them, through these changes,
to see that quality continues to be monitored, maintained and improved.
Healthwatch Hillingdon 7th May 2015
Graham Hawkes, Chief Executive Officer
Summary of Recommendations
1. A copy of the discharge summary is made available for patients at discharge from A&E
2. Timely notification is sent to GP’s of the results of outpatient appointments
3. Relocation of the PALS office to a more prominent position within the Trust for easier
access for the public
 01895 272997 |  [email protected] | www.healthwatchhillingdon.org.uk
Registered Office: Healthwatch Hillingdon, 20 Chequers Square, The Pavilions Shopping Centre, Uxbridge UB8 1LN
Company Limited by Guarantee | Company Number: 8445068 | Registered in England and Wales | Registered Charity Number: 1152553
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Statement from External Services
Scrutiny Committee
Response on behalf of the External
Services Scrutiny Committee at the
London Borough of Hillingdon
The External Services Scrutiny Committee welcomes
the opportunity to comment on the Trust’s
2014/2015 Quality Report and acknowledges
the Trust’s commitment to attend its meetings
when requested. However, the Trust’s request for
the Committee to read the report and provide a
response within 15 days of receipt is unrealistic.
Furthermore, the draft version of the report sent
to the Committee highlighted a number of areas
which required further, or updated, information. The
inadequate state of this report and the omissions
therein has somewhat hampered Members ability to
comment on the content. This is clearly not ideal.
The Trust’s five Quality Priorities during 2014/2015
were:
1. Accessible and Responsive Services - continuing
to improve the outpatient experience
2. Improving Inpatient Care Project
3. Improving patient safety in Emergency and
Maternity Care
4. Introducing and embedding patient care bundles
/ pathways
5. Improve responsiveness to patient need
On a positive note, the Committee was delighted
to learn that the Paediatrics Team had won a
£50k innovation Challenge Prize for their schools
outreach work and received three commendations
in the national Quality Care Programme Awards.
Furthermore, of the 24,076 responses received by
the Trust in relation to the Friends and Family Test
in 2014, 93% of patients are happy to recommend
the Trust’s services to their family and friends. In
2014/2015, 89.3% of patients also stated that they
had had a positive experience of leaving hospital.
Although Members are encouraged by these results,
concern has been raised that these responses appear
to be inconsistent with the outcome of the recent
CQC inspection.
150
Although the Committee is reassured that the
early supported discharge workstream / “Home
Safe” has resulted in early discharge for one third
of those patients screened over the age of 65, it is
disappointing to note that the readmission rates at
Hillingdon have remained static over the last year.
With regard to discharges, it is noted that the
25% target was not achieved and only 23.1% of
patients were discharged before midday. Whilst it
is acknowledged that the inception of the Acute
Medical Unit (AMU) , the Surgical Assessment Unit
(SAU) and speciality based wards will go some way
to improving this outcome, the Committee would
like to be kept updated on progress at regular
intervals throughout the year.
Members are encouraged by the improvements that
have been made in relation to the FAIR assessment
(one of the indicators of the national dementia
CQUIN) following the appointment of a Clinical
Nurse Specialist for Dementia in October 2014.
Although the Trust had not met its 90% target for
screening and assessing all relevant patients in the
first half of the year, following this appointment
progress was made in achieving the target for
“find” in Q3 and Q4 and “assess and investigate”
in Q4.
Although the Committee recognises the amount of
work that has been undertaken by the Trust over
the last year with regard to achieving its Quality
Priority targets (and the wide range of pressures that
it has been under), it is disappointing to note that
a significant amount of statistical information was
missing from the draft report.
It is noted that the Trust has developed four key
areas for improvement in 2015/2016 on which the
following draft Quality Priorities for 2015/2016 have
been based:
1. Safeguarding - Ensuring the safety of vulnerable
and older people
2. Improving the safety of medicines management
and the experience of people requiring
medicines in the inpatient and outpatient
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
3. Improving maternity services
4. Improving Communication with our patients
Looking forward, there are areas where the Trust
continues to demonstrate that progress and
improvements have been made but the Committee
notes that there are a number of areas where further
improvements are still required. We look forward to
being updated on the progress of the implementation
of priorities outlined in the Quality Report over the
course of 2015/16.
The Hillingdon Hospitals NHS
Foundation Trust response to
the consultation
The Hillingdon Hospitals NHS Foundation Trust thanks
all its stakeholders for their comments about the
2014/15 Quality Report.
The Trust is pleased that our key stakeholders recognise
the Trust’s commitment to improve the quality of the
care and services that we provide and to work closely
with them in achieving further improvement. The
Trust enjoys a good working relationship with both
Healthwatch Hillingdon and with the Hillingdon Clinical
Commissioning Group and it looks forward to further
collaborative working to help shape the quality agenda
and the delivery of safe, high quality care.
The Trust is also pleased that its key stakeholders are
in agreement with its quality priorities for 2015/16,
recognising where we have made good progress
in quality improvement across a range of quality
indicators and also where further work needs to be
driven forward to realise the expected outcomes that
we wish to achieve. The Trust has taken comments
on board as part of the consultation for the Quality
Report and as such these are aligned with our
partners’ views on where we need to focus our efforts.
These are recognised by our key stakeholders and it is
very positive that both Healthwatch Hillingdon and our
local commissioners wish to continue to work closely
with us.
Our stakeholders have recognised and commended
our excellent scores on the FFT, our improved mortality
05
rates, our harm free care performance and the
improvement in the NHS Staff Survey results. Areas
of underperformance have been acknowledged
and the Trust would like to reassure its stakeholders
that these areas will continue to be a key priority for
the Trust and a focus in the forthcoming year.
The Trust acknowledges the concern raised by
the External Services Scrutiny Committee (ESSC)
in relation to the tight deadlines for response
to the draft Quality Report and that a number
of areas within the report required further, or
updated, information. The Trust has to work to
strict timelines for production of the Quality Report
and for the report to be submitted to Monitor. In
addition the Trust has to wait for final and approved
end of year data, all of which is not readily available
earlier in the month of April. The Trust is pleased
that the ESSC recognises the amount of work that
has been undertaken by the Trust over the last year
with regard to achieving its quality priority targets.
The Trust acknowledges and welcomes the
recommendations put forward by Healthwatch
Hillingdon. The Trust will endeavour to review these
elements during this forthcoming year to ensure
that progress is made to realise improvement in
these areas. The Trust will ensure Healthwatch
Hillingdon is updated accordingly.
Our stakeholders have recognised that we have
presented an honest and robust summary of
the overview of quality of care at the Trust,
acknowledging, alongside our achievements,
that some targets have not been met and that
we are committed to continue to make further
improvements in 2015/16. Our key stakeholders
have noted the findings of our announced Care
Quality Commission (CQC) inspection and we
will work with our commissioners to ensure that
the improvement plan is robustly monitored and
actively progressed.
We look forward to continuing our very positive
working relationships with our key stakeholders to
support the delivery of improved quality of care and
patient experience.
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Independent Auditor’s Report
to the Council of Governors of
The Hillingdon Hospitals
NHS Foundation Trust on the
Quality Report
Respective responsibilities of the
directors and auditors
We have been engaged by the council of governors
of The Hillingdon Hospitals NHS Foundation Trust to
perform an independent assurance engagement in
respect of The Hillingdon Hospitals NHS Foundation
Trust’s quality report for the year ended 31 March
2015 (the ‘Quality Report’) and certain performance
indicators contained therein.
Our responsibility is to form a conclusion, based
on limited assurance procedures, on whether
anything has come to our attention that causes us
to believe that:
• the quality report is not prepared in all material
respects in line with the criteria set out in the
‘NHS foundation Trust annual reporting manual’;
• the quality report is not consistent in all material
respects with the sources specified in ‘Detailed
guidance for external assurance on quality
reports 2014/15’; and
• the indicators in the quality report identified as
having been the subject of limited assurance in
the quality report are not reasonably stated in all
material respects in accordance with the ‘NHS
foundation Trust annual reporting manual’ and
the six dimensions of data quality set out in the
‘Detailed guidance for external assurance on
quality reports’.
This report, including the conclusion, has been
prepared solely for the council of governors of The
Hillingdon Hospitals NHS Foundation Trust as a body,
to assist the council of governors in reporting The
Hillingdon Hospitals NHS Foundation Trust’s quality
agenda, performance and activities. We permit the
disclosure of this report within the Annual Report
for the year ended 31 March 2015, to enable the
council of governors to demonstrate they have
discharged their governance responsibilities by
commissioning an independent assurance report in
connection with the indicators. To the fullest extent
permitted by law, we do not accept or assume
responsibility to anyone other than the Council of
Governors as a body and The Hillingdon Hospitals
NHS Foundation Trust for our work or this report,
except where terms are expressly agreed and with
our prior consent in writing.
Scope and subject matter
The indicators for the year ended 31 March 2015
subject to limited assurance consist of the national
priority indicators as mandated by Monitor:
• maximum time of 18 weeks from point of
referral to treatment in aggregate – patients on
an incomplete pathway , prepared on the basis
set out on page 129; and
• maximum waiting time of 62 days from urgent
GP referral to first treatment for all cancers.
We refer to these national priority indicators
collectively as the ‘indicators’.
152
The directors are responsible for the content and
the preparation of the quality report in accordance
with the criteria set out in the ‘NHS foundation Trust
annual reporting manual’ issued by Monitor.
We read the quality report and consider whether
it addresses the content requirements of the
‘NHS foundation Trust annual reporting manual,
and consider the implications for our report if we
become aware of any material omissions.
We read the other information contained in the
quality report and consider whether it is materially
inconsistent with:
• board minutes for the period 1 April 2014 to
29 May 2015;
• papers relating to quality reported to the board
over the period 1 April 2014 to 29 May 2015;
• feedback from Commissioners, dated 12 May
2015;
• feedback from governors;
• feedback from local Healthwatch organisations;
• the Trust’s complaints report published under
regulation 18 of the Local Authority Social
Services and NHS Complaints Regulations 2009;
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
• the latest national patient survey;
• the latest national staff survey;
• Care Quality Commission Quality Report dated
•
11 February 2015;
the Head of Internal Audit’s annual opinion over
the Trust’s control environment dated April 2015.
We consider the implications for our report if we
become aware of any apparent misstatements or
material inconsistencies with those documents
(collectively the ‘documents’). Our responsibilities do
not extend to any other information.
We are in compliance with the applicable
independence and competency requirements of
the Institute of Chartered Accountants in England
and Wales (ICAEW) Code of Ethics. Our team
comprised assurance practitioners and relevant
subject matter experts.
Assurance work performed
We conducted this limited assurance engagement
in accordance with International Standard
on Assurance Engagements 3000 (Revised) –
‘Assurance Engagements other than Audits or
Reviews of Historical Financial Information’ issued by
the International Auditing and Assurance Standards
Board (‘ISAE 3000’). Our limited assurance
procedures included:
• evaluating the design and implementation of the
key processes and controls for managing and
reporting the indicators;
• making enquiries of management;
• testing key management controls;
• limited testing, on a selective basis, of the
data used to calculate the indicator back to
supporting documentation;
• comparing the content requirements of the ‘NHS
foundation Trust annual reporting manual’ to the
categories reported in the quality report; and
• reading the documents.
A limited assurance engagement is smaller in scope
than a reasonable assurance engagement. The
nature, timing and extent of procedures for gathering
sufficient appropriate evidence are deliberately limited
relative to a reasonable assurance engagement.
Limitations
05
Non-financial performance information is subject to
more inherent limitations than financial information,
given the characteristics of the subject matter and
the methods used for determining such information.
The absence of a significant body of established
practice on which to draw allows for the selection
of different, but acceptable measurement
techniques which can result in materially different
measurements and can affect comparability. The
precision of different measurement techniques may
also vary. Furthermore, the nature and methods
used to determine such information, as well as the
measurement criteria and the precision of these
criteria, may change over time. It is important
to read the quality report in the context of the
criteria set out in the ‘NHS foundation Trust annual
reporting manual’ and the explanation of the basis
of preparation of the 18 week Referral-to-Treatment
incomplete pathway indicator set out on page 129
which sets out the approach the Trust has taken to
patients with “unknown” clock start dates.
The scope of our assurance work has not included
testing of indicators other than the two selected
mandated indicators, or consideration of quality
governance.
Basis for qualified conclusion
As set out in the section on pages 129 and 130
of the Trust’s Quality Report, the Trust identified a
number of issues in respect of data quality in its 18
week Referral-to-Treatment reporting during the
year. The key issues include cases where incorrect
pathway start dates or stop dates are being applied
for which corrective action has been taken on
a number of cases through the Trust’s internal
validation processes during the year.
We performed substantive procedures on a limited
sample of cases which confirmed the variety and
nature of issues identified by Management. As a
result of the issues identified, we have concluded
that there are errors in the calculation of the 18
week Referral-to-Treatment incomplete pathway
indicator. We are unable to quantify the effect of
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
these errors on the reported indicator for the year
ended 31 March 2015.
Qualified conclusion
Based on the results of our procedures, except
for the matters set out in the basis for qualified
conclusion paragraph above, nothing has come to
our attention that causes us to believe that, for the
year ended 31 March 2015:
• the quality report is not prepared in all material
respects in line with the criteria set out in the
‘NHS foundation Trust annual reporting manual’;
• the quality report is not consistent in all material
respects with the sources specified in ‘Detailed
guidance for external assurance on quality
reports 2014/15’; and
• the indicators in the quality report subject to
limited assurance have not been reasonably
stated in all material respects in accordance with
the ‘NHS foundation Trust annual reporting
manual’.
Deloitte LLP
Chartered Accountants
St Albans
29 May 2015
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Annex 2
Statement of Directors’
responsibilities in respect of the
Quality Report
– the latest national patient survey published
21s May 2015
– the latest national staff survey dated 18th
February 2015
– the Head of Internal Audit’s annual opinion
over the Trust’s control environment dated
13th April 2015
– CQC Intelligent Monitoring Report dated
14th May 2015
The Directors are required under the Health Act
2009 and the National Health Service (Quality
Accounts) Regulations to prepare Quality Accounts
for each financial year.
Monitor has issued guidance to NHS foundation
Trust boards on the form and content of annual
quality reports (which incorporate the above legal
requirements) and on the arrangements that NHS
foundation Trust boards should put in place to
support the data quality for the preparation of the
Quality Report.
In preparing the Quality Report, Directors are
required to take steps to satisfy themselves that:
• the Quality Report presents a balanced picture of
•
•
•
• the content of the Quality Report meets the
•
requirements set out in the NHS Foundation
Trust Annual Reporting Manual 2014/15 and
supporting guidance
the content of the Quality Report is not
inconsistent with internal and external sources of
information including:
– board minutes and papers for the period
April 2014 to 27th May 2015 (date of
statement)
– papers relating to quality reported to the
Board over the period April 2014 to 27th
May 2015 (date of statement)
– feedback from commissioners dated 12th
May 2015
– feedback from governors dated 5th May 2015
– feedback from local Healthwatch
organisations dated 7th May 2015
– feedback from Overview and Scrutiny
Committee dated 5th May 2015
– the Trust’s complaints report published under
regulation 18 of the Local Authority Social
Services and NHS Complaints Regulations
2009, dated 27th May 2015
05
•
the NHS foundation Trust’s performance over the
period covered
the performance information reported in the
Quality Report is reliable and accurate
there are proper internal controls over the
collection and reporting of the measures of
performance included in the Quality Report, and
these controls are subject to review to confirm
that they are working effectively in practice
the data underpinning the measures of
performance reported in the Quality Report is
robust and reliable, conforms to specified data
quality standards and prescribed definitions, is
subject to appropriate scrutiny and review and
the Quality Report has been prepared in
accordance with Monitor’s annual reporting
guidance (which incorporates the Quality
Accounts Regulations) (published at www.
monitor.gov/annualreportingmanual) as well as
the standards to support data quality for the
preparation of the Quality Report (available at
www.monitor.gov.uk/annualreportingmanual).
The directors confirm to the best of their knowledge
and belief they have complied with the above
requirement in preparing the Quality Report.
By order of the board
Shane DeGaris
Chief Executive
The Hillingdon Hospitals
NHS Foundation Trust
Richard Sumray
Chair
The Hillingdon Hospitals
NHS Foundation Trust
155
05
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Glossary
A
Ambulatory Care Pathway
Allows patients who are safe to go home to be managed promptly as
outpatients, without the need for admission to hospital, following an
agreed plan of care for certain conditions.
B
Berwick Review
Commissioned following the Mid Staffordshire Hospitals enquiry and
publication of the Francis Report. The review includes recommendations to
ensure a robust nationwide system for patient safety.
C
156
Call Management System (CMS)
A database, administration, and reporting application designed for complex
contact centre operations with high call volume.
Care Pathway
Anticipated care placed in an appropriate time frame which is written and
agreed by a multidisciplinary team.
Care Quality Commission (CQC)
The independent regulator of health and social care in England. www.cqc.
org.uk
Care Quality Commission (CQC)
Intelligent Monitoring System
A form of monitoring to give CQC inspectors a clear picture of the areas of
care that need to be followed up within an NHS acute Trust. Together with
local information from partners and the public, this monitoring helps the
CQC to decide when, where and what to inspect. 160 acute NHS Trusts are
grouped into six priority bands for inspection based on the likelihood that
people may not be receiving safe, effective, high quality care. Band 1 is the
highest priority Trust and band 6 the lowest.
Cellulitis
Cellulitis is an infection of the skin and the tissues just below the skin
surface. Any area of the skin can be affected but the leg is the most
common site.
Clinical audit
A quality improvement process that seeks to improve patient care and
outcomes by measuring the quality of care and services against agreed
standards and making improvements where necessary.
Clinical Negligence Scheme for
Trusts (CNST) – Maternity
Administered by the NHS Litigation Authority (NHSLA), provides an
indemnity to members / their employees in respect of clinical negligence
claims. Trusts are assessed on their level of risk management against
detailed standards.
Clostridium Difficile infection
(C-Diff)
A type of infection that occurs in the bowel that can be fatal. There is a
national indicator to measure the number of C. Difficile infections that
occur in hospital.
Comfort at Night campaign
This campaign supports reducing disturbances at night and includes
increasing staff awareness of the issue and changing staff attitude ensuring
that essential nursing and midwifery standards are applied.
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
05
Commissioning for Quality and
Innovation (CQUIN)
A payment framework enabling commissioners to reward quality by linking
a proportion of the Trust’s income to the achievement of local quality
improvement goals.
Community Acquired
Pneumonia
Inflammatory condition of the lung usually caused by infection and acquired
from normal social contact (that is, in the community) as opposed to being
acquired during hospitalisation.
Computerised Tomography (CT)
This is an X-ray procedure that combines many X-ray images with the aid
of a computer to generate cross-sectional views and, if needed, threedimensional images of the internal organs and structures of the body
D
Department of Health (DH)
The government department that provides strategic leadership to the NHS
and social care organisations in England. www.dh.gov.uk
Diabetic Ketoacidosis (DKA)
Consistently high blood glucose levels can lead to a condition called diabetic
ketoacidosis (DKA). This happens when a severe lack of insulin means the
body cannot use glucose for energy, and the body starts to break down
other body tissue as an alternative energy source. Ketones are the byproduct of this process. Ketones are poisonous chemicals which build up
and, if left unchecked, and will cause the body to become acidic – hence
the name 'acidosis'
Dr Foster
An organisation that provides healthcare information enabling healthcare
organisations to benchmark and monitor performance against key
indicators of quality and efficiency.
E
Eighteen (18) week wait
A national target to ensure that no patient waits more than 18 weeks from
GP referral to treatment. It is designed to improve patients’ experience of
the NHS, delivering quality care without unnecessary delays.
Electronic Document Records
System
This helps the Trust to manage clinical records in electronic format making
records management more efficient and ensuring patient records are more
accessible to clinicians.
157
05
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
F
FAIR assessment for dementia
Find, Assess, Investigate and Refer (FAIR) – The identification of patients
with dementia and other causes of cognitive impairment that prompts
appropriate referral and follow up after they leave hospital and ensures that
hospitals deliver high quality care to people with dementia and support
their carers.
Foundation Trust (FT)
NHS Foundation Trusts were created to devolve decision making from
central government to local organisations and communities. They still
provide and develop health care according to core NHS principles – free
care, based on need and not ability to pay.
Friends and Family Test (FFT)
An opportunity for patients to provide feedback on the care and treatment
they receive. Introduced in 2013 the survey asks patients whether they
would recommend hospital wards, A&E departments and maternity services
to their friends and family if they needed similar care or treatment.
G
‘Getting it right first time’ (GIRFT)
The ‘Getting it right first time’ (GIRFT) report published by Professor Briggs
in late 2012, considered the current state of England’s orthopaedic surgery
provision and suggested that changes can be made to improve pathways of
care, patient experience, and outcomes with significant cost savings.
Governors
The Hillingdon Hospitals NHS Foundation Trust has a Council of Governors.
Governors are central to the local accountability of our foundation Trust and
helps ensure the Trust board takes account of members and stakeholders
views when making important decisions.
GP Commissioners
GP Commissioners are responsible for ensuring adequate services are
available for their local population by assessing needs and purchasing
services.
H
158
Health and Social Care
Information centre (HSCIC)
The HSCIC is an Executive Non Departmental Public Body (ENDPB) set up
in April 2013. It collects, analyses and presents national health and social
care data helping health and care organisations to assess their performance
compared to other organisations.
Healthwatch (formerly LINk)
Healthwatch is a new independent consumer champion that gathers and
represents the views of the public about health and social care services in
England. http://www.healthwatch.co.uk
Hospital Episode Statistics (HES)
The national statistical data warehouse for the NHS in England. ‘HES’
is the data source for a wide range of healthcare analysis for the NHS,
government and many other organisations.
Hospital Standardised Mortality
Ratio (HSMR)
A national indicator that compares the actual number of deaths against
the expected number of deaths in each hospital and then compares Trusts
against a national average.
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
I
05
Indicator
A measure that determines whether the goal or an element of the goal has
been achieved.
Inpatient
A patient who is admitted to a ward and staying in the hospital.
Inpatient Survey
An annual, national survey of the experiences of patients who have stayed
in hospital. All NHS Trusts are required to participate.
K
Keogh Review
A review of the quality of care and treatment provided by those NHS
Trusts and NHS foundation Trusts that were persistent outliers on mortality
indicators. A total of 14 hospital Trusts were investigated as part of this
review.
L
Local Clinical Audit
A type of quality improvement project involving individual healthcare
professionals evaluating aspects of care that they themselves have selected
as being important to them and/or their team.
London Health Programme
Standards
Programme to improve the quality and safety of acute emergency and
maternity services based on achieving key standards of practice.
M
Mandatory
Mandatory means ‘must’ as outlined by an organisation for the role of the
staff member.
Magnetic resonance Imaging
(MRI)
Magnetic resonance imaging is a type of scan that uses strong magnetic
fields and radio waves to produce detailed images of the inside of the body.
Meticillin-resistant
staphylococcus aureus (MRSA)
A type of infection that can be fatal. There is a national indicator to
measure the number of MRSA infections that occur in hospitals.
Meticillin-sensitive
Staphylococcus aureus (MSSS)
MSSA can cause serious infections, however unlike MRSA MSSA is more
sensitive to antibiotics.
Monitor
The independent regulator of NHS Foundation Trusts. http://www.monitor.
gov.uk
Multidisciplinary team meeting
(MDT)
A meeting involving healthcare professionals with different areas of
expertise to discuss and plan the care and treatment of specific patients.
159
05
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
N
National Clinical Audit
A clinical audit that engages healthcare professionals across England and
Wales in the systematic evaluation of their clinical practice against standards
and to support and encourage improvement and deliver better outcomes in
the quality of treatment and care.
The priorities for national audits are set centrally by the Department of
Health and all NHS Trusts are expected to participate in the national audit
programme.
National Reporting and Learning
System (NRLS)
The National Reporting and Learning System (NRLS) is a central database
of patient safety incident reports submitted from health care organisations.
Since the NRLS was set up in 2003, over four million incident reports have
been submitted. All information submitted is analysed to identify hazards,
risks and opportunities to continuously improve the safety of patient care.
Neutropenic sepsis
Neutropenic sepsis is caused by a condition known as neutropenia, in
which the number of white blood cells (called neutrophils) in the blood
is low. Neutrophils help the body to fight infection. People having anticancer treatment, particularly chemotherapy and more rarely radiotherapy,
can be at risk of neutropenic sepsis. This is because these treatments can
temporarily lower the number of neutrophils in the blood.
Never events
Never events are serious, largely preventable patient safety incidents
that should not occur if the available preventative measures have been
implemented. Trusts are required to report nationally if a never event occurs.
NHS Litigation Authority (NHSLA)
Established to indemnify NHS Trusts in respect of both clinical negligence
and non-clinical risks. It manages both claims and litigation and has
established risk management programmes against which NHS Trusts are
assessed.
NHS number
A 12 digit number that is unique to an individual, and can be used to track
NHS patients between organisations and different areas of the country. Use
of the NHS number should ensure continuity of care.
O
160
Operating Framework
An NHS- wide document outlining the business and planning arrangements
for the NHS. It describes the national priorities, system levers and enablers
needed to build strong foundations whilst keeping tight financial control.
Outpatient
A patient who goes to a hospital and is seen by a doctor or nurse in a clinic,
but is not admitted to a ward and is not staying in this hospital.
Overview and Scrutiny
Committee (OSC)
OSC looks at the work of NHS Trusts and acts as a ‘critical friend’ by
suggesting ways that health-related services might be improved. It also
looks at the way the health service interacts with social care services, the
voluntary sector, independent providers and other Council services to jointly
provide better health services to meet the diverse needs of the area.
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
P
05
PAS- Patient Administration
System
The system used across the Trust to electronically record patient information
e.g. contact details, appointment, admissions.
Pressure ulcers
Sores that develop from sustained pressure on a particular point of the
body. Pressure ulcers are more common in patients than in people who are
fit and well, as patients are often not able to move about as normal.
Priorities for improvement
There is a national requirement for Trusts to select three to five priorities
for quality improvement each year. This must reflect the three key areas of
patient safety, patient experience and patient outcomes.
PROMs (Patient Reported
Outcome Measures)
PROMs collect information on the effectiveness of care delivered to NHS
patients as perceived by the patients themselves. Hospitals providing four
key elective surgeries invite patients to complete questionnaires before and
after their surgery The PROMs programme covers four common elective
surgical procedures: groin hernia operations, hip replacements, knee
replacements and varicose vein operations.
Pulmonary Embolism (PE)
A blood clot in the lung.
Pyelonephritis
A kidney infection that can cause an unpleasant illness which is sometimes
serious
R
Re-admissions
A national indicator. Assesses the number of patients who have to go back
to hospital within 30 days of discharge from hospital.
Root Cause Analysis (RCA)
A method of problem solving that looks deeper into problems to identify
the root causes and find out why they're happening.
161
05
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
S
162
Safety Thermometer
The NHS Safety Thermometer is a local improvement tool for measuring,
monitoring and analysing patient harms and ‘harm free’ care. http://www.
hscic.gov.uk/thermometer
Schwartz Round
This offers healthcare staff scheduled time to openly and honestly discuss
the social and emotional issues they face in caring for patients and families.
Secondary Uses Service (SUS)
A national NHS database of activity in Trusts, used for performance
monitoring, reconciliation and payments.
Sepsis
A potentially fatal whole-body inflammation (a systemic inflammatory
response syndrome) caused by severe infection.
Serious Incidents
An incident requiring investigation that results in one of the following:
• Unexpected or avoidable death
• Serious harm
• Prevents an organisation’s ability to continue to deliver healthcare
services
• Allegations of abuse
• Adverse media coverage or public concern
• Never events
Shaping a Healthier Future
(SaHF)
A programme to improve NHS services for people who live in North West
London bringing as much care as possible nearer to patients. It includes
centralising specialist hospital care onto specific sites so that more expertise
is available more of the time; and incorporating this into one co-ordinated
system of care so that all the organisations and facilities involved in caring
for patients can deliver high-quality care and an excellent experience.
Single sex accommodation
A national indicator which monitors whether ward accommodation has
been segregated by gender.
Statutory
Statutory means ‘by law’.
Summary Hospital-level Mortality
Indicator (SHMI)
The Summary Hospital-level Mortality Indicator (SHMI) is an indicator which
reports on mortality at Trust level across the NHS in England. The SHMI
is the ratio between the actual number of patients who die following
hospitalisation at the Trust and the number that would be expected to die
on the basis of average England figures, given the characteristics of the
patients treated there.
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
V
Venous thromboembolism (VTE)
05
An umbrella term to describe venous thrombus and pulmonary embolism.
Venous thrombus is a blood clot in a vein (often leg or pelvis) and a
pulmonary embolism is a blood clot in the lung. There is a national indicator
to monitor the number of patients admitted to hospital who have had an
assessment made of the risk of them developing a VTE
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163
06
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Statement of Accounting
Officer’s Responsibilities
164
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
STATEMENT OF THE CHIEF
EXECUTIVE’S RESPONSIBILITIES
AS THE ACCOUNTING OFFICER
OF THE HILLINGDON HOSPITALS
NHS FOUNDATION TRUST
The NHS Act 2006 states that the Chief Executive
is the Accounting Officer of the NHS Foundation
Trust. The relevant responsibilities of the Accounting
Officer, including their responsibility for the propriety
and regularity of public finances for which they are
answerable, and for the keeping of proper accounts,
are set out in the NHS Foundation Trust Accounting
Officer Memorandum issued by Monitor.
Under the NHS Act 2006, Monitor has directed
The Hillingdon Hospitals NHS Foundation Trust
to prepare for each financial year a statement of
accounts in the form and on the basis set out in the
Accounts Direction. The accounts are prepared on
an accruals basis and must give a true and fair view
of the state of affairs of The Hillingdon Hospitals
NHS Foundation Trust and of its income and
expenditure, total recognised gains and losses and
cash flows for the financial year.
06
The Accounting Officer is responsible for keeping
proper accounting records which disclose with
reasonable accuracy at any time the financial position
of the NHS Foundation Trust and to enable him/her to
ensure that the accounts comply with requirements
outlined in the above mentioned Act. The Accounting
Officer is also responsible for safeguarding the assets
of the NHS Foundation Trust and hence for taking
reasonable steps for the prevention and detection of
fraud and other irregularities.
To the best of my knowledge and belief, I have
properly discharged the responsibilities set out in
Monitor’s NHS Foundation Trust Accounting Officer
Memorandum.
Shane DeGaris
Chief Executive
28th May 2015
In preparing the accounts, the Accounting Officer
is required to comply with the requirements of the
NHS Foundation Trust Annual Reporting Manual and
in particular to:
• Observe the Accounts Direction issued by
Monitor, including the relevant accounting and
disclosure requirements, and apply suitable
accounting policies on a consistent basis;
• Make judgements and estimates on a reasonable
basis;
• State whether applicable accounting standards
as set out in the NHS Foundation Trust Annual
Reporting Manual have been followed, and
disclose and explain any material departures in
the financial statements;
• Ensure that the use of public funds complies
with the relevant legislation, delegated
authorities and guidance; and
• Prepare the financial statements on a going
concern basis.
165
07
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014-15
Statement of Directors’
Responsibilities in Respect
of the Accounts
166
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014-15
STATEMENT OF DIRECTORS’
RESPONSIBILITIES IN RESPECT
OF THE ACCOUNTS
The Directors are required under the National Health
Service Act 2006 to prepare accounts for each
financial year. Monitor, with the approval of the
Secretary of State, directs that these accounts give a
true and fair view of the state of affairs of the Trust
and of the Statements of Comprehensive Income,
Financial Position, Tax Payers Equity, Cash Flow and
all disclosure notes in the Annual Accounts.
In preparing those accounts, Directors are
required to:
• Apply on a consistent basis accounting policies
according to the NHS Foundation Trust Annual
Reporting Manual 2014/15 with the approval of
the Secretary of State;
• 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;
• Comply with International Financial Reporting
Standards.
07
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.
167
08
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014-15
Independent
Auditor’s Report
168
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014-15
INDEPENDENT AUDITOR’S REPORT
TO THE BOARD OF GOVERNORS
AND BOARD OF DIRECTORS OF
THE HILLINGDON HOSPITALS NHS
FOUNDATION TRUST
Opinion on financial statements
of The Hillingdon Hospitals
NHS Foundation Trust
In our opinion the financial statements:
• give a true and fair view of the state of the Trust’s
affairs as at 31 March 2015 and of its income
and expenditure for the year then ended;
• have been properly prepared in accordance with
the accounting policies directed by Monitor
– Independent Regulator of NHS Foundation
Trusts; and
• have been prepared in accordance with the
requirements of the National Health Service
Act 2006.
Going concern
08
We have reviewed the Accounting Officer’s
statement on page 165 that the Trust is a going
concern. We confirm that:
• we have concluded that the Accounting Officer’s
use of the going concern basis of accounting
in the preparation of the financial statements is
appropriate; and
• we have not identified any material uncertainties
that may cast significant doubt on the Trust’s
ability to continue as a going concern.
However, because not all future events or
conditions can be predicted, this statement is not a
guarantee as to the Trust’s ability to continue as a
going concern.
The financial statements comprise the Statement
of Comprehensive Income, the Statement of
Financial Position, the Statement of Cash Flows,
the Statement of Changes in Taxpayers’ Equity
and the related notes 1 to 31. The financial
reporting framework that has been applied in their
preparation is applicable law and the accounting
policies directed by Monitor – Independent
Regulator of NHS Foundation Trusts.
Qualified Certificate
We certify that we have completed the audit of the
accounts in accordance with the requirements of
Chapter 5 of Part 2 of the National Health Service
Act 2006 and the Audit Code for NHS Foundation
Trusts except that we have qualified our conclusion
on the Quality Report in respect of the 18 week
Referral-to-Treatment incomplete pathway indicator.
169
08
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014-15
Our assessment of risks of material misstatement
The assessed risks of material misstatement described below are those that had the greatest effect on our audit
strategy, the allocation of resources in the audit and directing the efforts of the engagement team:
Risk
How the scope of our audit responded to the risk
NHS revenue and provisions
There are significant judgments in recognition of
revenue from care of NHS patients and in provisioning
for disputes with commissioners due to:
• the complexity of the Payment by Results
regime, in particular in determining the level of
overperformance and Commissioning for Quality
and Innovation (“CQUIN”) revenue to recognise
• the judgemental nature of provisions for
disputes with commissioners and other
counterparties, including in respect of outstanding
overperformance income for quarters 3 and 4.
We evaluated the design and implementation of
controls over recognition of Payment by Results income.
The settlement of income with Clinical
Commissioning Groups continues to present
challenges, leading to disputes and delays in the
agreement of year end positions.
The majority of the Trust’s income comes from
NHS Hillingdon CCG (14/15: £135.7m and 13/14
£128.3m) and NHS England (14/15: £16.1m and
13/14: £16.5m), increasing the significance of
associated judgements. See note 24 of the financial
statements for key related parties. NHS receivables
at 31 March 2015 were £17.9m (13/14: £16.6m) of
which £6.3m (13/14: £5.7m) were provided against.
Property valuations
The Trust holds property assets within Property, Plant
and Equipment at a modern equivalent use valuation.
The valuations are by nature significant estimates
which are based on specialist and management
assumptions and which can be subject to material
changes in value.
We have agreed baseline contract income to underlying
contracts and checked a sample of significant year-end
income balances to activity data.
We have tested the year-end calculations for partially
completed spells and CQUIN income, and evaluated the
results of the agreement of balances exercise.
We performed detailed substantive testing of the
recoverability of overperformance income and adequacy
of provision for underperformance through the year.
We challenged key judgements around specific areas
of dispute and actual or potential challenge from
commissioners and the rationale for the accounting
treatments adopted. In doing so, we considered the
historical accuracy of provisions for disputes and
reviewed correspondence with commissioners.
We evaluated the design and implementation of
controls over property valuations, and tested the
accuracy and completeness of data provided by the
Trust to the valuer. We considered the qualifications,
experience and independence of the valuer.
We used our internal valuation specialists, Deloitte Real
Estate, to review and challenge the appropriateness of
The value of property assets subject to valuation at 31 the key assumptions used in the valuation of the Trust’s
March 2015 is £136.5m (13/14: £110.2m), comprised properties, including through benchmarking against
revaluations performed by other Trusts at 31 March
of land, buildings and dwellings totalling £117.4m
and investment properties of £19.1m). See note 1 for 2015.
the associated accounting policy.
We assessed whether the valuation and the accounting
treatment of the impairment were compliant with the
relevant accounting standards, and in particular whether
impairments should be recognised in the Income
Statement or in Other Comprehensive Income.
170
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014-15
08
Risk
How the scope of our audit responded to the risk
Going concern
International Accounting Standards and the NHS
FT Annual Reporting Manual require Management
to assess the Trust’s ability to continue as a going
concern. Where Management is aware of material
uncertainties in respect of events or conditions
that cast significant doubt upon the going concern
ability of the NHS Foundation Trust, these should be
disclosed in the financial statements.
We have reviewed and challenged Management’s going
concern assessment, financial plans and forecasts;
including sensitivity analysis and actions available to
address issues arising.
The description of risks above should be read in
conjunction with the significant issues considered by
the Audit Committee discussed on page 57.
disclosure matters that we identified when assessing
the overall presentation of the financial statements.
We have reviewed the Trust’s available cash flow
forecasts to the end of 2016/17, and a review of the
Trust’s financial plan for 2015/16 including the level and
achievability of the CIPs, and any relevant agreement
of capital and revenue funding from Monitor and the
The deficit at 31 March 2015 of £6.1m (13/14: £0.7m Department of Health.
deficit) and increasing pressure on bed capacity and
delivery of cost improvement plans has increased our
focus on the ability of the Trust to continue as a going
concern.
An overview of the scope of our audit
Our audit procedures relating to these matters were
designed in the context of our audit of the financial
statements as a whole, and not to express an opinion
on individual accounts or disclosures. Our opinion on
the financial statements is not modified with respect
to any of the risks described above, and we do not
express an opinion on these individual matters.
Our audit was scoped by obtaining an
understanding of the entity and its environment,
including internal control. The Trust does not
have any subsidiaries and is structured as a single
reporting unit and so the whole Trust was subject to
the same audit scope. We performed testing at both
of the Trust’s sites.
Our application of materiality
Audit work to respond to the risks of material
misstatement was performed directly by the audit
engagement team, led by the audit partner. The
audit team included integrated Deloitte specialists
bringing specific skills and experience in property
valuations and Information Technology systems.
We define materiality as the magnitude of
misstatement in the financial statements that
makes it probable that the economic decisions
of a reasonably knowledgeable person would be
changed or influenced. We use materiality both
in planning the scope of our audit work and in
evaluating the results of our work.
We determined materiality for the Trust to be
£2.2m, which is below 1% of revenue and below
1.7% of equity.
We agreed with the Audit Committee that we would
report to the Committee all audit differences in excess
of £0.1m, as well as differences below that threshold
that, in our view, warranted reporting on qualitative
grounds. We also report to the Audit Committee on
Opinion on other matters prescribed by
the National Health Service Act 2006
In our opinion:
• the part of the Directors’ Remuneration Report
to be audited has been properly prepared in
accordance with the National Health Service Act
2006; and
• the information given in the Strategic Report and
the Directors’ Report for the financial year for
which the financial statements are prepared is
consistent with the financial statements.
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014-15
Matters on which we are required to
report by exception
Annual Governance Statement, use of
resources, and compilation of financial
statements
Under the Audit Code for NHS Foundation Trusts,
we are required to report to you if, in our opinion:
• the Annual Governance Statement does not
meet the disclosure requirements set out in the
NHS Foundation Trust Annual Reporting Manual,
is misleading, or is inconsistent with information
of which we are aware from our audit;
• the NHS Foundation Trust has not made proper
arrangements for securing economy, efficiency
and effectiveness in its use of resources; or
• proper practices have not been observed in the
compilation of the financial statements.
We have nothing to report in respect of these
matters.
We are not required to consider, nor have we
considered, whether the Annual Governance
Statement addresses all risks and controls or that
risks are satisfactorily addressed by internal controls.
Our duty to read other information in the
Annual Report
Under International Standards on Auditing (UK and
Ireland), we are required to report to you if, in our
opinion, information in the annual report is:
• materially inconsistent with the information in
the audited financial statements; or
• apparently materially incorrect based on, or
materially inconsistent with, our knowledge of
the Trust acquired in the course of performing
our audit; or
• otherwise misleading.
In particular, we have considered whether we
have identified any inconsistencies between our
knowledge acquired during the audit and the
directors’ statement that they consider the annual
report is fair, balanced and understandable and
whether the annual report appropriately discloses
those matters that we communicated to the audit
172
committee which we consider should have been
disclosed. We confirm that we have not identified
any such inconsistencies or misleading statements.
Respective responsibilities of the
accounting officer and auditor
As explained more fully in the Accounting Officer’s
Responsibilities Statement, the Accounting Officer
is responsible for the preparation of the financial
statements and for being satisfied that they give a
true and fair view. Our responsibility is to audit and
express an opinion on the financial statements in
accordance with applicable law, the Audit Code for
NHS Foundation Trusts and International Standards
on Auditing (UK and Ireland). Those standards
require us to comply with the Auditing Practices
Board’s Ethical Standards for Auditors. We also
comply with International Standard on Quality
Control 1 (UK and Ireland). Our audit methodology
and tools aim to ensure that our quality control
procedures are effective, understood and applied.
Our quality controls and systems include our
dedicated professional standards review team.
This report is made solely to the Board of Governors
and Board of Directors (“the Boards”) of The
Hillingdon Hospitals NHS Foundation Trust, as a
body, in accordance with paragraph 4 of Schedule
10 of the National Health Service Act 2006. Our
audit work has been undertaken so that we might
state to the Boards 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 trust and the Boards as a body, for
our audit work, for this report, or for the opinions
we have formed.
Scope of the audit of the financial
statements
An audit involves obtaining evidence about the
amounts and disclosures in the financial statements
sufficient to give reasonable assurance that
the financial statements are free from material
misstatement, whether caused by fraud or error. This
includes an assessment of: whether the accounting
policies are appropriate to the Trust’s circumstances
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014-15
and have been consistently applied and adequately
disclosed; the reasonableness of significant
accounting estimates made by the Accounting
Officer; and the overall presentation of the financial
statements. In addition, we read all the financial
and non-financial information in the annual report
to identify material inconsistencies with the audited
financial statements and to identify any information
that is apparently materially incorrect based on,
or materially inconsistent with, the knowledge
acquired by us in the course of performing the
audit. If we become aware of any apparent material
misstatements or inconsistencies we consider the
implications for our report.
08
Craig Wisdom ACA Senior Statutory Auditor
for and on behalf of Deloitte LLP
Chartered Accountants and Statutory Auditor
St Albans, UK
28 May 2015
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014-15
Annual Governance
Statement
174
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014-15
ANNUAL GOVERNANCE
STATEMENT
1. Scope of responsibility
As Accounting Officer, I have responsibility
for maintaining a sound system of internal
control that supports the achievement of the
NHS Foundation Trust’s policies, aims and
objectives, whilst safeguarding the public
funds and departmental assets for which
I am personally responsible, in accordance
with the responsibilities assigned to me. I am
also responsible for ensuring that the NHS
Foundation 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 Foundation Trust Accounting
Officer Memorandum.
2. 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 Hillingdon
Hospitals NHS Foundation 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 Hillingdon Hospitals
NHS Foundation Trust for the year ended 31
March 2015 and up to the date of approval of
the annual report and accounts.
3. Capacity to handle risk
The Board is responsible for reviewing the
effectiveness of the system of internal control
including systems and resources for managing
all types of risk. The Trust Board approved Risk
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Management Strategy and Policy (including Board
Assurance Framework) ensures that the Trust
approaches the control of risk in a strategic and
organised manner. It sets out the responsibilities
of Executive Directors and Senior Managers in
relation to their leadership in risk management
and makes it clear that all employees have a role
to play in risk management appropriate to their
level. The Board has established a committee
structure to provide assurance on and challenge
to the Trust’s risk management process. Each of
these committees are chaired by a Non-Executive
Director to enhance this challenge, and the chairs
report formally to the Board to escalate issues that
require further Board discussion.
An example of this is the attendance at the Quality
& Risk Committee (QRC) of clinical and managerial
staff to present on quality assurance work and risk
management issues. At each QRC meeting a clinical
division, represented by the divisional management
team, presents on clinical and quality governance
issues providing an opportunity to discuss areas such
as clinical audit and progress of work in relation to
learning from clinical incidents and areas of risk –
this supports frank open discussions with Executive
and Non-Executive colleagues and the opportunity
to escalate, particularly where there is on-going risk.
The two main Board committees for risk
management are the Audit & Assurance Committee
(AAC) and the QRC. The AAC provides assurance
that there is a sound system of internal control
and governance. The QRC ensures that risks to the
delivery of the Trust’s services are identified and
addressed. Corporate risks are reported from ward
to Board/QRC via Divisional Governance Boards
using the online risk register managed by the
Trust’s Governance department. Local divisional/
department/ward risks are also managed using
the online risk management system. The Trust has
built on its accreditation of NHLSA level 2 status
attained in March 2014, and level 2 CNST for
the maternity services in April 2014, by ensuring
that the clinical divisions further strengthen their
clinical and quality governance arrangements. This
has been monitored at the Clinical Governance
Committee (CGC) reporting to the QRC. The CGC
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receives a bi-monthly report from each clinical
division outlining key areas of risk, progress against
national audit requirements, and review of key
patient safety indicators, clinical effectiveness and
patient experience data. Further impetus has been
afforded to this reporting for the key core service
areas following the results of the CQC inspection
of October 2014. The QRC provides assurance to
the Trust Board in matters relating to clinical quality
and standards of care. The Medical Director and
Director of Patient Experience & Nursing (DPEN)
together provide leadership in clinical and quality
governance, supported by the Clinical Director for
Quality & Safety and the Deputy Director of Nursing
& Integrated Governance.
In 2014/15 the Trust commissioned KPMG to
undertake a governance review, which took into
account the requirements of the Monitor and
CQC ‘well-led’ framework and sought to provide
background to the Board’s future commissioning of
a tri-annual review under Monitor requirements. This
followed from last year’s KPMG Quality Governance
review which reported favourably.
The review encompassed three areas:
• Assessing the effectiveness of the Board.
• Assessing the Board Committee structure and
the flow of information
• Assessing the effectiveness of the Council of
Governors.
The review was undertaken in June and July 2014
and included observation of a number of meetings
at the Trust (such as Board, Board Committee
and Council of Governors meetings); interviews
with Board members and Governors; surveys of
Board members and Governors; and an extensive
document review.
The overall position was positive, with a number
of areas identified to further strengthen the Trust’s
governance. The review concluded that the Trust’s
governance arrangements are
‘…well designed, operating effectively and provide
good governance, effective control and sound
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decision making processes for the Trust. The
component parts of the governance arrangements
work well together with mature understanding
of respective roles and responsibilities, particularly
within the Board of Directors and its subcommittees.
Individuals within the governance structure are
reflective and engaging in their approach to
challenge and ensure they are positively fulfilling
their governance responsibilities.’
However the subsequent findings of the CQC
inspection in October (overall rating of requires
improvement and 2 warning notices) raised issues
around the assurance processes in place at the Trust
and the Board’s oversight of aspects of standards. A
learning review into the outcomes of the inspection
is being undertaken, and the resulting actions to be
taken to strengthen governance from ward to Board
and will be a key priority for early 2015/16. CQC
findings are discussed in more detail in section 4.
The Board Assurance Framework (BAF) is a key
proactive risk identification tool for the Trust. The
Trust’s strategic objectives are reviewed annually,
and mapped into the BAF. The BAF aims to provide
the Board with assurance that significant threats to
achieving the principal Trust objectives have been
identified and are being appropriately controlled,
and that there is timely and reliable assurance in
place to evidence this. Actions within the BAF
address how assurances will be provided; or, where
assurances have identified inadequate controls,
how controls will be improved. The BAF provides
a structure for the evidence to support the Annual
Governance Statement. Any unacceptable residual
levels of risk remaining are further risk assessed and
added to the corporate risk register to ensure the
gaps in control are reduced or closed as soon as
reasonably practicable. The BAF has cross references
from the delivery of strategic objectives to the
corporate risk register; to regulatory standards e.g.
NHSLA, CQC in order to demonstrate where a
strategic objective links with a regulatory standard;
and to the monthly performance targets where
trends in poor performance exist. Following the
KPMG report the BAF has been strengthened
with the addition of an overall risk rating for each
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014-15
strategic objective; the assurances are branded
as either external or internal; an arrow indicator
to show if a control or assurance or risk level has
either stayed the same, strengthened or weakened.
The overall BAF risks and the remaining KPMG
considerations were reviewed in the March 2015
Board seminar. The BAF did highlight gaps in
compliance across the year for staffing, backlog
maintenance, statutory and mandatory training,
non-participation in all national audits, and medical
devices; these were clearly not closed down
sufficiently in-year.
The AAC and QRC have the opportunity to review
and shape the BAF at their quarterly meetings. The
Trust Board reviews the BAF twice a year and there is
an annual afore mentioned Board Seminar to refresh
the BAF.
There are structured processes in place for incident
reporting, the investigation of Serious Incidents and
following up outcomes from Board commissioned
external reports. The Trust Board, through the Risk
Management Strategy & Policy (including BAF) and
the Incident Policy (including Serious Incident (SI)),
promotes open and honest reporting of incidents,
risks and hazards. The Trust has a positive culture of
reporting incidents enhanced by accessible online
reporting systems available across the Trust. The latest
available National Reporting Learning System (NRLS)
report (September 2014) has shown the Trust to be in
the highest 25th percentile for incident reporting.
The Trust has fully implemented the Duty of
Candour (DoC) process from November 2014 when
this became law. The Being Open Policy has been
amended as has the Incident management including
SI policy, in order for staff to be clear on the steps
necessary to adhere to the statutory and contractual
elements of the DoC for incidents of moderate harm
or above. The Datix incident management system
forms have been adapted to alert the Governance
team when an incident has been classified as a DoC.
This means that the necessary steps are followed
and logged in order to be compliant with this
statute. A clear flowchart has been devised and
disseminated to relevant staff, along with a letter
09
template which will be used to communicate the
outcome of any DoC investigations to patients/
carers. The process is monitored via the Governance
Process Focus Group and the Clinical Governance
Committee by exception.
Clinical and non-clinical events that are assessed
using the Trust Incident (including SI) policy to
be a SI are forwarded to the Chief Executive or
designated Executive to confirm the incident is an SI.
Once declared, SIs are reported on the Department
of Health Strategic Executive Information System
(STEIS); to Monitor; and a bi-monthly update to
the Trust Board on the progress of investigation/
action progress and lessons learnt. Lessons learnt
are shared within clinical divisions at governance
board meetings and clinical governance forums/
audit days and across Divisions via the CGC and
other meetings, such as the Sisters/Charge Nurses’
meeting. Further information on the SIs, and the
actions taken as a result of the learning from these,
is included in the Quality Report.
The Patient Safety and Quality Report, which aims
to triangulate information on patient safety, patient
experience and clinical effectiveness is presented
quarterly at the QRC and the CGC. This includes
learning from SIs, complaints, claims and references
work that is being taken forward to reduce risk; it
also includes the provision of a quality dashboard
with red, amber green (RAG) rating against the
best available national/local standard and includes
exception reporting. Regular monthly reports
for complaints and incidents (including SIs) are
presented to each Divisional Clinical Governance
Board. This supports the triangulation of quality data
and more effective and critical decision-making.
Risk management training and awareness is
included in the mandatory ‘New Employees Week’
programme for all new employees. The Trust’s
Health and Safety team deliver risk management
training appropriate to all levels across the Trust
including the Trust Board. The Nursing Education
Skills Programmes are reviewed three monthly,
and updated to ensure the latest evidence-based/
best practices are incorporated. This would include
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014-15
learning from NPSA alerts and incidents that occur
which impact on clinical practice; for example
the EPIC3 National Evidence-Based Guidelines for
Preventing Healthcare-Associated Infections in NHS
Hospitals in England and the NICE clinical guideline
on Intravenous fluid therapy in adults in hospital.
This is now incorporated in training programmes,
bespoke ward sessions, and all ward areas are
informed about these changes.
The Board is committed to a culture of continual
learning and quality improvement. Where
appropriate, Internal Audit and clinical audit are
used to provide assurance that changes to practice
have become embedded. One example from clinical
audit was the undertaking of a re-admissions audit.
The main action from this was to implement a
rolling process of audit of re-admissions. This new
audit process will make it ‘business-as-usual’ for an
in-depth clinical investigation to occur every time a
patient is readmitted within 30 days of a previous
discharge. The daily review system uses technology
to create readmission alerts. Investigations are
completed in as real-time as possible and aim to
capture both the medical and, critically, the patient’s
perspective as to the causal factors leading to the
readmission. All results are electronically stored in a
central database to enable further trend analysis.
There continues to be an increased focus following
the publication of the Francis report on how we
critically review information on quality and what
type of data is received both at the Board and at
QRC. Major reports from healthcare regulators are
used to assess what lessons the Trust can learn from
noteworthy incidents and events in other healthcare
organisations in order to evaluate and improve our
practice. An intrinsic part of the Trust’s clinical quality
strategy; now in year two; is the implementation of
recommendations from the Francis report, Berwick
and Keogh reviews which highlight the importance
of patient safety and quality improvement and the
importance of each and every individual within the
organisation taking responsibility for this agenda.
The Trust continues to drive forward this strategy
via an annual action plan which is reviewed at
the QRC. Each division also develops an annual
178
quality action plan which is based on the overall
plan as part of their divisional business plan. To
support an improved safety culture and quality
improvement the Trust has pledged its’ commitment
to the national ‘Sign up to Safety’ campaign. The
campaign’s mission is to strengthen patient safety
in the NHS with the aim of delivering harm-free
care for every patient, every time, everywhere. It
champions openness and honesty and supports
everyone to improve the safety of patients. Some of
the key areas of focus as part of this campaign will
be to:
• Increase shared learning across the Trust when
things go wrong by ensuring there is good
divisional and department level feedback to staff
• Seek greater assurance on the links between
Board level quality objectives through to team
objectives and outcomes
• Deliver improvements in patient safety by
building our local capability and knowledge
through Patient Safety Collaboratives via our
Academic Health Science Network.
The Trust continues to review the nursing and
midwifery workforce using acuity and dependency
tools and other mechanisms, the focus is to
improve nursing/midwifery numbers and care at
the bedside. The Trust has been driving forward a
robust recruitment and retention work programme
to reduce the number of vacancies in our nursing
workforce and to support the increased activity
during this past year. The Trust will continue to
monitor the quality of care through patient surveys,
detailed and patient focussed nursing performance
templates, via the Patient Safety Thermometer
and via national and local clinical audit data. The
Trust critically reviews mortality data as part of
the mortality review process with shared learning
– this forms an integral part of our ambition to
ensure that we continue our work on reducing
hospital mortality, particularly the variation between
weekend and weekday mortality rates. During
April 2015 the Trust moved to a new clinically led
organisation with the appointment of 4 Divisional
Directors. The Divisional Directors, (who are
Medical Consultants) are accountable to the Chief
Operating Officer and responsible for the safe
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014-15
efficient management of the clinical divisions within
the Trust.
The Divisional Team is comprised of the Divisional
Director, Assistant Director of Operation and an
Assistant Director of Nursing, who work together
to provide robust management structure to provide
high quality efficient care.
4. The risk and control framework
The system of internal control is based on an
on-going risk management process that is
embedded in the organisation and combines many
elements. The aforementioned comprehensive
Risk Management Strategy & Policy (including
BAF) is available to all staff on the Trust’s intranet
site. All staff are responsible for managing risks
within the scope of their role and responsibilities
as employees of the Trust. The purpose of this
risk management policy is to ensure that the Trust
manages risks in all areas using a systematic and
consistent approach. The document describes the
Trust’s overall risk management process and the
Trust’s risk identification, evaluation and control
system, which includes the risk matrix used to
evaluate risks. Risks are identified reactively and
proactively.
All risks are assessed against one standard tool
this ensures that a consistent approach is taken
to the evaluation and monitoring of risk in terms
of the assessment of likelihood and impact. Risks
are monitored through a formal reporting process
where the assessed level of risk and its strategic
significance determines where it will be reviewed
and monitored. The monitoring of risks and action
plans have been undertaken by the Trust Board/Trust
Board committees during 2014/15.
These committees are supported by Executive
chaired committees/groups and Divisional
governance structures that channel information up
to and down from the Board/Board committees via
the online risk register.
Risk appetite as well as risk tolerance is covered in
the risk strategy. However, the risk strategy is due its’
09
three yearly review this calendar year; and together
with governance reflections on the current risk
evaluation matrix and the CQC Inspection findings,
the Trust has made a decision to review this strategy
ahead of time. The CQC found that the Trust had
tolerated risks on its risk register with apparent lack
of movement for several years a Board Seminar in
March 2015 discussed some elements of the Risk
Management Strategy & Policy and amendments
were made to risk appetite and risk tolerance
strengthened. These changes are summarised:
• Adoption of the NPSA risk evaluation matrix
• Target risk levels, including the date by which
this should be attained and frequency of risk
review agreed.
The Board and through its committees views risks
and the progress of actions designed to mitigate
risk, on an individual risk basis. The accepted risks
are reviewed at least annually by QRC/Divisional
Governance Boards to check that the controls for
these accepted risks still stand. QRC recommends
which corporate risks may be accepted based on
the level of the required resource; assurance that
all reasonable measures have been put in place to
mitigate any risks; and that there is assurance that
these are monitored regularly. Risk consequences
are considered as part of cost improvement plans,
business cases, capital expenditure projects and
staffing and workforce priorities regarding vacancy
authorisation. This ensures that the Trust is taking
account of the key inter-linking priorities and
dependencies of finance, operation and service
quality risk in order to deliver the best quality service
to patients.
The Trust Board reviews all of the high corporate
risks quarterly; the QRC reviews all the medium and
high corporate risks quarterly and the Divisional
Boards review all relevant risks at all levels quarterly.
From January 2015 the Trust Management Executive
(TME) have received and reviewed the high and
medium corporate risk register monthly. Part of the
review is to see what progress has been made to
close down the gaps in control and whether the risk
can be downgraded if sufficient measures have been
put in place to control the risk.
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Quality Governance
The key quality governance and leadership
structures that support the Trust in ensuring that the
quality of care is being routinely monitored across all
services and that poor performance or variation in
quality is challenged are:
• ‘Clinical Fridays’ allow the corporate nursing
• Monthly reporting to the Board via the quality
•
•
•
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and performance report. Each quarter the
QRC receives a more comprehensive Quality
and Patient Safety Report which looks at e.g.
mortality indicators – reviewing variance by
day of the week and performance in relation
to national and regional averages, nursing
quality indicators by ward and outcomes of
clinical audit with presentation of action plans
by clinical leads. It also includes information on
the key quality indicators that feature on the
Trust’s quality dashboard and other information
such as patient feedback from NHS Choices.
Any external/peer reviews, and a summary of
performance against KPIs in the Annual Quality
Report “Look forward” section are also reported
with escalation to the Board where required.
A detailed quarterly overview of complaints in
terms of themes and lessons learned and actions
taken; claims and litigation data; incidents
numbers, severity and themes by clinical division
and medium and high risks and actions being
taken to address is also received at QRC.
Clinical divisions review their quality data in
relation to patient safety, patient experience
and clinical effectiveness on a monthly basis at
their divisional governance boards; a divisional
exception report is received by the CGC and
any concerns on quality are escalated via this
Committee to the QRC.
SIs have a named executive lead and panel
reports are presented to the Board with resulting
actions reviewed bi-monthly until complete. Root
cause analysis is used and forms the basis of the
report together with the creation of action plans.
There is a programme of regular inspections
of clinical areas by the DPEN, Chief Executive
and other Board members giving them the
opportunity to talk to staff and patients about
their experience.
•
•
team and divisional senior nurses, alongside the
DPEN, to work with clinical staff on wards and in
departments to experience the environment and
delivery of care, engaging with staff and patients
and their carers. Any issues or concerns are
escalated accordingly to the Executive Team and
Trust Board, via the quality narrative within the
Quality and Performance report and the Putting
People First report.
There is a robust framework to ensure that
all service changes have a Quality Impact
Assessment (QIA) which is then reviewed by
the Medical Director. Any schemes where there
are quality concerns are reviewed at a multiprofessional Clinical Assurance Panel (CAP), with
the project leads presenting the scheme and the
actions being taken to mitigate any associated
risks to quality.
Listening to Patients/Governors: it is important
that there is a range of opportunities to support
patients in providing feedback and raising their
concerns. This is welcomed by the Trust as a
learning organisation which is always striving for
quality improvement. Patients can complete local
patient experience surveys, provide feedback
via the Trust website, via NHS Choices, in
person directly to department managers and
matrons or via the PALS/Complaints offices.
There is opportunity for patients and members
of the public to attend the Trust’s People in
Partnership (PiP) meetings and there are also
specialty-based focus and support groups where
patient feedback can be obtained. The Board
receives patient stories as part of understanding
the patient experience; this ensures that the
voice of the patient and their families/carers is
heard first hand by Board members; stories are
captured directly from patients via 1:1 interviews,
complaints and PALS feedback.
The following points are set out in our clinical
quality strategy; the Trust recognises that in
line with emerging best practice and national
quality improvement initiatives there are several
key strategic enablers that will support the
Trust to drive the quality agenda these include
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014-15
implementing improvements in relation to the
London Health Programme Emergency and
Maternity Care Standards; increasing and improving
our understanding of patient reports of clinical
outcomes; staff views/recommendations; and review
of our nurse to patient ratios. In addition the Trust
recognises the need to ensure that we have key
elements, such as accurate data collection and
analysis, more effective coordination, interpretation
and presentation of quality information at all levels
of the organisation, effective risk management and
clinical audit, systematic processes for assessing
the impact of service changes on quality, strong
clinical leadership and greater patient involvement
in improving services. Further information on
the quality of the Trust’s services and the Board’s
priorities for improving clinical quality is presented in
the Quality Report.
Care Quality Commission (CQC) Compliance
The Trust is not currently fully compliant with
the registration requirements of the Care
Quality Commission. The Trust was inspected
by the CQC in October 2014, and received the
final rating in February 2015. They rated the Trust
overall as ‘Requires Improvement’ (with inadequate
for ‘safe’; requires improvement for ‘effective’,
‘responsive’ and ‘well-led’; and a good rating for
‘caring’). Two Warning Notices were received on
Regulation 12: Cleanliness and Infection Control and
Regulation 10: Assessing and Monitoring the Quality
of Service Provision, and 5 Compliance Notices for
Regulation 13: Medicine Management, Regulation
15: Safety and Suitability of Premises, Regulation
16: Safety, Availability and Suitability of Equipment,
Regulation 20: Records and Regulation 22: Staffing.
The Trust commenced an intensive improvement
programme in December, building on the
improvement work commenced after initial
feedback by the CQC in October and appointed
an experienced Interim Director of Compliance
employed specifically to address compliance gaps,
manage the programme and monitor progress for
the Executive. The Executives are each accountable
for delivery of at least one regulatory improvement
plan with governance arrangements and assurance
09
that included twice weekly Trust-wide Sit-rep
meetings, weekly Executive meetings and Steering
Group and monthly updates to the Trust Board and
Clinical Quality Group (CQG) arm of the Clinical
Commissioning Group.
To ensure the Trust embeds the important changes it
is reviewing its current assurance processes:
• The Governance team examine the Intelligent
Monitoring report; and produces a tracker profile
for review by the Executive Team and senior
management. The results are challenged and
investigated where required and dialogue with
the CQC is raised as necessary. In July 2014 the
Trust was rated in band 6 the lowest risk band.
• Hitherto the process to provide assurance
on compliance with CQC registration
requirements has been that the QRC receives
a CQC compliance report twice yearly and
AAC annually. This report is produced by
the Governance team and is an outcomebased review of all the regulated outcomes
demonstrating where any concerns with
potential non-compliance are arising. This
process did highlight gaps during the year which
were clearly insufficiently closed.
In light of the CQC inspection:
• The Trust Board is closely monitoring the
progress against the key CQC actions and has
commenced a root cause analysis review of the
reasons which lead to Trust non-compliance.
• The CQG are working with the Trust to identify
gaps in their assurance processes and also
monitor and comment on progress of the Trust’s
improvement plan;
• Major changes have been made to the Trust’s
use of National guidance such as National
Specifications of Cleanliness (NSC), NHS Protect
Medicines Management tool and DH Guidance
on Safeguarding Children.
• Corporate risks rated moderate and above are
reviewed monthly at TME
• The Trust has commenced a revised programme
of mock-CQC inspections which aim to ensure
complete compliance against each regulation
and not only those found to be non-complaint;
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014-15
• The Trust’s Internal Audit programme will be
realigned to provide assurance against the
programme and the regulations with warning
and compliance notices.
The CQC have requested their first full progress report
which was delivered on 4th March. The CQC revisited the Trust on 5th and 7th May 2015. Pending
further information requests and the approval of the
CQC Board, the inspectors will likely recommend
the de-escalation of the Warning Notices against
regulations 10 and 12; regulation 10 likely to be
removed completely; regulation 12 likely to have
some follow up compliance actions; review the 4
red ‘inadequate’ ratings in the safety domain against
A&E, Medicine, Surgery and Services for Children to
see whether these can be upgraded. The inspectors
fed back that they observed many areas of excellent
practice which they will detail in their report.
Significant gaps in control
Gaps in control have been identified by the CQC
as stated.
Following a visit on 26th February 2015 by Health
and Safety Executive (HSE) Inspectors, the Trust
has been issued with an improvement notice for
failing to implement the Health and Safety (Sharps
Instruments in Healthcare) Regulations 2013 in a
timely manner. To meet the regulations fully the
Trust must substitute all traditional unprotected
medical sharps with a ‘safer sharp’ where it is
practicable to do so by 29th May 2015. Action
is underway to replace hypodermic needles and
butterfly needles by end April 2015. A trial of safer
scalpels to allow surgeons to identify appropriate
safer scalpels is to commence in April, with
introduction of the chosen devices by the beginning
of May 2015.
The organisation’s major risks
Clinical risks in-year:
• Suboptimal staffing issues in relation to
paediatric A&E nursing and medical staff;
suboptimal maternity staffing and escalation
wards (as identified in a Compliance Notice
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by the CQC in December). The presence of a
Paediatric Consultant in A&E 2-10pm every
day (except Sunday) means that there is not
an ongoing paediatric medical staffing risk
for 2015/16. Mitigations regarding overall
nursing staff include: regular national and
international recruitment drives; a biannual
staffing establishment review; monthly tracking
of nursing vacancies and report to the Director
of Nursing at the monthly Nurse & Midwifery
Assembly; Trust Board; QRC and Clinical
Governance Committee are tracking the CQC
action plan which includes safer staffing.
• Failure to meet hospital acquired infection
parameters; MRSA has breached the target of
zero by one case; Clostridium difficile infection
(CDI) the Trust exceeded the trajectory of 16
with a total of 18 cases. Mitigations included:
Delivery of the Infection Prevention & Control
(IP&C) strategy and annual action plan and
implementing ‘Start Smart, Then Focus’
antimicrobial prescribing guidance. Each
Trust attributed CDI case, through the Root
Cause Analysis (RCA) process, was assessed
with actions generated by this process being
implemented in a timely way. There will be close
monitoring of antimicrobial prescribing with
critical review at divisional governance boards
and the Infection Control Committee. Infection
control rates are reviewed by the Infection
Control Committee, QRC and the Board.
• Through unsustainable demand, uncontrolled
delays to the delivery timelines and an inability
to deliver the required clinical workforce NW
London Shaping a Healthier Future (SaHF)
delivers precipitate, poorly planned change,
which adversely impacts quality and safety.
A programme implementation governance
structure has been established to ensure that
there is involvement from all major stakeholders
and to monitor programme progress.
• Through an inability to meet the clinical
standards, deliver the requisite workforce, deliver
behavioural change, sustain expected patient
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014-15
experience and an unsustainable demand on
the system, SaHF does not deliver the planned
benefits to improve quality and safety of health
and care across NW London. Clinical standards
were approved in the Decision Making Business
Case and all providers are now creating
plans which support the delivery of these
standards – this will remain under review by the
Implementation Clinical Board.
Finance risks in-year:
• Financial – under delivery of Quality Innovation
Productivity and Prevention (QIPP) unplanned
demand for services and unplanned cost
pressures relating to CQC compliance with
a consequential risk to liquidity. This risk is
mitigated by robust project planning supported
by a rigorous monthly and quarterly performance
management framework, monthly formal QIPP
reviews and monthly Trust Board reporting. The
Trust has a committed working capital facility
equivalent to an additional 30 days of operating
expenses and an agreed contract with Hillingdon
Clinical Commissioning Group (CCG) that
reduces the risk of cash flow problems. The risk
of healthcare revenue falling and leaving the
Trust with a deficit in-year was in part mitigated
by an agreed contract based on a guaranteed
minimum financial value, with an agreed
marginal rate for over performance that was
enhanced further in-year due to unprecedented
unplanned demand. In addition, a £10m working
capital loan was agreed and utilised in-year
to reduce the Trust’s historically high payables
levels. Due to the mitigations put in place by
management during the year the Trust reduced
to a deficit of £2.5m what otherwise would have
been a far greater financial shortfall.
• Fragile estate infrastructure and scale of long
and short term investment required exceeds the
Trust’s financial capacity and leads to a failure of
the financial plan and interruption of/reduced
quality/safety of service delivery as identified by
the CQC. This comes under Regulation 15 of
the Health and Social Care Act 2008 (Regulated
Activities) Regulations 2010: Safety and
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Suitability of Premises. A strengthened emphasis
on and capacity for assessing compliance against
healthcare premises standards and then carrying
out any required remedial works will provide
more robust identification and management of
risks arising from the condition of the estate.
The condition of key building systems is assessed
by a 5 yearly survey of the estate condition,
risk assessed and rated against available capital
and supported by a robust planning process
and delivery management regime; the capital
expenditure plan for the estate has been
delivered for 2014/15 and is being planned for
2015/16. However, the available funds are very
unlikely to be sufficient to address many of the
shortcomings in the estate and reduce the risk
of failure of key systems. Regular environment
audits occurred e.g. Patient-led Assessment of
the Care Environment (PLACE) and mini PLACE
inspections to inform of any issues and improve
the environment of care where required. This
funding shortfall has been raised with both
Monitor and the Department of Health.
The main future risks facing the Trust are
summarised:
Future clinical risks:
• Failure to comply with Regulation (CQC, HSE)
e.g. the CQC warning notices on Cleaning &
Infection Control, Assessing and Monitoring
and compliance notices against Medicine
Management, Safety and Suitability of Premises,
Equipment, Records and Staffing. Failure in
compliance with any of the regulatory failings
puts patient and staff at risk of harm. Failing to
comply with the Warning Notices in the defined
timeframe specified by the CQC, could result in
the Trust being placed into Special Measures.
There is a Trust-wide improvement programme
for each of the CQC regulations breached.
Capital and revenue spend has been re-prioritsed
to address gaps related to specific CQC findings
and regulatory failings. Board evaluation work
has commenced on ‘lessons learnt’ to provide
sustainable change to safeguard against
regulatory failure in the future.
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• Through the transition of care to Hillingdon,
proposed by SaHF there is a risk that the Trust
is unable to maintain clinical quality as service
is transferred, impacting adversely on patients
and carers (particularly in relation to maternity
and paediatrics. The risks include not having the
available resource in place to safely manage the
additional workload. This is to be mitigated by
establishing clinical governance systems around
changes to and transfers of services, agreeing
key performance indicators and planning for
staged and safe transfer; allowing for possible
double running of services during transition; and
ensuring quality metrics are tracked post-change
so any undesirable trends can be identified and
rectified early. There is continued close working
with the Maternity and Paediatrics working
groups and clinical implementation groups to
develop transition plans.
• Failure to come within MRSA or C difficile
trajectory. The objective for 2015/16 has been
set at eight cases of CDI. Actions to mitigate
include: delivery of the IP&C strategy and annual
HCAI action plan, implementing actions from
RCA learning; and the ‘Start Smart, Then Focus’
antimicrobial prescribing guidance. Infection
control rates are reviewed by the Infection
Control Committee, QRC and the Board.
• Failure to deliver safe patient care may lead to
safeguarding issues; disparity over a seven day
service and failure of other quality measures
which may be as a result of inadequate staffing
provision. These risks are mitigated by embedding
early warning systems such as the National
Early Warning (NEW) scoring system with more
effective identification and earlier response to the
deteriorating patient; ward heatmaps reviewed
quarterly at QRC and monthly at divisional
governance boards and nursing performance
meetings. The newly appointed Safeguarding
Children Lead nurse will strengthen safeguarding
processes. At the clinically led steering group
agreement is sought with Trust stakeholders
regarding the seven day standard priorities these
then align with the contract and CQUIN.
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• Non-elective (emergency) demand continues to
increase at a rate that cannot be sustained by
the Trust. Non-elective activity increased last year
and peaked during September when there was
a 17% increase in the number of admissions.
If activity continues to increase at the rate seen
last year the Trust’s physical capacity would
become exhausted. This would represent a risk
to patient safety and considerable decrease in
patient satisfaction. The Trust would be unable
to maintain A&E or 18 week performance.
The Trust is working closely with the CCG to
manage demand and focus on a number of
admission and attendance avoidance schemes.
The Trust also has a number of mitigation plans
for managing demand including robust internal
escalation polices. All children are risk assessed
before being discharged from the resuscitation
department in A&E. The focus on greater use
of ambulatory care and in-reach rapid response,
coupled with length of stay reductions will give
the Trust greater capacity to manage surges in
demand. If demand continues to increase the
Trust has physical capacity at the Mount Vernon
site that could be commissioned given the
appropriate lead time.
• Due to unprecedented levels of emergency
activity the Trust has insufficient staff available to
meet demand. Last year the Trust experienced
significant staff shortages and became overreliant on bank and agency staff. In addition to
the financial impact, the use of agency staff can
lead to less effective ward management. This is
mitigated by the development of an extensive
nurse recruitment programme. The programme
targets local and overseas nurses and aims
to over recruit band 5, 6 and 7 nursing staff.
Agreements have been reached with a number
of nursing agencies to provide fixed term
contracts of agency staff. This gives the agency
nurse a guaranteed minimum hours contract
in return for agreeing to work for the Trust for
extended periods of time.
• Children with high acuity and complex medical
needs requiring high dependency care are
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014-15
currently being cared for on a general paediatric
ward that is not commissioned or staffed for this
level of care. Actions to mitigate this risk include:
The Trust continues to work with the CCG on
commissioning paediatric high dependency
beds; it is also likely that the SaHF programme
will see an increase in paediatric activity and
creating of a HDU for children. Monitoring of
this risk is via recording current levels of HDU
activity, incident reporting relating to HDU care/
staffing incidents; reports to Clinical Governance
& Risk Committee and Paediatric Clinical
Governance Committee bi-monthly.
Future financial risks:
• Commissioning risk that Hillingdon CCG’s
out of hospital strategy results in Trust deficit.
This will be mitigated by continuing to agree
contracts with Hillingdon CCG that promote
robust collaborative working and financial risk
sharing to redesign clinical pathways yet at the
same time provide sufficient revenue to cover
the Trust’s costs including guaranteed minimum
financial values that can be enhanced and or
fixed cost transitional support.
• Commissioning risk if the cost of activity is
not paid for in full then the Trust will have to
manage the additional financial risk. The form
of healthcare contract the Trust will agree
with its lead commissioner will guarantee a
minimum payment with an agreed rate of
over performance. However, as was the case
in the last financial year the minimum value
can be enhanced by negotiation to cover
justifiable excess costs of delivering service levels
above the agreed contract. Monthly formal
contract meetings with Hillingdon CCG as
lead commissioner are in place so financial and
service issues can be flagged and addressed
quickly is necessary.
• Recruitment to fill vacancy levels is insufficient
to enable the Trust to significantly reduce
its agency costs. This is being taken forward
by management as a priority with a focused
recruitment programme including overseas
09
initiatives and is subject to continual
management review.
• The level savings required in 2015/16 and its
impact on the quality of care provided. To
give the Trust the very best opportunity of
delivering its savings requirement in full a Project
Management Office (PMO) is in place to support
managers and clinicians to achieve identified
savings plans. They also play a key performance
role and support management to identify
additional savings schemes to mitigate underdelivery against the main plan. Throughout the
year weekly/fortnightly risk assessment allows
early sign of potential areas of non-delivery to
ensure mitigating actions are put in place to
prevent slippage or non-delivery. To manage
the service risk as robustly as possible all savings
schemes have a project initiation document that
requires risk assessment. Any significant risks
identified need a comprehensive Quality Impact
Assessment (QIA) that is reviewed by the Clinical
Assurance Panel (CAP) led by the Medical
Director. The CAP reviews, approves or rejects
any schemes, thereby assuring the organisation
that change and transformation programmes do
not pose a material risk to the delivery of safe,
high quality care. The CAP also reviews quality
KPIs related to projects to track any changes
alongside key changes to service delivery.
• The increasing cost of compliance to
meet statutory and regulatory service and
infrastructure standards particularly in light of
the recent CQC report and the need for major
investment in staff and the estate. This is being
addressed by management with a phased
approach to both revenue and capital investment
over the next two financial years. The Medical
Director, Nurse Director and Chief Operating
Officer have together reviewed the required
investment and prioritised first expenditure to
rectify and sustain warning notice and must-do
compliance issues. The financial consequences
of this process have been built into the Trust’s
2015/16 annual financial planning. In respect of
all the future financial risks highlighted above
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014-15
reasonable downside sensitivity analysis has
been undertaken and plans put in place that
although will not completely mitigate the risks
identified will however reduce the consequences
of their combined potential impact on the Trust’s
sustainability.
• Given the extent of the financial risks facing the
Trust in 2015/16 there is an increased likelihood
the cash required for day to day operations
and for investment could fall short of what is
required and start to impede on service delivery.
To manage this risk in addition to the £5.4m
cash balance at the start of the year and £4m
of assessed working capital headroom available
management have agreed some elements of
the 2015/16 contract with HCCG will be paid
upfront for the year. In addition, services invoiced
outside of the guaranteed minimum will be
added to the routine payment cycle thereby
increasing monthly cash flow.
Future Estate Risk:
• The estate has suffered from under-investment
over an extended period and many building
services have failed or are beyond their economic
and design lives. There is a risk that the Trust is
unable to access sufficient funding to sustain
safe services in the long term. Key facilities such
as theatres, Critical Care and many wards are
of a design and condition that does not lend
itself to safe healthcare without substantial
backlog and ongoing investment. A waste
incinerator that provides the majority of heat
to the Hillingdon acute site has a remaining
operational life of only 3-4 years. Investment
in energy efficiency has been very low and a
major replacement facility will be needed. Most
of the engineering plant is of 1960s vintage,
and some has fallen into disuse while others are
increasingly prone to failure. The optimum longterm solution is likely to entail re-providing core
facilities in a modern form, but this may require
capital beyond the capacity of the Trust.
• Public access to services and car parking
capacity; planning approval has been granted to
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temporarily increase the number of car parking
spaces available.
The Trust will remain focused on the tension between
quality, safety, financial efficiency, and risk to ensure
that patient care remains uncompromised. The Trust
will do this by having regular Board and Executive
reviews of progress and delivery of agreed plans and
check that all schemes are quality impact assessed.
Data Security
For data security, the Trust has an established
Information Security Management System (ISMS)
similar to that defined within the International
Standard (ISO) 27001. This entails the identification
and classification of information assets, risk
assessing those assets and then establishing control
frameworks to keep those assets secure. The Trust
has committed to establishing ISMS through its
compliance with the Information Governance
(IG) Toolkit. One key element of our compliance
is having a current Information Risk Policy. The
policy is supported by an Information Governance
Strategy and accompanying procedures. These set
out the arrangements for governing information risk
processes, i.e. the framework of accountability and
the roles and responsibilities of staff, management
and committees. Together these contribute to the
organisation meeting its legislative and regulatory
requirements, as well as meeting requirements
from the Health and Social Care Information
Centre for organisations to manage the security
of their information, defined within the IG Toolkit.
Compliance evidence for Version 12 of the IG Toolkit
has been uploaded to NHS Connecting for Health
and all requirements are at a level 2 or 3. Internal
Audit re-audited the IG toolkit in March 2015 and
gave substantial assurance.
The Trust has undertaken a programme of review of
its information security risks, based on an Internal
Audit. In 2014 audits were carried out on the
Trust’s malware controls and the power and uninterruptible power supplies (UPS) to its datacentres.
The Trust received substantial assurance rating for
its Malware controls. However, there was limited
assurance of the power and UPS, mainly because
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014-15
of the information provided during a period of
management change. A subsequent joint action
plan drawn up by Estates and ICT departments,
assured the AAC that there are adequate
management arrangements over power and UPS
and that the associated risks are being appropriately
managed. On 18th August 2014 there was a power
cut in the Hillingdon area and the supply to the
Hillingdon Hospital site was lost for 48 minutes. All
computer systems in the hospital datacentre were
maintained by the UPS and there was no disruption
to the ICT services. This incident provides further
assurance that these back-up systems are adequate.
Compliance with the NHS Foundation Trust
condition 4 (FT Governance): Corporate
Governance Statement
The Assistant Director of Governance & Quality
Standards has a system in place whereby compliance
with the NHS Foundation Trust condition 4 (FT
Governance) has been reviewed at least six monthly
over the past financial year. The October 2014
AAC were presented with an assurance report
that any risks identified by the Executive Team
relating to the delivery of the Annual Monitor
Corporate Governance Board Statements are
being managed appropriately. Each element of the
Corporate Governance Board Statements were
presented alongside assurance of compliance
which includes Internal and External Audits of Trust
practice. The report was taken in context with the
BAF and Corporate Risk Register. The principal
risks to compliance have been captured within
the risk section of this document. All statements
were ‘confirmed’ in the October AAC with no
risks to compliance identified. The layout of the
governance statements was simplified following
comments received at the October AAC and risks
and mitigations revised. These were then reviewed
by the Executive Team prior to their presentation at
the April 2015 AAC; ahead of Trust Board review to
‘confirm’ or ‘not-confirm’ the Corporate Governance
Board Statements. During the final preparation
process some residual material risks to compliance
were identified and some statements will be ‘not
confirmed’ and relevant mitigating actions have been
put in place as detailed in the CQC section above.
09
There have been some Internal Audit reports
reviewed by AAC giving ‘limited assurance’ this
year. In most cases actions have been taken to
close down the gaps; however further diligence
is required to drive them to timely completion.
Outstanding issues reside with some internal audit
actions and these are followed up by Internal Audit
and reported accordingly to AAC.
Public Stakeholders
The Trust involves its key public stakeholders with
managing the risks that affect them through the
following mechanisms:
• Engagement with the local Health Overview and
Scrutiny Committee
• Engagement with the Local Healthwatch
• The Council of Governors are consulted on key
issues and risks as part of the annual plan
• Regular People in Partnership Forums which
enables the Trust to listen to the views and
opinions of the communities we serve, share
information about what the Trust is doing, and
planned future developments, and provides
an opportunity for members to meet and
communicate with staff, Governors and fellow
members
• Annual Members Meeting
• Engagement with user and support groups e.g.
Fighting Infection Together, Maternity Services
Liaison Committee, People Improving Cancer
Services, Patient Transport Group and the
Patient-led Assessment of the Care Environment’
(PLACE).
• Inviting public members and local stakeholders
to identify priorities for our Quality Report.
Control measures are in place to ensure that all
the organisation’s obligations under equality,
diversity and human rights legislation are
complied with. Equality impact analysis/assessment
is carried out as standard procedure for all Trust
policies and new developments/service changes. An
equality and diversity toolkit is available for staff on
the Trust’s intranet to support them with completing
an EIA. In addition the Trust has published its
statutory equality & diversity reports: Workforce
Equality Compliance Report and the Service Equality
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014-15
Compliance Report providing assurance that the
Trust is compliant with equality legislation.
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.
The Hillingdon Hospitals NHS Foundation
Trust has undertaken risk assessments and
Carbon Reduction Delivery Plans are in place
in accordance with emergency preparedness
and civil contingency requirements, as based
on UKCIP 2009 weather projects, to ensure
that this organisation’s obligations under
the Climate Change Act and the Adaptation
Reporting requirements are complied with.
Adaptation reporting uses a risk assessment
approach; coupled with regular detailed buildings
condition survey, in conjunction with resilience
planning, based on weather-based risks e.g. heat
wave, extreme cold, drought, and flood.
5. Review of economy, efficiency and
effectiveness of the use of resources
The following key processes are in place to ensure
that resources are used economically, efficiently and
effectively:
• Scheme of Delegation and Reservation of
Powers approved by the Board sets out the
decisions, authorities and duties delegated to
officers of the Trust.
• Standing Financial Instructions detail the financial
responsibilities, policies and procedures adopted
by the Trust. They are designed to ensure that an
organisation’s financial transactions are carried
out in accordance with the law and Government
policy in order to achieve probity, accuracy,
economy, efficiency and effectiveness.
• Robust competitive processes are used for
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•
•
•
procuring non-staff expenditure items. Above
£25k, procurement involves competitive
tendering.
All procurement tendering activities are
published within nominated publications; in-line
with Public Contracts Regulations 2015; and
are advertised in line with Department of Health
guidance.
Saving schemes are assessed for their impact
on quality with local clinical ownership and
accountability.
Use of National and London benchmarking for
non-clinical support functions.
The Trust Board has gained assurance from the AAC
in respect of financial and budgetary management
across the organisation. The AAC also receives
quarterly reports regarding losses, special payments
and compensations (with high value – over £50K
approved by the Board), write-off of bad debts and
contingent liabilities. The AAC has reviewed levels
of charges for overseas visitors to ensure they take
account of the risk of non-payment. The value of
losses and special payments has reduced this year
and remain immaterial at less than 0.2% of the
Trust’s turnover.
The Board has a Transformation Committee that
meets quarterly to review the Trust’s transformation
programme and major strategic service change
business cases. This includes the use of information
technology to lever change.
Value for money discussions take place at a
management group chaired by the Chief Operating
Officer where the discussion is based on service
line reporting reviewing how much a service costs
to run versus the income it generates and how it
is performing both clinically and operationally. This
is particularly the approach used around services
where competition is greatest and/or where a service
is out to tender. Board Seminar sessions then look
at specific services and decide whether or not to
expand them.
Further information with reference to the Trust’s
financial future regarding the Going Concern
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014-15
assessment, is included in the Strategic Report of
this Annual Report. This draws specific attention to
the recent financial performance, the challenging
financial context facing the Trust and the
programme the Board is investing in to support the
delivery of the savings identified going forward.
There are a range of internal and external audits
that provide further assurance on quality of financial
data, economy, efficiency and effectiveness,
these include internal audit reports on creditors,
financial reporting and budgetary control,
healthcare contracting & payment by results, cash
management, cost improvement programmes, and
financial and activity data and clinical coding. These
are all reported to AAC.
Compliance with the Code of Governance
The Board has reviewed itself against the NHS
Foundation Code of Governance. The Board has
made the disclosures required by the Code in
the governance section of the Directors’ Report,
including explanations for non-compliance with
provisions of the Code. Attendance records and
coverage of work for each Board committee is also
included in this section of the annual report.
6. Information Governance
The Trust has had no data security/information
governance incidents categorised at level 2 on
the Information Governance Incidents reporting
Tool in 2014/15, therefore was not subject to any
investigations by the Information Commissioners
Office.
Low scoring minor incidents are reported and
monitored at the Information Governance Steering
Group which meets a minimum of four times a
year and is chaired by the Trust’s Senior Information
Risk Owner.
7. Annual Quality Report
The directors are required under the Health Act
2009 and the National Health Service (Quality
Accounts) Regulations 2010 (as amended) to
prepare Quality Accounts for each financial
year. Monitor has issued guidance to NHS
Foundation Trust Boards on the form and
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content of annual Quality Reports which
incorporate the above legal requirements in
the NHS Foundation Trust Annual Reporting
Manual 2014/15.
The Trust’s commitment to quality improvement and
quality governance is clearly outlined in its three year
clinical quality strategy; this describes a system of
quality performance management, and a clear risk
management process. Having the right structures
and processes in place allied to an appropriate
culture with supporting values and behaviours has
been strongly emphasised.
In addition, the Trust has used existing systems
for quality performance management to assess its
current position in relation to regional and national
performance. An annual quality action plan is
developed to support delivery of the strategy; this
in turn informs the business planning process and
the priorities identified for inclusion in the annual
quality report.
Information on quality is supplied to the Board,
its committees and the management team by the
Information and the Clinical Governance teams
who collect and maintain an oversight of quality
information. Alongside key quality indicators as
part of the quality dashboard, information is also
included on clinical audit, clinical incidents, SIs and
the learning from them, complaints and claims. This
flow of information ensures that key risks to quality
are identified. Quality Governance is led by the
DPEN and the Medical Director.
However, the findings of the CQC inspection
conducted in October 2014 raised concern over
the existing processes and systems that maintain
patient safety and ensure the delivery of quality care
– this includes the robustness and critical scrutiny of
the corporate risk register by senior management
and the tolerance of poor performance against
local and national standards and targets. The Trust
has recognised that it must demonstrate effective
and robust policies and processes to ensure risks
to patient safety are reduced alongside achieving
positive outcomes for patients.
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As part of its consultation on the annual quality
report the Trust has spoken with clinical staff
via Divisional governance board meetings, and
senior clinical and management staff meetings.
The Information Team has also undertaken a
triangulation exercise examining data sources that
they regularly analyse for potential underlying
issues of quality related to performance or data, not
otherwise identified.
All of the above has assisted the Trust be clear on its
targets. The Trust has reflected on the progress of
its priorities for 2014/15 and has discussed this with
its key stakeholders in order to agree new priorities
for 2015/16. Determining SMART objectives is
underway and this work is closely aligned with our
clinical quality strategy objectives and our overall
Trust Strategy.
The Trust has a comprehensive clinical audit work
plan covering both national and local audits. Regular
updates on clinical audit are reported to the QRC.
Following the CQC inspection in October 2014,
actions are being taken to strengthen compliance
with clinical audit processes. A new three year
clinical audit strategy is in production, which will
include giving dedicated time to clinical audit leads
ensuring all relevant national audits are completed,
and increase the number of action plans produced
and implemented following audits.
Nursing performance meetings continue to be
conducted on a monthly basis with the Deputy
Director of Nursing and each of the inpatient
wards’ senior sisters/charge nurses and the relevant
matrons. A nursing quality dashboard is reviewed
within these meetings to allow ward to Board
reporting. The dashboard is also presented to the
QRC on a quarterly basis.
A framework exists for the management and
accountability of quality of performance data and
data quality. This is supported by a comprehensive
audit programme and the Data Quality Policy, which
consist of a set of quality data groups that run
across the organisation. These groups report to an
Executive Director-led steering group which feeds
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quarterly into the AAC. These quarterly data quality
and performance quality reports cover the Monitor
compliance data, reported to the Board, and other
key data quality issues such as NHS number and
duplicate records. This, together with the data audit
results, and the use of Data Quality Badges which
are described in each monthly performance report,
provides assurance to the Board on data quality and
data performance issues and strength of internal
control. There will be a new integrated performance
report in 2015/16 which will give better indications
over quality metrics, early warning and trends to
enable swifter interventions to keep performance
on track. The quality of elective waiting time data
in particular will continue to be reviewed monthly
at the elective performance meeting and divisional
data quality groups, ensuring all elective lists are
managed and assessed on electronic systems. Two
key data areas have been identified this year where
further actions are being implemented:
1. NHS Number coverage on clinical systems – the
programme to integrate information systems is
continuing to address this with seven remaining
systems identified for 2015/16.
2. Trust Board Indicators assurance – regular review
and local auditing.
The priorities for the Annual Quality Report are
drawn together and shaped via a structured timeline
which engages our key stakeholders, such as our FT
membership, our Governors, our local Healthwatch
and local organisations from the third sector. Clinical
Divisions, the Clinical Governance Committee and
the QRC are all also actively engaged in the process.
This approach and the leadership involved ensure
the Quality Report represents a balanced view.
8. Review of effectiveness
As Accounting 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 NHS Foundation Trust who
have responsibility for the development
and maintenance of the internal control
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014-15
framework. I have drawn on the content of
the quality report attached to 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 Assurance Committee, Quality & Risk
Committee, and a plan to address weaknesses
and ensure continuous improvement of the
system is in place.
The process that has been used to maintain and
review the effectiveness of the system of internal
control centres on:
• Development, review and challenge of the BAF
which is compiled by Corporate Governance in
conjunction with the relevant Executive Directors
and their senior managers; the BAF is then
scrutinised quarterly at both the QRC and AAC
prior to being reviewed by the Board twice yearly.
The BAF is reviewed and challenged as described
in section 3 above. There is then an annual
examination and refreshing of the principal risks.
The BAF was strengthened following KPMG
recommendations in January 2015. On reflection
the BAF did detail some of the gaps in control
that the CQC inspection highlighted; however
insufficient regard was given by the organisation
and lessons have been learnt from this gap in
control as detailed in the CQC section above.
Internal audit have reviewed the BAF and
risk management arrangements and given
reasonable assurance that the Trust has in place
adequate and appropriate arrangements for
gaining assurances about the effectiveness of
the organisation’s system of internal control.
• The work of Internal Audit to review the Trust’s
key processes of financial and non-financial
internal control. The work-programme is risk
based, and findings reported to the AAC.
The Head of Internal Audit Opinion has given
09
‘reasonable assurance’ that there is a generally
sound system of internal control designed to
meet the organisation’s objectives, and that
controls are generally being applied consistently.
However, some weakness in the design and/
or inconsistent application of controls put the
achievement of particular objectives at risk.
• The governance review undertaken by KPMG
in the summer of 2014, gave positive overall
conclusions. This built on an earlier review
by KPMG into the Trust’s position against the
Monitor Quality Governance Framework in the
preceding financial year, which also reported
positively.
• Following the Board governance review, a
number of actions to improve the effectiveness
of the Board and Committees were undertaken.
These included revised cover sheets, with an
improved executive summary, which has been
rolled out across the Board and the Committees.
• A framework exists for the management and
accountability of quality of performance data
and data quality as detailed in section 7 above.
This, together with the data audit results and
input to the AAC, provides assurance to the
Board on data quality and data performance
issues and strength of internal control.
The cost improvement plan is always a challenge,
however the CAP provides me with assurance that
clinical quality should not be compromised. The
MRSA/C. difficile and 4 hour A&E targets were
tested alongside aspects of staffing; performance
remained within all specified targets except for 4
hour A&E target in quarter 3 and 4, and C. difficile
exceeded trajectory in quarter 4; the Trust managed
to attain a Continuity of Services risk rating score of
3 throughout the year.
On balance, I therefore conclude that the Board has
conducted a review of the effectiveness of the Trust’s
system on internal control and found them to be
challenged and requiring improvement. However,
I am satisfied that the measures that have been
191
09
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014-15
put in place following the CQC inspection findings
addresses the issues raised with respect to regulatory
compliance.
Given the National and London position with A&E
4 hour target, if the current levels of high demand
continue into 2015/16 this will remain a challenging
target alongside the reduced ceiling for C.difficile,
which has been set at 8 cases for 2015/16.
Conclusion
My review confirms that The Hillingdon Hospitals
NHS Foundation Trust has the following significant
control issues as identified in section 4:
Regulatory compliance issues with the CQC: two
Warning Notices for Regulation 12: Cleanliness and
Infection Control and Regulation 10: Assessing and
Monitoring The Quality of Service Provision and 5
Compliance Notices for Regulation 13: Medicine
Management, Regulation 15: Safety and Suitability
of Premises, Regulation 16: Safety, Availability and
Suitability of Equipment, Regulation 20: Records and
Regulation 22: Staffing.
HSE improvement notice for: failing to implement
the Health and Safety (Sharps Instruments in
Healthcare) Regulations 2013 in a timely manner.
The Trust Board will continue to proactively drive
forward the agreed actions to attain compliance
with the gaps identified against CQC and HSE
regulations. The Board has also put in place a review
process to learn from the issues raised by the CQC
in 2014/15 and will put in place further measures to
maintain compliance going forward.
Shane DeGaris
Chief Executive 28 May 2015
192
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
10
Annual Accounts
2014/15
193
10
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
ANNUAL ACCOUNTS 2014-15
Foreword to the accounts
The accounts for the year ended 31- March 2015 have been prepared by the Hillingdon Hospitals NHS Foundation
Trust in accordance with paragraphs 24 and 25 of Schedule 7 of the National Health Service Act 2006 in the form
which the Independent Regulator of NHS Foundation Trusts (Monitor) has, with the approval of the Secretary of
State, directed.
In order to present a true and fair view, the accounts of an NHS Foundation Trust must comply with International
Financial Reporting Standards (IFRS) as adopted by the European Union unless directed otherwise. These
accounting standards are published by the International Accounting Standards Board. The Annual Reporting
Manual is consistent with these standards which the Trust follows in preparing its accounts. Any departures from
these standards are agreed with the external auditors and the Audit and Assurance Committee.
Shane DeGaris
Chief Executive
28 May 2015
194
10
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
STATEMENT OF COMPREHENSIVE INCOME
Operating Income from patient care operations
NOTE
3
31 March 2015 31 March 2014
£000
£000
194,347
181,366
Other operating income
3
27,482
22,935
Total operating income from continuing operations
3
221,829
204,301
(225,839)
(199,610)
3
(4,010)
4,691
Finance income
8
17
19
Finance expense – financial liabilities
9
(2,014)
(1,819)
Finance expense – unwinding of discount on provisions
25
(73)
(63)
PDC Dividends payable
(3,897)
(3,572)
NET FINANCE COSTS
(5,967)
(5,435)
3,874
–
(6,103)
(744)
Operating expenses of continuing activities
OPERATING (DEFICIT)/SURPLUS
FINANCE COSTS
OTHER NON OPERATING INCOME
Increase in fair value of investment property
10
DEFICIT FOR THE YEAR
Other comprehensive income
Impairments charged to Reserves
12
(567)
–
Revaluations credited to reserves
12
12,744
–
6,074
(744)
TOTAL COMPREHENSIVE INCOME/(EXPENSE) FOR THE YEAR
The notes on pages 199 to 242 form part of these accounts.
195
10
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
STATEMENT OF FINANCIAL POSITION
NOTE
31 March 2015
31 March 2014
£000
£000
Non-current assets
Intangible Assets
11
2,980
2,141
Property, plant and equipment
12
136,708
124,637
Investment property
14
19,137
14,816
Trade and other receivables
18
967
1,435
159,792
143,029
Total non-current assets
Current assets
Inventories
17
2,778
2,943
Trade and other receivables
18
16,790
18,325
Cash and cash equivalents
19
5,483
5,733
25,051
27,001
184,843
170,030
Total current assets
Total assets
Current liabilities
Trade and other payables
20
(22,427)
(24,523)
Borrowings
21
(3,239)
(1,680)
Provisions
25
(957)
(168)
(26,623)
(26,371)
(1,572)
630
158,220
143,659
Total Current Liabilities
Net current (liabilities)/assets
Total assets less current liabilities
Non-current liabilities
Borrowings
21
(31,804)
(23,359)
Provisions
25
(2,314)
(2,272)
124,102
118,028
71,456
71,456
33,799
22,362
18,847
24,210
124,102
118,028
Total assets employed
Financed by taxpayers’ equity:
Public dividend capital
Revaluation reserve
Income and expenditure reserve
Total taxpayers’ equity
12.2
The financial statements on pages 195 to 198 were approved by the Board and authorised for issue on
and signed on its behalf by:
Shane DeGaris
Chief Executive
28 May 2015
196
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
STATEMENT OF CHANGES IN
TAXPAYERS’ EQUITY
Taxpayers' Equity at 1 April 2014
Deficit for the year
Transfers between reserves*
Total
Public Dividend
Capital
Revaluation
Reserve
£000
£000
£000
£000
118,028
71,456
22,362
24,210
(6,103)
(740)
Impairments
(567)
(567)
Revaluations
12,744
12,744
124,102
Income and
Expenditure
Reserve
(6,103)
–
Taxpayers' Equity at 31 March 2015
10
71,456
33,799
740
18,847
* Transfers between reserves is a depreciation adjustment required due to revaluations of land and buildings.
Taxpayers' Equity at 1 April 2013
Deficit for the year
Transfers between reserves
Public Dividend Capital received
Taxpayers' Equity at 31 March 2014
107,567
60,251
23,090
24,226
(744)
–
(744)
–
(728)
728
11,205
11,205
–
–
118,028
71,456
22,362
24,210
197
10
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
STATEMENT OF CASH FLOWS
NOTE
For the Year Ended
31 March 2015
For the Year Ended
31 March 2014
£000
£000
(4,010)
4,691
Depreciation and amortisation
8,648
8,043
Impairments
6,933
1,038
Cash flows from operating activities
Operating (Deficit)/Surplus
Non-cash income and expense:
0
(33)
(44)
(47)
1,856
(3,489)
165
99
(2,524)
2,348
758
264
11,782
12,914
17
19
(999)
(439)
(13,573)
(14,683)
0
50
(14,555)
(15,053)
0
11,205
10,000
0
(390)
(390)
(1,368)
(1,140)
Capital element of LIFT
(181)
(236)
Interest paid
(329)
(272)
Interest Element on Finance Lease
(286)
(192)
Interest Element on LIFT
(1,399)
(1,355)
PDC dividend paid
(3,523)
(3,654)
2,524
3,966
(Decrease)/Increase in cash and cash equivalents
(250)
1,827
Cash and Cash equivalents at start of year
5,733
3,906
5,483
5,733
(Gain) on disposal
Receipt of Donated Assets
Decrease/(Increase) in Trade and Other Receivables
Decrease in Inventories
(Decrease)/Increase in Trade and Other Payables
Increase in Provisions
Net cash generated from operations
Cash flows from investing activities
Interest received
Purchase of intangible assets
Purchase of Property, Plant and Equipment Exchequer
Financed
Sales of property plant and equipment
Net cash used in investing activities
Cash flows from financing activities
Public dividend capital received
Loans received from the Department of Health
Loans repaid to the Department of Health
Capital element of finance lease rental payments
Net Cash Generated from financing activities
Cash and Cash equivalents at end of year
198
19
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Note 1 Accounting Policies
1.1 Basis of Preparation
Monitor, the Independent Regulator of NHS
Foundation Trusts has directed that the financial
statements of NHS Foundation Trusts shall meet the
accounting requirements of the NHS Foundation
Trusts Annual Reporting Manual (FT ARM), as
agreed with HM Treasury. Consequently, the
following financial statements have been prepared
in accordance with the 2014-15 FT ARM. The
accounting policies contained in that manual follow
International Financial Reporting Standards (IFRS)
and the HM Treasury’s Financial Reporting Manual
(FReM) to the extent that they are meaningful and
appropriate to NHS Foundation Trusts. The particular
policies adopted by the Trust are described below.
They have been applied consistently in dealing with
items considered material in relation to the accounts.
1.2 Accounting judgments and key
sources of estimation and uncertainty
In the application of the Trust’s accounting policies
management is required to make judgments,
estimates, and assumptions about the carrying
amount of assets and liabilities that are not readily
apparent from other sources.
The estimates and associated assumptions are
based on historical experience and other factors
considered of relevance. Actual results may differ
from those estimates and underlying assumptions
are continually reviewed. Revisions to estimates are
recognised in the period in which the estimate is
revised, if the revision affects only that period, or
in the period of revision and future periods if the
revision affects both current and future periods.
The following are the areas that critical judgments
have been made in the process of applying
accounting policies at the end of the reporting
period that have a risk of causing a material
adjustment to the carrying amount of assets and
liabilities within the next financial year:-
• Going Concern
• Asset valuation and lives
• Impairments of receivables
• Provisions
• Accruals
10
The critical judgements are addressed in the
accounting policies that follow.
1.3 Going Concern
After making enquiries, the directors have a
reasonable expectation that the Foundation Trust
has adequate resources to continue in operational
existence for the foreseeable future. There is a
degree of uncertainty regarding outcomes which
may affect incoming resources to the Trust. Readers
of these accounts are advised to refer to the Annual
Governance Statement of the Trust for more detail.
The Trust has produced these accounts on a going
concern basis.
1.4 Accounting convention
These accounts have been prepared under the
historical cost convention modified to account for
the revaluation of property, plant and equipment,
intangible assets, inventories and certain financial
assets and financial liabilities.
1.5 Current / non-current classification
Assets and liabilities are classified as current if they
are expected to be realised within twelve months
from the Statement of Financial Position date, the
primary purpose of the asset and liability is to be
traded, or of loans and receivables where they have
a maturity of less than twelve months from the
Statement of Financial Position date. All other assets
and liabilities are classified as non-current.
199
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
1.6 Consolidation
The Trusts charitable funds would ordinarily under
IAS 27 be considered as a subsidiary entity in that
the Hillingdon Hospitals NHS Foundation Trust are
corporate trustees and as such exert control over the
uses of these funds. The Trust has decided not to
consolidate the charitable funds due to the immaterial
nature of the balances and instead the summary
details are shown by way of a separate note.
1.7 Income Recognition
Income in respect of services provided is recognised
when, and to the extent that, performance occurs,
and is measured at the fair value of the consideration
receivable. The main source of revenue for the Trust
is from NHS commissioners for healthcare services.
Where income is received for a specific activity that
is to be delivered in the following year, that income
is deferred.
Income from the sales of non-current assets is
recognised only when all material conditions of sale
have been met, and is measured as the sums due
under the sale contract.
1.8 Partially Completed Spells
The Partial Spells accrual relates to patients who
remain undischarged at 31/03/2015. The Trust reflects
income at the point of discharge in line with the
matching concept. The Trust have accrued income on
a per patient basis to 31/03/2015 based on average
tariff rates for the speciality. Ordinarily this activity
is coded once the patient has been discharged and
generated a Health Resource Grouper code to which
National Tariff rates are applied to calculate the
income. Hence an average tariff is applied based on
point of delivery and length of stay by speciality.
1.9 Expenditure on employee benefits
Salaries, wages and employment-related payments
are recognised in the period in which the service is
received from employees.
200
1.10 Pensions and other retirement
benefits
Past and present employees are covered by the
provisions of the NHS Pensions Scheme. Details
of the benefits payable can be found on the NHS
Pensions website at www.nhsbsa.nhs.uk/pensions.
The scheme is an unfunded, defined benefit
scheme that covers NHS employers, GP Practices
and other bodies, allowed under the direction of
the Secretary of State, in England and Wales. The
scheme is not designed to be run in a way that
would enable NHS bodies to identify its share of the
underlying scheme assets and liabilities. Therefore,
the scheme is accounted for as if it were a defined
contribution scheme: the cost to the NHS body of
participating in the scheme is taken as equal to
the contributions payable to the scheme for the
accounting period.
For early retirements other than those due to ill health
the additional pension liabilities are not funded by
the scheme. The full amount of the liability for the
additional costs is charged to the employer.
1.11 Other expenses
Other operating expenses are recognised when, and
to the extent that, the goods or services have been
received. They are measured at the fair value of the
consideration payable.
Expenditure is recognised in operating expenses
except where it results in the creation of a non
current asset such as property, plant and equipment.
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
1.12 Property, plant and equipment
Recognition
Property, plant and equipment is capitalised if:
•
•
•
•
•
•
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 will be supplied to,
the Trust;
the cost of the item can be measured reliably; and
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 a cost of more
than £250, where the assets are functionally
interdependent, they had broadly simultaneous
purchase dates, are anticipated to have
simultaneous disposal dates and are under single
managerial control; or
items form part of the initial equipping and
setting-up cost of a new building, ward or unit,
irrespective of their individual or collective cost.
Componentisation
Where a large asset, for example a building, includes
a number of components with significantly different
asset lives e.g. plant and equipment, then these
components are treated as separate assets and
depreciated over their own useful economic lives.
Valuation
All property, plant and equipment are measured
initially at cost, representing the cost 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. All assets are
measured subsequently at fair value.
Land and buildings used for the Trust’s services or for
administrative purposes are stated in the Statement
of Financial Position at their revalued amounts,
being the fair value at the date of revaluation less
any subsequent accumulated depreciation and
impairment losses. Revaluations are performed with
sufficient regularity to ensure that carrying amounts
are not materially different from those that would
10
be determined at the end of the reporting period.
Fair values are determined as follows:
• Land and non-specialised buildings – market
•
•
value for existing use
Investment Properties – market value and or net
rental income stream
Specialised buildings – depreciated replacement
cost
HM Treasury has adopted a standard approach
to depreciated replacement cost valuations based
on modern equivalent assets and, where it would
meet the location requirements of the service being
provided, an alternative site can be valued.
Properties in the course of construction for service
or administration purposes are carried at cost, less
any impairment loss. Cost includes professional
fees but not borrowing costs, which are recognised
as expenses immediately, as allowed by IAS 23
for assets held at fair value. Assets depreciation
commences when they are brought into use.
A full revaluation exercise took place in the 2014/15
financial year. In line with Treasury guidance,
where appropriate the revaluation was based on
a Modern Equivalent Assets replacement basis.
The valuation was carried out in accordance with
the Royal Institute of Chartered Surveyors (RICS)
Appraisal and Valuation Manual insofar as these
terms are consistent with the agreed requirements
of the Department of Health and HM Treasury. The
Surveyors were Gerald Eve.LLP on 31st January 2015.
The Trust carries out a full revaluation exercise at
least every five years unless the Trust considers
there has been significant market movement In the
intervening years. The Trust took advice from Gerald
Eve LLP who advised that there have been significant
market movements relating to the Trust’s land and
buildings for the 2014/15 financial year.
New fixtures and equipment are carried at
depreciated historic cost as this is not considered to
be materially different from fair value.
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
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.
Depreciation, amortisation and impairment
Freehold land, properties under construction, and
assets held for sale are not depreciated.
202
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.
Other impairments are treated as revaluation losses.
Reversals of other impairments are treated as
revaluation gains.
An impairment arising from a loss of economic
benefit or 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 income 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.
Otherwise, depreciation and amortisation are
charged to write off the costs or valuation of
property, plant and equipment and intangible noncurrent assets, less any residual value, over their
estimated useful lives, in a manner that reflects
the consumption of economic benefits or service
potential of the assets. The estimated useful life of
an asset is the period over which the Trust expects
to obtain economic benefits or service potential
from the asset. This is specific to the Trust and
may be shorter than the physical life of the asset
itself. Estimated useful lives and residual values
are reviewed each year end, with the effect of any
changes recognised on a prospective basis. Assets
held under finance leases are depreciated over the
lease period.
Revaluation Gains, Losses and De-Recognition
“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 income.
In accordance with the Foundation Trust Annual
Reporting Manual (FT ARM), impairments that
are due to a loss of economic benefits or service
potential in the asset are charged to operating
expenses. A compensating transfer is made from the
revaluation reserve to the income and expenditure
De-Recognition
Assets intended for disposal are reclassified as ‘Held
for Sale’ once all of the following criteria are met: 1)
the asset is available for immediate sale in its present
condition subject only to terms which are usual and
customary for such sales; 2) the sale must be highly
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’.”
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
probable i.e. management are committed to a plan
to sell the asset; or an active programme has begun
to find a buyer and complete the sale; 3) the asset is
being actively marketed at a reasonable price; 4) the
sale is expected to be completed within 12 months
of the date of classification as ‘Held for Sale’; and
the actions needed to complete the plan indicate it
is unlikely that the plan will be dropped or significant
changes made to it.
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. 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 economic
life is adjusted. The asset is de-recognised when
scrapping or demolition occurs.
1.13 Investment Property
Investment property is property held to earn rentals
or for capital appreciation or both. A key factor
in determining classification would be whether
property was saleable separately. In considering
whether land meets this criteria the Trust would
consider whether property had direct public access.
Investment property is accounted for
underInternational Accounting Standard 40. A gain
or loss arising from a change in the fair value of
investment property is recognised in profit or loss for
the period in which it arises.
1.14 Donated assets
10
Donated property, plant and equipment assets
are capitalised at their fair value on receipt. The
donation is credited to income at the same time,
unless the donor has imposed a condition that the
future economic benefits embodied in the donation
are to be consumed in a manner specified by the
donor, in which case, the donation 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 assets are subsequently accounted for
in the same manner as other items of property, plant
and equipment.
1.15 Intangible Assets
Recognition
Intangible assets are non-monetary assets without
physical substance which are capable of being sold
separately from the rest of the Trusts 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 Foundation Trust
and where the cost of the asset can be measured
reliably:
• The project is technically feasible to the point of
•
•
•
•
completion and will result in an intangible asset
for sale or use;
The Foundation Trust (FT) intends to complete
the asset and sell or use it;
The FT has the ability to sell or use the asset;
How the asset will generate probable future
economic benefits e.g. the presence of a market
for its output or where it is to be used for
internal use, the usefulness of the asset;
Adequate financial, technical, and other
resources are available to the FT to complete the
development and sell or use the asset during
development.
Internally generated intangible assets
Internally generated goodwill, brands, mastheads,
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
publishing titles, customer lists, and similar items
are not capitalised as intangible assets, neither is
expenditure on research.
Impairments
Assets that are subject to amortisation are reviewed
for impairment whenever events or changes in
circumstances indicate that the carrying amount
may not be recoverable. Any impairment loss is
recognised in the Statement of Comprehensive
Income to reduce the carrying amount to the
recoverable amount.
Software
Software which is integral to the operation of
hardware e.g. an operating system, is capitalised
as part of the relevant item of property, plant and
equipment. Software which is not integral to the
operation of hardware e.g. application software is
capitalised as an intangible asset.
Measurement
Intangible assets are recognised initially at cost,
comprising of 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 fair value. Revaluation gains
and losses and impairments are treated in the same
manner as for property, plant and equipment.
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 economic lives in a manner consistent with the
consumption of economic or service delivery benefits:
• Development expenditure up to 5 years
• Software up to 5 years
204
1.16 Leases
The Trust as lessee
Finance leases
Where substantially all risks and rewards of ownership
of a leased asset are borne by the NHS Foundation
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 as an item of property plant and
equipment.
The annual rental 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. The lease liability,
is de-recognised when the liability is discharged,
cancelled or expires.
Operating leases
Other leases are regarded as operating leases and the
rentals are charged to operating expenses on a straightline basis over the term of the lease. Operating lease
incentives received are added to the lease rentals and
charged to operating expenses over the life of the lease.
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 Lessor
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 on a straight-line basis over
the lease term.
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
1.17 Local Improvement Finance Trust
(LIFT) transactions
HM Treasury has determined that government
bodies shall account for infrastructure LIFT schemes
where the government body controls the use of
the infrastructure and the residual interest in the
infrastructure at the end of the arrangement as
service concession arrangements, following the
principles of the requirements of IFRIC 12. The
Trust therefore recognises the LIFT asset as an item
of property, plant and equipment together with a
liability to pay for it. The services received under the
contract are recorded as operating expenses.
The annual lease plus payment is separated into
the following component parts, using appropriate
estimation techniques where necessary:
a. Payment for the fair value of services received;
b. Payment for the LIFT asset, including finance
costs;
The Trust is currently party to a 25-year LIFT lease
plus contract.
Services received
The fair value of services received in the year is
recorded under the relevant expenditure headings
within ‘operating expenses’.
LIFT Asset
LIFT assets are recognised as property, plant and
equipment, when they come into use. The assets
are measured initially at fair value in accordance
with the principles of IAS 17. Subsequently, the
assets are measured at fair value, which is kept up
to date in accordance with the Trust’s approach for
each relevant class of asset in accordance with the
principles of IAS 16.
10
An annual finance cost is calculated by applying
the implicit interest rate in the lease to the
opening lease liability for the period, and is
charged to ‘Finance Costs’ within the Statement of
Comprehensive Income.
The element of the lease plus payment that is
allocated as a finance lease rental is applied to meet
the annual finance cost and to repay the lease
liability over the contract term.
An element of the lease plus payment increase due
to cumulative indexation is allocated to the finance
lease. In accordance with IAS 17, this amount is not
included in the minimum lease payments, but is
instead treated as contingent rent and is expensed
as incurred. In substance, this amount is a finance
cost in respect of the liability and the expense
is presented as a contingent finance cost in the
Statement of Comprehensive Income.
1.18 Inventories
Inventories are stated at the lower of cost or net
realisable value. Cost is calculated on a FIFO basis
(First In First Out).
1.19 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.
LIFT liability
A LIFT liability is recognised at the same time as the
LIFT assets are recognised. It is measured initially at
the same amount as the fair value of the LIFT assets
and is subsequently measured as a finance lease
liability in accordance with IAS 17.
205
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1.20 Provisions
1.22 Non-clinical risk pooling
The amount recognised as a provision is the best
estimate of the expenditure required to settle the
obligation at the end of the reporting period, taking
into account the risks and uncertainties.
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 the NHS Litigation
Authority and, in return, receives assistance with
the costs of claims arising. The annual membership
contributions, and any excess payable in respect of
particular claims are charged to operating expenses
as and when they become due.
Injury Benefits and Early Retirement:- Where a
provision is measured using the cash flows estimated
to settle the obligation, its carrying amount is
the present value of those cash flows using HM
Treasury’s discount rates.
1.23 Contingencies
From 2012/13 The Treasury publishes three discount
rates that are to be employed. These are short term
less than 5 years. Medium term 5 to 10 years and
long term over 10 years. Where cash flows are
expected to fall into more than one on these time
frames, then multiple discount rates will need to
be used when calculating the carrying value of the
provision.
The Trust will continue using its long term rate of
3% as there is no material effect in changing the
rate used.
The period over which future cash flows will be paid
is estimated using the England life expense tables as
published by the Office of National Statistics.
1.21 Clinical negligence costs
The NHS Litigation Authority (NHSLA) operates a
risk pooling scheme under which the Trust pays an
annual contribution to the NHSLA which in return
settles all clinical negligence claims. The contribution
is charged to expenditure. Although the NHSLA is
administratively responsible for all clinical negligence
cases the legal liability remains with the Trust.
206
A contingent liability is a possible obligation that
arises from past events and whose existence will
be confirmed only by the occurrence or nonoccurrence of one or more uncertain future events
not wholly within the control of the Trust, or a
present obligation that is not recognised because
it is not probable that a payment will be required
to settle the obligation or the amount of the
obligation cannot be measured sufficiently reliably. A
contingent liability is not recognised but is disclosed
unless the possibility of a payment is remote.
A contingent asset is a possible asset that arises from
past events and whose existence will be confirmed
by the occurrence or non-occurrence of one or more
uncertain future events not wholly within the control
of the Trust. A contingent asset is not recognised but
is disclosed where an inflow of economic benefits is
probable.
Where the time value of money is material,
contingencies are disclosed at their present value.
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
1.24 Public Dividend Capital (PDC) and PDC
dividend
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 Trust. HM Treasury has determined
that PDC is not a financial instrument within the
meaning of IAS 32.
A charge, reflecting the cost of capital utilised by the
NHS Foundation 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 NHS Foundation Trust
during the financial year. Average relevant net assets
is defined as the average of the opening and closing
reserves less the average of the opening and closing
net book value of donated assets, less the average
cleared/available balance of the Government Banking
Service balances over the year. The dividend thus
calculated is not revised should any adjustment to
net assets occur as a result of the audit of the annual
accounts.
1.25 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.
1.26 Corporation Tax
10
The Trust is a Health Service body within the
meaning of s519A ICTA 1988 and accordingly in
relation to specified activities of a Foundation Trust
(s519A (3) to (8) ICTA 1988).
None of the Trust’s activities in the period are subject
to a corporation tax liability.
1.27 Third party assets
Assets belonging to third parties (such as money
held on behalf of patients) are not recognised in
the accounts since the Trust has no beneficial
interest in them.
1.28 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 Trust makes both taxable and exempt supplies and
incurs input tax that relates to both kinds of supply.
The Trust is therefore classified as ‘partly exempt’.
Partly exempt businesses must undertake calculations
which work out how much input tax they may recover.
The percentage relating to partially exempt supplies
is currently 1.25% which reduces the Trust’s VAT
recovery. This percentage is reviewed annually.
207
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
1.29 Financial instruments and financial
liabilities
Recognition
Financial assets and financial liabilities which
arise from contracts to the purchase or sale of
non-financial items (such as goods or services),
which are entered into in accordance with the
Foundation Trust’s normal purchase, sale or usage
requirements, are recognised when, and to the
extent which, performance occurs i.e. when receipt
or delivery of the goods or services is made.
Interest on loans and receivables is calculated using
the effective interest method and credited to the
Statement of Comprehensive Income.
Financial assets or financial liabilities in respect of
assets required or disposed of through finance leases
are recognised and measured in accordance with
the accounting policy for leases described below.
De-Recognition
All financial assets are de-recognised when the
rights to receive cash flows from the assets have
expired or the Trust has transferred substantially all
of the risks and rewards of ownership.
1.31 Other financial liabilities
Financial liabilities are de-recognised when the
obligation is discharged, cancelled or expires.
They are included in current liabilities except for
amounts payable more than 12 months after the
reporting period, which reclassified as long-term
liabilities.
Classification and Measurement
Financial assets are categorised as loans and
receivables or available for sale as financial assets.
Financial liabilities are classified as other financial
liabilities.
1.30 Loans and receivables
Loans and receivables are non-derivative financial
assets with fixed or determinable payments which
are not quoted in an active market. They are
included in current assets if receivable in the current
reporting period, or in non current assets if outside
the current reporting period.
The Trust’s loans and receivables comprise cash and
cash equivalents, NHS debtors, accrued income and
other debtors.
208
Loans and receivables are recognised initially at fair
value, net of transaction costs, and are measured
subsequently at amortised cost, using the effective
interest method. The effective interest rate is the
rate that discounts exactly estimated future cash
receipts through the expected life of the financial
asset or, when appropriate, a shorter period, to the
net carrying amount of the financial asset.
All other financial liabilities are recognised initially
at fair value, net of transaction costs incurred, and
measured subsequently at amortised cost using the
effective interest method. The effective interest rate is
the rate that discounts exactly estimated future cash
payments through the expected life of the financial
liability or, when appropriate, a shorter period, to the
net carrying amount of the financial liability.
Interest on financial liabilities carried at amortised
cost is calculated using the effective interest method
and charged to finance costs. Interest on financial
liabilities taken out to finance property, plant and
equipment or intangible assets is not capitalised as
part of the cost of those assets.
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
10
1.32 Impairment of financial assets
1.35 Financial risk management
At the end of the reporting period, the Trust assesses
whether any financial assets, other than those held
at ‘fair value through profit and loss’ are impaired.
Financial assets are impaired and impairment
losses recognised if there is objective evidence of
impairment as a result of one or more events which
occurred after the initial recognition of the asset and
which has an impact on the estimated future cash
flows of the asset.
International 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 Foundation Trust has with
Clinical Commissioning Groups and the way those
Clinical Commissioning Groups are financed, the
NHS Foundation 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 NHS Foundation 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 NHS Foundation
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. Trust 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.
For financial assets carried at amortised cost, the
amount of the impairment loss is measured as the
difference between the asset’s carrying amount and
the present value of the revised future cash flows
discounted at the asset’s original effective interest
rate. The loss is recognised in the Statement of
Comprehensive Income and the carrying amount of
the asset is reduced directly or through the use of a
bad debt provision.
1.33 Foreign currencies
The Trust’s functional currency and presentational
currency is sterling. Transactions denominated
in a foreign currency are translated into sterling
at the exchange rate ruling on the dates of the
transactions. Resulting exchange gains and losses
are recognised in the Trust’s surplus/deficit in the
period in which they arise.
1.34 Government Grants
Government grants are grants from Government
bodies other than income from Clinical
Commissioning Groups or NHS trusts for the
provision of services. Where a grant is used to
fund revenue or capital expenditure it is taken to
the Statement of Comprehensive Income to match
that expenditure. The exception to this is where
specific grant conditions apply regarding the
recognition of income.
Interest rate risk
To date, the Trust has only borrowed from UK
Government for capital expenditure. The borrowings
were for 1–25 years, in line with the life of the
associated assets, and interest charged at the
National Loans Fund rate, fixed for the life of the
loan. The Trust therefore has low exposure to
interest rate fluctuations.
209
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Credit risk
Because the majority of the Trust’s income comes
from contracts with other public sector bodies, the
Trust has low exposure to credit risk. The maximum
exposures as at 31 March 2015 are in receivables
from customers, as disclosed in the trade and other
receivables note.
Liquidity risk
The majority of the Trust’s operating costs
are incurred under contracts with Clinical
Commissioning Groups, which are financed
from resources voted annually by Parliament.
The Trust is not, therefore, exposed to significant
liquidity risks.
1.36 Events after the reporting period
There are no post balance sheet events to report.
1.37 Research and Development
Research and development expenditure is charged
against income in the year in which it is incurred,
except insofar as development expenditure relates
to a clearly defined project and the benefits of it
210
can reasonably be regarded as assured. Expenditure
so deferred is limited to the value of future benefits
expected and is amortised through the Operating
Cost Statement on a systematic basis over the
period expected to benefit from the project. It
should be revalued on the basis of current cost.
The amortisation is calculated on the same basis as
depreciation, on a quarterly basis.
1.38 Significant Accounting Assumptions
The Trust has not made any significant accounting
assumptions.
1.39 Accounting standards and
amendments issued but not yet adopted
in the ARM
The following new and revised standards and
interpretations were in issue but not yet adopted in
the ARM. None of these new and revised standards
and interpretations have been adopted early by the
Trust. The Trust do not expect that the adoption of
the standards listed in the table below will have a
material impact on the financial statements of the
Trust in future periods.
Change published
Published by IASB
Financial year for which the change first
applies
IFRS 13 Fair Value Measurement
May-11
Adoption delayed by HM Treasury. To be
adopted from 2015/16.
IFRS 15 Revenue from contracts
with cust
May-14
Not yet EU adopted. Expected to be effective
from 2017/18.
IFRS 9 Financial Instruments
Jul-14
Not yet EU adopted. Expected to be effective
from 2018/19.
IAS 36 (amendment) – recoverable
amount disclosures
May-13
To be adopted from 2015/16 (aligned to IFRS 13
adoption)
Annual Improvements 2012
Dec-13
Effective from 2015/16 but not yet EU adopted
Annual Improvements 2013
Dec-13
Effective from 2015/16 but not yet EU adopted
IAS 19 (amendment) – employer
contributions to defined benefit
pension schemes
Nov-13
Effective from 2015/16 but not yet EU adopted
IFRIC 21 Levies
May-13
EU adopted in June 2014 but not yet adopted
by HM Treasury.
10
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Note 2 Segmental Analysis
Corporate Unallocated
Division
Income
Total
Surgical
Division
Medical
Division
Women &
Children’s
Division
Cancer &
Clinical
Support
Services
31 March
2015
31 March
2015
31 March
2015
31 March
2015
31 March
2015
31 March
2015
31 March
2015
(£’000)
(£’000)
(£’000)
(£’000)
(£’000)
(£’000)
(£’000)
65,587
73,437
37,691
13,592
–
190,307
Non NHS Clinical Income
1,116
707
305
1,907
5
4,040
Other Income
2,405
2,249
1,277
2,264
11,703
19,898
69,108
76,393
39,273
17,763
11,708
Pay
(33,023)
(39,945)
(19,058)
(26,653)
(25,072)
(143,751)
Non Pay
(13,809)
(13,736)
(2,685)
(12,108)
(20,644)
(62,982)
(2,334)
(2,316)
(850)
5,479
21
0
NHS Clinical Income
Unallocated Income
Total Operating Revenue
Internal Recharges
Unallocated Expenses
7,584
7,584
7,584
221,829
–
–
–
–
–
(3,525)
(3,525)
Total Operating
Expenditure before
Depreciation,
Impairments and Interest
(49,166)
(55,997)
(22,593)
(33,282)
(45,695)
(3,525)
(210,258)
Earnings before Interest,
Taxation, Depreciation
and Amortisation
19,942
20,396
16,680
(15,519)
(33,987)
4,059
11,571
Allocated Depreciation &
Amortisation
(419)
(226)
(28)
(354)
(565)
Unallocated Depreciation
& Amortisation
–
–
–
–
–
(7,056)
(7,056)
Unallocated Impairments
–
–
–
–
–
(6,933)
(6,933)
Operating Surplus/(Deficit)
19,523
20,170
16,652
(15,873)
(34,552)
(9,930)
(4,010)
(1,592)
211
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Note 2 Segmental Analysis (continued)
Corporate Unallocated
Division
Income
Total
Surgical
Division
Medical
Division
Women &
Children’s
Division
Cancer &
Clinical
Support
Services
31 March
2014
31 March
2014
31 March
2014
31 March
2014
31 March
2014
31 March
2014
31 March
2014
(£’000)
(£’000)
(£’000)
(£’000)
(£’000)
(£’000)
(£’000)
60,876
66,739
32,841
16,809
-
177,265
450
352
89
1,669
1,385
3,945
2,356
2,163
1,166
2,405
9,246
-
-
-
-
-
5,755
5,755
63,682
69,254
34,096
20,883
10,631
5,755
204,301
Pay
(29,751)
(32,929)
(18,385)
(24,842)
(23,513)
(129,420)
Non Pay
(13,631)
(11,045)
(2,320)
(10,690)
(21,279)
(58,965)
(2,261)
(1,994)
(815)
5,088
(18)
-
-
-
-
-
-
(2,144)
(2,144)
Total Operating Expenditure
before Depreciation,
Impairments and Interest
(45,643)
(45,968)
(21,520)
(30,444)
(44,810)
(2,144)
(190,529)
Earnings before Interest,
Taxation, Depreciation and
Amortisation
18,039
23,286
12,576
(9,561)
(34,179)
3,611
13,772
Allocated Depreciation &
Amortisation
(460)
(198)
(16)
(325)
(441)
Unallocated Impairments
-
-
-
-
-
(6,603)
(6,603)
Unallocated Impairments
-
-
-
-
-
(1,038)
(1,038)
17,579
23,088
12,560
(9,886)
(34,620)
(4,030)
4,691
NHS Clinical Income
Non NHS Clinical Income
Other Income
Unallocated Income
Total Operating Revenue
Internal Recharges
Unallocated Expenses
Operating Surplus/(Deficit)
17,336
(1,440)
The only activity of the NHS Foundation Trust is Healthcare and its primary customer is NHS Hillingdon CCG. However, segmental information has been
included on the basis the following information is reported regularly to the Chief Executive for the purpose of allocating resources to that segment and
assessing its performance. Transactions between divisions would reflect the re-allocation of shared costs. All services relating to transactions shown below
were provided to external customers of the Trust.
Segmental net assets are not recorded as part of the internal reporting process and as such are not disclosed.
The reportable segments are different operational divisions within the Trust, which provide different groups of service. They are managed separately as they
involve different medical disciplines and patient groups. Segments have not been aggregated.
The major external customer is NHS Hillingdon CCG which accounted for revenue of £136,701k and features in all segments. No other customer accounted
for more than 7.25% of revenue.
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Note 3.1 Operating income (by nature)
10
31 March 2015
31 March 2014
£000
£000
Elective income
32,053
30,490
Non elective income
60,620
53,129
Outpatient income
50,984
50,077
Income From Activities
Acute Trusts
NHS Clinical Income
7,844
10,103
38,806
33,466
224
224
3,816
3,877
Total income from activities
194,347
181,366
Total other operating income
27,482
22,935
221,829
204,301
A & E income*
Other NHS clinical income
All Trusts
Private patient income
Other clinical income
Total Operating Income
* on the 1st October 2013 an expanded Urgent Care Centre (UCC) opened on the Hillingdon site operated by a 3rd party. The
reduction in A&E income in this financial year reflects the full year impact of the expanded UCC opened in 2013/14.
Note 3.2 Operating lease income
31 March 2015
31 March 2014
£000
£000
Rents recognised as income in the year
1,611
1,411
Contingent rents recognised as income in the year
1,812
436
TOTAL
3,423
1,847
- not later than one year;
1,321
1,321
- later than one year and not later than five years;
5,283
5,283
- later than five years.
92,451
93,772
sub total
99,055
100,376
- not later than one year;
214
199
- later than one year and not later than five years;
658
699
- later than five years.
148
246
1,020
1,144
100,075
101,520
Operating Lease Income
Future minimum lease payments due
on leases of Land expiring
on leases of Buildings expiring
sub total
TOTAL
Leasing arrangements are all with bodies external to the UK Government.
Leasing arrangements relate significantly to land rental on both the Hillingdon and Mount Vernon sites.
213
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Note 3.3 Operating Income
31 March 2015
31 March 2014
£000
£000
117
129
–
16
190,191
177,120
Income from activities
NHS Foundation Trusts
NHS Trusts
CCGs and NHS England*
1,669
1,613
Non NHS: Private patients
224
224
Non-NHS: Overseas patients (non-reciprocal)
882
934
NHS injury scheme (formerly RTA)
919
943
Local Authorities
345
387
194,347
181,366
719
607
Education and training
9,044
8,198
Grants and Donations
44
47
–
33
Non-patient care services to other bodies
8,002
6,405
Rental revenue from operating leases – minimum lease receipts
1,611
1,411
Non NHS: Other
Total income from activities
Other operating income
Research and development
Profit on disposal of other tangible fixed assets
Rental revenue from operating leases – contingent rent
1,812
436
Other*
6,062
5,612
188
186
27,482
22,935
221,829
204,301
190,191
177,120
31,638
27,181
221,829
204,301
1,762
1,587
273
281
99
95
Staff accommodation rentals
107
110
Clinical excellence awards
247
156
Catering
996
884
Income in respect of staff costs where accounted on gross basis Total other operating income
Total Operating Income
*Income from Commissioner requested Services
Commissioner Requested Services
Other Services
Total Operating Income
* Analysis of Other Operating Income: Other
Car parking
Estates recharges
Pharmacy sales
533
508
Other
2,045
1,991
Total
6,062
5,612
Property rentals
214
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Note 3.4 Overseas visitors (relating to patients
charged directly by the foundation trust)
10
31 March
2015
31 March
2014
£000
£000
Income recognised this year
882
934
Cash payments received in-year (relating to invoices raised in current and previous years)
600
611
Amounts added to provision for impairment of receivables (relating to invoices raised in
current and prior years)
(9)
(126)
263
563
Amounts written off in-year (relating to invoices raised in current and previous years)
215
10
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Note 4 Operating Expenses
Services from NHS Foundation Trusts
Services from NHS Trusts
Employee Expenses – Executive directors
Employee Expenses – Non-executive directors
Employee Expenses – Staff
Supplies and services – clinical (excluding drug costs)
Supplies and services – general
Establishment
Transport – business travel
Transport – other
Premises – Business rates payable to Local Authorities
Premises – Other
Increase/(decrease) in provision for impairment of receivables
Increase in other provisions
Inventories written down (net, including inventory drugs)
Drugs costs (non inventories)
Drugs inventories consumed
Rentals under operating leases – minimum lease receipts
Rentals under operating leases – contingent rent
Depreciation on property, plant and equipment
Amortisation on intangible assets
Impairments of property, plant and equipment
Audit services- statutory audit
Clinical negligence – amounts payable to the NHSLA (premiums)
Legal fees
Consultancy costs
Training, courses and conferences
Patient travel
Car parking & Security
Redundancy – (Included in employee expenses)
Early retirements – (Included in employee expenses)
Hospitality
Insurance
Other services
Losses, ex gratia & special payments- (Not included in employee expenses)
Losses, ex gratia & special payments- ( included in employee expenses)
Other
TOTAL OPERATING EXPENSES
All expenses above related to continuing operations.
216
2014-15
£000
1,063
200
1,075
135
143,055
22,906
3,772
4,443
120
1,223
688
6,752
978
925
82
1,085
14,383
304
4
8,162
486
6,933
93
4,121
160
62
733
4
156
109
–
29
227
1,286
38
–
47
225,839
2013-14
£000
311
226
1,089
143
128,495
20,942
3,359
4,169
94
1,273
869
5,783
198
432
38
926
12,278
471
43
7,516
527
1,038
88
4,605
128
95
869
6
104
51
72
34
255
2,868
88
63
64
199,610
10
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Note 5 Operating lease Expenditure
Payments recognised as an expense
31 March 2015
31 March 2014
£000
£000
304
471
4
43
308
514
31 March 2015
31 March 2014
£000
£000
311
304
Between one and five years
1,245
1,215
Later than five years.
1,090
1,367
Total
2,646
2,886
Minimum lease payments
Contingent rents
Total future minimum lease payments
Payable:
Not later than one year
The Trust is party to a ten year lease agreement for a modular healthcare building on the Hillingdon Hospital site ending October 2023.
217
10
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Note 6 Employee costs and numbers
6.1 Employee costs
Salaries and wages
Social security costs
Employer contributions to NHS
Pension scheme
Termination benefits
Agency/contract staff
Less Salary Costs Recharged to
Other Organisations
Employee benefits expense
Of the total above:
Charged to capital
Charged to revenue
Analysed into Operating
Expenditure (Note 4)
Employee Expenses – Staff
Employee Expenses – Executive
directors
Redundancy
Early retirements
Special Payments
Total Employee benefits excl.
capitalised costs
Total 31 March 2015
Permanently
employed
£000
£000
111,147
105,159
9,721
9,337
12,158
11,822
Other
£000
5,988
384
336
Total 31 March 2014
Permanently
employed
£000
£000
106,212
101,527
9,350
9,041
11,782
11,521
Other
£000
4,685
309
261
132
13,623
(1,336)
132
(1,336)
13,623
-
205
4,811
(1,264)
205
(1,264)
4,811
-
145,445
125,114
20,331
131,096
121,030
10,066
1,206
144,239
145,445
1,111
124,003
125,114
95
20,236
20,331
1,326
129,770
131,096
1,222
119,808
121,030
104
9,962
10,066
143,055
1,075
122,819
1,075
20,236
-
128,495
1,089
118,533
1,089
9,962
-
109
-
109
-
-
51
72
63
51
72
63
-
144,239
124,003
20,236
129,770
119,808
9,962
6.2 Directors aggregate remuneration
Executive Directors
Non Executive Directors*
Total**
31 March 2015 31 March 2015 31 March 2014 31 March 2014
Remuneration
Number of
Remuneration
Number of
£000
Directors **
£000
Directors **
1,075
9
1,089
9
135
9
143
10
1,210
18
1,232
19
**Analysis of Directors Remuneration
(£000)
Gross pay
Employer Pension Contributions
Employer National Insurance Contributions
Total
998
1,018
97
96
115
118
1,210
1,232
*Non Executive Directors are not members of the NHS pension scheme.
** The number of directors denotes the number of individuals employed in a director position at some point during the financial year,
not the number of directors simultaneously employed.
218
10
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
6.3 Average number of
people employed
Medical and dental
Administration and estates
Healthcare assistants and
other support staff
Nursing, midwifery and health
visiting staff
Scientific, therapeutic and
technical staff
Total
Other
Total 31 March 2015
Permanently
employed
Number
Number Number
434
420
14
732
681
51
Other
Total 31 March 2014
Permanently
employed
Number
Number Number
407
402
5
727
689
38
590
871
441
722
149
149
510
796
407
712
103
84
415
3,042
371
2,635
44
407
379
2,819
359
2,569
20
250
20
20
–
21
21
–
Of the above:
Number of whole time equivalent
staff engaged on capital projects
6.4 Early Retirements due to ill health
There were no early retirements on the grounds of ill-health during 2014/15
31 March 2015 31 March 2014
Number
Number
-
2
31 March 2015 31 March 2014
Cost of early retirements on the grounds of ill-health*
£000
£000
-
77
*The cost of early retirement due to ill health is borne by the NHS Business Services Authority who administer NHS pensions.
219
10
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
6.5 Exit Packages
31 March 2015
Cost of
Number of
Total Total cost
Cost of
Number
Cost of
Number of
Exit package cost
special
of exit departures
other number
of other
compulsory compulsory
band (including
of exit packages where special payment
redundancies redundancies departures departures
any special
payments element
agreed packages
agreed
payment element)
have been included
in exit
made
packages
Number
£000s
Number
£000s Number
£000s
Number
£000s
<£10,000
–
–
1
6
–
–
–
–
£10,001-£25,000
–
–
1
17
–
–
–
–
£25,001-50,000
–
–
£50,001-£100,000
–
–
–
–
–
–
–
–
–
–
–
–
–
–
£100,001-£150,000
1
109
–
–
1
109
–
–
£150,001-£200,000
–
–
–
–
–
–
–
–
>£200,001
–
–
–
–
–
–
–
–
Total
1
109
2
23
1
109
–
–
Number of
Total Total cost of
departures
number exit packages
where special
of exit
payments have
packages
been made
Cost of
special
payment
element
included
in exit
packages
6.6 Exit Packages
Exit package cost
band (including
any special
payment element)
31 March 2014
Cost of
Number
Cost of
Number of
other
of other
compulsory compulsory
redundancies redundancies departures departures
agreed
agreed
Number
£000s
Number
£000s
Number
£000s
Number
<£10,000
1
2
5
19
6
21
1
10
£10,001 – £25,000
1
17
2
23
3
40
1
13
£25,001 – 50,000
1
32
1
40
2
72
1
40
£50,001 – £100,000
1
72
–
–
1
72
–
–
Total
4
123
8
82
12
205
3
63
Exit packages: other (non-compulsory)
departure payments
2014-15
2014-15
2013-14
2013-14
Agreed
number
Total value of
agreements
Agreed
number
Total value of
agreements
£000
220
£000s
£000
Contractual payments in lieu of notice
2
23
5
19
Exit payments following Employment
Tribunals or court orders
–
–
3
63
Total
2
23
8
82
10
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
6.7 Staff sickness absence
31 March 2015
Total days lost
Total staff years*
31 March 2014
Number
Number
34,627
29,537
2,750
2,582
13
11
Average working days lost
*Staff years is a calculation based on the number of working days of full time and part time staff employed by the Trust converted into
composite staff years.
Note 7 Better Payment Practice Code
7.1 Better Payment Practice Code – measure of compliance
31 March 2015
31 March 2014
Number
£000
Number
£000
Total Non-NHS trade invoices paid in the year
88,903
98,243
70,440
83,385
Total Non NHS trade invoices paid within target
43,047
51,990
38,547
46,161
48%
53%
55%
55%
Total NHS trade invoices paid in the year
2,951
10,606
2,573
9,848
Total NHS trade invoices paid within target
1,174
4,929
1,311
6,004
40%
46%
51%
61%
Percentage of Non-NHS trade invoices paid within target
Percentage of NHS trade invoices paid within target
The Better Payment Practice Code requires the Trust to aim to pay all undisputed invoices by the due date or within 30 days of receipt of
goods or a valid invoice, whichever is later. 7.2 The Late Payment of Commercial Debts (Interest) Act 1998
Amounts included in finance costs from claims made under this legislation
31 March 2015
31 March 2014
£000
£000
10
4
Note 8 Finance income
31 March 2015
Interest on bank accounts
31 March 2014
£000
£000
17
19
31 March 2015
31 March 2014
£000
£000
286
192
10
4
254
268
Note 9 Finance expenses
Interest expense:
Interest paid on Finance leases
Interest on late payment of commercial debt
Interest paid on Capital loans from the Department of Health
Interest due on Working Capital loans from the Department of Health
65
Interest on LIFT contract
1,399
1,355
Total
2,014
1,819
221
10
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Note 10 Other non-operating income
31 March 2015
31 March 2014
£000
£000
3,874
–
Increase in fair value of investment property*
Note 11 Intangible Assets
Cost brought forward at 1st April 2014
31 March 2014
£000
£000
4,582
3,953
Other Reclassifications
326
281
Additions – purchased
999
439
-
-91
Cost at 31 March 2015
5,907
4,582
Amortisation Brought Forward at 1st April 2014
2,441
2,005
486
527
-
-91
Amortisation at 31 March 2015
2,927
2,441
Net Book Value at 31 March 2015
2,980
2,141
Disposals
Amortisation provided in Year
Disposals
Intangible Assets consists of Software Licences.
222
31 March 2015
-
-
136,708
2,885
10,318
5,695
117,810
136,708
37,292
-
400
-
36,892
37,292
–
-
-
-
-
-
-
-
-
37,292
-
-
4,823
-
-
-
-
-
-
32,469
£000
Land
Buildings
79,236
2,575
9,918
-
66,743
79,236
674
–
–
(9,937)
(1,045)
-
-
3,895
7,761
79,910
-
-
(2,769)
9,334
(567)
(6,933)
-
-
10,490
70,355
£000
dwellings
excluding
1,034
-
-
-
1,034
1,034
36
–
–
(463)
-
-
-
172
327
1,070
-
-
290
(36)
-
-
-
-
-
816
£000
Dwellings
2,068
-
-
-
2,068
2,068
–
-
-
-
(72)
-
-
-
72
2,068
-
-
-
(11,252)
-
-
-
-
1,884
11,436
10,304
310
–
3,451
6,543
10,304
14,772
-
-
-
244
-
-
2,197
12,331
25,076
-
-
-
260
-
-
44
1,286
1,144
22,342
£000
construction
£000
Plant and
machinery
Assets under
* Reclassification balance of £773k relates to £326k within Note 11 (Intangible Assets) and £447k within Note 14 (Investment Property).
Total 31 March 2015
Donated
LIFT
Finance leased
Owned
Financed as follows:
Net Book Value (A – B)
24,133
Disposals / derecognition
Depreciation at 31 March 2015 (B)
–
(10,400)
Transfers to/from assets held for sale
Revaluations
Reclassifications *
(3,662)
-
reserve
-
Impairments charged to the revaluation
8,161
30,034
Impairments charged to operating expenses
Provided During the Year
Depreciation at 1 April 2014
160,841
Disposals
Cost or valuation at 31 March 2015 (A)
-
2,344
(4,435)
(567)
(6,933)
44
1,943
13,774
Transfers to/from assets held for sale
Revaluations
Reclassifications *
reserve
Impairments charged to the revaluation
Impairments charged to operating expenses
Additions – donated
Additions – Leased
Additions – purchased
154,671
£000
Current Year
Cost or valuation at 1 April 2014
Total
12.1 Property, plant and equipment
Transport
-
-
-
-
-
–
18
-
-
-
-
-
-
-
18
18
-
-
-
-
-
-
-
-
-
18
£000
equipment
6,736
–
–
2,244
4,492
6,736
8,578
-
-
-
(2,793)
-
-
1,892
9,479
15,314
-
-
-
(2,741)
-
-
-
657
256
17,142
£000
technology
Information
10
38
-
-
-
38
38
55
-
-
-
4
-
-
5
46
93
-
-
-
-
-
-
-
-
-
93
£000
fittings
Furniture &
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
223
224
Additions – purchased
Total 31 March 2014
Donated
LIFT
Finance leased
Owned
Financed as Follows:
Net Book Value (A – B)
Depreciation at 31 March 2014 (B)
124,637
32,469
-
350
10,522
2,823
-
32,119
32,469
–
-
5,136
106,156
124,637
30,034
(212)
Disposals
-
-
7,516
1,038
Provided During the Year
-
32,469
-
-
-
-
-
32,469
£000
Land
21,692
154,671
Impairments charged to operating expenses
Depreciation at 1 April 2013
Cost or valuation at 31 March 2014 (A)
(281)
(264)
Disposals
47
3,545
15,015
Reclassifications
Additions – donated
Additions – Leased
136,609
£000
Prior Year
Cost or valuation at 1 April 2013
Total
12.1 Property, plant and equipment
Buildings
62,594
2,489
10,172
-
49,933
62,594
7,761
–
874
3,525
3,362
70,355
-
1,751
-
-
3,229
65,375
£000
dwellings
excluding
489
-
-
-
489
489
327
-
-
164
163
816
-
-
-
-
-
816
£000
Dwellings
11,364
-
-
-
11,364
11,364
72
–
72
-
-
11,436
-
(2,527)
-
-
9,857
4,106
10,011
334
–
2,994
6,683
10,011
12,331
(212)
-
2,200
10,343
22,342
(264)
(368)
47
2,499
1,071
19,357
£000
construction
£000
Plant and
machinery
Assets under
Transport
-
-
-
-
-
–
18
-
-
-
18
18
-
-
-
-
-
18
£000
equipment
7,663
-
-
2,142
5,521
7,663
9,479
–
92
1,621
7,766
17,142
–
863
-
1,046
858
14,375
£000
technology
Information
47
-
-
-
47
47
46
–
-
6
40
93
-
-
-
-
-
93
£000
fittings
Furniture &
10
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
10
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
12.2 Revaluation reserve balance for property, plant & equipment
At 1 April 2014
Land
Buildings
excluding
dwellings
Dwellings
£000
£000
£000
£000
£000
£000
13,220
8,596
464
70
12
22,362
Depreciation adjustment*
Impairments
Revaluations
At 31 March 2015
At 1 April 2013
Depreciation adjustment*
At 31 March 2014
Plant and Furniture &
machinery
fittings
(740)
-
(567)
Total
(740)
-
-
-
(567)
4,823
7,168
753
-
-
12,744
18,043
14,457
1,217
70
12
33,799
Land
Buildings
excluding
dwellings
Dwellings
Plant and Furniture &
machinery
fittings
Total
£000
£000
£000
£000
£000
£000
13,220
9,140
618
92
20
23,090
-
(544)
(154)
(22)
(8)
(728)
13,220
8,596
464
70
12
22,362
* Transfers between reserves is a depreciation adjustment required due to revaluations of land and buildings.
225
10
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
13.1 Economic lives of property, plant and equipment
Min life
Max life
Years
Years
5
15
Software
5
15
Licences & trademarks
5
15
Min life
Max life
Years
Years
Buildings exc Dwellings
2
60
Dwellings
5
5
Plant and Machinery
5
15
Transport equipment
5
5
Information Technology
5
15
Furniture and Fittings
5
15
31 March 2015
31 March 2014
£000
£000
14,816
14,816
447
-
Intangible assets – internally generated
Information technology
Intangible assets – purchased
13.2 Economic lives of property, plant and equipment
Note 14 Investment Property
Balance at Beginning of year
Recclassification from Operational Buildings
Net gain from Fair Value Adjustments
Balance at End of Year
Income from Occupied Investment Properties
Expenses of Investment Properties
Surplus
Expenses of unoccupied Investment Properties
3,874
-
19,137
14,816
2,667
1,441
(1,021)
(714)
1,646
727
3
–
31 March 2015
31 March 2014
£000
£000
-
1,038
15 Impairment of assets
Loss or damage from normal operations. Operating Expenses
Changes in market price. Operating Expenses
Changes in market price. Revaluation Reserve
Total Gross Impairments
226
6,933
567
7,500
1,038
10
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Note 16 Capital Commitments
Property, plant and equipment
31 March 2015
31 March 2014
£000
£000
1,063
5,263
Note 17 Inventory Movement
Total
Drugs
Consumables
Energy
Other
Current Year
£000
£000
£000
£000
£000
Carrying Value at 1st April 2014
2,943
1,123
1,673
11
136
28,432
14,180
14,004
38
210
(28,515)
(14,383)
(13,916)
(1)
(215)
Additions
Inventories recognised as expenses
Write-down of inventories recognised as
an expense
(82)
(43)
(39)
-
-
2,778
877
1,722
48
131
Total
Drugs
Consumables
Energy
Other
Prior Year
£000
£000
£000
£000
£000
Carrying Value at 1st April 2013
3,042
1,195
1,710
10
127
25,130
12,224
12,593
15
298
(25,191)
(12,278)
(12,610)
(14)
(289)
(38)
(18)
(20)
-
-
2,943
1,123
1,673
11
136
Carrying Value at 31st March 2015
Additions
Inventories recognised as expenses
Write-down of inventories recognised as
an expense
Carrying Value at 31st March 2014
227
10
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
18.1 Trade and other receivables
31 March 2015
31 March 2014
£000
£000
17,902
16,640
1,212
3,666
(6,323)
(5,743)
Current
NHS receivables – revenue
NHS receivables – accrued income
NHS provision for credit notes
-
147
Sub Total NHS
12,791
14,710
Prepayments
1,662
1,192
665
389
NHS PDC Dividend Receivable
VAT receivable
2,993
2,862
Provision for impaired receivables
(1,321)
(828)
Total current trade and other receivables
16,790
18,325
Other receivables
1,192
1,435
Less Provision for impaired receivables
Other receivables
Non-Current
(225)
-
Total non-current trade and other receivables
967
1,435
18.2 Provision for impairment of receivables
31 March 2015
31 March 2014
£000
£000
At 1 April
828
1,200
Increase in provision
978
198
(260)
(570)
-
-
1,546
828
31 March 2015
31 March 2014
£000
£000
0 – 30 days
92
128
30 – 60 days
621
15
Amounts Utilised
Amounts Reversed
At end of year
18.3.1 Ageing of impaired receivables
60 – 90 days
92
18
90 – 180 days
251
88
over 180 days
490
579
1,546
828
31 March 2015
31 March 2014
£000
£000
0 – 30 days
3,941
1,881
30 – 60 days
3,078
1,874
Total
18.3.2 Ageing of non-Impaired receivables past their due date
810
523
90 – 180 days
2,393
1,647
over 180 days
5,392
6,004
15,614
11,929
60 – 90 days
Total
228
10
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Note 19 Cash and cash equivalents
31 March 2015
31 March 2014
£000
£000
Balance at 1 April
5,733
3,906
Net (decrease)/increase in year
(250)
1,827
Balance at end of Year
5,483
5,733
4,658
4,757
825
976
Cash and cash equivalents as in statement of financial position
5,483
5,733
Cash and cash equivalents as in statement of cash flows
5,483
5,733
31 March 2015
31 March 2014
£000
£000
Receipts in advance
2,163
3,245
NHS payables – revenue
1,600
2,492
Pensions
1,791
1,756
Other trade payables – capital
1,117
916
Other trade payables – revenue
4,271
7,705
Social Security costs
2,968
2,847
Other payables
167
290
PDC dividend payable
227
–
8,123
5,272
22,427
24,523
Made up of
Cash with Government banking services
Commercial banks and cash in hand
Note 20 Trade and other payables
Current
Accruals and deferred income
Total Trade and Other payables
229
10
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
21.1 Borrowings
31 March 2015
31 March 2014
£000
£000
390
390
Working capital loan from Department of Health
1,000
–
Obligations under finance leases
1,521
1,109
Current
Capital loans from Department of Health
328
181
3,239
1,680
Capital loans from Department of Health
6,295
6,685
Working capital loan from Department of Health
9,000
–
Obligations under LIFT contracts
Total current borrowings
Non-current
Obligations under finance leases
4,119
3,956
Obligations under LIFT contracts
12,390
12,718
Total non current borrowings
31,804
23,359
The Trust is party to three Department of Health loans as follows:
- Loan 1 (for capital investment) received 15th December 2009 for £4.0m. Repayments commenced on 15th March 2010 and will
continue until 15th September 2034. The loan carries a fixed interest rate at 4.11%. - Loan 2 (for capital investment) received 15th September 2010 for £4.6m. Repayments commenced on 15th March 2011 and will
continue until 15th September 2030. The loan carries a fixed interest rate at 3.25%. - Loan 3 (for working capital) received 16th November 2014 for £10.0m. Repayments commence on 17th May 2015 and will continue
until 15th November 2024. The loan carries a fixed interest rate at 1.74%.
21.2 Loans Payments Scheduled
31 March 2015
31 March 2014
£000
£000
0 to 1 Year
1,799
644
1 to 2 years
1,769
630
2 – 5 Years
5,122
1,807
11,119
6,457
More Than 5 Years
230
Total Future Gross Loan Commitments
19,809
9,538
Less Interest Element
(3,124)
(2,463)
Total Future Net Loan Commitments
16,685
7,075
10
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Note 22 Finance lease liabilities
The lease arrangements relate to a number of equipment leases which vary in length from three to seven years.
All leases are with bodies external to government. Details of the accounting for finance leases can be found in
note 1 – accounting policies..
Amounts payable under finance leases
Gross lease liabilities
31 March 2015
31 March 2014
£000
£000
Within one year
1,771
1,334
Between one and five years
4,214
4,005
215
389
Sub total gross finance lease liabilities
6,200
5,728
Future Finance Charges
(560)
(663)
Total net finance lease liabilities
5,640
5,065
31 March 2015
31 March 2014
£000
£000
Within one year
1,521
1,109
Between one and five years
3,916
3,599
Later than five years
Net lease liabilities
Later than five years
Total net finance lease liabilities
203
357
5,640
5,065
231
10
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Note 23 NHS Local Improvement Finance Trust (LIFT) contract
The LIFT agreement is for a 25 year period which commenced in December 2008. The scheme is for the provision
of clinical accommodation on the Mount Vernon Hospital site which comprises four surgical theatres and
outpatient suites. The annual lease payment (inclusive of interest, capital and services) is £1,557k per annum. The
LIFT agreement is with a body external to government. Details of the accounting for the LIFT contract can be found
in note 1 – accounting policies.
23.1 LIFT liabilities
Amounts payable under the LIFT contract
Gross LIFT liabilities
Not later than one year
31 March 2015
31 March 2014
£000
£000
1,221
1,090
4,371
4,462
Later than five years
20,099
21,229
Sub total gross LIFT liability
25,691
26,781
Future Finance Charges
(12,973)
(13,882)
Total net LIFT liability
12,718
12,899
31 March 2015
31 March 2014
£000
£000
328
181
Later than one year, not later than five years
Net LIFT liabilities
Not later than one year
924
1,000
Later than five years
11,466
11,718
Total net LIFT liability
12,718
12,899
Later than one year, not later than five years
23.2 Charges to expenditure
The Trust is committed to the following service charge payments over the life of the LIFT scheme:LIFT projected future expenditure
31 March 2015
31 March 2014
£000
£000
336
467
Later than one year, not later than five years
1,911
1,766
Later than five years
6,065
6,545
Total
8,312
8,778
Not later than one year
232
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Note 24 Related party transactions
10
During the year none of the Trust board members or members of the key management staff, or parties related to
any of them, has undertaken any material transactions with The Hillingdon Hospitals NHS Foundation Trust.
The United Kingdom Government is regarded as a related party to the extent that it controls the Department
of Health and National Health Organisations through legislation and funding by the taxpayer. During the year
The Hillingdon Hospitals NHS Foundation Trust has had a significant number of material transactions with the
Department, and with other NHS entities as well as directly with the UK Government. These transactions are
itemised below subject to a minimum of £100k for transactions and balances for the year to 31st March 2015.
These limits are in accordance with the Agreement of balances exercise for Whole Government Accounts.
233
10
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Current
Receivables
as at
31 March 2015
Current
Receivables
as at
31 March 2014
Current
Payables
as at
31 March 2015
Current
Payables
as at
31 March 2014
£000s
£000s
£000s
£000s
Central And North West London MH
NHS Foundation Trust
–
715
–
60
Kings College Hospital NHS
Foundation Trust
–
150
–
51
Moorfields Eye Hospital NHS
Foundation Trust
–
231
–
60
24.1 Balances
Entities
Royal Brompton And Harefield NHS
Foundation Trust
–
150
–
51
Royal Free London NHS Foundation Trust
–
231
–
60
3,893
4,049
7
872
87
47
311
462
East And North Hertfordshire NHS Trust
Imperial College Healthcare NHS Trust
North West London Hospitals NHS Trust
–
275
–
68
1,262
581
–
23
810
–
81
–
NHS Barnet CCG
–
131
–
–
NHS Brent CCG
–
813
244
–
226
69
–
–
Ealing Hospital NHS Trust
London North West Healthcare NHS Trust
** Established 1 Oct 2014 **
NHS Central London (Westminster) CCG
NHS Chiltern CCG
–
61
–
–
NHS Coastal West Sussex CCG
–
75
–
–
986
283
–
–
–
163
–
85
NHS Harrow CCG
NHS Herts Valleys CCG
NHS Hillingdon CCG
7,868
4,406
128
–
NHS Hounslow CCG
281
1,075
–
–
–
25
–
80
438
137
–
–
–
158
–
–
NHS North West Surrey CCG
NHS Slough CCG
NHS West London (K&C & Qpp) CCG
431
1,994
–
457
Health Education England
NHS England
–
58
–
–
Department of Health (PDC dividend only)
–
147
227
–
2,832
905
829
163
819
979
4,759
4,603
19,933
17,908
6,586
7,095
Other NHS (Balances below £100k)
Central and Local Government
Total Related Parties Balances
234
10
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
24.2 Transactions
Entities
Revenue Year to Revenue Year to
31 March 2015
31 March 2014
Expenditure Year Expenditure Year
to 31 March 2015 to 31 March 2014
£000s
£000s
£000s
£000s
Royal Free London NHS
Foundation Trust
241
259
262
152
Central And North West London
MH NHS Foundation Trust
970
1,471
767
402
–
–
–
184
521
189
271
168
6,228
6,735
393
350
Imperial College Healthcare NHS
Trust
473
1
748
931
London North West Healthcare
NHS Trust ** Established 1 Oct
2014 **
954
–
228
–
North West London Hospitals
NHS Trust **Dis-established 1
Oct 2014**
–
477
–
52
Ealing Hospital NHS Trust ** Disestablished 1 October 2014**
Kings College Hospital NHS
Foundation Trust
Royal Brompton And Harefield
NHS Foundation Trust
East And North Hertfordshire
NHS Trust
–
459
–
32
West Hertfordshire Hospitals
NHS Trust
107
106
53
53
NHS Aylesbury Vale CCG
129
140
–
–
NHS Barnet CCG
206
248
–
–
2,434
2,565
–
–
511
391
–
–
3,402
3,072
–
–
15,249
12,216
–
–
NHS Brent CCG
NHS Central London
(Westminster) CCG
NHS Chiltern CCG
NHS Ealing CCG
NHS Hammersmith And Fulham
CCG
512
444
–
–
NHS Harrow CCG
7,734
4,950
–
–
NHS Herts Valleys CCG
4,707
4,441
127
–
NHS Hillingdon CCG
135,657
128,295
–
–
NHS Hounslow CCG
3,687
3,836
–
–
181
160
–
–
–
105
–
–
NHS Slough CCG
586
454
–
–
NHS West London (K&C & Qpp)
CCG
140
265
–
–
NHS Windsor, Ascot And
Maidenhead CCG
393
202
–
–
16,109
16,460
–
3
NHS North West Surrey CCG
NHS Richmond CCG
NHS England
235
10
24.2 Transactions
NHS Litigation Authority
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Revenue Year to Revenue Year to
31 March 2015
31 March 2014
Expenditure Year Expenditure Year
to 31 March 2015 to 31 March 2014
–
–
Health Education England
9,439
8,182
–
–
Other NHS
3,006
2,999
1,522
794
Total NHS
213,576
199,122
8,731
7,891
1,563
1,613
22,968
22,126
215,139
200,735
31,699
30,017
British Telecommunications plc
–
–
297
–
Other non WGA entities
–
–
14
–
215,139
200,735
32,010
30,017
Central and Local Government
Total Whole Government
Accounts (WGA)
4,360
4,770
Non WGA Entities*
Total Related Parties
Transactions
* No transactions were noted with related parties of any Directors of THH, these transactions were conducted with related parties of
senior managers in the Department of Health.
236
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The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Note 25 Provisions
Current
Non-current
31 March 2015
31 March 2015
£000
£000
Provision relating to tax and national insurance*
781
–
Pensions relating to staff
176
2,314
Total
957
2,314
Current
Non-current
31 March 2014
31 March 2014
£000
£000
168
2,272
Current Year
Previous Year
Pensions relating to staff
* This is a provision introduced in 2014/15 that represents the potential liability of the Trust in meeting tax and National Insurance
liabilities of staff who are not on the payroll for the last four years
Provisions for liabilities and charges analysis
31 March 2015
31 March 2014
£000
£000
2,440
2,113
Arising during the year
925
432
Utilised during the year- accruals
(39)
(41)
(128)
(127)
73
63
3,271
2,440
Within one year
957
168
Between one and five years
704
672
After five years
1,610
1,600
Total
3,271
2,440
Provisions at start of year
Utilised during the year- cash
Unwinding of discount
Provisions at end of year
Expected timing of cash flows:
Provisions are liabilities that are of uncertain timing or amounts which the Trust expects to be settled by a transfer of economic benefits.
The provision for staff pensions has been calculated using information supplied by NHS Business Service Authority Pensions Division.
Clinical Negligence liabilities
Amount included in provisions of the NHSLA in respect of clinical
negligence liabilities of The Hillingdon Hospitals NHS Foundation Trust
31 March 2015
31 March 2014
£000
£000
47,918
31,112
237
10
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Note 26 Contingent liabilities
Contingent liabilities
31 March 2015
31 March 2014
£000
£000
111
26
The Trust’s contingent liabilities include £90k relating to employee work injuries and £21k relating to public slips or falls.
Note 27 Financial instruments
27.1 Financial Assets*
Trade and other receivables
31 March 2015
31 March 2014
£000
£000
17,757
18,363
5,483
5,733
23,240
24,096
31 March 2015
31 March 2014
£000
£000
16,685
7,075
Obligations under finance leases
5,640
5,065
Obligations under LIFT contract
12,718
12,899
Trade and other payables excluding non financial liabilities
15,228
15,280
3,271
2,440
53,542
42,759
31 March 2015
31 March 2014
£000
£000
19,416
17,128
In more than one year but not more than two years
5,707
1,894
In more than two years but not more than five years
5,608
4,937
Cash and cash equivalents (at bank and in hand)
Total at end of year
27.2 Financial Liabilities*
Borrowings excluding Finance lease and LIFT liabilities
Provisions Under Contract
Total at end of year
*Book value is equivalent to fair value
27.3 Maturity of Financial Liabilities
In one year or less
238
In more than five years
22,811
18,800
Total
53,542
42,759
10
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Note 28 Continuity of Service Risk Rating
31 March 2015
Metric
Criteria
Capital Service
PDC Dividends payable
3,897
3,572
Interest Payments
2,087
1,819
390
390
Capital element of LIFT
181
236
1,368
1,140
7,923
7,157
(6,103)
(744)
8,162
7,516
486
527
Impairments of property, plant and equipment
6,933
1,038
Interest Expense
2,014
1,819
73
63
3,897
3,572
Total Capital Service
Deficit for the year before exceptionals
Depreciation on property, plant and equipment
Amortisation on intangible assets
Unwinding of Discount Provisions
PDC Dividends payable
Gain on disposal
Total Revenue Available for Debt Service
Capital Service Cover
Cash available for Liquidity Purposes
0
(33)
15,462
13,758
1.95
Current Assets
Current Liabilities
Inventories
Total Cash available for Liquidity Purposes
Operating Expenses within EBITDA
Weighting Actual
Loans repaid to the Department of Health
Capital element of finance lease rental payments
Revenue Available for Debt Service
Actual Rating
Operating Expenses
Depreciation on property, plant and equipment
Amortisation on intangible assets
Impairments of property, plant and equipment
(Gain)/Loss on disposal
Total Operating Expenses within EBITDA
Liquidity
Continuity of Service Risk Rating
50%
1.92
25,051
27,001
(26,623)
(26,371)
(2,778)
(2,943)
(4,350)
(2,313)
225,839
199,610
(8,162)
(7,516)
(486)
(527)
(6,933)
(1,038)
0
33
210,258
190,562
(7.45)
Weighted Average Weighting
3.00
2.00
2.50
50%
(4.37)
100%
3
239
10
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Note 28 Continuity of Service Risk Rating (continued)
Continuity of Service Risk Rating boundaries:
Weighting
Capital Service Cover
Liquidity
4
3
2
50%
>2.5
<2.5
<1.75
50%
>0
<0
<-7
100%
The Trust achieved a CSRR of 3 in the year.
Note 29 Third party assets
The Trust held £11k cash and cash equivalents at 31 March 2015 (£12k at 31 March 2014) which relates to
monies held by the NHS Trust on behalf of patients. This has been excluded from the cash and cash equivalents
figure reported in the accounts.
240
10
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Note 30 Losses and Special Payments
31 March 2015
Losses and Special Payments
Numbers
Value
31 March 2014
Numbers
£000
Value
£000
Losses
Losses of cash:
Theft/Fraud
–
–
–
Overpayment of salaries, wages, fees and allowances
5
5
4
1
Other causes
2
–
1
–
Private patients
5
–
2
–
overseas visitors
150
263
138
563
13
1
26
13
Stores Losses
2
82
4
38
Total Losses
177
351
175
615
Compensation payments
12
76
–
–
Personal Injury with advice
3
13
14
46
Employment Payments
–
–
3
63
Other
24
28
17
2
Total Special Payments
39
117
34
111
216
468
209
726
Bad debts and claims abandoned
Other
Stores
Special payments
Total Losses and Special Payments
Amounts Recovered
9
18
The amounts reported in this note were incurred as actual costs for the year to date and do not contain any accrued costs. These sums
have been reported to and approved by the Audit Committee of the Trust.
241
10
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
Note 31 NHS Hosted charities
Name of Charity: – The Hillingdon Hospitals Foundation Trust General Amenities Fund and Other Related Charities
(The Charity)
Charity Registration Number : 1056493
Corporate Trustee: The Hillingdon Hospitals NHS Foundation Trust
From Charity's Statement of Financial Activities
31 March 2015
31 March 2014
£000s
£000s
371
229
(258)
(245)
113
(16)
18
(11)
131
(27)
31 March 2015
31 March 2014
£000s
£000s
544
523
141
59
32
16
-
(16)
717
582
26
29
Unrestricted Reserves
691
553
Total reserves
717
582
Total Incoming Resources
Resources Expended
Resource surplus
Gains on revaluation and disposal
Net Movement in funds
From Charity’s Balance Sheet
Investments (Non Current Assets)
Current Assets:
Cash
Other Current Assets
Current Liabilities
Net assets
Represented By:Restricted Reserves
The Charity is controlled by The Hillingdon Hospitals NHS Foundation Trust (The Trust) which acts as Corporate Trustee. Under the
accounting standard IFRS 10, the Charity is required to be consolidated within the Trust accounts (This replaced the accounting standard
IAS 27 in the 2014/15 Accounts). However the Trust has decided to depart from this standard on the grounds of materiality (Income
from the Charity is equivalent to 0.5% of Trust Income); the lack of any meaningful benefit to users of the accounts and the potential
excessive costs in terms of management and systems redesign. The detailed accounts of the charity can be found on the Charity
Commission website or contacting the Trust’s Finance Department to request a copy.
242
The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15
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243
The Hillingdon Hospitals
NHS Foundation Trust