Annual Report and Accounts 2012/13 - Royal Devon & Exeter Hospital

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2. Our Trust Royal Devon and Exeter NHS Foundation Trust 29 Annual Report and Accounts 2012/13 Stewardship At the same time as navigating the RD&E through an increasingly complex external environment and coping with the year-on-year constraints on our finances, the organisation faced a prolonged winter period with attendances at an unprecedented high. Reluctantly, but in the interest of patient safety, the Board decided that priority had to be given to emergency and urgent patients and, as a consequence, routine surgery was cancelled or restricted for a significant period of time. This had a knock-on effect over a period of months on the Trust's Referral To Treatment (RTT) targets for admitted patients and resulted in a backlog of patients who had already breached the 18 week target. The Trust's failure to achieve the 18 week RTT target for admitted patients placed the Trust in a position in which it was at risk of regulatory intervention by Monitor. Targets are clearly important but the Board knew that behind the statistics were real patients having to wait an unnecessarily long time to receive the treatment they required. The Board took the view that it would ensure that substantial effort was placed on managing down the backlog of patients but to do this in an ethical way, namely to treat those who had waited the longest first and those whose conditions necessitated more immediate treatment. The Board approved a plan, agreed with Monitor, to manage the backlog into a treatment list that was sustainable and it is expected that this would be cleared by the autumn 2014. As a consequence, the RD&E was placed on amber-red rating by Monitor. The Board was mindful that tackling the backlog of patients who had breached the 18 week RTT target involved a great deal of hard work and dedication by staff to ensure that patients were being treated in a timely way. In examining some of the causes of the RTT backlog, the Board considered what lessons it needed to learn to prevent a similar backlog occurring in the future. Performance information has continued to evolve over the course of the year reflecting changes in the governance structures, greater clarity about what information was useful to the Board (particularly in triangulating data and making connections between financial information and quality of service) and in some of the detail presented to the Board (particularly on the Ward to Board reporting) and subsequent “drill downs”. Over the next year the Board will continue to develop and refine the performance information it receives. The Government’s plan for health and social services is for more care to be delivered close to home, thereby reducing the demand on hospital services and residential care. As in other parts of the country, our partners are still in the early stages of developing this approach and therefore there has been no reduction in the demand for our services. Rather, there was a 14% increase in the numbers of very elderly patients coming through our doors over the last year – particularly in the period October 2011 to May 2012 and an increase in the complexity of their cases. This placed real strains on our systems, and had significant knock-on effects for our elective patients, particularly in orthopaedics, surgery and cardiology, at a level not seen before. At the same time, we experienced problems in discharging patients who were ready to leave hospital but required ongoing care, in a community hospital or other community setting. Public health data confirms there will continue to be a significant increase in the number of very elderly people in Devon. These demographic changes coupled with the wider changes in the healthcare and social care system means the pressures we are experiencing are unlikely to recede in the short term. Enabling patients who are able to move out of the hospital in an appropriate way, and ensuring that the wider health and social care community develop alternative services to reduce the demand on our services, remains an issue that we will continue to address, working closely with our CCG and local authority partners. On the basis of this analysis, and the need to ensure the Trust did not add to the backlog of patients not hitting the RTT 18 week target, the Board decided to progress: • The redesignation of Lowman ward from a surgical day case/admissions unit to an inpatient medical ward and the recruitment of a permanent staffing complement • The purchase of a 48-bed modular unit and recruitment of a permanent staffing complement.
30 2. Our Trust Royal Devon and Exeter NHS Foundation Trust Annual Report and Accounts 2012/13 The modular unit includes a: • 28-bed medical ward • 20-bed short stay rehabilitation ward (based on the model successfully piloted between November 2011 and April 2012). This decision was not taken lightly at a time of real financial constraints. Identifying an investment of £4.6m capital and £6m revenue was not straightforward, but the Board was clear that its key priority was to ensure that patient safety and quality was maintained. Getting this additional capacity up and running by December 2012, and ensuring that it was staffed appropriately, was challenging. The staffing issues involved not only local recruitment but also international recruitment to ensure that the Trust had high quality, well-trained staff to undertake the new roles in the new ward areas. The new facility opened in December 2012, and has helped the Trust manage winter 2012/13 in a way that has been more sustainable and better for patients. Longer term, the focus in our strategy on providing healthcare at home, on a more joined up healthcare service and, ultimately, a smaller acute service, remains central to the direction of travel for the RD&E. As well as overseeing the performance of the Trust as a whole, the Board’s stewardship role entailed looking at a number of issues in more detail including: • Regularly reviewing the Patient Engagement and Experience quarterly reports and reports from the Engagement & Experience Committee • Reports from the Governance Committee on a range of issues such as the Corporate Risk Register and ensuring that exception reporting to the Board took place if action plans were not effective in controlling risk • Receiving and debating the Annual Infection Control Report and action plan. The Board also has a stewardship over the Trust’s finances. The Business Review in the Our Finances section (p.130) sets out more details about the Trust’s financial and trading position over the year.
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Annual Report and Accounts 2012/13 - Royal Devon & Exeter Hospital

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