Annual Report and Accounts - The Great Western Hospital

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6.8 Statements from Primary Care Trusts, Local Involvement Networks and Overview and Scrutiny Committee 6.8.1 Health Overview and Scrutiny Committee Statements The Swindon Health Overview & Scrutiny Committee is encouraged by the work that is already being undertaken to improve services amongst the priority areas for quality improvement. The Health Overview & Scrutiny Committee is committed to having a good working relationship with the Great Western Hospital NHS Foundation Trust and, based on the Committee’s knowledge, endorses the Quality Account for 2011/12. The Committee is grateful to the Chief Executive and her team for the regular updates at Committee meetings on what is working well, and in some cases, what is not working so well within the Foundation Trust. The Foundation Trust has been open and transparent throughout the overview and scrutiny process and the committee hopes that this continues through to the next municipal year. The Committee looks forward to continuing to work with The Great Western Hospital NHS Foundation Trust to continue to improve acute hospital care and community care for the residents of Swindon and the region. 6.8.2 Governors Statement Over the course of the past year the Governor Group have had the opportunity to receive regular Quality updates at both the Council of Governors Meetings and in the more focused Patient Experience Working Group, which has an open invitation to the local CQC officials, This group has the opportunity to feed in on a regular basis on matters of Patient Care and is regularly updated on new initiatives. It also on occasions, calls for reports on areas that have been highlighted which are of potential concern. It is a highly motivated group which helps to keep Patient Experience at the top of the Hospitals agenda. This Quality Report presents a balanced and accurate account of the performance of the Trust over the period 2011/12” 6.8.3 LINks Statements Local Involvement Network commentary on the Great Western Hospitals NHS Foundation Trust (GWH) draft Quality Account 2011/12 Local Involvement Network (LINks) welcome the opportunity to comment on the draft Quality Account from Great Western Hospital. Swindon has responsibility for co-ordinating responses from other LINks because the Trust’s head office is in Swindon. The first draft QA was circulated to LINks in Gloucestershire, Oxfordshire, West Berkshire and Wiltshire. The Trust responded to the initial comments made by LINks and this commentary has been amended accordingly. Combined LINk comments In making this composite response we have considered the Department of Health published guidance which includes this statement, “year-round stakeholder engagement during the process of producing Page 134 of 211
a Quality Account and the opportunity for local scrutiny is seen as an important feature to ensure that Quality Accounts are locally meaningful and reflect local priorities.” There is an expectation that GWH will demonstrate in this QA that patients and the public have been involved in its production. The Chief Executive’s statement clarifies this point as does the Governors’ statement. Ruth Lockwood, GWH Associate Director for Quality and Patient Safety attended the October 2011 Swindon LINk steering group to present information to the group about service improvements at GWH mid-year. Specifically referring to the published draft Quality Account, The QA appears to reflect the priorities of the local population in broad terms, – patient care, safety, involvement, dignity and nutrition. It was not apparent that any important issues have been missed out. However many of the graphs in the original draft were felt to be confusing particularly with the added dimension of the merger of GWH with WCHS. We understand that the graphs will be clearer in the final version of the QA. The use of abbreviations and jargon is often a major problem for people not familiar with the language regularly used in health and care services. We hope that some significant editing between draft and final versions will have added to the document’s clarity for a wider readership; as will the addition of the glossary. The three month backlog of data transfer from paper to electronic systems (incident reporting) may cause doubt over the accuracy of some of the other performance data. However we understand from GWH that the backlog should now be in the process of being cleared and that all data is readily available. We refer to the 2011/12 priority about patient experience “to ensure privacy when discussing treatment and care with patients”. People with hearing loss tend to talk and need to listen to people who talk a little louder than normal. We understand that patients are asked if they are happy for their treatment or care to be discussed at the bedside and that they will be moved to a private area if they have concerns about the privacy. Whilst there are references to end of life care, there are no specific references to the Liverpool Pathway (LCP) being used when appropriate. We understand that the LCP will be included in the 2012/13 QA. Care Quality Commission (CQC) We noted in their October 2011 report on Dignity at 100 UK hospitals the CQC reported that they had moderate concerns at GWH. We are pleased to hear that the Annual Report clarifies the position. Review of Priorities We are pleased to note that GWH have developed the 2012/13 plan to continue to improve in key patient areas such as falls, ulcer and infection. We also welcome the information that the Trust has considered important patient improvement measures where it is felt there is local need and priority and is including dementia as a key quality measure. This also links with the CQC’s quality and risk profile. Jo Osorio Swindon LINk development officer josorio@swindon.gov.uk 01793 497777 22 May 2012 /LINk/GWH Page 135 of 211
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Great Western Hospitals NHS Foundat
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CONTENTS 1 Chair and Chief Executiv
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The Great Western Hospital became a
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Underpinning this, our values are t
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3.2 Principal activities of the Tru
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Further Companies Act Disclosures 3
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Business Review / Management Commen
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3. To ensure that staff are proud t
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6. To work in partnership with othe
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With funding received from the Depa
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3.13 Contractual arrangements The T
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Patient care 3.16 Development of se
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3.20 New or significantly revised s
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3.24 Complaints Handling For the Tr
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The Trust actively responds to feed
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3.25 Using patient experience to dr
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The table below shows the CQUIN res
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Action plans based on the Quarterly
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3.27 Development of services with o
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3.29 Health and Overview Scrutiny C
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3.32.5 Interests held by Directors
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4.3 Attendance at meetings of the R
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4.7 Board of Directors’ employmen
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Remuneration Name Title Salary (Ban
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4.8.4 Additional disclosures The Tr
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5.1.2 Elected Governors - Public Co
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5.1.4 Nominated Governors Name Nomi
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5.1.6 Lead and Deputy Lead Governor
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“Eyes and Ears” - An initiative
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5.1.12 Nominations and Remuneration
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Rowland Cobbold, Non-Executive Dire
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Lyn Hill-Tout, Chief Executive (unt
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5.2.3 Length of appointments of Non
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5.2.6 Attendance at meetings of the
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5.3 Audit Committee 5.3.1 The Audit
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5.4 Directors’ responsibility for
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Note: Angela Gillibrand and Rowland
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The Mental Health Act / Mental Capa
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The Trust has a wide range of staff
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5.8.6 Membership Strategy To encour
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Page 93 and 94: No. Audit Title Reconstruction Audi
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Page 105 and 106: Part 3 - Other Information 6.4 Over
Page 107 and 108: GRAPH - Clostridium Difficile WCHS2
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Page 129 and 130: Priority 16: To ensure patients are
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Page 141 and 142: Graph 1 - GWH carbon footprint (ton
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Page 147 and 148: The Trust will be working towards a
Page 149 and 150: Detailed below is a summary of the
Page 151 and 152: Wiltshire Community Health Services
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Page 157 and 158: 10.2.2 Governance risk rating The t
Page 159 and 160: 11 OTHER DISCLOSURES IN PUBLIC INTE
Page 161 and 162: 13 AUDITOR’S OPINION AND CERTIFIC
Page 163 and 164: 14 ANNUAL GOVERNANCE STATEMENT 14.1
Page 165 and 166: • the key controls to mitigate ag
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Page 169 and 170: 14.5 Review of economy, efficiency
Page 171 and 172: Process Board Role and Conclusions
Page 173 and 174: 15 GLOSSARY OF TERMS BARS - Blood A
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1 CHAIR AND CHIEF EXECUTIVE’S REP
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2 OUR TRUST 2.1 Vision - Your healt
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3 DIRECTOR’S REPORT General Compa
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3.3.2 The Brunel Treatment Centre O
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14 In relation to the use of financ
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Checklist, a World Health Organisat
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organisations to adapt to these cha
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TABLE - Wiltshire Community Activit
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The Trust is currently reviewing it
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Enhanced Quality Governance Reporti
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The Trust is using its foundation t
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of implementing the programme. Incl
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As part of the corporate back offic
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What patients and service users hav
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3.25.3 Patient Surveys The PICKER I
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3.25.5 Annual Inpatient Survey The
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CHART - Percentage of patients who
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3.28 Working with our partners to s
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3.31 Statement as to disclosures to
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4 REMUNERATION REPORT Information n
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4.5 Remuneration of senior managers
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4.8 Pension Benefits and Remunerati
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The accounting policies for pension
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5 NHS FOUNDATION TRUST CODE OF GOVE
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There is currently a vacancy for th
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5.1.5 Attendance at meetings of the
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In addition, in preparing the Trust
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5.1.11 Council of Governors Meeting
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5.2 Board of Directors 5.2.1 The Bo
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Roger Hill, Non-Executive Director
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Helen Bourner, Director of Business
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5.2.4 Statement about the balance,
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5.2.9 Significant Commitments of th
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5.3.2 The work of the Audit, Risk a
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5.6 Nominations Committee 5.6.1 The
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5.7 Mental Health Act / Mental Capa
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5.8 Membership 5.8.1 Membership The
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The groupings of the members in the
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5.8.8 Membership development propos
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G.1.2 - The Board should clarify in
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and Governors. We have also commenc
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Regulation 1. To sustain compliance
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Audit / confidential enquiry title
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Audit Title Submitted/Required (%)
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No. Audit Title Learning From The P
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No. Audit Title 8. Diabetes Ketoaci
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No. Audit Title Audit Summary/Learn
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No. Audit Title Audit Summary/Learn
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6.3.4 Registration with Care Qualit
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Steering Group, provides a quarterl
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Clostridium Difficile: The goal for
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Priority 2: To reduce harm associat
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Priority 3: To reduce harm associat
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Pressure ulcers Community: The comm
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Safe care of the patient receiving
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CHART - Serious Incidents grouped b
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The three top serious incident caus
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West conference call in August 2011
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Priority 9: To review the clinical
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Priority 12: To undertake nutrition
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• A regular ongoing training prog
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Community: • Q1 Performance April
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The survey results demonstrate that
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6.6 Performance against key nationa
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6.8 Statements from Primary Care Tr
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6.8.4 Wiltshire Primary Care Trust
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6.9 Independent Assurance Report to
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7 SUSTAINABILITY REPORTING 7.1 Stro
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Graphs 3 and 4 show energy consumpt
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Graph 7 - Water consumption in WCHS
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8 EQUALITY REPORTING 8.1 Equality d
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9 STAFF SURVEY REPORT 9.1 Our staff
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It was agreed that we would focus o
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Appraisal rates. The overall rate f
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A quarterly “Voluntary Service Ma
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10 REGULATORY RATINGS REPORT 10.1 M
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10.3.2 Explanation for differences
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12 STATEMENT OF ACCOUNTING OFFICER
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14.4 The risk and control framework
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Risk Licence to operate (compliance
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The governors and wider stakeholder
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Steps which have been put in place
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14.8 Conclusion I have not identifi
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Annual Report and Accounts - The Great Western Hospital

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