Annual Report and Accounts 2012/13 - Royal Bournemouth Hospital

The Royal Bournemouth and ChristchurchHospitals NHS Foundation TrustAnnual Report and Accounts 2012/13Presented to Parliament pursuant to Schedule 7, paragraph 25 (4) of the NationalHealth Service Act 2006.

Foreword from the Chairman1. Foreword fromthe ChairmanSafety, listening to patients and our staffand improving the patient experiencehave always been a focus for the Trust’sBoard of Directors, and have gainedgreater prominence throughout the yearfollowing the publication of the FrancisReport.While we are never complacent, I hopethat when reading our Annual Reportyou are reassured about our continuedexcellent performance, as demonstratedby examples of providing first class carefor our patients and the level of ward toBoard reporting within the organisation.In March 2013 the Trust narrowly missedout on the top spot and was ratedsecond out of around 150 trusts in thefirst ever overall assessment of NHShospital quality in England by MHP HealthMandate, based on what matters mostto people. This included risk of infection,rate of complaints and patient outcomes.A highlight during the year was theapproval of our development plans forChristchurch Hospital. We received atremendous amount of support fromlocal residents, staff, governors and thepublic which showed great communityspirit. We thank you for supporting ourplans which will ensure that ChristchurchHospital remains a focal point for thelocal community and health services aremaintained and developed. You can findout more on page 15 of this report.You will also read about the continualimprovements to the quality of servicesand care we provide for patients. Forexample, we now provide a 24/7 PrimaryPercutaneous Coronary Intervention(PPCI) service at the Royal BournemouthHospital where patients are admitteddirectly to the Dorset Heart Centre for lifesaving stenting.Our staff have been recognised bothlocally and nationally for theircommitment to improving patient careand their ‘can do’ attitude. Supportingour staff are over 800 volunteers whoalso give their time to our hospitals, andwithout whom we would not be able toprovide the standard of services thatwe do. Our Council of Governors, whoare also volunteers, continue to providechallenge and support to both the Boardof Directors and staff within our hospitals,all working for the same end goal toimprove the patient experience. You canread more about the impact they havehad from page 114.I am personally very proud that wecontinue to make improvements despitethe challenges we are faced with. Whenwe received an unannounced inspectionduring one of our busiest periods, theCare Quality Commission inspectorsfound us to be compliant in all areas,providing external reassurance to theBoard, the Council of Governors, staffand patients.The next 12 months will provide similarchallenge as we progress with our planto merge with Poole Hospital NHSFoundation Trust, while maintaining thefocus on running our hospitals effectivelyand providing high quality care for all.Jane StichburyChairmanAnnual Report and Accounts 2012/13 7

Foreword from the Chief Executive2. Foreword from theChief ExecutiveEach year I pay tribute to our staff whocontinue to go above and beyond,providing the best for patients despitecontinued pressures and challenges. Thecontribution of our staff this year is evenmore significant and outstanding giventhe emergency pressures we have seensince the summer of 2012. I am veryproud of the dedication and commitmentboth staff and volunteers have shown topatients and the NHS and thank them.Local people have many reasons to beproud of their health services.Despite the challenges, we have seensome excellent examples of peoplepulling together. Local GPs have beenworking on our wards with hospital staffsupporting patient discharges, as wellas in the Emergency Department to seethose patients who do not need to beseen by the emergency team. This hasreally shown how doing things differentlytogether really can make the experiencebetter for patients.We have continued to see excellentperformance in a number of areas:l extremely low levels of infection andno outbreaks of Norovirusl meeting all cancer waiting timesWe have invested in front line serviceswith additional nurses employed so thatall of our wards now meet the most recentRoyal College of Nursing guidance. Wehave refurbished the EmergencyDepartment, installed an additional MRIscanner and opened a new EndoscopyUnit for the cleaning of scopes. Ourcontinued investment in patient care isonly possible because of the efforts bystaff to delivery our efficiency plans whichensure we make a surplus each year thatcan be reinvested.Progress with the plan to merge withPoole Hospital NHS Foundation Trust hascontinued throughout the year with theBoard’s firm belief that this is the rightthing to do to protect local services andensure continued quality of care for ourpatients. As the first two foundation trustsproposing to merge we are paving theway for others. The challenges facing theNHS mean that even more organisationswill in the future need to explore potentialcollaborations to remain sustainable.Over the next few pages you will readabout the many areas where we arecontinually striving to deliver the bestquality care for our patients. I hope byreading this Annual Report you are proudof our achievements, as we are, andreassured that your local services providequality, patient-centred care that we arecontinuously striving to improve.Tony SpotswoodChief Executive8Annual Report and Accounts 2012/13

Directors’ Report3. Directors’ Report3.1 About the TrustThe Trust gained Foundation status on1 April 2005, following three consecutiveyears of being rated as a three starperforming trust. The Foundation Trustincludes the Royal Bournemouth andChristchurch hospitals (RBCH), whichare located about three miles apart onthe south coast, and a Sterile SupplyDepartment in Poole.The hospitals are close to the New Forestin the east and the Jurassic coastlinein the west with most of the catchmentpopulation covered by Dorset and WestHampshire clinical commissioning groups.RBCH provides a wide range of hospitalservices from its two main sites as wellas community settings in the Dorset, NewForest and south Wiltshire areas to a totalpopulation of around 550,000 which risesduring the summer months.On the key measures by which healthcareproviders are judged, the Trust hastraditionally performed very strongly.These include being externally rated ashaving:l excellent waiting timesl excellent infection controll excellent management of resourcesThis excellent performance wasrecognised when, in 2009, the Trust wasnamed HSJ Acute Organisation of theYear and, in 2010, CHKS Safest Hospitalin the UK.More recently, the Trust was ratedsecond out of around 150 trusts in thefirst ever overall assessment of NHShospital quality in England by MHPHealth Mandate. It was based on a rangeof measures of what mattered most topeople, including levels of infection, ratesof complaints and patient outcomes.In November 2011, the Board of Directorsmade the decision to progress with aplan to merge with Poole Hospital NHSFoundation Trust. Both trusts continueto work through the merger process butremain independent organisations untilmerger is approved and the proposednew trust is licensed.The Royal Bournemouth HospitalAnnual Report and Accounts 2012/13 9

Directors’ Reportl to work with partner organisations toimprove the health of local peoplel to maintain financial stability enablingthe Trust to invest in and developservices for patients.3.2 How the Trust is runThe Foundation Trust is accountableto Monitor, the regulator, which ensuresthe governance and performance ofthe organisation is sufficient and in linewith its terms of authorisation (recentlyreplaced by a licence). The Trust is alsoaccountable to local people through itsgovernors and members. In addition,there are a large range of inspection andregulatory bodies, including the CareQuality Commission (CQC), to which theTrust is also accountable.The Council of Governors, whichrepresents around 12,000 members, ismade up of public, staff and appointedgovernors. It ensures members’ viewsare heard, and are fed back to the Trust’sBoard of Directors, and that members arekept up to date with developments withinthe hospitals. You can read more aboutthe work of governors and details of theTrust’s membership from page 114.The Trust is run by a Board of Directors,which is made up of full-time executiveand part-time non-executive directors.Together, they are responsible for theday-to-day running of the Trust. Muchof this work is done by the executivedirectors who work closely with theclinical leaders and managers throughoutthe Trust. The Board also works closelywith the Council of Governors. The Boardformally meets once a month, exceptin August. Its role is to determine theoverall corporate goals for the Trust andbe responsible for ensuring they aredelivered together with its quality andperformance targets.There are also a number of key healthpartners that work closely with the Trustin developing and delivering services,such as local primary care trusts (nowreplaced by clinical commissioninggroups), community healthcare providersand social services.Board of DirectorsDuring 2012/13, the Trust’s Board ofDirectors was made up of the followingmembers:Jane Stichbury,ChairmanJane has a long career inpublic service with 32 yearsspent in policing. She helda number of high profilepositions including Deputy AssistantCommissioner of the MetropolitanPolice and Chief Constable of Dorset.Jane spent five years as Her Majesty’sInspector of Constabulary for the southof England before her appointment asChairman at the Foundation Trust from1 April, 2010.Alex Pike,Non-ExecutiveDirectorAlex is Global Brand VicePresident for Unilever andformer Marketing Director ofFitness First. Alex joined the Trust as aNon-Executive Director in June 2006and has a wide range of experience inmarketing and communication. She wasappointed Senior Independent Director in2009 and Chairs the Patient Experienceand Communications Committee.Ken Tullett,Non-ExecutiveDirectorKen has 14 years ofexperience as Non-ExecutiveDirector of the Trust, havingbeen appointed as a Non-Executive ofthe predecessor NHS trust in September1998. He was previously a senior officerin the Royal Navy and senior executiveof UK and international defence projectswith experience of Whitehall, theProcurement Executive, and the DefenceEvaluation and Research Agency. Kenhas experience at a senior level withinindustry in the UK and overseas and isfamiliar with commercial practices andmarketing. Ken is the Chairman of theCharitable Funds Committee.Annual Report and Accounts 2012/13 11

Directors’ ReportBrian Ford,Non-ExecutiveDirectorBrian was appointed asa Non-Executive Directorof the predecessor NHS trust inDecember 2001. He practised as aChartered Accountant from 1973 to1992 and has since worked as a Non-Executive Director, consultant andexpert witness. Brian is Chairman of theFinance Committee and the WorkforceDevelopment Committee.David Bennett,Non-ExecutiveDirectorDavid has extensiveexperience in strategy andoperational consulting and has heldsenior commercial roles in the logistics,telecoms and technology sectors. Davidjoined the Trust’s Board of Directorsas a Non-Executive Director in October2009 and sits on the Audit, Finance andPatient Experience and CommunicationsCommittees.Steven Peacock,Non-ExecutiveDirectorSteven was appointed Non-Executive Director in October2009. He is a Chartered Accountant andhas worked in retail and fast movingconsumer goods for the last 16 years -most recently as Director of CorporateFinance for the Estee Lauder Companies.Steven has a wide range of financialand commercial experience. Steven isChairman of the Audit Committee.Pankaj Davé,Non-ExecutiveDirector (until 31March 2013)Pankaj is a qualifiedaccountant with significantbusiness experience gained withblue chip companies. He has workedinternationally in Chief Financial Officerand Strategy Director roles with BP plc,he has also been responsible for leadingoperational and technical delivery teamsat a UK oil field. Pankaj joined the Trustin February 2011 and was Chairman ofthe Healthcare Assurance Committeeand a member of the Finance and AuditCommittees until he left on 31 March2013. He is also a Board Trustee forKidney Research UK.Tony Spotswood,Chief ExecutiveTony has been ChiefExecutive of the Trust since2000. He was previouslyChief Executive of Leicester GeneralHospital between 1998 and 2000 anda Trust Director for 20 years. Tonyhas extensive experience of leadingorganisations through strategic changeincluding service reconfiguration andmerger.Helen Lingham, ChiefOperating OfficerHelen joined the Trust inApril 2008 as Director ofOperations, prior to thatshe was Director of Operations at NHSLothian. Helen is responsible for strategicleadership, delivery of performancerelated targets and the development ofclinical services across the acute hospital.Her background is in radiography priorto moving into NHS management in2003. Helen was appointed Deputy ChiefExecutive in 2010.Richard Renaut,Director of ServiceDevelopmentRichard joined the NHS 16years ago through the NHSmanagement training scheme. He hasworked in both primary care and tertiaryhospital settings. Prior to his appointmentas Director of Service Development inApril 2006, Richard was General Managerof the Orthopaedic Directorate.12Annual Report and Accounts 2012/13

Directors’ ReportKaren Allman, Directorof Human ResourcesKaren was appointed Directorof Human Resources in 2007.She joined the NHS in 2003from the Audit Commissionwhere she was HR Director for DistrictAudit. Her early career was spent inthe private sector in retail with Marks &Spencer and Fenwick before working inthe City at the London Stock Exchange.Stuart Hunter, Directorof FinanceAppointed in February 2007,Stuart has over 20 years ofNHS experience, combinedwith being a qualified memberof the Chartered Institute of ManagementAccountants. Stuart brings a commercialoutlook to the Trust while understandingthe fundamental complexities of thehealth service.Dr Mary Armitage,Medical DirectorMary was appointed MedicalDirector in November 2009.She is a Consultant Physicianand Endocrinologist and waspreviously Clinical Director for Medicine.Mary served as Clinical Vice President ofthe Royal College of Physicians between2004 and 2007.Paula Shobbrook,Director of Nursingand MidwiferyPaula joined as Director ofNursing and Midwifery inSeptember 2011. PreviouslyDirector of Nursing at Winchester Hospitalwhere she worked for 10 years, Paula’sNHS career includes working as a wardsister in acute medicine, cardiac andrespiratory specialties. She also spentsome time working in primary care beforemoving back in to a hospital setting.Following Pankaj Davé’s resignation asa Non-Executive Director on 31 March2013, the Foundation Trust made aninterim appointment to the role of Non-Executive Director at the beginning ofMay with a view to making a permanentappointment later in the financialyear 2013/14. Ian Metcalfe, who waspreviously a Non-Exective Director, wasappointed to this role by the Council ofGovernors.The timing of the recruitmentto this role on a permanent basis hasbeen delayed with a view to allow time togain greater certainty around the timing ofthe proposed merger.In the case of the persons who aredirectors at the date when this report isapproved:l so far as each of the directors isaware, there is no relevant auditinformation of which the Trust’sauditors are unawarel each of the directors has taken allthe steps that they ought to havetaken to make themselves aware ofany relevant audit information and toestablish that the Trust’s auditors areaware of that information.This confirmation is given and should beinterpreted in accordance with section418 of the Companies Act 2006.3.3 A look back on the yearHospital index based on publicpriorities ranks RBCH secondon qualityIn March 2013 the Foundation Trustnarrowly missed out on the top spot andwas rated second out of around 150trusts in the first ever overall assessmentof NHS hospital quality in England, basedon what matters most to people.The Quality Index was published byMHP Health Mandate as part of Qualityat a glance: Using aggregate measuresto assess the quality of NHS hospitals.In November 2012, the Secretaryof State for Health, Jeremy Hunt,signalled his wish to develop a seriesof ‘OFSTED-style’ ratings for hospitals.The independent report, reported in TheTimes, suggested how this could bedone.Annual Report and Accounts 2012/13 13

Directors’ ReportThe report found that patient experienceand waiting times mattered most tothe public. It identified the following 10factors which were considered to have animpact on a person’s choice of services,and rated trusts based on comprehensivedata that was available:1. Risk of getting an infection from thehospital.2. The rate of recent (written) patientcomplaints about the hospital.3. The chance of your operation beingcancelled at short notice.4. The number of patients who saidthey got better after being treated inhospital.5. The number of patients who said theyhad a good experience of care.6. Whether you would have to sharea sleeping area or bathroom withsomeone of the opposite sex.7. How long you would have to waitfor an operation.8. The risk you would be harmed duringtreatment.9. If you were involved in decisionsabout your care.10. The number of staff at the hospitalwho would recommend it to familyand friends.Richard Renaut, Director of ServiceDevelopment, said: “We are committedto putting patients first and I am pleasedthat, in the areas that are importantto patients and service users, we areperforming well. Our performance isdown to the hard work and commitmentof our staff to ensuring we provide thebest possible care and outcomes for ourpatients.”The 10 highest performing trusts are:1. West Suffolk NHS Foundation Trust2. The Royal Bournemouth andChristchurch Hospitals NHSFoundation Trust3. Harrogate and District NHSFoundation Trust4. Kettering General Hospital NHSFoundation Trust5. Frimley Park Hospital NHS FoundationTrust6. Salford Royal NHS FoundationTrust7. Royal National OrthopaedicHospital NHS Trust8. Gateshead Health NHS FoundationTrust9. The Newcastle upon Tyne HospitalsNHS Foundation Trust10. South Devon Healthcare NHSFoundation TrustYou can read full details of the report,including data used and the full QualityIndex at http://mhpccom.wpengine.netdna-cdn.com/health/files/2013/03/Qualityat-a-glance.pdfLife-saving service now treatingpatients 24/7A life-saving service which treats heartattack patients within 60 minutes is nowavailable 24 hours a day, seven days aweek at the Royal Bournemouth Hospital.The Primary Percutaneous CoronaryIntervention (PPCI) service, which hasbeen running from 9am-5pm Monday toFriday since 2007, now treats heart attackpatients from across Dorset, Hampshireand Wiltshire, at any time of the day ornight.Dr Suneel Talwar, ConsultantInterventional Cardiologist, said: “A heartattack is caused by the blockage of anartery that supplies the heart with blood.This artery can be unblocked by theinflation of a small balloon and insertionof a stent within the artery (known asangioplasty), restoring blood flow to theheart.“When this emergency angioplasty andstenting is done in an acute heart attack,it is referred to as PPCI. It is the mostimmediate, effective treatment for acuteheart attacks currently available.”14Annual Report and Accounts 2012/13

Directors’ ReportParamedics now take patients who arehaving a heart attack, because of ablocked artery, directly to the cardiaccatheter lab at the Royal BournemouthHospital for specialist treatment, ratherthan via the Emergency Department.Christchurch development giventhe go-aheadThe Trust was delighted when, in March2013, Christchurch Borough Council’sPlanning Committee approved theplans for a £10 million development atChristchurch Hospital.The support from the local communitywas overwhelming with almost 1,500letters of support submitted to the counciland letters to local media, showing greatcommunity spirit. Thank you to everyonewho supported the application.The plans secure services at ChristchurchHospital for the future and significantlyimprove the buildings that services aredelivered in. They include:l an expanded on-site GP service(The Grove)l pharmacyl community clinicsl NHS key worker accommodation thatsupports NHS recruitment and easeshousing pressuresl high quality nursing home andassisted living accommodation, forwhich there is a clear demandl over 80 new jobs long term and a £30million boost to the local economyFor over two years the Trust has workedwith the council, the public, its membersand staff to design a scheme that isaffordable, meets planning requirementsand ensures services are secured.The Planning Committee turned downthe original planning application basedon conservation concerns. The Trustresubmitted its planning application withimprovements and released details of twoindependent reports to reassure somemembers of the public that some of thebuildings, which would be knocked downas part of the plans, were unsuitableto meet modern health care needs andalternatives to demolishing the formerworkhouse and identifying any potentialarchitectural and historical merits hadbeen explored.In a joint open letter to the localcommunity, Chairman Jane Stichbury andChief Executive Tony Spotswood wrote:“We would both like to express oursincere thanks to local people, patientsand our staff for their overwhelmingsupport of the developments proposedfor Christchurch Hospital.“We are delighted that the PlanningCommittee voted unanimously to supportour revised application which will securethe future of NHS services at the localhospital, ensuring it remains a focal pointfor the local community.“We will keep you informed of theprogress of the development overthe coming months and how we arecontinuing to provide even better servicesfor our patients and the community.“Thank you again for your support andgreat sense of community spirit.”Proposed new building: sympathetic to existing buildings and increased landscapingAnnual Report and Accounts 2012/13 15

Directors’ ReportHospital films win nationalawardThe Trust was recognised in theprestigious UK Public SectorCommunications Awards for a series offilms that support the patient journey.The films were created, using charityfunding, to reduce anxiety and improvethe patient experience by illustrating whatwill happen before, during, or after theirhospital visit. The films can be watchedby the patient with family or friends in thecomfort of their own home, allowing themto familiarise themselves with the hospitaland their treatment before it happens.The range of films covers patientexperiences in endoscopy, cardiacrehabilitation, and orthopaedics, toname a few. You can watch the films atwww.rbch.nhs.uk.“Virtual Q” to transform patientexperienceThe Genito-urinary Medicine (GUM)Department (sexual health services)introduced a virtual queuing system forpatients that will transform the patientexperience.Instead of queuing in advance to beseen in the week patients can send atext to request a slot in advance. Theyreceive a text detailing a time slot for thatafternoon.Kate Bond, Clinical Leader inGenito-Urinary Medicine, said: “We havemade this change in a bid to improveprivacy and dignity and we believe thatthis will help to make the walk-in a betterexperience for our patients.”Appy FeetA brand new phone application wasdeveloped by the Bournemouth Diabetesand Endocrine Centre (BDEC) aimed atchanging the lives of people who sufferfrom nerve damage (neuropathy), causedby diabetes.The ‘Appy Feet’ app can be downloadedon to an iPhone, iPod touch or iPad, tomonitor pain, mood, ability to performAppyfeet: changing the lives of peopleday-to-day activities like housework andexercise, as well as sleeping patterns.The app also stores daily glucose levelsand can remind the user each day toenter their latest data.Development of the app was supportedby the fundraising efforts of BrockenhurstManor Golf Club Ladies Captain 2011,Pam Capon, who enthusiastically adoptedthe cause to improve care and treatmentfor diabetes sufferers. Her son,daughter-in-law and three grandchildrenall have diabetes.Professor David Kerr, ConsultantPhysican and Diabetologist at BDEC said:“We developed the application to recordphysical and emotional health everyday, it then automatically packages upthe data to help the patient and doctorunderstand what it means to live withneuropathy and to record the impact ofchanging treatment.”The ‘Appy Feet’ app can be downloadedfor free at https://itunes.apple.com/gb/app/appy-feet/id576722758.16Annual Report and Accounts 2012/13

Directors’ ReportNurses shortlisted for improvingstroke services abroadNurses from the stroke service at theRoyal Bournemouth Hospital (RBH) wereshortlisted for a prestigious ‘InternationalNurse of the Year Award’ for collaboratingwith health professionals in Wessexand Ghana to improve patient care.Sponsored by the Nursing Standard,the award recognises nurses whoseinternational work has made a differenceto the healthcare of people outside theUK.Part of a larger team forming theWessex-Ghana Stroke Partnership, thenurses from RBH have been supportingcolleagues from Korle-Bu TeachingHospital in Accra, Ghana, over severalyears to develop the first specialist strokeunit in West Africa.Clare Gordon, Consultant Stroke Nurse atRBH said: “The UK team has thoroughlyenjoyed working with our colleaguesin Ghana. We have had to understandtheir different healthcare systems, strokepathology, and cultures to help themimprove stroke care in Korle-Bu Hospital.Despite this we recognise many of thechallenges facing our colleagues in Ghanaare similar to the challenges we havefaced over the past 10 years to improvestroke care.”New technology cuts heartpatient decision timesNew video streaming software wasintroduced at the Royal BournemouthHospital which means that heart surgeonsat Southampton University Hospital nolonger have to travel to discuss whetheror not a patient needs referring fromBournemouth for cardiac surgery.Surgeons from both hospitals can nowconduct their regular meetings virtually,ruling out the need for a 60 mile roundtrip and resulting in faster decisions forcardiac patients.Dr Peter O’Kane, Cardiac Consultantat the Trust, said: “We have too manyclinical cases for a once a month jointmeeting with cardiac surgeons. Thistechnology now allows more frequentconsultations which drastically cutspatient waiting times and simplifiesdecision making, leading to significantlyimproved efficiency and outcomes for ourpatients.”Touch screen menu serviceto revolutionise hospital mealtimesFor the first time in the UK, a newsystem was rolled out across the RoyalBournemouth Hospital which meantpatients could preview meals and maketheir selection just hours before they areserved.This followed a recommendation by theScrutiny Committee of the Council ofGovernors, in its 2011 report on patientnutrition and meal service, to enablepatients to order food on the same dayit was eaten.Terry Reeves, Catering Manager, said:“Our patients are provided with a fullrange of hot meals, sandwiches, saladsand snacks which are planned by thecatering team and dietitians.“Even when you are not unwell, it isdifficult to choose a meal a day inadvance - what you feel like eating oneday, you may not feel like eating the next.By making a choice on the day, patientsare more likely to eat a full meal and getthe essential nutrients needed to helptheir recovery.”The menu, ordered free via Hospediascreens, includes a picture anddescription of the meal plus dietaryinformation such as calories, proteinand fat.Annual Report and Accounts 2012/13 17

Directors’ ReportBournemouth and Christchurch Hospitals NHS HeroesOur heroes recognisedNine members of staff from the RoyalBournemouth and Christchurch hospitalswere named NHS Heroes. They werenominated by patients and their familiesor their work colleagues, for the differencethey make to the lives of patients in theircare.Jane Stichbury, Chairman, presentedcertificates to the members of staff ata ceremony in January and said: “Ourheroes, recognised by these awards, alldemonstrate the very best of the NHS,they are supremely professional and gothe extra mile for patients and colleagues.Each and every one has made a veryspecial contribution to patient care hereat RBCH, and they take a positive“can do” approach. The differentnominations are inspiring, and all are tobe congratulated.”NHS Heroes 2012:l Sarah Parsons,Occupational Therapistl Gemma Brittan,Neurotherapy Team Leaderl Debbie Detheridge,Orthodontics Team Managerl Maggie Goodison, Catering Assistantl Wendy Elcock, Midwifel BJ Waltho,Associate Director of Operationsl William Marshall,Physiotherapy Assistantl Christine Weight, Breast Care Nurse18Annual Report and Accounts 2012/13

Directors’ ReportAnother ‘gold’ for DorsetThe Olympics may be over but the Trustwas awarded its very own ‘gold’ in Augustfor its achievements in reducing carbon.The Carbon Saver’s ‘Gold’ standard, anational certificate, was awarded aftera site assessment in July of areas suchas carbon monitoring, investment andreduction programmes.Laura Dale, Sustainability Manager atRBH, said: “Achieving this accreditationis in recognition of the hard work wehave put in across all areas to reduceour carbon emissions by 6% over thelast two years. It goes to prove that theeffort every single member of our staffputs in, no matter how small, can make adifference.”You can read more about the Trust’ssustainability achievements on page 52.3.4 Support from charities andvolunteersEach year the Royal Bournemouth andChristchurch hospitals are fortunateto receive many charitable gifts fromlocal residents and patients; this moneyis governed by the Charitable FundsCommittee which reports to the Board ofDirectors, whose members are trusteesof the charity. This money is used toenhance the already excellent care that isreceived by the patients of RBCH.In 2012/13 the Trust spent an incredible£2,190,000 of charitable funds on itemsto benefit patients and staff. Thesemuch-needed items include funding fortraining, research and medical equipment;each item approved for funding has tomeet strict criteria set by the charity’strustees and enhance treatment and carefor patients and staff. Examples of thecharitable spending this year includes:l exercise classes for oncology patientsl oncology researchl replacement apheresis machine usedfor stem cell transplant required toincrease number of transplants andprovide a resilience for the servicel virtual queuing system in GU Medicine(sexual health services) which reducedqueuing and created a more robustpatient pathway and treatmentl sonosite breast scanner used toassess patients in breast clinic andhelp speed up the diagnostic andtreatment process for patientsl urology cystoscopes used to replaceaging equipment which was nolonger able to provide images ofcontemporary quality; the new scopesprovide a quicker procedure forpatientsl thoracic gas transfer equipment usedin the diagnosis and monitoring of lungdiseaseThis funding provided by the localcommunity is extremely important andhelps provide a higher standard of careor better experience for our patients,above and beyond what the NHS couldotherwise afford.The Foundation Trust is also fortunateto receive great support from a numberof hospital charities to improve both thepatient experience and working lives ofstaff. The Trust thanks the following fortheir continued efforts and support for thehospitals.l Friends of the Eye Unitl League of Friends Bournemouthl Chaplaincyl Christchurch Hospital League ofFriendsl Macmillan Caring Locallyl WRVSl Appeal Shopl Tulip AppealAnnual Report and Accounts 2012/13 19

Directors’ ReportFriends of the Eye Unit: making a difference to patientsFriends provide new day unit foreye surgeryGenerous donations from patients all overthe south west contributed to a £200ktransformation of the eye day surgery unitat the Royal Bournemouth Hospital. Theimprovements include new examinationrooms and a new reception and waitingarea.The renovation project was fundedentirely from charitable funds, with £80kfrom the fundraising efforts of the Friendsof the Eye Unit, and £120k from legaciesleft to the Eye Unit.Margaret Neville, Chair of the Friendsof the Eye Unit, said: “This is a massiveimprovement in terms of patient care,dignity and privacy. This investment wasable to happen due to the very generousdonations, legacies and membershipfunding.”Along with the three new examinationrooms, improvements have been made tothe reception area and signage which isnow much clearer - making the unit morewelcoming for everyone.Clinical Director, David Etchells, said:“We are extremely grateful to those whoremember the Eye Unit in their donationsand bequests. Their generous gifts havemade, and continue to make, a realdifference for patients at the unit.”20Volunteers fund wheel chairsWheelchairs funded by a hospitalcharity shop mean patients at the RoyalBournemouth Hospital will reach theirdestination in comfort.The 50 wheelchairs are used by patients’carers or hospital porters to help patientswho have difficulty walking and gettingaround the hospital site.The wheelchairs cost £30k, an amountraised entirely by the hospital charity shopthanks to generous donations from thepublic and the volunteers who give theirtime to organise and assist in the shop atRBH.Dorinda Sheppard, volunteer coordinatorat the shop, said: “It is wonderful to seethe money that we have raised go tohelp patients directly, in assisting them ingetting into the hospital and to the rightdepartment. Many patients are in pain orhave difficulty walking and these chairsmake their visit just a little easier at whatcan be a stressful time.”Ian Barnett-Potts, Portering ServicesManager, said: “The new wheelchairshave replaced ones which had been inuse for 15 years and had clocked upsome 10,000 miles in that time. They arevery sturdy and hard wearing, patients willfind them more comfortable, and the newdesign means they are easier to push.”Annual Report and Accounts 2012/13

Directors’ ReportGenerous donation benefitsbreast patientsPatients at the Breast Care Unit atthe Royal Bournemouth Hospital arebenefitting from a brand new piece ofequipment, donated by the Tulip Appealcharity.The Galaxy probe upgrade cost £9,700and helps surgeons locate the mostimportant lymph gland during cancersurgery. It does this by giving a clearervisual display of the scan and alerts themto the patients potentially affected lymphglands.Mr Tony Skene, Breast Surgeon,commented: “The unit is very gratefulto the Tulip Appeal for this extremelygenerous donation. The machine will beof great benefit to our patients.”In addition, refurbishment of the breastprosthesis room and the quiet roomwas also completed thanks for the TulipAppeal. This area is used by the HeadStrong support group and the unit is nowmore patient friendly for those using theserooms.Sue Bungey, Secretary to the Trusteesof the Tulip Appeal, commented: “I’mdelighted that we have been able toprovide this piece of equipment and therefurbishment. For a small group of ladiesthis has been a huge achievement and Iwould like to thank everyone locally whohas given money to this very worthwhilecharity.”Jigsaw building design giventhe go-aheadThe Board of Directors was delighted togive the go-ahead to the detailed designof a ‘Jigsaw’ building. The purpose-builtCancer and Blood Disorders Unit and anew Women’s Health Unit have long beenan ambition for patients and staff alike.The proposal fully uses funds raised fromthe current and previous Jigsaw appeals,as well as committing further NHSfunds. It will ensure a purpose-designedfacility is up and running for patients toreceive specialist care in an excellentenvironment.The two-floor building will be built at theRoyal Bournemouth Hospital betweenthe Eye Unit and the Derwent Suitefor Orthopaedics (subject to detailedplanning permission). The Trust alreadyhas outline permission for the location ofthe new building.Artist’s impression of what the Jigsaw building will look like21Annual Report and Accounts 2012/13 Annual Report and Accounts 2012/1321

Directors’ ReportArtist’s impressions of the proposed Jigsaw buildingNew facilities for oncology andhaematology patients on one floor wouldfocus on day care and outpatients, whichmake up the vast bulk of the service.Breast care and gynaecology would beon the other floor in a dedicated Women’sHealth Unit; bringing many servicestogether to ensure better privacy anddignity and more one-stop services inmore spacious surroundings.The Trust worked with patients and thepublic for their views on the design andlayout of the units before submitting theplanning application. Once planning isagreed there is an estimated build time of12 months.Jane Stichbury, Chairman of the Boardof Directors and Charity Trustees, said atthe time: “The Board is delighted to beable to commit the first tranche of fundingand to start the next phase of this excitingproject. We have had previous delaysbut we now have a proposal that will fullyuse all the money raised in an excitingway. It really does complete the jigsawof excellent services that will now bedelivered in excellent facilities.”Richard Renaut, Director of ServiceDevelopment, said: “Both Bournemouthand Christchurch hospitals receivetremendous support from volunteers andcharitable giving, for which patients andstaff alike are very grateful. This allowsus to provide even better care to patientsthan we would otherwise.“Having focused fundraising for severalyears on these two specific services wewill now progress spending the fundsraised as they were intended. We’ll thenstart looking across both hospitals atother patient priority areas for things wecan do that are above and beyond thetaxpayer funded services. As a resultwe’ll be asking our supporters to help usidentify the next areas where they wantto work with us on improving our servicesfor local patients.”To find out how to get involved log on towww.jigsawappeal.org.ukNon-NHS activitiesMonies generated from the surplusof The Bournemouth Private Clinic,which receives the Trust’s income fromprivate patients, are donated throughThe Bournemouth Healthcare Trust topurchase medical equipment, improvepatient facilities and support staff welfareand training.Volunteers supporting thepatient experienceThe Royal Bournemouth and Christchurchhospitals are extremely fortunateto receive the support of over 800volunteers including partnership volunteerorganisations. Over the last 12 monthsthe Trust has been reviewing andextending the number and roles of ourvaluable volunteers.Volunteers’ roles are diversifying andtraining and development continues tosupport them in these roles. Volunteersnow attend mandatory training, in linewith national recommendations.Volunteer’s duties include:l main receptions meet and greetl ward supportl providing patient companionsl administration supportl driving the indoor train22Annual Report and Accounts 2012/13

Directors’ Reportl surveying patients for real time patientfeedbackl meals companions to help those inneed of minimal supportl meal time assistants to help feedpatients who have been carefullyselected by clinical staffl gardeningThe Trust continues to recruit volunteerswho are happy to provide support inthe evenings and weekends. Anyoneinterested should contact the VolunteersManager on 01202 704161.The Board of Directors thanks all thevolunteers at the Royal Bournemouthand Christchurch hospitals for theircontinued support to our patients and theorganisation.ChaplaincyIn among all the changes affecting thehospitals some things never change andthe services led by the chaplaincy remainthe same:l Sunday afternoon at 2.30pm: Chapelservice of hymns and songsl Wednesday at 6pm: Roman CatholicMassl Thursday at 1pm: Holy Communionl Friday lunchtime: Muslim prayers incongregation.The Macmillan memorial servicecontinues six times a year in the chapel atChristchurch Hospital. In the developmentof the Christchurch site, the Chapel willbe replaced in a very similar form as atpresent to ensure this spiritual place isretained.It is good to share the chapel space withMuslim brothers and sisters and it isheartening to see the amount of use thechapel has each day from the religious,spiritual and for those of no belief -providing a quiet place in a busy hospital.At the beginning of the year, friend andcolleague Reverend Bob Leigh was takenfrom us, in illness and death. ReverendRobert Manning left the team in the latesummer and has not yet been replaced,Chaplains: privileged to serve patients and staffbut the work continues. More patientsthan ever have asked to ‘see the chaplain’and it is a privilege to serve them. Somewish to share good news and theyrejoice with them. Some wish to sharebad news, and they try to console. Andwhen asked they will bring comfort tothe dying. Bereavement takes up part oftheir time, spending it with relatives of thedeceased, who need to come and saytheir goodbyes, yet another privilege.Relatives and especially staff memberscome to the chaplain for advice or just thelistening ear.Thank you to the team of Chaplains andChaplaincy volunteers for their dedicationand help in looking after the spiritualneeds of the Trust, and for others in theorganisation who help us in our ‘special’services at St Luke’s tide and Christmas,namely the League of Friends, SalvationArmy and the choir of St John’s.Creditor Payment PolicyIn accordance with the Better PaymentPractice Code, the Trust aims to pay allvalid invoices by their due date or within30 days of receipt, whichever is later.Following the outsourcing of the Trust’sTransactional Finance service to EastLancashire Financial Services with effectfrom 1 April 2012, there was a short delayin the payment of some invoices. Thisreduced the cumulative performance forthe year, however, performance currentlybenchmarks well, with more than 90% ofall non-NHS invoices being paid withinthe agreed terms.Annual Report and Accounts 2012/13 23

Business Review4. Business Review4.1 Performance overview2012/13 has been a challenging year where the Trust has experienced significant levelsof emergency admissions, as well as a continual increase in elective demand andreferrals to cancer services.Despite this, the organisation has achieved, and in many cases exceeded, most ofits core governance indicators during the year. In addition, the Trust continued toprogress its transformational work to ensure delivery of quality services in the contextof the national financial challenges.Patient experienceIn 2012/13 the Department of Health reverted back to monitoring referral to treatmenttimes using the thresholds of 90% of admitted patients and 95% of non-admittedpatients to be treated within 18 weeks. The Trust performed well against both theadmitted and non-admitted targets, though this became increasingly challenging inthe last quarter of 2012/13. This was predominantly due to the sustained high level ofemergency admissions together with the increasing demand on cancer services.24Annual Report and Accounts 2012/13

Business ReviewSafetyThe Trust achieved the national and local MRSA objective and is well below theMonitor ‘de minimis’ target of 6. The Trust also achieved its national target forClostridium Difficile. The Trust continued to perform well against its contractualVenous Thromboembolism risk assessment target.Annual Report and Accounts 2012/13 25

Business ReviewQualityDespite increasing pressure on the Trust’s emergency services, more than95% of patients waited four hours or less in the Emergency Department from arrival.One of the particular areas of challenge for the Trust in 2012/13 was against the localstroke indicators. Although improvements were seen earlier in the year, four hourdirect admission to the Stroke Unit and 90% stay on the unit could not be achievedfor all patients. This was usually due to individual clinical reasons or the impact of theemergency care activity. The Trust did, however, continue to perform well against thebrain imaging target with more than 90% of patients being scanned within 24 hoursand also provided thrombolysis for appropriate and eligible patients.26Annual Report and Accounts 2012/13

Business ReviewPatients received timely access to cancerservices in line with the following nationalcancer standards including:l maximum 14 day wait from an urgentGP referral for suspected cancerl maximum 14 day wait for patients withbreast disease symptomsl maximum 31 day wait from diagnosisto treatment for all cancersl maximum 31 day wait for furthertreatments following the initialtreatmentl maximum 62 day wait from urgentreferral to treatment for all cancersThis year, the number of patients decidingnot to accept appointments withinthe ‘fast track’ timescales the Trust isrequired to meet, has made it difficultto always achieve the national level ofperformance required against the 14day targets. As a result, the Trust hascontinued to work with local GPs andcommissioners to ensure these patients’pathways are managed appropriately tomeet the clinical needs and wishes of ourpatients. The Trust has also continued toexperience significant levels of referral toits Urology Service.Full compliance with CQCunannounced inspectionThe Care Quality Commission (CQC)carried out a routine, unannouncedinspection in November 2012 to checkthat essential standards of quality andsafety were being met by the Trust. TheTrust was found to be fully compliant withthe standards that were reviewed.These were:l consent to care and treatmentl care and welfare of people who useservicesl safety and suitability of premisesl requirements relating to workersl recordsThe assessors visited the EmergencyDepartment, Ward 4 and Ward 23,outpatients and the Eye Unit. They alsospent time with the estates and HRteams to review processes regardingmanagement of the hospital site andrecruitment.The report included positive feedbackfrom patients which reflects the sheerhard work and commitment of the staff.Two patient quotes referring to staff thatwere highlighted in the inspection reportwere:“It has been us, rather than them and me;they have been marvellous.”“I can’t speak about them highly enough;they have always taken time to explain allthe details to me.”(These quotes are from patients who werespoken to by the CQC assessors.)Paula Shobbrook, Director of Nursingand Midwifery, said: “It is very pleasingthat the professionalism of staff hasbeen acknowledged by the inspectors.It is even more commendable given theinspection was made during a time whenthe hospital was extremely busy and thereare considerable pressures on staff. It isextremely reassuring that our patientscontinue to receive a safe and high qualitypatient experience.“We can always improve and will continueto work with staff and patients in allareas.”Planning and responding toemergency pressuresIn recognition of the sustainedemergency pressures during the year,the Board of Directors agreed the earlyimplementation, and extension, of thehospitals’ traditional winter plan. Thisincluded:l 15 additional nursing posts on medicalwardsl the opening of a Treatment andInvestigation Unit in December. Theunit frees up inpatient capacity acrossa range of specialities and supports upto 250 patients a week, many of whomwould previously have been seenelsewhere in the organisationAnnual Report and Accounts 2012/13 27

Business Reviewl additional medical support - increasedresources to provide more supportand consultant time; available at thefront door and to look after elderlypatients with surgical problemsl a greater focus on improving thedischarge process and reducingre-admissions. To support reductionsin length of stay, commissioners andsocial services agreed to support‘out of hospital assessments’for community hospital (CHC)assessments. This enables patientsto leave hospital much earlier in theprocessl a joint initiative between socialservices and the OPAL team to enablepatients to be fast-tracked home,with reablement support, continuedthroughout the winterl increased staffing into the dischargecoordination team to provide a sevenday service, eradicating some delaysand reducing length of staysl increased support into the clinical siteteam. An additional full time Band 6nurse for the clinical site team wasappointed over the winter period toenhance the resilience of the team andensure a hospital at night contact isavailable over the entire weekend. Thisalso supported junior doctors withtheir workloadl a housekeeping ‘SWAT’ team wasintroduced to deal with deep andterminal cleans in a timely mannerl additional portering specificallybetween Emergency Department andX-rayl specific directorate support, includinga dementia nurse specialist, pharmacysupport in acute medical unit andadditional therapy staffl increased presence of primary care(GPs) in the Emergency DepartmentThe Trust is very reliant on other partnerorganisations that provide services suchas intermediate care and social care tobe responsive and meet the needs ofpatients in a timely way. Weeklycross-organisational teleconferenceswere held to help promote and agreeearly solutions to the significant issuesfaced.Health groups gathered foremergency pressure talksKey health and social care groupscame together in February and Marchfor executive level talks to discussemergency pressures and the long term,quality of care for patients.Representatives from primary care,secondary care, community care,commissioners and the ambulanceservice met to decide what needs to bedone to make a significant difference forpatients in the right place in the system.Twelve key action points were developedfrom the meeting which were agreed byall healthcare chief executives acrossDorset. For example, what changes needto be made in caring for the frail, elderlyand those with dementia to ensure abetter system for the patients and theirfamilies and carers. An overarchingsteering board led by GPs has also beenintroduced to oversee progress and toensure proposals are implemented.Helen Lingham, Chief Operating Officerat RBCH, said: “We had an excellentdiscussion around what needs changingin the system to better support theemergency and urgent care needs of ourpopulation.“There was a clear acknowledgement thatwe have to manage the system differentlyin order to retain high quality care underincreasing demand.“The only way we will succeed is byagreeing joint responsibility for thechallenges. The steering board will alsoensure we do what we say we need todo.”28Annual Report and Accounts 2012/13

Business ReviewBringing together the bestof bothAs potentially the first two foundationtrusts to merge, the last 12 months hasbeen a great learning curve for the Trustas it experiences the merger processwith Poole Hospital NHS FoundationTrust. Much progress has been madewith a continued firm belief by the Boardof Directors that merger is the right thingto do to ensure we continue to providehigh quality care locally for patients andresidents.The proposed merger will allow the newmerged organisation, if approved, todeliver key patient benefits includingincreased medical staff cover in all keyareas. In so doing, patient outcomeswill improve and patient morbidity andmortality rates will be reduced. It istherefore vital that the merger proceeds,to deliver these important patient benefits.Furthermore, the merger will achievesignificant savings and will create afinancially viable organisation able towithstand changes in tariffs, by bringingtogether two largely complementarytrusts, one with a focus on electivecare (RBCH) and one with a focus onnon-elective care (Poole Hospital). Theproposed merger will also enable themerged trust to implement an ambitiousinvestment plan including the building of anew maternity unit in Poole.It is currently anticipated that, shouldthe merger be approved, the neworganisation would be licensed by April2014.Leading the new organisationIn July 2012, following an independentappointment process involving governorsfrom both organisations, the proposedBoard of Directors for the new trust wasannounced. Proposed appointments tothe new board are made to support theplanning process and ensure a smoothtransition of responsibility if the mergerproceeds. The members of the proposedboard are:Chairman:Jane StichburyNon-Executive Directors:David BennettMichael MitchellSteven PeacockAlex PikeAngela SchofieldNick ZieblandPankaj Davé was appointed as a memberof the proposed board but following hisdeparture as a Non-Executive Director ofthe Foundation Trust he will no longer bea member of the proposed board.Chief Executive:Tony SpotswoodExecutive Directors:Karen Allman,Director of Human ResourcesMr Robert Talbot, Medical Director*Stuart Hunter, Finance DirectorHelen Lingham, Chief Operating OfficerRichard Renaut, Director of StrategyPaula Shobbrook, Director of NursingMary Sherry, Director of Post-mergerIntegration and Development*** Mr Robert Talbot was appointed to theproposed board in September 2012 following adecision by Dr Mary Armitage, Medical Director,to retire in 2013.**In December 2012, Mary Sherry, ChiefOperating Officer at Poole Hospital NHSFoundation Trust, was appointed to theproposed board as Director of Integration andBenefits Realisation.The Council of Governors of the neworganisation will approve the appointmentof the Chairman, Non-Executive Directorsand the Chief Executive, should theproposed merger proceed.Annual Report and Accounts 2012/13 29

Business ReviewCompetition inquiry processIn November 2012, the Office of FairTrading (OFT) announced that it wouldreview the proposed merger as part ofits new role in assessing the competitionaspects of foundation trust mergers - asset out in the Health and Social Care Act2012.In January 2013, the OFT, as expected,referred the proposed merger to theCompetition Commission. This allowedfor a period of further review and analysis,which was anticipated by the trusts beingthe first foundation trusts in the UK tofollow this process, and will reassure thata merger is indeed in the best interests ofpatients and staff.During the remainder of the financialyear the trusts have been working withthe Competition Commission (CC) topresent a strong case on the clinical andfinancial benefits of merger and respondto information requests. A decision by theCC is expected in the summer of 2013.Public consultation outcomesIn April 2012 the Trust completed a jointpublic consultation with Poole HospitalNHS Foundation Trust on the proposedgovernance arrangements for theproposed merged trust.The feedback provided was reviewedand considered by the governors anddirectors of both Trusts.The name “Bournemouth and Poole NHSFoundation Trust” was chosen for theproposed new organisation.The public membership constituencies forthe new organisation are:l Bournemouthl Poolel Dorset (including local authority areasfor Christchurch, East Dorset, NorthDorset, Purbeck, West Dorset andWeymouth and Portland)l Hampshire and WiltshireThe following classes make up the staffconstituency of the new organisation:l medical staffl clinical staffl all other staffThe Council of Governors will be made upof 31 governors - 20 public governors, sixeach from the Bournemouth, Poole andDorset constituencies and two from theHampshire and Wiltshire constituency.There will also be five staff governors andsix appointed governors representinglocal stakeholder organisations.The minimum age to be a member ofthe new organisation will be 12 andthe minimum age to vote and to be aGovernor will be 16.The consultation proposals for the neworganisation on the size and compositionof the Board of Directors, the constitutionand elections were adopted withoutchange.4.2 Financial performanceFollowing the Trust continued to maintainstrong financial control during the year,culminating in a surplus of incomeover expenditure of £3.6m (1.4% of its£249m turnover). This surplus exceededthe financial target set and agreed withMonitor, the Trust’s regulator.Delivering a surplus is a key part of theTrust’s medium term financial strategy,and will be retained and used tosupport the 2013/14 capital investmentprogramme approved by the Board ofDirectors. The capital programme sets outplans to invest a further £9.4m in facilitiesto provide high quality healthcare.The surplus is the result of deliveringsignificant cost improvement duringthe year combined with a high level offinancial control within the individualdirectorates. The Trust has resourcedand implemented a significant numberof additional activities to contain thepressures experienced during the winterperiod and received a contribution tothese costs via the Strategic HealthAuthority. The Trust also received agenerous contribution from the StrategicHealth Authority towards the costsincurred as a result of the merger process30Annual Report and Accounts 2012/13

Business Reviewto ensure patient care is not impacted bythese additional costs.The Trust has successfully deliveredsavings of £8.5m during the year,underpinning the financial positiondescribed above and continuing thestrong performance of previous years.This exceeded the Trust’s targetedsavings for the year by £19,000. Itrecognises the requirement to delivergreater efficiencies as part of thechanging dynamic of the availableresources to fund public services;and efficiency plans totalling £9.6mhave been approved by the Board ofDirectors for 2013/14. Delivery of theseplans is monitored through the ServiceImprovement and TransformationTeam with regular reports to executivemanagement and the Board of Directors.The process of monitoring these planswill be enhanced further by a monthlymechanism to measure whether there isany potential adverse effect on the qualityof the service provided.It is recognised however, that as theTrust has transformed services overmany years, to continue to deliver suchefficiencies will be ever more difficult inthe future as a single organisation. TheTrust has a Reference Cost Index of 91;meaning that the organisation alreadyTable 1. Risk ratingsprovides a mix of services at lower thanexpected (national average) cost, which isindicated by an index of 100.After making enquiries, the Directorshave a reasonable expectation that theFoundation Trust has adequate resourcesto continue in operational existence forthe foreseeable future. For this reason,they continue to adopt the going concernbasis in preparing the accounts.The accounts have been prepared undera direction issued by Monitor and can befound in part 2 of this report.4.3 Regulatory risk ratingsMonitor assigns each NHS foundationtrust a risk rating for governance andfinance as defined in its terms ofauthorisation.The ratings below in Table 1 indicate therelative performance for the Trust againsteach element of the financial risk rating.The financial risk ratings are allocatedusing a scorecard which compares keyfinancial metrics consistently across allfoundation trusts. The ratings reflect thelikelihood of a financial breach of an NHSfoundation trust’s terms of authorisation(now replaced by a licence). A rating offive reflects the lowest level of financialrisk and a rating of one the highest. Thereare four governance risk ratings: red,amber-red, amber-green and green.2012/13 Financial Performance Actual RatingUnderlying performance - earnings before interest, tax,depreciation and amortisation marginAchievement of plan - earnings before interest, tax,depreciation and amortisation achieved5.8% 393.8% 4Financial efficiency - return on assets 1.4% 3Financial efficiency - income and expenditure surplus margin 1.1% 3Liquidity - liquid ratio days 57.4 4Overall financial risk rating 3As explained above, the overall ratings take into account finance and governance.The actual results for 2011/12, together with the latest figures, are set out overleafin Table 2.Annual Report and Accounts 2012/13 31

Business ReviewTable 2. Overall ratingsAnnual Plan 2011/12 Qtr 12011/12Qtr 22011/12Qtr 32011/12Qtr 42011/12Financial risk rating 5 5 4 4Governance risk ratingAmber-GreenAmber-GreenAmber-RedGreenAnnual Plan 2012/13 Qtr 12012/13Qtr 22013/13Qtr 32012/13Qtr 42012/13Financial risk rating 3 3 3 3Governance risk rating Green Green Green Green4.4 Principal risks anduncertaintiesThe Assurance Framework (AF)provides a dynamic system for theTrust to identify and manage risks.This is reviewed monthly by the Board’sHealthcare Assurance Committee (HAC).Identification and quantification of risks,and proactive management allowsthe Board to assess risks and theirmanagement. The AF is populated fromissues arising from the risk register, andrisks to achieving the Trust’s strategicplan objectives.Within the AF, key risk controls havebeen put in place to provide necessaryassurances on identified gaps in controlsystems. Action plans to further reducerisk are mapped against the identifiedobjectives. Risk reduction is achievedthrough a continuous cycle of theidentification, assessment, control andreview of risks.These two sources of strategic, highlevel risks to the organisation’s ability toachieve its objectives ensure the AF isupdated and reviewed monthly. Each riskhas a lead executive director responsible.In 2012/13 the risks were reportedunder each of the Trust’s strategicgoals. Notable (high and moderate) risksincluded the following areas, and how therisk status changed over the year:l emergency pressures - high all yearl pressure ulcers - risk reduced asambition for 50% reduction achievedl Christchurch Hospital scheme -reduced following planning approvall bowel cancer screening and capacity/waits - moderate all year, as demandremainedl several patient safety objectives(Clostridium Difficile, falls, dementia)- remained moderate until year end,when annual objective achievedl nurse staffing levels being adequate- moved from high to low asbenchmarking completed and extrastaffing improved and recruitedl Office of Fair Trading (OFT) andCompetition Commission delay tomerger benefit - moved from moderateto high, as delays and complexityintroducedl several financial risks - moved frommoderate to low or closed as financialissues were successfully managedThe introduction of new AF risks, andchanges to their status, shows activemanagement and review of theseissues, thus providing the Board andstakeholders strong assurance that risksand uncertainties are being addressed.32Annual Report and Accounts 2012/13

Business Review4.5 Trends and factors affectingthe futureThe key trends affecting the services topatients that we can provide are exploredin more detail in our forward plan for2013/14, but are summarised here. Theyinclude:Wider trendsl reducing funding (relative to increasingactivity)l ageing population, with greater healthneedsl rising expectations, reinforced by theFrancis Inquiry and recommendationsl new commissioners seeking carecloser to home, and centralisation ofspecialist careLocal trendsl significant increases in emergencycare demandl reduced numbers of training gradedoctors, making rotas more difficult tosustainThe work throughout 2012/13 andplanned for future years, includingmerger, is seeking to address thesethrough improved quality, costeffectiveness,and positioning to delivercommissioner and stakeholder goals.Further details of the 2012/13Transformation Plan for better care andbetter value, are listed throughout thedocument, but include the following:Theatres productivityThe Trust has continued to experience aperiod of sustained growth in the electiveand emergency surgery caseload andoperating theatre capacity has becomeincreasingly challenged. The need torespond flexibly to changes in demandand accommodate complex surgery aswell as some new surgical techniques,has led to a review of our operatingtheatres.Over the last 12 months our surgeons,anesthetists and theatre staff have beeninvolved in evaluating the operatingtimetable for all of our specialities andthey have developed a revised theatretimetable and staffing model that will:l establish specialist based theatreswherever possiblel introduce dedicated theatre teamsl adopt a Trust-wide theatre schedulingpolicyl establish a framework that would allowadoption of longer working daysl embrace the concept of continualimprovement to drive theatreefficienciesThis new model is based on ‘lean’methodologies that increase flowand reduce ‘waste’, for examplethrough downtime or movement,while maintaining or improving patientexperience, safety and clinical outcomes.This improved efficiency will ensurepatients have their operation on time andreduce inconvenience from delays orcancellations.Seven day servicesIn 2012 the Trust carried out a reviewof out of hours services and weekendworking arrangements and will beusing the data to support a new SevenDay Services project to be launchedin 2013. A number of service changeshave already been introduced such asincreased access to specialist services,senior medical staff and therapies atweekends and a full review of furtherpotential improvements will be consideredas part of the project.Length of stayWork on the Length of Stay projecthighlighted the opportunity to introducea nurse-led Treatment and InvestigationUnit at the Royal Bournemouth Hospital.The unit was opened in December 2012and provides a modern environmentfor patients to receive treatments suchas infusions, where an overnight stay isnot required. The unit has proved to besuccessful in freeing up bed capacity onthe main inpatient wards and has beenvery well received by patients, some ofwhose comments include ‘A calm andAnnual Report and Accounts 2012/13 33

Business Reviewwelcoming environment. Friendly andefficient staff. I felt very informed andinvolved in my treatment’.4.6 Investing in servicesThe Trust has continued to invest inpatient services over the last 12 months.This has only been possible due to carefulfinancial management and deliveringabove what was expected in theorganisation’s Cost Improvement Plan.Developments include:l Endoscopy Reprocessing Unit: anewly built unit for the cleaning ofscopesl Emergency Department/Acute MedicalUnit: refurbishment and remodellingl an additional MRI scannerl lift refurbishmentl Coronary Care Unit: an additional bayand shower/WC facilities to providesingle sex accommodationl design work for both the ChristchurchHospital development and thedesign of the new Jigsaw buildingfor women’s health and haematologyunitsl refurbishment of resident blocks4.7 Business continuity andemergency resilience planningThe Trust has ensured, with itsresponsibilities under the CivilContingencies Act 2004, that thefollowing plans are in place so that theorganisation remains resilient to anyemergency situation:l Major Incident Planl Business Continuity Planl Chemical, Biological, Radiological,Nuclear and explosive (CBRNe) Planl Pandemic Influenza PlanWithin each of these plans, eachdirectorate and department hasspecific plans for their area. Theseplans set out each department’s rolesand responsibilities in the event of anemergency, helping to ensure a cohesiveresilient emergency response. The Trust’semergency preparedness arrangementsensure continued patient care in timesof emergency and that normal businessis maintained as far as reasonablypracticable.The Trust still continues to work withmulti-agency partners to ensure the safetyand welfare of the local communities inthe event of an emergency incident. Thiswork facilitates the production ofmulti-agency emergency plans tohelp facilitate a robust, resilient, saferesponse to any emergency incident thecommunities in Dorset may experience atany time.On 1 April 2013, primary care trustsand the strategic health authoritieswere dissolved and replaced by clinicalcommissioning groups and local andnational commissioning boards. Althoughthis will not directly impact on emergencypreparedness, it is likely to strengthenlinks with neighbouring counties and leadto NHS trusts facilitating even strongermutual aid agreements. This will alsoenable a more holistic geographicalresponse to any incident facilitated by theclinical commissioning groups and theWessex NHS Commissioning Board LocalArea Team.In October 2012 the Trust ran a livechemical, biological, radiological, nuclear,explosive (CBRNe) incident exercisewhich not only tested the Trust’s CBRNePlan but additionally the major incidentand business continuity plans. Thishas led to some slight amendments inour plans and procedures to aid betterresponse and recovery. Further testingof the Trust’s emergency planningarrangements is due to take place insummer 2013.4.8 Putting patients firstQuality governanceAll aspects of quality are ultimatelyreported to the Board of Directors. Thereis a framework of sub committees whichsit underneath this for quality governance.These are:l Patient Experience andCommunications Committee34Annual Report and Accounts 2012/13

Business Reviewl Healthcare Assurance Committeel Clinical Governance and RiskCommitteel Patient Experience Action Group(now Patient Experience PerformanceCommittee)All aspects of patient safety and patientexperience are reported into and throughthese committee structures up to theBoard, using a dashboard and narrativereporting.The performance overall is monitoredby the Care Quality Commission andinternally produced provider complianceself-assessments for each of the CareQuality Commission’s outcomes arepresented to the appropriate committeefor review and monitored by the AuditCommittee.Specific items of concern are ratedon a risk register and presented to theHealthcare Assurance Committee monthlywith a progress update on mitigatingactions.There are no inconsistencies with theannual governance statement. Throughthe year a full review of the qualitygovernance framework both externallyand internally has been performed, witha final gap analysis and action planbeing submitted to the Board. This willbe available for Monitor and all relevantcommittees.There has been one unannouncedvisit to the Trust, by the Care QualityCommission in the last year. The outcomewas acknowledgement that the Trust wascompliant with its registration and thestandards assessed.In addition, two unannounced visits fromthe quality team at the local primarycare trusts were performed, visitingareas in the Emergency Department,ward areas and maternity unit. Areas ofpositive feedback were disseminatedappropriately, and areas for improvementdiscussed with the commissioning teamthrough the regular quality meetings.Patient care improvementKey improvements in patient care arecentred both around structure and directinterventions which impact on both safetyand experience. The Trust’s Governorsplay a key role in supporting this work.Improvements included:l rationalisation of nursing documentsand risk assessments into one overalldocument. This also encompassesintentional rounding, the 15 stepsand the six C’s, the Chief NursingOfficer for England’s drive on care andcompassionl patient experience governanceframework and development of aspecific accountability structurel patient feedback boards for thepublic to view the Trust’s actions forimprovementl development and implementation ofa ward ‘scorecard’, and staffing keyperformance indicators, which arereviewed monthly by key stakeholdersand ward clinical leadersl specific specialty improvements havebeen implemented in wound carewith preventative measures suchas specific devices for preventingpressure damage, and a skin careguidance protocol. Infection controlmeasures have improved considerablytoo, with many visible means for handwashingl falls prevention has been led througha ‘safety express’ group and wehave key items such as low bedsand development of dementia carestrategies for patients at risk of fallingtool volunteers trained as meal timeassistants to aid patients with feeding,encouraging fluids and ensuringmealtimes are a sociable eventl monitoring of the patient experiencethrough implementation of the friendsand family test, real time patientfeedback, patient experience cardsand volunteer companionsAnnual Report and Accounts 2012/13 35

Business Reviewl actions to improve patient experiencedirected by the Patient ExperiencePerformance Committee, includingpatient experience templates, friendsand family test, patient informationl monthly action plans from wards toaddress patient feedbackl one-to-one interviews for examplerelating to end of life with identifiedactions taken through the End of LifeCare Steering Boardl focus groups, patient diaries andpatient shadowing to understandthe patient perception and respond,including improved written informationand staff education to ensureimproved communicationl Carer and Young People’s Forumresulting in a carers informationsheet and staff education on theyoung person’s perspective throughpreceptorship trainingl Patient Opinion and NHS Choicescomments now being directed, andwhere necessary investigated, withreplies provided within set criterial stakeholder events have included widestakeholder and partnership agenciesto inform the patient experiencestrategy and learning disabilitiesevents, with actions including thedevelopment of a friends and familytest for those with learning disabilitiesin partnership with BournemouthPeople Firstl NHS Change Day to enable staff andvolunteers to pledge their support toimproving the patient experience andto gather patient experience feedbackl working in partnership with LINks hasresulted in an enter and view visit, aleaving hospital survey and an actionplan to address the issues from ayoung person’s survey across localsocial and healthcare that “a problemhas to fit in one box”Service improvements followingpatient surveys and CQCreportsMedication safety within the Trustcontinues to be monitored followinga visit from the CQC in 2011. Specificaudits were completed and reported intothe medication incident review group.A project for improving medicationadministration began in March 2013 andwill continue into the new financial year.The ward scorecard was developed for allward areas and units to be able to reviewtheir data against set goals for example,medication incidents, or falls or numbersof complaints. This enables teams to seethe impact of the care they are delivering,and review and improve accordinglyincluding against patient surveys andfeedback. Results and actions againstthis are displayed in the ward and unitareas for the public to view. They areupdated every quarter.A ward staffing review against nationallyset Royal College of Nursing guidancefrom 2010 and 2012 has been completed,to ensure safe staffing levels on wards forpatients on wards.An audit of noise at night was performedby the governors as a deeper reviewfollowing patient survey results (resultswill be available in July 2013).Patient safety walkrounds occur everymonth with members of the board toexamine areas of the Trust in detail. Theyalso give have an opportunity to raiseissues directly to senior staff for supportin enabling and empowering them todeliver optimum patient care. Actions arerecorded by the risk team and logged forimprovement.Volunteer numbers have been increasedand extended training provided to supportbedside companions who give bedsidesupport for patients, including using theTV system Hospedia to support mealsordering at the bedside in line with theCatering project to improve the mealtimeexperience. The bedside companionsalso spend time talking and listening to36Annual Report and Accounts 2012/13

Business Reviewpatients and are trained to signpost anypatient concerns.To improve hand hygiene with staff andTrust visitors, each ward has a floor handhygiene graphic on the floor and wallstogether with gel dispensers.Patient feedbackboards located atthe entrance toeach ward andLCD screensthroughout theTrust promotethe actions takenwithin specificclinical areasto evidencetheir actionsand responsesto patientfeedback in aframework of“you said wedid”.Patientstories are presentedat the Board of Directors meetings andmeetings of the Healthcare AssuranceCommittee.LCD screens have been furtherdeveloped to support patient educationto include the friends and family test andencouraging patients to ask questionsregarding their treatment and care.The Orthopaedic Directorate isdeveloping an innovative mobile phoneapp which will be free to patients,designed to provide information on theirphysiotherapy exercises and informationon what to bring to hospital for theirsurgery. They have also been shortlistedfor a patient safety award for the totalknee replacement patient advice magnet.Publication of the Friends and FamilyTest is provided at ward entrances andis available on LCD screens, the internetand in the main atrium in accordance withthe Department of Health directive.Ensuring the best patientinformation to support care andtreatmentDuring the year, the Trust workedtowards, and achieved a new certificationstandard for patient information. TheInformation Standard is a certificationscheme and quality mark, supportedby the Department of Health, for allorganisations producing evidence-basedhealth information for the public. It helpspatients and the public to quickly identifyreliable sources of quality, evidencebasedinformation through the use of aneasily recognised quality mark.The Trust’s information was assessedby The Royal Society for Public Health(RSPH) in April 2013. While the patientinformation process is largely thesame, the Trust has made the followingimprovements:l the policy includes patient informationon the websitel there is a new approval form whichmust be submitted with all leafletsl a readership panel has been set up,made up of patients and members ofthe publicl greater focus on referencingYou can find out more about theInformation Standard atwww.theinformationstandard.orgThe Patient Information Group continuedto approve a high number of leaflets tosupport patient care. During the year 423leaflets were submitted, 408 (96%) ofwhich were approved within one month.A large number of these leaflets are forsurgery, medicine, speciality servicesand ophthalmology, all of which are fullycompliant with the Information Standard.The Patient Information Monitoring Groupmeets quarterly to ensure the continuedquality of information.The Trust also received a national awardfor its patient films. You can find out moreon page 16.Annual Report and Accounts 2012/13 37

Business ReviewThe following has also been carried outthroughout the year:l an audit on leaflet racks throughoutthe organisation showing complianceof 75%. All non-compliant leafletsidentified were external leaflets. Thesehave subsequently been reviewed andadded to the Trust’s approved list ofpatient information providersl an audit of Trust leaflets was carriedout against the organisation’sminimum criteria, which achievedcompliance of 86%l staff training took place on howto produce good quality patientinformation and the approval processPatient safety walkroundsThe Board of Directors and governorscarried out nine walkrounds as part ofits patient safety programme during theyear. The walkrounds encourage staffto feedback on their experiences. Stafffelt that they worked well and they wereable to express any concerns they had.Subsequent actions from the visit arefollowed up and good practice is sharedwith other wards. In addition to thepatient safety walkrounds, members ofthe Board visit others areas on informaloccasions. A plan has now been devisedfor 2013 walkrounds including night visits.The Francis Report raised a numberof questions nationally on the level oftransparent ward to Board reportingthroughout the organisation. To ensurethis, the following is carried out:l the Board hears a patient story inthe public part of the Board meeting.Sometimes the patient attends themeeting. This includes accountsfrom both grateful patients who havereceived quality care and those whoseexperience could have been betterl governors ask questions at the endof part one of the monthly Board ofDirectors’ meetingsl the Board closely monitors quality ofcare and patient outcomes througha performance report. Non-executivedirectors provide appropriatechallenge where necessary38l the Governor Scrutiny Committeecarries out at least one independentreview each year on a patient topic.Recent examples include patientdischarge letters and hospital at night.Governors review evidence, suchas patient and staff surveys, beforepresenting their findings to the Boardl each clinical area displays their patientfeedback from a multitude of sourcesincluding real time patient surveys andpatient experience comments cardsl staff can approach any director orsenior manager should they feel thatthere are areas of care provided at ourhospitals that do not meet our highstandardsl patient comments received via theNHS Choices / Patient Opinionwebsites are monitored at Boardlevel by the Patient Experience andCommunications Committeel governors and other volunteers carryout real time patient surveys, talking topatients while they are still in hospital.Feedback is provided to clinicalleaders so that it can be acted onquickly and learning sharedl the Trust takes part in independentnational patient surveys (you can readmore on page 36)l staff, governors and patients areencouraged to speak out when theydon’t think something is right. Staffare encouraged to report adverseincidents that are followed up closelyl the Care Quality Commission carriesout unannounced inspections to allhealthcare providers to check thatessential standards of quality andsafety were being met (you can readabout the Trust’s full compliancefollowing an unannounced inspectionon page 27)The Trust is very proud of its staff and theservices provided for patients but boththe Board and staff are not complacent.We know that we can always do better toimprove the experience for our patients.Annual Report and Accounts 2012/13

Business ReviewResearch activityThis Trust engages in a full portfolio ofboth clinical research and laboratorybasedscientific research projects. TheTrust is an active member of the NationalInstitute for Health Research governedWestern Comprehensive ResearchNetwork. Locally, the Trust has been apioneer of consortium working havingset up the Dorset Research Consortium.This body acts on behalf of all the trusts,primary care, secondary care and mentalhealth, coordinating governance acrossthe area.The Trust has a history of activelypursuing commercial clinical trial work.The infrastructure of the organisation hasbeen tailored to facilitate the needs of thepharmaceutical industry allowing patientsaccess to otherwise inaccessible newtreatments. For example, approximately25% of all cancer patients are enrolled onclinical trials which offers them the verylatest in treatment while relieving the NHSof the care costs associated with theirtreatment.In recognition of the Trust’s track recordin this area, Quintiles, the world’s largestclinical trial organisation, has entered intoa “partner site” agreement with the Trustallowing the organisation access and firstrefusal on all the trial work available tothem. This will greatly increase activityover the next 18 -24 months.The number of new patients enrolled intoclinical trials in 2012/13 was 1,157.4.9 Complaint handlingComplaints made to the Trust aremanaged within the terms of the Trust’scomplaints procedure and nationalcomplaint regulations for the NHS. Theoverriding objective is to resolve eachcomplaint with the complainant throughexplanation and discussion.Every complainant is sent a letter (by postor email) on receipt of their complaint,explaining the proposals for investigation,inviting them to contact the ComplaintsManager to discuss this if this has notalready happened. Complainants arealso advised about clinical confidentialityand the support available to them fromthe Independent Complaints AdvocacyService (ICAS).Each complaint is investigated by thedirectorates concerned and, whereappropriate, the advice of a clinician fromanother area is obtained. This evidenceforms the basis for a response to thecomplainant from the Chief Executive.Further details of the complaints receivedto the Trust can be found in the QualityReport.How to make a complaintIf you have a complaint about theexperience received at the RoyalBournemouth or Christchurchhospitals please contact the ComplaintsManager on 01202 704452 or emailsimon.dursley@rbch.nhs.uk4.10 Public consultationThe Trust completed a consultation on itsAnnual Plan, which included proposals forChristchurch Hospital.The Trust also completed its joint publicconsultation with Poole Hospital NHSFoundation Trust on the proposedgovernance arrangements for the neworganisation (you can read the outcomesof the consultation on page 30).In October 2012 the Trust wrote to healthoverview and scrutiny committees inDorset and Hampshire about a temporarychange to where the Trust’s inpatientoncology service is provided. FromNovember 2012 the small number ofpatients needing inpatient hospital carewere admitted to the oncology ward atPoole Hospital, rather than the RoyalBournemouth Hospital. The outpatientand day care services remain unchanged.It has been extremely difficult for theTrust to recruit and provide enoughappropriately trained medical staff neededto look after patients who need complexoncology inpatient care on both sites.This is because of a national shortageof suitably qualified staff. By temporarilymoving the inpatient service to Poole,Annual Report and Accounts 2012/13 39

Business Reviewthe Trusts can pool the staff resources toincrease the medical staff available andensure patients have access to the bestcare possible. The temporary transferremains under review with commissionersand local health overview and scrutinycommittees updated.4.11 Our strength is our staffOne of the Trust’s strengths, and thereason for consistently performing well,is its staff. Without their extraordinarycommitment and dedication the Trustwould not have been able to achieve thesuccesses mentioned within this Report.The Foundation Trust is a significantemployer in the area with 3,543.93 wholetime equivalents as of 31 March 2013.Staff turnover is below the nationalaverage and generally staff regard theTrust as a good place to work - asdemonstrated in staff surveys carried outduring the year (further details can befound over the next few pages).Sickness absence for the Trust at the endof 2012/13 was 3.72% against a target of3.50%. The national average was 2.6%(Office of National Statistics).During the year, the Board of Directorsagreed funding to increase the levelof nursing on all wards to meet RoyalCollege of Nursing guidance. This is aratio of one nurse to eight patients on allgeneral wards and one nurse to sevenpatients on all elderly care wards duringday shifts. The hospital also recruitedall 35 newly qualified nurses out on thewards.Informing and consulting ourstaffDuring 2012/13 the Trust consulted itsstaff and staff side representatives on anumber of issues, including:l specialist nurse reviewl day surgery unit - change to shiftpatterns to include occasional nightand weekend cover. Consultationmeetings took place during July andAugust with formal notice of the newshift pattern starting in December2012. This was a minor organisationalchangel telecoms (switchboard) - transferof staff. Consultation began on 22October 2012 with the transfer of 11staff taking place on 1 December 2012l IT consultation - consultation startedin February 2013 to transfer 35members of staff from Poole Hospitalto RBCH and 35 RBCH members ofstaff are also currently undergoingconsultation on the restructurel occupational health - Consultationstarted in September 2012 to transferthe Occupational Health Departmentat Poole Hospital to RBCH. It wascompleted on 1 December 2012. Thisaffected five permanent staff andthree who were working via the staffresource pool and one via agency40Annual Report and Accounts 2012/13

Business Reviewl molecular pathology - consultationwith three members of staff due to astructure changel Two consultations in the Eye Unit.The first was to change acute referralclinic times at the weekend as from 1April 2013. The other was to close theEye Unit ward at weekends. Patientswould be cared for at the Derwentinsteadl procurement - consultation beganon the 1 October 2012 for 30 daysaffecting approximately 17 staffConsultation with staff happensdirectly through face to face briefingopportunities, written briefings for linemanagers across the organisation anddetails in Trust publications.As well as formal consultation, theTrust makes available information on,for example, the Trust’s performance,good news, events and developments,as well as ensuring good internalcommunications. This is carried outthrough:l regular meetings with staff siderepresentativesl monthly ‘Ask the Exec’ sessionswhere staff can hear from the Trust’sexecutive directors and ask questionsl bi-monthly staff newsletter - Buzzwordl monthly Core Briefl a well-used intranet sitel an induction for new staff - heldmonthlyl open day for staff and members of thepublicl briefings at directorate and ward levelas and when neededl a summary from each Board ofDirector’s meetingl internal briefing system via leaders inthe organisationl a weekly bulletin for staff circulated viaglobal emaill fortnightly face to face leaders’briefing with the Chief ExecutiveAsk the ExecsAsk?Annual Report and Accounts 2012/13 41?Core BriefAprilFrom: Tony Spotswood, Chief ExecutiveThank you fromBoard of DirectorsThe Board of Directors would liketo express its sincere thanks toall staff in responding so well tothe emergency pressures we arefacing.Emergency admissions to thehospital remain at a high level.Over the past year, RBCH hasalso seen a significant increasein ambulance admissions incomparison to other local hospitals.Even with these increasednumbers, we continue to be ahigh-performing trust in relationto ambulance handovers, withover 95% being handled within30 minutes.There were no hospital acquiredMRSA cases in 2012/2013 and inMarch there were no wards closedOpensessionHave you got any questions about the Trust that youwould like to ask our Chief Executive?If so, come along and ask - this is your chance to askthe questions you would like answers to.the ExecsYou can also email your questions in advance to theCommunications Department at comments@rbch.nhs.ukdue to norovirus. Considering thepressures the hospital is under,these are very impressive numbersand it is down to excellentmanagement and control ofinfection by ward staff and theinfection control team.While the level of emergencyactivity has been extraordinary,infection control remains high,single-sex wards have beenmaintained and staff sicknesslevels are low, indicating weare managing effectively as anorganisation. This is excellentconsidering the pressures we areunder and is in large part down tothe commitment and hard work ofour staff. Thank you.Tony Spotswood,Chief Executive?Tony Spotswood, Chief Executive.Thursday16th Mayat 12.30pmin theRBH Lecture TheatreLunch will be provided2013Second place for Bournemouthnurse in national thrombosis awardCongratulations to Hayley Flavell, ConsultantNurse of Anticoagulation at the RoyalBournemouth Hospital (RBH), who scoopedsecond place at the British Journal of Nursingawards.The award for Thrombosis Nurse of the Yearrecognised excellence and commitment acrossthe UK to drive forward care and servicesprovided by thrombosis and cardiac nurses.Hayley has worked as a nurse consultant atRBH for over four years and has specialisedin the field of anticoagulation and thrombosissince 1998 when she set up one of the firstcommunity deep vein thrombosis (DVT)CompetitionCommissioninvestigationpausedThe Competition Commission(CC) has paused its investigationinto the proposed mergerbetween RBCH and PooleHospital NHS FoundationTrust. This is so both trustscan respond to the detailedinformation requests made bythe CC.It is not yet known how long theCC will pause the investigation.The CC process and full reviewwas expected to last 24 weekswith the potential for this to beextended to 32 weeks should itwish.We will let you know when theinvestigation resumes.HospitalWednesday29th MayOpen Dayat 12.30pm in theHoward CentreChristchurchWednesday 12 June 2013Lunch will be providedl Atrium exhibition l Educational presentationsl Department stands l Competitions...and lots more2013 - Issue 210am - 4pmservices. Her work within the hospital Trusthas seen the development of robust VenousThromboembolism (VTE) preventionpolicies and tailored patient informationleaflets and videos. As a result, thePathology Department at RBH iscurrently being reviewed to becomean exemplar centre.Hayley said: “I was extremely flattered to benominated for the award and was humbledto be with so many outstanding nurses.”The Thrombosis Nurse of the Yearaward ceremony took place in Londonon 22 March.10.30am: Hip Arthritis: New treatments andPrevention Dr Robert Middleton, Consultant Orthopaedic SurgeonThe Royal Bournemouth and Christchurch Hospitals Staff MagazineFriends andFamily TestA number of presentations will be held throughout the day in the Chapel11.30am: Understanding Dementia12.30pm: Cherishing the Skin You’re InDr Sue Hazel, Consultant in Geriatric MedicineDr Ian Pearson, Consultant Dermatologist1.30pm: Medicine and the New Media Professor DavidKerr, Consultant Physician in the Bournemouth Diabetes and Endocrine Centre2.45pm: Understanding ArthritisDr Neil Hopkinson, Rheumatology ConsultantPlaces at these talks are limited so if you would like to attend,NHS WinterHeroesJigsaw plansplease call: 01202 704271 to book your placeor email: communications@rbch.nhs.ukStaff engagement...much more insideupdate NHS Change DayNews n Focus on n Secret lives of n Noticeboard n FundraisingIn addition to the internal communicationmethods mentioned above, the Trustuses other methods to engage with staff,including awareness stands outside thestaff restaurant, poster campaigns anddirectorate and departmental meetings.The NHS Employers staff engagementtoolkit has shown a strong link betweenstaff engagement and Trust performance,including quality of services, financialmanagement and patient satisfaction.In the 2012 Staff Survey the Trust’sscore of 3.72 was above (better than)average when compared to acutetrusts of a similar size. (You can readmore about our survey results frompage 43).

Business ReviewThe indicator of staff engagement iscalculated using staff survey questionsthat relate to staff engagement, i.e. staffmembers’ perceived ability to contributeto improvements at work; their willingnessto recommend the Trust as a place towork or receive treatment and the extentto which they feel motivated and engagedwith their work.Staff health and wellbeingThe Trust has continued to promotehealth and wellbeing topics throughits ‘First Friday Fitness’ sessions, withparticular focus during the last 12 monthson:l healthy eating and dietary advicel blood pressure monitoringl fitness - corporate membership oflocal clubs and organisationsl supporting staff with stressmanagementThese sessions draw on the expertiseof the Trust’s professional staff, whowillingly give their own time to help deliverthe sessions, and also support from localbusinesses, many of whom attend on aregular basis.The Valuing Staff and Wellbeing Grouphas continued to meet on a quarterlybasis to discuss benefits for staff, whichhave included:l ‘Fit for work’ sessions, organised bythe staff physiotherapist on a twiceweekly basisl stress management sessionsl links with BH Live (local gyms andcorporate memberships)l change of provider for the EmployeeAssistance Programmel production of a quarterly health andwellbeing newsletterHealth andWellbeingWhat Stress!Issue 5In Healthcare 2013Feel stressed at work?If so, come along to theStress Awareness Studyday on the 9th May 2013.What Is The Aim Of The Seminar?The programme is designed to :• provide the latest clinicaland scientific information onstress & its management;• allow you to upgrade your personal and professional stressmanagement skills• provide you with a range of techniques for coping with stress inyour healthcare setting• increase your awareness of personal stress and develop‘emotional immunity’• Provide additional approaches for the professional that can beused in clinical settings with patients.The course will run on 9th May 2013Morning session - 9:30 - 12:30Afternoon Session - 13:30 - 16:30(Please only attend one)Venue - Lecture Theatre (education Centre)For further informationNewsletterplease contact the Training Department Ext: 4530Spring 2013HibernatingPCsLast year the IT Departmentimplemented Power Studio,a PC power saving softwarethat hibernates your computerif it is not being used. Thishelps save money and reducescarbon emissions.A number of PCs are exemptfrom the hibernation policyas they need to be accessed24/7. We have applied thehibernation software to thosePCs that do not currently haveit, except for those that areexempt, on Wednesday 27February.To wake the PC up from itshibernated state, press thepower button. Any MicrosoftOffice Documents you wereworking on will reappear.If you need to leave your PCon overnight, you can overridethe hibernation process.http://rbhintranet/itservices/2013pdf/powerstudio.pdf tofind out how.If you have any questionsor feel that your PC needsto be exempt, email:dean.feegrade@rbch.nhs.ukThe Occupational Health and HumanResources teams have continued tosupport managers in the management ofsickness absence, with:l training sessions for managers andsupervisors to help them deal withchallenging sickness issuesl complex case meetings to discusssuitable ways forward for individualcasesl redeployment of staff with limitationsto their health which prevents themfrom continuing in their current role42Annual Report and Accounts 2012/13

Business ReviewNew film supports staff trainingEach year around 1,327 members ofclinical staff receive mandatory trainingon the safe practice of dealing with arange of risks associated with sharps andinoculations.This year the Occupational Health Teamproduced a short film which staff candownload from the Trust’s intranet. Itcomprehensively takes an individualthrough how they should deal with arange of potential risks, for exampledealing with a blood splash of body fluidsor a sharps injury.Feedback has been positive with manystaff saying that the film holds theirattention and is presented better than lastyear.New Employee AssistanceProgrammeIn March 2013 a new EmployeeAssistance Programme was launched toprovide support for staff. The programmehelps staff with issues relating to:l relationships and familyl moneyl retirementl work and careerl bullying and harassmentl health and wellbeingl management support.The service is available 24 hours a dayand is confidential, independent and freeof charge.The new scheme is more proactive thanthe previous. The Trust’s case worker isable to get involved within the workingenvironment. They sit on the Trust’sValuing Staff Group and have increasedavailability to attend meetings to supportand promote the benefits of the service tostaff.Healthcare technician postIn 2012/13 a new healthcare technicianrole was introduced to work across theTrust and Poole Hospital NHS FoundationTrust. This is an integral role andsupports the nursing structure within theOccupational Health Team by assistingwith the triage of patients withpre-placement screening. They also:l assist clinical staff with triage ofworkload, sharp and inoculationinterventionsl take blood for testing of blood bornevirusesl carry out audiology checks for hearingloss in workers exposed to noiseregularly - both in-house and external,which brings income into the Trustl spirometry for assessing lungfunctions in dusty workingenvironment or where chemicals areused both internally and externally.Some income is also brought into theTrust from this workstreamThe speed and turnaround of workload inthe Occupational Health Department hasbeen assisted by this development whichhas had an impact on quality of care forstaff. This post has also assisted in datainputting thus enabling the department toproduce more accurate qualitative datafor use within the Trust.2012 Staff SurveyOnce again, the 2012 Staff Survey wascarried out on behalf of the Trust by thePicker Institute between October 2012and December 2012.In accordance with the nationally agreedprotocol, a random selection of 850employees, from those employed on 1September 2012, were asked to completeand return the questionnaire. Of these,845 were eligible to complete the survey.The remaining five staff were ineligibledue to maternity leave, long-term sick orhaving recently left the Trust.The staff survey questionnaire contentis agreed nationally. The Trust used thecore questions for acute trusts. Thequestionnaire included questions groupedin the following topics:l work-life balancel training, learning and developmentl your job and organisationAnnual Report and Accounts 2012/13 43

Business Reviewl errors, near misses and incidentsl violence, bullying and harassmentl occupational health and safetyl infection control and hygienel health and well-beingl background detailsPrevious years have shown that the Staff Survey is a consistent indication of staffopinion and action plans undertaken following the surveys have resulted in significantimprovements.The 2012 response rate was 56.2%, a reduction of 4.8% since 2011 although greaterthan the average Picker Institute response rate of 45.6%.Compared to the 2011 Staff Survey, the Trust scored significantly better on sevenquestions and significantly worse on seven questions. There was no significantdifference on 65 questions:Significantly improvement on the following questions: 2011 2012No infection control training 6% 3%No training on how to handle confidential information 13% 7%No training on how to deliver good patient care 40% 27%Do not feel trusted to do my job 3% 1%Not able to do my job to a standard I am pleased with 20% 10%Communication between senior management and staff is noteffective44% 34%Discrimination from manager/team leader or other colleagues 6% 4%In the past year there has been a focus on increasing the amount of governancetraining, at induction and mandatory training, which is reflected in staff having beentrained on how to handle confidential information. Induction and mandatory trainingalso includes various elements of training on patient care. Also, the Trust has increasedcommunication to staff to keep them well informed about changes and to seek theiropinions.The Trust scored significantly worse in the following seven areas and an action plan isin place for the next 12 months. You can read more about how the Trust is committedto patient care on page 34.44Annual Report and Accounts 2012/13

Business ReviewSignificantly worsened on the following questions 2011 2012Appraisal/review not helpful in improving how I do job 41% 48%Do not feel my role makes a difference to patient service users 1% 3%Senior managers do not act on staff feedback 24% 34%Senior managers are not committed to patient care 13% 21%If friend/relative needed treatment would not be happy withstandard of care provided by organisation5% 11%My job is not good for my health 20% 26%Felt unwell due to work stress in last 12 moths 25% 34%Top five ranking scoresTrustscore2012Trustscore2011NationalaverageEffective team working 3.82 3.84 3.72Staff believing the Trust provides equalopportunities for career progression or promotion93% 92% 88%Work pressure felt by staff 2.93 Newmeasure3.08Staff job satisfaction 3.65 3.56 3.58Staff motivation at work 3.91 3.92 3.84Scores are a combination of relevant questions weighted and out of 5.Bottom five ranking scoresTrustscore2012Trustscore2011NationalaverageStaff witnessing potentially harmful errors, nearmisses or incidents in last monthStaff agreeing that their role makes adifference to patients36% 33% 34%88% 92% 89%Staff experiencing physical violence from patients,relatives or the public in last 12 months16% Nocomparablemeasure15%Staff having equality and diversity training in last12 monthsStaff feeling satisfied with the quality of workand patient care they are able to deliver55% 58% 55%78% 78% 78%Annual Report and Accounts 2012/13 45

Business ReviewStaff pledgesThe staff pledges are taken from the NHS Constitution which was published in January2009 and updated in March 2012 and 2013. The Trust has scored well overall -average or better than average in all but three of the staff key findings for staff pledges:l % of staff agreeing that their role makes a difference to patientsl % witnessing potentially harmful errors, near misses or incidents in the last monthl % experiencing violence from patients, relatives or the public in the last 12 monthsChange since 2011surveyRanking, compared to allacute trusts in 2012Staff pledge 1:To provide all staff with clear roles, responsibilitiesand rewarding jobs.% of staff feeling satisfied with thequality of work and patient care theyare able to deliver% agreeing that their role makes adifference to patientsl No changel No changel Average! Below(worse than) averageWork pressure felt by staff - √ Lowest (best) 20%Effective team workingl No change √ Highest (best) 20%% working extra hoursl No change √ Below(better than) averageStaff pledge 2:To provide all staff with personal development, access toappropriate training for their jobs and line management supportto succeed.% receiving job-relevant training,learning or development in last12 months- √ Above(better than) average% appraised in last 12 monthsl No change l Average% having well-structured appraisalsin last 12 monthsl No changel AverageSupport from immediate managersl No change √ Highest (best) 20%46Annual Report and Accounts 2012/13

Business ReviewChange since 2011surveyRanking, compared toall acute trusts in 2012Staff pledge 3:To provide support and opportunities for staff to maintain theirhealth, well being and safety.Occupational health and safetyreceiving health and safety training inlast 12 months% suffering work-related injury inlast 12 monthsInfection control and hygiene% saying hand washing materialsare always availableErrors and incidents% witnessing potentially harmfulerrors, near misses or incidents inlast month% reporting errors, near misses orincidents witnessed in last monthFairness and effectiveness ofincident reporting proceduresViolence and harassment! Decrease(worse than 2011)! Increase(worse than 2011)! Decrease(worse than 2011)l No change! Decrease(worse than 2011)√ Increase(better than 2011)√ Above(better than) average√ Below(better than) average√ Above(better than) average! Above(worse than) averagel Average√ Highest (best) 20%% experiencing physical violencefrom patients/relatives in last 12months% experiencing physical violencefrom staff in last 12 months% experiencing harassment, bullyingor abuse from patients/relatives inlast 12 months% experiencing harassment, bullyingor abuse from staff in last 12 months- ! Above(worse than) average- l Average- √ Below(better than) average- √ Lowest (best) 20%Health and wellbeing% feeling pressure in last 3 monthsto attend work when feeling unwelll No change√ Below(better than) averageAnnual Report and Accounts 2012/13 47

Business ReviewChange since 2011surveyRanking, compared toall acute trusts in 2012Staff pledge 4:To engage staff in decisions that affect them, the services theyprovide and empower them to put forward ways to deliver betterand safer services.% reporting good communicationbetween senior management andstaff- l Average% able to contribute towardsimprovements at work√ Increase(better than 2011)l AverageAdditional Theme: Staff Satisfaction.Staff job satisfactionStaff recommendations of the Trustas a place to work or receivetreatment√ Increase(better than 2011)! Decrease(worse than 2011)√ Highest (best) 20%l AverageStaff motivation at workl No change √ Highest (best) 20%Additional Theme: Equality and diversity.% having equality and diversitytraining in last 12 monthsl No changel Average% believing Trust provides equalopportunities for career progressionor promotion% experiencing discrimination atwork in last 12 monthsl No change √ Highest (best) 20%l No change √ Lowest (best) 20%Friends and family questionsThe ‘Friends and Family Test’ is oneof the four national CQUIN goals for2013/14. The top 10 correlated staffsurvey questions fall into themes aroundcaring about patients/concerns, staffbeing happy in their jobs, staff beinginvolved in decision making and errorsbeing corrected when they are reported:48Annual Report and Accounts 2012/13

Business ReviewQuestion 2012 Average(median) foracute trusts2011(Q12c) I would recommend my organisation asa place to work(Q12a) Care of patients/service users is myorganisation’s top priority(Q12b) My organisation acts on concerns raisedby patients/service users(Q11e) Senior managers are committed topatient care(Q8g) The extent to which my organisation valuesmy work(Q14c) My organisation takes positive action onhealth and wellbeing59 55 6960 63 6264 68 -42 49 5342 40 3849 43 -(Q11d) Senior managers act on staff feedback 26 26 29(Q11b) Communication between senior managersand staff is effective(Q11c) Senior managers here try to involve staffin important decisions(Q18e) When errors, near misses or incidents arereported my organisation takes action to ensure thatthey do not happen again.35 34 2632 28 3166 61 63RecommendationsFollowing the 2012 Staff Survey thefollowing recommendations were made:l for the full report to be made availableto general managers and heads ofdepartment to enable them to developan action plan specific to concernswithin their own directorates for thenext half-yearly reviewl the Workforce Strategy andDevelopment Committee and theValuing Staff and Wellbeing Group toreview the corporate actions plans attheir May meetingsl a presentation and summary leafletto be available at the next health andwellbeing dayl a corporate plan is developed for themain points of concern, as describedaboveCorporate planAs in previous years the Trust hasdeveloped a corporate action plan usingstaff survey data that has worsened orwhere the Trust compares less favourablyto other Trusts. They include:l actions taken when errors, nearmisses and incidents are reportedback to staff for discussion withinteams and learning for the futurel the zero tolerance of violence towardsstaff from patients, relatives andvisitors to be reiterated and actiontaken when problems occurl the Trust communicates prioritiesaround patient care and how staff canhelp deliver improvementsl stress management training is madeavailable to staffAnnual Report and Accounts 2012/13 49

Business Reviewl staff are encouraged to completethe stress self-assessment within theTrust’s wellbeing toolkit and to takepersonal responsibility to make plansfor healthy lifestyles and work-lifebalancel the Trust will continue to prioritise‘putting patients first’ andcommunicate its values to staff viain-house publications, in policiesand protocols, at meetings and otherappropriate opportunitiesThese actions are monitored by theWorkforce Strategy and DevelopmentCommittee and reviewed quarterly by theValuing Staff and Wellbeing Group.Awarding staff excellenceEach year the Trust holds the StaffExcellence Awards to recognise andreward the hard work and commitmentfrom staff over the previous 12 months.2012 was no exception and the Trust sawsome outstanding examples of staff goingthe extra mile to ensure patients receivethe best care and experience possible.Award for Putting Patients FirstThis award is for the individual or teamwho has successfully introduced achange in working practices that hasimproved the patient experience. Thiscan either be as a result of feedback frompatients or their own actions.Winner: Stroke Early SupportedDischarge (ESD) Team for their schemeto provide ongoing rehabilitation to strokepatients in their own homes.Award for Patient SafetyThis award is made to an individual orteam that has improved patient safetyand/or mitigated risk either withina specific area or across the wholeorganisation.Customer Care AwardThis award is for the individual or teamwho has provided excellent customercare to patients or other users (thisincludes services to patients, the public,partners and to other members of staff).Winner: Sally Clarke, Discharge Planneron Ward 26 for the way that she dealswith patients and their families whenmaking decisions on when and wherepatients go when they are ready to leavehospital.Award for LeadershipThis award is to the individual who showsexceptional leadership skills in eithersupporting staff through organisationaldevelopment/change, encouraging staffdevelopment or motivating individualsor teams to achieve personal ororganisational goals.Winner: Pauline Hawkes, Acting Headof Midwifery. Pauline led the MaternityUnit to CNST Level 2; this is the onlybirthing centre in the country to achievethis.Award for Transformation or InnovationThis award is for staff who have eithertransformed services to provide betterpatient-focused care, contributed toservice or organisational improvementsor contributed towards the Protecting ourFuture, Better Care, Better Value (qualityand efficiency) initiative.Winner: Sara Pullinger, EnhancedRecovery Nurse Practitioner, forintroducing enhanced recovery protocolsinto colorectal and urological majorsurgery.Winner: The Diabetes Outreach Teamfor reducing the number of patientmedication errors by using a targetedapproach to staff training.50Annual Report and Accounts 2012/13

Business ReviewTeam of the Year AwardThis award is for a team who hasdemonstrated that they have used theprinciples of team working to achievegood practice and/or they have providedan improved performance or service as aresult of multi-disciplinary team working.Winner: The Emergency Department- despite bed pressures and seasonalchallenges, the team has low sicknessrates, staff come in on their days off, andthe team sustains an enthusiastic andcommitted response to front line healthcare.Award for QualityThis award is made to an individual orteam who has significantly contributed toimproving the quality of services and careprovided for patients.Winner: The Dementia Strategy Groupfor improving the hospital experience forpeople with Dementia, and reducing thelength of stay for patients with dementiafrom 33 days (2009) to 18 days (2011).Unsung Hero AwardThis award is presented to an individual,team or volunteer who works continuouslyand tirelessly behind the scenes, goes theextra mile with little thanks or has madean outstanding contribution. Staff andmembers of the public are able to makenominations for this award.Winner: Beryl Andrews, Volunteerin Stoma Care, who has helped withadministration, stock control, greetingpatients and answering the phones fortwo days a week for the last 18 years.Chairman’s AwardThe Chairman’s Award is a special awardgiven to the overall achiever selected fromthe winners of all the award categories.The award is judged by the Board ofDirectors.Winner: In 2011 it was awarded to theDementia Strategy Group.Mentor Awards 2012The Trust also presents the Mentor Awardto individuals in recognition of the workthey have done to support students. The2012 winners were:l Julie Sweeting, Ward 9l Pippa Longley, Ward 14.12 Ensuring equality anddiversityRBCH recognises that equality meanstreating everyone with equal dignity andrespect irrespective of any protectedpersonal characteristics. In doing so itacknowledges that people have differentneeds, situations and goals. Achievingequality requires the removal of thediscriminatory barriers that limit whatpeople can do and can be, eliminatingharassment and victimisation.The Trust is committed to ensuring thatpeople do not experience inequalitythrough discrimination or disadvantageimposed by other individuals, groups,institutions or systems in terms of:l outcomes - related to both health careand/or employmentThe Dementia StrategyGroup, Award for Qualityand 2012 Chaiman’sAward winnersAnnual Report and Accounts 2012/13 51

Business Reviewl access - related to clinical servicesand/or employment and promotionopportunitiesl the degree of independence they haveto make decisions affecting their lives.l treatment - related to both clinical careand employmentAs part of the Equality Act 2010, thereare nine protected characteristics. Theseare gender, race, disability, religion orbelief, sexual orientation, age, genderreassignment, pregnancy and maternityand civil partnership or marital status.Decisions made in relation to thesecharacteristics are made in a fair andtransparent way. As a public sectororganisation, there are some additionalequality duties which we are committedto achieving. This means that the Trustmust have due regard to the need to:l eliminate unlawful discrimination,harassment and victimisation andother conduct prohibited by the Actl advance equality of opportunitybetween people who share aprotected characteristic and thosewho do notl foster good relations between differentpeople when carrying out their duties,tackling prejudice and promotingunderstandingl ensure that policies and servicesare appropriate and accessible to allmeeting their different needsHaving due regard to these areas meansthat the Trust can provide an efficient andeffective service.There are also some specific dutiesthat we are required to adhere to. TheTrust must be transparent about howit is responding to the Equality Dutypublishing relevant, proportionateinformation showing compliance with theEquality Duty on an annual basis, andmust set and monitor equality objectives.This information must be available tostaff, service users and the general public.The Trust’s website publishes informationon how it believes the organisationmeets these duties and this informationis updated regularly. This includesinformation on recruitment and retentionand development and support of disabledemployees. The Single Equality Schemeand Action Plan sets out the Trust’svision for 2011-2015. It clearly identifiesa number of objectives that the Trust isworking to achieve during this period.4.13 Reducing our carbonfootprintThe NHS aims to reduce its carbonfootprint by 10% between April 2007 andApril 2016. In support of this target, theFoundation Trust (RBCH) has developeda Sustainable Management Plan (SMP)that was sign by the Board of Directorsin January 2011. It affirms the Trust’sobjectives and targets for reducingcarbon emissions and enables theorganisation to contribute to the NHS aimof becoming a low carbon, sustainableprovider of high quality healthcare.The Trust is committed to continuallyimprove on minimising the impact ofits activities on the environment, and indoing so reinforcing its commitmentsto both the Good Corporate CitizenshipModel and cost improvement.The NHS has set an overall carbonreduction target for NHS trusts to achievea 10% reduction by April 2016 (from2007/08 baseline year). The Trust hasadopted a series of carbon reductiontargets in support of the NHS target toreduce emissions by 10% by April 2016.The key areas for action are:l energy, water and carbonmanagementl sustainable procurement and foodl low carbon travel, transport andaccessl waste reduction and recyclingl green spacesl staff engagement and communicationl buildings and site designl organisational and workforcedevelopmentl partnership and networksl governance, IT and finance52Annual Report and Accounts 2012/13

Business ReviewSustainableManagementPlanLow Carbon, Patient Focused HealthcareThe Trust regularly reviews and reportson progress against the Good CorporateCitizenship Assessment Model andkey actions within an accompanyingSustainable Management Action Plan.Monitoring, reviewing and reporting ofenergy and carbon management arecarried out quarterly via the CarbonManagement Group. Richard Renaut,Director of Service Development, is theboard level lead for sustainability. Thisensures that sustainability issues havevisibility and ownership at the highestlevel of the organisation.Sustainability achievementsRBCH has been progressing with energyand carbon management over the lastcouple of years. During the year the Trusthas worked to make progress in a numberof areas.Energy, water and carbonmanagementThe Trust has been investing in energyefficient lighting across the hospitalsites. LED lights have been installed inone ward environment, main corridors, anumber of office areas, accommodationrefurbishments, and in all car parks atRoyal Bournemouth Hospital.The Trust has also initiated an energyperformance contract energy reductionscheme with the aim of reducing utilitiesconsumption by 25% through variousinfrastructure changes. The Trust willwork on this initiative in partnership withBritish Gas, and an investment gradeaudit has been commissioned.Sustainable procurementand foodThe Trust recognises its responsibility tocarry out its procurement activities in anenvironmentally and socially responsiblemanner, and the considerable influencewe have in using our buying power toencourage healthy and sustainablefood production and consumption. Inresponse, the Catering Department hasdeveloped a Health and Sustainable FoodPolicy Statement.A food waste digester has also beeninstalled within the kitchen at the RoyalBournemouth Hospital. The wastedigester replaced the waste disposalmaceration unit within the kitchen,and the digester works by the use ofenzymes that breaks down the food andturns it into grey water. This installationwill save the Trust money throughavoided water and maintenance costsassociated with maceration. It improvesthe carbon footprint of the organisationthrough reduced water consumption anddemonstrates a positive environmentalcommitment and best practice to refrainfrom macerationThe Commercial Services Departmentensures that all suppliers are asked toprovide information on environmentalperformance during the pre-qualificationquestionnaires process.Low carbon travel, transportand accessThe Catering Department has recentlyinvested in an electric van for the deliveryof meals between the Royal Bournemouthand Christchurch hospitals. The electricvan will help the organisation reduceits travel related carbon footprint andsupport a sustainable future, while stillAnnual Report and Accounts 2012/13 53

Business Reviewproviding the ability to deliver the foodservice. The vehicle will be chargedat Royal Bournemouth Hospital usingrenewable energy generated from thethree Solar PV Installations on site.Members of staff who regularly driveTrust vehicles or the pool cars were alsoidentified and sent on the Energy SavingTrust smart driving course. This traininghelps drivers to become more efficientdrivers and can save organisations up to15% on fuel costs.Waste reduction and recyclingThe Trust has recycling facilities withinthe education centre at the RoyalBournemouth Hospital by providingco-mingled recycling bins and foodwaste bins. All co-mingled recyclingis processed by the Trust’s wastecontractor and all food waste iscomposted. Thispilot has beenwell receivedand commingledrecycling is in theprocess of beingintroduced acrossall areas of theTrust. Batteryrecycling facilitieshave also beenrolled out acrossthe Trust.paper• copier paper • computer paper• office paper • newspapers • magazines• coated paper• copier paper wrapperscans• drink cans • food tinsplease wash a l cans and tinsThe installationof Dyson air blade hand driers in nonclinicalwashrooms has been carriedout at the Royal Bournemouth Hospital.Great savings can be achieved throughthe installation of these items through theavoided cost in paper towel purchasingand disposal.• plastic bottles • aerosolsplastic bottles• plastic bottlesplease rinse a l bottles• crisp packets • yoghurt pots • cling film• plastic bags • sandwich wrapperscardboard• flattened cardboard • card packaging• paper • magazines • food & drinks cartonsBuildings and site designIn developing its services and facilities,the Trust will aim to meet the BREEAMperformance benchmarks (including‘BREEAM Excellent’ for new builddevelopments) in respect of thespecification, design, construction anduse of our buildings. The BREEAMmeasures include aspects related toenergy and water use, the internalenvironment (health and well-being),pollution, transport, materials, waste,ecology and management processes.Green spacesThe Estates Team has carried out anumber of improvements to encouragewildlife and enhance biodiversity aroundthe hospital sites. Around 30 bird boxeshave been installed, covered duck housesprovided around the lake, log piles havebeen formed to encourage biodiversityand a wildflower site has also been trialledto encourage nectar feeding bees andother insects. The Trust has also beentrialling green pest control in the form of aHarris Hawk.Staff engagement andcommunicationsThe Trust is committed to ensuringstaff, patients, visitors and suppliers/contractors are able to effectivelyengage with, and support, the carbonreduction plan. The Trust is the secondNHS organisation to take part in theGreen Impact Scheme, an environmentalaccreditation and awareness schemerun by the National Union of Students.Currently 17 teams have signed up tothe scheme and an awards ceremonywill be held in July to reward staffon their sustainable actions. Regulararticles about sustainability and energyawareness are included within the staffmagazines, as well as regular awarenessraising events, such as the NationalClimate Week campaign and annual NHSSustainability Day.54Annual Report and Accounts 2012/13

Business ReviewOrganisational and workforcedevelopmentA range of initiatives associated withhealth improvement and promoting thehealth of staff, patients and the public areled and overseen by the Trust’s Healthand Wellbeing Group.Partnership and networksThe Trust continues to work inpartnership with key stakeholders underlocal strategic partnerships to ensure thecollaboration aids the integration of thesustainability agenda.GovernancePerformance against targets is reportedquarterly to the Carbon Group. The Trusthas a target to achieve a carbon reductionof 10% by April 2016, which it is on targetto achieve. A Sustainable DevelopmentPolicy has also been signed off on behalfof the Trust by the Carbon Group. TheTrust also routinely reports on energyconsumption through the Departmentof Health ‘Estates Returns InformationCollection mechanism’ (ERIC).IT and financeThe Trust has introduced sustainabilitycriteria for completion as part of allbusiness cases. The IT Department hasrecently completed the rolling out of thePC power management software, aimedat reducing energy consumption throughcomputers being left on unnecessarily.Future priorities and targets for 2013/14:l update the RBCH SustainableManagement Plan and action planl Catering Department to achieve theBronze Food for Life Catering Markto show case all work done regardinglocal, healthy and sustainable foodl sustainable procurement policy andassociated action planl waste management strategyl conduct staff and patient travel surveyl explore potential of collaboration withneighbouring companies to reducecongestion around sites during peaktimesl expansion of Green Impact Schemel further utilisation of electric vehiclesfor cross site travell climate change risk mitigation planPerformance data: Greenhouse gas emissions and energy use2007-082008-092009-102010-112011-122012-13Total gross emissions: 13,307 12,584 11,737 12,371 11,626 12,572Non-financialindicators(tonnes CO2e)Gross Emissions scope 1 (Gas/oil/fleet vehicles/refrigerant losses)5,340 4,949 4,401 4,630 4,166 4,185Gross emissions scope 2 (Electricity) 7,511 7,172 6,876 7,247 7,142 8,161Gross emissions scope 3 (waste/water)456 463 460 494 318 226Electricity: non-renewable 9,823 9,704 10,332 11,215 11,053 11,275Relatedenergyconsumption(MWh)Electricity: renewable 4,072 3,889 3,857 3,738 3,684 3,758Gas 28,457 25,435 22,371 23,566 21,512 21,480Oil 0 356 556 162 246 194LPHW 1,535 6,629 10,104 7,903 5,125 6,696Financialindicators(£1,000’s)Expenditure on energy 1,545 2,344 2,003 2,035 2,225 2,675CRC gross expenditure - - - - 143 149Expenditure on official business travel - 428 448 391 324 389Energy consumption (MWh) per GIA floor area: 0.50 0.52 0.44 0.43 0.39 0.41Carbon emissions (Kg CO2e) per patient: 21.3 19.0 16.7 17.6 15.7 16.3Annual Report and Accounts 2012/13 55

Business ReviewRBCH energy costs have increasedby 20% in 2012/13. These increasesare largely due to the rising cost ofutilities, but also due to increasedutilities consumption in response to asignificantly colder winter in the 2012/13year compared to the mild weatherthe previous year. A slight increase inelectrical consumption has also beenobserved, and this is due to additionalelectrical load through new equipmentinstalled in 2012/13.Although total energy consumptionrelative to floor area has increased in2012/13 compared to the previous year,it has still reduced in comparison to2011/12, and has reduced by 24% fromthe 2007/08 baseline year.The Trust’s gross carbon emissionshave also risen in 2012/13. Although adecrease in scope 3 emissions has beenobserved, due to 526 tonnes of wastebeing diverted from landfill and sent toan energy recovery facility, an increase inscope 1 and 2 emissions has occurred.Gross carbon emissions have reducedby 5% from 2007/08 baseline year,and carbon emissions per patient havereduced by 23% since the baseline year.It is believed, with the commencing of theEnPC in 2013, that the Trust will remainon target to achieve its carbon reductiontargets outlined in the SustainableManagement Plan.RBCH purchase 25% of its electricitysupply from renewable sources.Renewable energy representsapproximately 8.4% of total energy use.In addition, RBCH generates 15% of itsenergy onsite, through the three solar PVinstallations and low pressure hot waterwhich is produced as a by-product ofon-site incineration and used to subsidisethe Royal Bournemouth Hospital heatingsystems.56Annual Report and Accounts 2012/13

Business ReviewPerformance data: Waste2007-082008-092009-102010-112011-122012-13Total waste 1,369 1,286 1,257 1,482 1,503 1,258Non-financial indicators(tonnes)High temp disposal waste 615 565 610 517 469 486Landfill 701 707 642 827 299 0Recycled/ reused 123 17 88 181 444 247Energy recovery 0 0 0 0 284 526Total waste cost 318 325 367 333 336 320Financial indicators(£000’s)High temp disposal waste 256 238 288 258 221 237Landfill 62 77 73 72 44 0Recycled/ reused 26 3 9 28 31 13Energy recovery 0 0 0 0 31 65In 2012/13 the Trust’s preferred wastecontractor collected a total 773 tonnesof non-hazardous waste. Of this, zerotonnes went to landfill, 526 tonnes wentto an energy recovery facility and 247tonnes was recycled, which includedmixed recycling (38 tonnes); baledcardboard (103 tonnes); and separatefood waste collections (60 tonnes). Inaddition to the general recycling, variousunwanted materials were collected forreuse or recycling, including curtains andbedding that were sent to Medical AidInternational to be used in third worldcountries.Annual Report and Accounts 2012/13 57

Business ReviewPerformance data: Water2007-082008-092009-102010-112011-122012-13Non-financial indicators(000’s m3)Financial indicators(£1,000’s)Water consumption 130 138 143 142 140 141Sewerage 112 118 117 124 122 122Water supply costs 115 121 121 140 147 155Sewerage costs 144 147 151 168 164 181Water usage per GIA (floor area) 1.47 1.57 1.34 1.33 1.31 1.32RBCH water consumption increasedby 883 cubic meters (0.6%) in 2012/13compared to the previous year.Although RBCH water consumption hasincreased between 2007/08 and 2011/12,water consumption per square metre ofgross internal floor area has decreasedby 10% in 2012/13 from the baseline year(2007/08).58Annual Report and Accounts 2012/13

Quality Report5. Quality Report 2012/131. Statement by the ChiefExecutiveThis is the fifth Quality Report publishedby The Royal Bournemouth andChristchurch Hospitals NHS FoundationTrust to accompany our Annual Report.In this report we have outlined some ofthe quality activities which have takenplace in the Trust over 2012/13.Our quality program has also beenenhanced by wide-ranging patient safetyinitiatives which cover a large range ofspecialties and topics. We continue tobe part of a Foundation Trust PatientSafety Collaborative “NHS QUEST”which combines the shared experiencesand learning from 13 Acute FoundationTrusts across the country to promoteand improve patient safety. This yearNHS QUEST work has concentrated onpatient safety and readmissions; reducingmortality, and improving ‘harm free’ care.There were a number of successfulinspections during the year, the mostimportant of which was a re-inspectionby the Care Quality Commission (CQC)which identified that we met outcomestandards for areas such as consent,care and welfare, safety and estates. Ourmidwifery-led maternity services retainedNHSLA Level 2 and the Trust was ratedthe second best hospital in England onquality in an independent report (the MHPHealth Mandate Quality Index).It is acknowledged that we set ourselvesambitious quality and safety targets for2012/13 and, whilst progress is positive,we did not meet all of our aspirations inall cases. Where this is the case we havehighlighted this in the Quality Reportand identified the actions we will take inthe year ahead to further embed qualityinitiatives and patient safety programmes.The views of our various stakeholdershave been very important to thedevelopment of this report and in thechoice of the priorities for 2013/14.We have chosen to continue with our‘harm free’ care programme for 2013/14supported by a new “releasing timeto lead” programme for ward clinicalleaders. Patient safety and continuingto improve the patient experience willremain a prominent agenda for theBoard of Directors and we welcome theopportunity to work with patients, carers,Foundation Trust members and the publicon a wide range of patient experience andpatient safety initiatives this year.It has not been possible to include allof the quality improvement and patientsafety initiatives that we have been orwill be engaged in within this report.However, we hope that it will fulfill thepurpose it sets out to achieve - to providean accurate account of quality activity inthe Foundation Trust and to demonstrateour clear commitment to qualityimprovement and patient safety.To the best of my knowledge theinformation contained within thisdocument is accurate.Tony SpotswoodChief ExecutiveAnnual Report and Accounts 2012/13 59

Quality Report2. Priorities for Improvementand Statements of Assuranceon the Quality of ServicesProvidedOur quality improvement prioritiesin 2012/13 - progress against planIn line with the Trust’s vision: “Puttingpatients first while striving to deliver thebest quality healthcare” the Trust’s Boardof Directors agreed a comprehensiveset of strategic goals and objectives for2012/13. The key goals for quality were:l To offer patient centred servicesthrough the provision of high quality,responsive, accessible, safe, effectiveand timely care.l To promote and improve the quality oflife of our patients.l To strive towards excellence in theservices and care we provide.l To work collaboratively with partnerorganisations to improve the health oflocal people.The 2011/12 Quality Report identified thefollowing specific quality improvementpriorities to be monitored in 2012/13.Safety express harm free careSafety Express is a national Quality,Innovation, Productivity and Prevention(QIPP) safe care initiative and the NHSsafety thermometer data collectioninitiative is a national and localCommissioning for Quality and Innovation(CQUIN) target.The Trust’s Quality Report for 2011/12set out as the main quality objectivefor the year completion of the safetythermometer across all wards areas withan over-arching aim: “to deliver harmfree care as defined by the absence ofpressure ulcers, harm from falls, catheteracquired urinary tract infection (CA-UTI)and Veno-thrombosis (VTE)”.‘Harm free’ care is measured using astandard NHS Safety Thermometerdata collection tool. This requires wardsto record ‘harms’ (hospital acquiredpressure ulcer, fall, CA-UTI, hospitalacquired VTE) for all patients on the wardeach month.The survey is undertaken on the sameday each month on all wards and for alloccupied beds.60Annual Report and Accounts 2012/13

Quality ReportThe data is recorded on a standardaudit sheet and results are validatedprior to entry onto the national electronicstandard safety thermometer datacollection.In 2012/13 the Foundation Trust achievedan average of 90% harm free care. This isslightly lower than the national average for2012/13 for acute trusts (92%).The Trust score for 2012/13 is slightlybelow the national average as a result of ahigher number of patients being admittedto hospital with an existing pressureulcer. The Trust is currently workingwith community colleagues to supportpressure ulcer prevention initiatives andtraining.Quality initiatives undertaken in 2012/13for each safety express patient safetyobjective are outlined in the followingsections of the Quality Report.Hospital acquired pressure ulcers98% of hospital inpatients surveyed(6941) using the national NHS SafetyThermometer tool in 2012/13 had ‘harmfree’ care in respect of hospital acquiredpressure ulcers.Quality improvements in yearl Mandatory training complianceincreased in yearl In house e-learning film producedl Link roles on each ward firmlyestablished. 2 study days held in year,monthly meetings established to sharelearning and good practicel Clinical leader ward rounds pilotedl Tissue viability lead weekly wardrounds in Medicine for the Elderlyimplementedl New templates for safe operatingprocedures introducedl Patient information drafted (awaitingapproval by the Patient InformationGroup)Annual Report and Accounts 2012/13 61

Quality Reportl New criteria for heel lift suspensionboots implemented and additionalfunding provided to support roll outl New nursing reviews anddocumentation (called care rounding)developed to record 2 hourly wardroundsAction plan priorities for 2013/14l Roll out of new standardoperating procedures and nursingdocumentationl Increase in ward based trainingl Competency standards to be agreedfor risk assessment documentationl Routine documentation audit to berolled out as part of NHS SafetyThermometer data collectionl Continue pilot of Tissue Viability wardroundsl Clinical leader wards rounds to be fullyestablished and monitored (Standardoperating procedures and auditplan to be implemented to supportcompliance)l Mattress availability to be reviewedby Equipment Library (pilot of trackingsystem to be implemented in 2013/14)Inpatient fallsLess than 1% of hospital inpatientssurveyed (6941) using the national NHSSafety Thermometer tool in 2012/13 hada fall resulting in harm whilst admitted tohospital. 99% of patients surveyed hadharm free care.Quality improvements in yearl Reduction in serious falls in yearl Falls training now part of mandatoryclinical training and inductionl E-learning and in house filmsproducedl Falls Strategy Group enhanced withmembership now including Dementialeads for the Trust, allied healthprofessionals, representatives fromall clinical directorates and RiskManagement team members.l Risk assessment complianceimproved in yearl Slippers provided to all patientsassessed at high risk of fallsl Walkrounds with Dementia lead andEstates established. Action plansin place to improve environment forpatients at riskAction plan priorities for 2013/14l Business case for protected timefor ward link staff to support FallsPrevention Strategyl Routine environment audits plannedwith Estates and Dementia leadl Competency standards to be agreedfor risk assessment documentationl Focus on actions to reduce repeatedfalls in patients and falls at nightl Routine documentation audit to berolled out as part of the NHS SafetyThermometer data collectionNew hospital acquired venousthromboembolism (VTE)Less than 0.5% (0.45%) of hospitalinpatients surveyed using the nationalNHS Safety Thermometer tool in 2012/13had a new hospital acquired venousthromboembolism (a “blood clot”) duringadmission. This compares to a nationalacute trust average score of 1.17%.Quality improvements in yearl Local clinical leadership establishedbut gaps in awareness of the need toreport hospital acquired VTE remain(focus for 2013/14)l VTE risk assessment complianceimproved to average/month of 93%(national and local target for 2012/13was 90%)l Reduction in VTE readmissionsl Decrease in number of hospitalacquired VTE root cause analysisinvestigations required in yearl Only 1 preventable hospital acquiredVTE in yearAction plan priorities for 2013/14l Improve risk assessment complianceto the national target of 95%62Annual Report and Accounts 2012/13

Quality Reportl Provide ward scorecard on riskassessment compliance (monthlyreport to Clinical Leaders meeting)l Update patient information includingpatient story filmReducing catheter associatedurinary tract infectionsLess than 1.5% (1.25%) of hospitalinpatients surveyed using the nationalNHS Safety Thermometer tool in2012/13 had a new catheter relatedurinary tract infection during admission.This compares to a national acute trustaverage score of 1.56%.Quality improvements in year andaction plan priorities for 2013/14l Education and training, includingward based training and specificcompetencies have been improved.Within the Trust there are NursePractitioners with well-establishedpractice and competencies forcatheter insertion. Further work withthe Trust’s Professional DevelopmentTeam and external agencies andhealthcare organisations will continuein 2013/14l Policies for insertion and managementof urinary and supra pubiccatheters. Workstreams on policydocumentation, criteria for urinarytract infections, risk assessments andreview/removal procedures have beenled by the Infection Control Team.A full review of the Urinary CatheterManagement Policy has taken place,and a revised policy approved. Thenew policy includes the agreeddiagnostic criteria and reason forcatheter use. Recommendations forreview of use and consideration forremoval have also been incorporatedinto the policy. All tenets of the policyare reflected in a new pathway tool,which has also been incorporated intonew documentationl Compliance and documentation.Clinical leadership has been supportedby the Continence Group, the InfectionControl Directorate Leads and theClinical Leaders in compliancewith the NHS Safety Thermometerscorecardl Recording. To further improvedocumentation, and facilitate theaudit of compliance, a label to identifyinformation about urinary catheterinsertion clearly within the healthcarerecords has been formatted, and iscurrently in use. The initial responsehas been favorable and an audit of useis in progress. Further work is requiredto gain an overall view of compliancewith use of urinary devicesAnnual Report and Accounts 2012/13 63

Quality Reportl Recording of urinary tract infectionrates. The data that has beenprovided by the wards as part of themonthly NHS Safety Thermometerdata collection is validated by theInfection Control Nurses. The datanow provides the Trust with a routinereport which will support prevalence ofcatheter use and infection rates. Thisalso allows further development ofWard to Board reporting, comparisonby ward and, also benchmarking withother similar trusts.Our quality p riorities for2013/14In order to identify priorities for qualityimprovement in 2013/14, we have used awide range of information sources to helpdetermine our approach. These includegathering the views of patients, publicand carers using real-time feedback;collating information from claims,complaints and adverse incidents; andusing the results of internal and externalclinical audits and patient surveys to tellus how we are doing in relation to patientcare, experience and safety. We havealso used risk reports and listened towhat staff have told us during ExecutiveDirector Patient Safety Walkrounds.We have considered the results of thenational staff survey to help us decidewhere we need to focus our qualityimprovement efforts and actions. Wehave also taken on board the nationalpicture for patient safety and collaboratedwith other acute Trusts (as part of SouthWest networks and NHS QUEST) to lookat how joint initiatives may be undertakenand best practice developed together.The Trust has formally consulted withkey stakeholders (general public,governors and commissioners) to helpidentify quality improvement prioritiesfor 2013/14. Priorities have beenconsidered with clinical staff as part ofservice delivery and clinical governancemeetings.Following consultation, the Boardof Directors have agreed that thepriorities for 2013/14 should be furtherimprovement in:l Reducing Harm from Inpatient Fallsl Reducing Harm from HospitalAcquired Pressure Ulcersl Reducing Urinary Tract Infectionscaused by cathetersl Reducing Hospital Acquired VenousThromoboembolism (VTE blood clots)The rationale for adopting the samepriorities for 2013/14 as 2012/13 hasbeen endorsed by the Board of Directorsand Council of Governors and is to ensureeffective implementation of all new qualityinitiatives and to focus on embedding andsustaining change.A specific objective is to improve on2012/13 compliance and achieve anaverage of 95% ‘harm free’ care for2013/14. A further objective is to reducethe 2012/13 NHS Safety Thermometerbaseline number of hospital acquiredsevere harms from falls and pressureulcers by 50% in 2013/14.The Trust will continue to monitor ‘harmfree’ care using the Safety Express NHSSafety Thermometer tool across allward and inpatient areas. All inpatientareas will continue to complete theNHS Safety Thermometer tool eachmonth and this tool will be enhancedto include monthly risk assessmentcompliance data. Data collection and‘harm free’ care performance will continueto be reported monthly to the Trust’sHealthcare Assurance Committee andBoard of Directors as part of a QualityDashboard. Where the information isavailable the Trust will review complianceagainst published national and localbenchmarking.64Annual Report and Accounts 2012/13

Quality ReportStatements of Assurance fromthe BoardThis section contains eight statutorystatements concerning the qualityof services provided by The RoyalBournemouth and Christchurch HospitalsNHS Foundation Trust. These arecommon to all trust quality accounts andtherefore provide a basis for comparisonbetween organisations.Where appropriate, we have providedadditional information that provides alocal context to the information providedin the statutory statements.Statement One: Review ofServicesDuring 2012/13 the Trust provided8 NHS services in accordance withits registration with the Care QualityCommission:l Management of supply of blood andblood derived productsl Assessment or medical treatment forpersons detained under the MentalHealth Act 1983l Diagnostic and screening proceduresl Maternity and midwifery servicesl Family planningl Surgical proceduresl Termination of pregnanciesl Treatment of disease, disorder orinjuryThe Trust has reviewed all the dataavailable to it on the quality of care inall of these NHS services provided.This has included data available fromthe Care Quality Commission, externalreviews, participation in National Auditsand National Confidential Enquiries andinternal clinical audits.The income generated by the NHSservices reviewed in 2012/13 represents100% of the total income generated fromthe provision of NHS services by the Trustfor 2012/13.Additional Information:The data reviewed for the QualityReport covers the three dimensionsof quality - patient safety, clinicaleffectiveness and patient experience.Information reviewed includeddirectorate clinical governance reports,risk register reports, clinical auditreports, patient survey feedback, realtime monitoring comments, complaints,compliments and adverse incidentreports, quality dashboards andquarterly clinical governance data. Thisinformation is discussed routinely atTrust clinical governance meetings.There is a clear quality reportingstructure where scheduled reportsare presented from directorates andspecialist risk or quality sub groupsto the Clinical Governance and RiskCommittee each month. Many of thereports are also reported quarterlyto our commissioners as part of ourrequirement to provide assuranceon contract and quality performancecomplianceStatement Two: Participation inClinical AuditDuring 2012/13, 31 National clinical auditsand 4 national confidential enquiriescovered NHS services that the Trustprovides.During 2012/13 the Trust participated in84% (26/31) of national audits and 100%of national confidential enquiries which itwas eligible to participate in.The national clinical audits and nationalconfidential enquiries that the Trust waseligible to participate in during 2012/13are shown in the tables overleaf.The national audits and nationalconfidential enquiries that the Trustparticipated in, and for which datacollection was completed during 2012/13,are listed alongside the number of casessubmitted to each audit or enquiry as apercentage of the number of registeredcases required by the terms of that auditor enquiry.Annual Report and Accounts 2012/13 65

Quality Reportn - yes n - no n - not applicableNational Clinical Audits for Inclusion inQuality Report 2012/13Eligible toParticipateParticipatedin 2012/13DataCollectioncompletedin 2012/13Rate of caseascertainment(%)Acute Coronary Syndrome or AcuteMyocardial Infarction (MINAP)n n n 100%British Thoracic Society (BTS) AdultAsthman n n Local auditin progressAdult Cardiac Surgery n n n nBTS Adult Community AcquiredPneumonian n n Local auditundertakenAdult Critical Care (ICNARC) n n n 100%Bowel Cancer n n n 100%BTS Bronchiectasis n n n nCardiac Arrest n n n 79%Cardiac Arrhythmia n n n nCardiothoracic Transplant n n n nCarotid Interventions n n n 93%Congenital Heart Disease(Paediatric Cardiac Surgery)n n n nComparative Audit of BloodTransfusionn n n 100%Coronary Angioplasty n n n 100%Adult Inpatient Diabetes n n n 100%Diabetes (Paediatric) n n n nEmergency Use of Oxygen n n n 100%Epilepsy 12 (Childhood Epilepsy) n n n nFalls And Bone Health n n n No datacollection in2012-13Fever in Children n n n 100%Fractured Neck of Femur n n n 44%(50 casessubmittedbut only22 patientseligible)66Annual Report and Accounts 2012/13

Quality ReportHead and Neck Oncology n n n 100%Heart Failure n n n 100%Health Promotion in Hospitals n n n The Trusthas signedup for healthpromotinghospital for2013/14Heavy Menstrual Bleeding n n n 54%Hip Fracture Database n n n nInflammatory Bowel Disease n n n Still openLung Cancer n n n 100%National Joint Registry n n n 100%Neonatal Intensive and Special Care n n n nNon Invasive Ventilation n n n (8 eligiblecases)Oesophago-Gastric Cancer n n n 100%Paediatric Asthma n n n nPaediatric Intensive Care n n n nPaediatric Pneumonia n n n nPain Database n n n 52% (49/95patientsreturnedboth forms)Parkinson’s Disease n n n 100%Potential Donor n n n 100%Prescribing Observatory for MentalHealthn n n nPsychological Therapies n n n nPulmonary Hypertension n n n nRenal Colic n n n 100%Renal Registry n n n nRenal Transplantation (NHSBT UKTransplant Registryn n n nSchizophrenia n n n nAnnual Report and Accounts 2012/13 67

Quality ReportStroke National Audit PilotProgramme (SNAP - combinedsentinel and SNAP)n n n Not involvedin pilotTrauma (TARN) n n n nVascular Surgery Database n n n 100%National Audit of Dementia n n n 100%National Confidential Enquiries forInclusion in Quality Report 2012/13Eligible toParticipateParticipatedin 2012/13DataCollectioncompletedin 2012/13Rate of caseascertainment(%)Asthma Deaths (NRAD) n n n 100%Cardiac Arrest Procedures n n n 100%Bariatric Surgery n n n 100%Alcohol Related Liver Disease n n n 100%Sub Arachnoid Haemorrhage n n n 100%Centre for Maternal and Child DeathEnquiries for Inclusion in Quality Report2012/13Eligible toParticipateParticipatedin 2012/13DataCollectioncompletedin 2012/13Rate of caseascertainment(%)Perinatal Mortality n n n All relevantcasesreportedMaternal Deaths n n n All relevantcasesreportedThe reports of 6 National audits publishedin 2012/13 were reviewed by the Trust in2012/13 and the Trust intends to take thefollowing actions to improve the quality ofhealthcare provided:3rd Round UK Irritable Bowel DiseaseAudit (UKIBD) Auditl Following the publication of the3rd Round UKIBD audit, clinicianswill improve the number of patientsprescribed bone protection and theuse of the Malnutrition UniversalScreen Tool (MUST) assessment toinform referral to dietitians as well asincreasing the number of patients seenby the IBD nurse specialistNational Outpatients Surveyl The results were positive in that theTrust performed significantly better on12 questions when compared to itsown results from the previous surveyin 2009. When compared againstother trusts, we performed better thanaverage on 32 questions, average on4 questions and only below averageon 2 questions. The results have beenincorporated into the Trust PatientEngagement Strategy68Annual Report and Accounts 2012/13

Quality ReportNational Confidential Enquiry intoPatient Outcome and Death (NCEPOD)Report - Time to Intervenel In response to the NCEPOD ReportTime to Intervene a business case toprovide full supporting care has beendiscussed with the Trust ManagementBoard and Board of Directors and anaudit of surgical acuity requirementshas been undertaken to inform thisNCEPOD Report - An Age Old Probleml Following publication of the NCEPODReport An Age Old Problem a pilotservice providing Medicine for theElderly support for surgical andorthopaedic patients has provedsuccessful. A business case to set upthis new service is being writtenConfidential Enquiry into MaternalDeaths in the UK (CEMAC) Report 2011- Saving Mothers’ Livesl Policies and mandatory trainingprogrammes have been updatedin maternity in line with therecommendations of the SavingMothers’ Lives (CEMAC 2011) reportConfidential Enquiry into Suicide andHomicide by People with a MentalIllness (CISH)l The report was considered at theTrust’s Clinical Governance and RiskCommittee and it was concluded thatno additional action was requiredAdditional Information:The Trust did not participate in the 3British Thoracic Society (BTS) auditsthis year as local audits had alreadybeen undertaken on these topics.The Trust will, however, be participatingin the BTS Bronchiectasis Audit in thecoming year as a new service is beingset up.Results of local clinical audits arereviewed within the directorates andat directorate clinical governancecommittees. A summary of actionsnoted from clinical audits is reviewedquarterly by the Trust ClinicalGovernance and Risk Committeeand by the Healthcare AssuranceCommittee.The Trust has developed a detailedclinical audit plan for 2013/14 toinclude national, corporate and localclinical audit priorities. Progress ismonitored via directorate clinicalgovernance committees and theTrust Clinical Governance and RiskCommittee. Progress is also reportedquarterly to the Healthcare AssuranceCommittee, Audit Committee andBoard of Directors.The reports of 286 local clinical auditswere reviewed by the Trust in 2012/13and the Trust intends to take thefollowing actions to improve the quality ofhealthcare provided:l On completion of the annualantimicrobial rolling audit, regularantibiotic ward rounds have beenestablished with robust referralpractices from ward pharmacists.The results were presented to theTrust Clinical Governance andRisk Committee who supportedimplementation of an electronicprescribing platform over the next yearto improve the quality of antimicrobialprescribingAnnual Report and Accounts 2012/13 69

Quality Reportl Following a Trust-wide health recordsaudit the Health Records Policy hasbeen amended to stop the use ofplastic wallets within the health recordand the audit tool has been amendedto include the standard relating toALERT notifications in the record.A “new entry” bookmark has alsobeen successfully trialledl Dysphagia Awareness trainingsessions have been organised fornurses, healthcare assistants andhousekeepers following an audit oflunchtime feeding practicesl Following an audit of adherenceto protected mealtimes policy, linknurses have been redefined foreach ward to raise awareness ofthe updated policy and assist in itsimplementation on wardsl As a result of an audit of CarotidArtery Disease and Endarterectomy intransient ischaemic attack (TIA) andMinor Stroke all patients who havesignificant artery stenosis should bereferred to a vascular surgeon on thesame day of the carotid doppler study.A pathway is also being developed toensure that patients with significantartery disease have surgery performedwithin 2 weeksl Pharmacy attendance at posttake ward rounds (PTWR) on theAcute Admissions Unit has beenimplemented to improve patient safetyand medicines managementl An audit of the assessment of feetin patients with diabetes showedthe quality of feet assessment inthese patients could be improved.A note is now added to the MedicalClerking Proforma to remind doctorsto complete these assessments andconsultants check these on post takeward roundsl Following an audit of therapyintervention for patients in Phase 1cardiac rehabilitation, a new cardiacpathway has been implemented onWards 21, 23, 24 and Intensive Careto guide therapist input for cardiacpatients. A new cardiac screening toolis also being developed to identifypatients who are appropriate fortherapist inputl Pre-operative education booklets havebeen introduced and are issued to allenhanced recovery and non-enhancedrecovery patients. This resultedfrom an audit of therapy within theenhanced recovery programmel The Stroke Team have developedan electronic Multidisciplinary Team(MDT) form and set standards forMDTs using the Manchester modelfollowing an audit of Stroke MDTGoalsl Patient information leaflets inEndoscopy have been updatedfollowing a patient satisfaction survey.Statement Three:Participation in Clinical ResearchThe number of patients receiving NHSservices provided or sub-contracted bythe Trust that were recruited during thatperiod to participate in research approvedby a research ethics committee was 1157(April 2012 - March 2013).Additional Information:Data for April 2012 to the end of March2013 is as follows: Band 1 = 429, Band2 =266, Band 3 = 377, Commercial =85. Total 1157. This compares to the2012/13 value of 1452 and thereforerepresents a drop in activity for theyear. The Trust has taken a numberof actions to address this. In addition,we are to be a partner site for Quintileswhich we confidently expect willincrease commercial activity in 2013/14despite a predicted global decrease inthe UK market over the period.70Annual Report and Accounts 2012/13

Quality ReportStatement Four:Use of Commissioning for Qualityand Innovation (CQUIN) paymentframeworkThe Trust’s income in 2012/13 wasnot conditional on achieving qualityimprovement and innovation goalsthrough the Commissioning for Qualityand Innovation (CQUIN) paymentframework. The Trust agreed a managedcontract during 2012/13 to share therisks during the transitional year to thenew clinical commissioning groups. As aresult the risks of over-performance andthe delivery of the CQUIN goals/paymentswere shared.Statement Five:Statements from the Care QualityCommission (CQC)The Trust is required to register with theCare Quality Commission and its currentregistration status is unconditional.The Care Quality Commission has nottaken any enforcement action against theTrust during 2012/13.The Trust has participated in 1 reviewor investigation by the CQC relating toits registration in 2012/13. The CQC didnot issue any concerns against the Trustduring 2012/13.Additional Information:The CQC inspected the RoyalBournemouth Hospital on the 22and 23 November 2012. On the firstday two inspectors carried out theinspection and on the second daytwo inspectors and an Expert byExperience attended. The inspectorsspoke with patients, relatives andclinical staff. They also undertook aSOFI observational on one ward wherepatients were not able to tell us abouttheir experiences. The inspectionsreviewed documentation standardsand discussed with staff the systemsfor managing patients’ records.Discussions were also held with theDirector of Nursing and Midwifery,senior staff representatives from theEstates Department, Human ResourcesDepartment and the Board of DirectorsCommentary from the inspection report(the full details of which are on the CQCwebsite) notes:“The patients we spoke with hadbeen fully involved in their treatment.Their consent had been obtained forprocedures and operations. Signedconsent forms were filed withinpatients’ medical records appropriately.Patients reported that they were happywith their treatment and care. No oneraised any concerns with us. They toldus that they had been well looked afterand were very positive about the staff.We found that the Estates Departmenthad developed highly organised andefficient systems for maintaining a safeenvironment for patients. Overall, wefound that there were efficient systemsfor management of records. Recordswe viewed were up to date, accurateand stored securely to maintainpeople’s confidentiality.”The CQC inspection report found thatthe Trust met CQC standards for:l Consent to care and treatmentl Care and welfare of people who useservicesl Safety and suitability of premisesl Requirements relating to workersl RecordsStatement Six:Data QualityThe Trust submitted records during2012/13 to the Secondary User Service(SUS) for inclusion in the Hospital Episodestatistics which are included in the latestpublished data.The percentage of records in thepublished data which included thepatients’ valid NHS number was 99.6%for admitted patient care: 99.8% foroutpatient care; and 97.2% for accidentand emergency care.Annual Report and Accounts 2012/13 71

Quality ReportThe percentage of records in thepublished data which included the validGeneral Practitioner Registration Codewas 100% for admitted patient care:100% for outpatient care; and 100% foraccident and emergency care.Additional Information:Collecting the correct NHS number andsupplying correct information to SUS(Secondary User Service) is importantbecause:l It is the only National Unique PatientIdentifierl It supports safer patientidentification practicesl It helps create a complete record,linking every episode of care acrossorganisationsThis standard covers the specific issueof capture of NHS numbers. The widerdata quality measures and assuranceon Information Governance are coveredunder the next standard.Statement Seven:Information Governance ToolkitAttainment LevelsAll NHS Trusts are required to completean annual Information Governanceassessment via the InformationGovernance Toolkit. The self-assessmentmust be submitted to Connecting forHealth, with all evidence uploaded by 31March 2013.The Trust’s Information GovernanceToolkit Version 10 assessment overallscore for 2012/13 was 76% but wasgraded Not Satisfactory, as the Trusthad achieved a score of at least a Level2 in all but one of the 45 requirements.This overall score includes 14 standardsgraded at Level 3, which is the maximumscore that can be attained on anystandard.Additional Information:The Trust’s overall score of 76%represents an increase in complianceof 4% from its 2011/12 Version 9submission. However, as noted theTrust’s submission was graded NotSatisfactory overall. In order to attainSatisfactory status, organisations arerequired to achieve a score of at leasta Level 2 in all of the 45 requirements.During 2012/13, the Trust did not meetthis target in one requirement in relationto Clinical Coding, which was gradedat a Level 1. This specific standardrequired the Trust to evidence a codingerror rate based upon the ClinicalCoding Audit Methodology set out bythe NHS Classifications Service. TheTrust has taken the decision to insteadadhere to the Charlson Index - thecomorbidity coding standards requiredby Dr Foster. Additional checks havebeen carried out to confirm that, werethe Trust to adhere to the Connectingfor Health coding standards, it wouldbe compliant with the requirements ofthe Information Governance Toolkit.The Trust has contacted the CareQuality Commission and Monitor toexplain the reason for this, as well ashighlighting the issue with Connectingfor Health.During 2012/13 the Trust hasenhanced its Information Governancearrangements by revising all the corepolicy documents to provide clearerand more practical guidance for staff.The list of Information Asset Ownersfor the Trust has also been recentlyupdated to ensure that all areas haddesignated an Information AssetOwner and they were aware of theirresponsibilities and have undertakeninitial/refresher training relevant to therole.At the same time there has been anincrease in the number of InformationGovernance incidents reported, whichdemonstrates growing awareness ofInformation Governance as a resultof mandatory training. This included72Annual Report and Accounts 2012/13

Quality Reportthree serious incidents which havesubsequently been reported to theInformation Commissioner’s Office.This reflects greater awareness of theInformation Commissioner’s Officethinking on issues of data protectionand patient confidentiality following aseries of fines of NHS organisationssince March 2012.Further work in 2013/14 will beundertaken to firmly embed theInformation Asset Owner roles withinthe organisation, including a thoroughreview and risk assessment of flows ofdata to and from the organisation. Workwill also be undertaken to embed andsustain the current 76% compliancewith the Information GovernanceToolkit.Statement Eight:Clinical Coding Error RateThe Trust was subject to a Paymentby Results (PbR) clinical coding auditduring the reporting period by the AuditCommission and the error rates reportedin the latest published audit for thatperiod of diagnosis and treatment coding(clinical coding) were 12.5%.The results should not be extrapolatedfurther than the actual sample audited;the services that were reviewed withinthe sample were 100 Finished ConsultantEpisodes (FCE’S) in Urology 100 FCE’Srandomly selected.Additional Information:Clinical coding is the process bywhich medical terminology writtenby clinicians to describe a patient’sdiagnosis, treatment and managementis translated into standard, recognisedcodes in a computer system. It isimportant to note that the clinicalcoding error rate refers to the accuracyof this process of translation, and doesnot mean that the patient’s diagnosis ortreatment was incorrect in the medicalrecord. Furthermore, in the definition todetermine the clinical coding error rate,‘incorrect’ most commonly means thata condition or treatment was not codedas specifically as it could have been,rather than there was an error. TheTrust’s error rate in the previous year’saudit was 13.7% against a nationalaverage of 9%.3.0 Review of qualityperformance 2012/13The following section provides anoverview of the care offered by the Trustbased on performance in 2012/13 againstkey quality indicators selected by theBoard of Directors in consultation withstakeholders. The indicators have beenselected to demonstrate the Trust’scommitment to patient safety, clinicaleffectiveness and enhancing the patientexperience. The indicators have also beenselected on the basis of data collection,accuracy and clarity.Reducing adverse eventsThe Trust supports an open culture forreporting and learning from adverseevents and near miss patient safetyincidents. The Trust has an AdverseIncident Policy and standard AdverseIncident Report (AIR) Form.All reported incidents are graded interms of the actual severity of theincident. Standard gradings set downby the National Patient Safety Agency(NPSA) are applied. All incidents arefully investigated, including near missand no harm events, and are used as anopportunity for reflective practice, sharedlearning and quality improvement.Annual Report and Accounts 2012/13 73

Quality ReportTable: Patient safety incidents reported to NPSA via the nationalreporting and learning system - April 2012 to March 2013Severity of Incident ReportedTotalNumberReported2012/2013% ofIncidentsReported2012/2013TotalNumberReported2011/2012% ofIncidentsReported2011/2012No Harm 3415 56.8% 3115 60.7%Minor / Low 2451 40.8% 1834 37.5%Moderate 115 1.9% 150 2.9%Major / Severe 30 0.5% 31 0.6%Catastrophic / Death 0 0 0 0Total: 6011 5130Nationally 0.8 % of patient safetyincidents reported to the NationalReporting and Learning System arerecorded as having caused severe harmor death. The Trust’s percentages forboth 2011/12 and 2012/13 are muchlower at 0.6% and 0.5% respectively.Examples of changes made as a resultof incident investigations this year haveincluded:l Staffing templates reviewed onwards and increased where requiredto ensure safe staffing levels areprovided for all shiftsl Funding for earlier use of heelprotection approved and new clinicalguideline implemented to support usel New protocols for gastrointestinalbleed patients have been developedand an update provided at a medicalgrand round meeting and in the juniordoctors’ teaching programl New system of checking anaestheticmachines implemented and newelectronic system of recording andfollowing up on missed checksestablishedl New standard operating procedures inpharmacy for dispensing of medicinesand new training programmesintroduced. There are also newposters in pharmacy dispensing areato alert patients to the importantprocess of identity checking prior todispensing medicationMedication safetyThe Trust’s Medicines GovernanceCommittee is chaired by the MedicalDirector and its remit is to enhanceand monitor the Trusts strategyto reduce medication errors,compliance with national standards formedicines management and ensuringimplementation of safe practice alerts andreports.The Trust’s Medication Incident ReviewGroup is chaired by the Deputy Directorof Nursing and Midwifery. It ensuresthat Directorates take responsibility forreviewing incidents involving medicines,sharing learning and initiatives to improvesafety and reduce risk.In 2012/13 a total of 753 medicationrelated adverse incidents were reportedand investigated. This is an increasefrom 2011/12 (679) and 2010/11 (509)and reflects the Trust’s commitment toencouraging open reporting.Of the 753 adverse incidents reported73% represented no harm events. Thisis consistent with previous years’ results(2011/12 - 75%, 2010/11 - 73%).74Annual Report and Accounts 2012/13

Quality ReportPatient safety and quality improvementInitiatives to support medication safetyand medication incident reduction during2012/13 have included:- Wards have completed medicinesmanagement self-assessment auditsand developed action plans to addressthe issues raised.- Wards have completed injectablesself-assessment audits with theirpharmacist and developed actionplans to address the issues raised.- Slam locks have been fitted to all ofthe medicines trolleys on the wards toreduce the risk of unauthorised accessto medicines.- Following a successful trial,pharmacists have attended posttake ward rounds for medicaladmissions since October 2012. Thiscontinues to show benefits in saferprescribing, reduction in missed dosesand reduced risk to patients frommedicines.- An audit of prescriptions for treatmentdoses of Low Molecular WeightHeparins (NPSA RRR014) wascompleted in October to December2012. The results and the need toimprove documentation and practiceis being discussed with the specialtiesand at educational meetings.- Introduction of antidote boxescontaining flumazenil and naloxoneto clinical areas for treatmentof therapeutic overdoses ofbenzodiazepines and opioids. Theboxes also contain a reporting formto encourage reporting as an adverseincident and to allow monitoring andencourage greater care in dosingparticularly during conscious sedation.- Introduced mandatory training oninjectable medicines for junior doctorsstarting work in the Trust.- Pharmacy implemented newprocesses (pink supply sheets andyellow bags) to ensure that urgentmedicines reach the patient to avoiddelayed and missed doses.- Actions taken to avoid unnecessaryomission of aspirin in patients at highrisk of blood clots and ensuring thatpatients take the doses as prescribedand given to them.- Implementation of a MedicationOmissions Audit.- A focused project commenced inthe first quarter of 2013 to improvemedication administration withspecific outcome goals of reducedmedication omission and betterpatient information. This work willcontinue through 2013/14.Reducing patient fallsPatient accidents form the largest groupof all patient safety incidents reportedto the National Patient Safety Agency(NPSA) via the National Reporting andLearning System (NRLS).The NPSA category “patient accidents”includes any slips, trips or falls bypatients. These may be non harm eventse.g. a patient has fallen walking along award corridor but not sustained an injury,or a harm event when a similar incidenthas occurred and the patient sustained abruise, cut or more serious injury.The Trust has invested heavily in stafftraining and equipment provision overthe past few years in order to reducethe number of patient falls. As previousnoted, quality and patient safety initiativesintroduced in year to reduce patient fallshave included:l Implementation of falls training as apart of clinical mandatory training andinductionl Production of e-learning and in-housefilms for falls prevention and fallsmanagementl Implementation of falls riskassessment documentationl Slippers provided to all patientsassessed at high risk of fallsl Walkrounds with dementia lead andestates established. Action plans inplace to improve environment forpatients at riskAnnual Report and Accounts 2012/13 75

Quality ReportRBCH Reported Patient Falls (all events) - 2011-13A total of 1,892 patient falls were reportedin 2012/13 compared to 1,505 in 2011/12.In 2012/13 1.2 % of reported incidentsresulted in severe harm to a patient, thiscompares to 1.5% in 2011/12.The number of patient falls reportedas serious incidents in 2012/13 was 21compared to 24 in 2011/12.As a year average, the Trust reported 9.18patient falls/1000 bed days, compared toan acute Trust average (2009, NPSA data)of 5.6/1000 bed days. This is higher than2011/12 and reflects the focus in year onreporting all adverse events including noharm and near miss events.In comparison, as a year average, theTrust reported 3.4 inpatient harm eventfalls/1000 bed days, compared to anacute Trust average (2012 National Auditdata) of 2.5/1000 bed days (the overallrange was 0.9-5.4).Ensuring high standards ofinfection prevention and controlThe Trust’s Board of Directors iscommitted to infection prevention andcontrol as a key priority at all levels ofthe organisation and takes a very activeinterest in the monitoring of infectioncontrol performance. The Director ofNursing and Midwifery, who acts asthe Director of Infection Preventionand Control (DIPC), briefs the Board ofDirectors on a regular basis. The Trustpublishes a detailed Infection ControlAnnual Report which is released publiclyand available on the Trust’s website.MRSA BacteraemiaThe Trust has reported no Trust attributedMRSA Bacteraemia for the year 2012/13.Clostridium difficileAll cases of Clostridium difficile infectionat the Trust are reported and investigated.The number of cases reported for2012/13 was 31; fewer than the annualtarget of 38, which was set by theDepartment of Health and was part ofthe Trust’s contract. This year there hasbeen improvement demonstrated by theTrust’s clostridium difficile (c.difficile) rateper 1000 bed days which was lower thanthe national and south west average for2012/13.76Annual Report and Accounts 2012/13

Quality ReportClean environmentAs part of the ongoing Infection ControlTeam initiatives to provide a safeenvironment, the Trust has installed eyecatching floor and wall poster promotingalcohol gel use. These have been installedin the entrance corridors of all wards. Anaudit of the use of gels before and afterinstallation showed an increase in usage.by representation from housekeepingand governors also undertake regularunannounced inspections.3M Clean-Trace Surface ATP deviceshave been used in the Trust by theInfection Control and Housekeepingteams, and each directorate, to carryout audit and provide assurance ofgood standards of cleanliness of theenvironment and equipment by detectingorganic material. The Trust has fundedtwo further hand held devices to supporteffective audit.Housekeeping carry out a qualitymonitoring process which givescompliance percentages monthly toall wards and departments, and workclosely with the Infection Control Teamand directorate senior nurses. TheInfection Control Team, accompaniedHousekeeping have taken over somewaste removal this year, providing a timeefficient service to the wards. They arecurrently trialling a new method of wastecollection from wards using collectionbins which will reduce the risks ofspillage and be more time-effective. Withproposed regular ‘trains’ the departmentis working with porters to maintain clearcupboards and reduce the ‘road blocks’in the corridors, leaving the areas clear.The Trust has also approved a businessplan, which will enable housekeeping toextend their services to cleaning sharedpatient equipment, for example hoists,walking aids and weigh scales, whichhistorically has been a nursing task.This will enable nurses to support ahigh standard of direct patient care andprovide agreed standards of cleanliness.Annual Report and Accounts 2012/13 77

Quality ReportThe Infection Control team have led an initiative to improve beverage provision atward level providing a new light weight and easily cleaned trolley. Trolleys have beenpurchased with flasks and containers for the benefit of our patients.Infection control improvements in yearThe Trust has seen a measurable decrease in the closure of wards and bays in 2012/13indicating an improvement in infection control practices across the Trust. Results for2012/13 compared to the previous year are shown in the table below.2012/13 2011/12Bed closures in days 98 362Numbers of bays closed and days closed forNumber of wards closed and days closed for14 bays closed- 41 days12 wards closed- 47 days69 bays closed-133 days34 wards closed-180 daysReducing hospital mortalityThe Trust has a multidisciplinary Mortality Group, chaired by the Medical Director,to review the Trust’s HSMR (Hospital Standardised Mortality Ratio) and Dr Fosterrelative risk reports on a monthly basis. The group also reviews death certificationand electronic Immediate Discharge Forms (e-IDF) to ensure accuracy of coding. Thegroup discusses areas of potential concerns regarding clinical care or coding issuesand identifies further work, including detailed case note review and presentations fromrelevant specialties.Mortality outlier alerts may be triggered by Dr Foster analysis, through Imperial College,or from the Care Quality Commission data analysis. Dr Foster is a leading providerof comparative information on health and social care services. Its online tools andconsumer guides are used by both health and social care organisations to inform theoperation of their services.Dr Foster produces an annual hospital guide and one metric within this, known asHospital Standardised Mortality Ratio (HSMR) has become a recognised way ofassessing hospital mortality.The chart below shows the most recent report available from Dr Foster for the Trust.An HSMR value of 100 represents an average “expected” value and therefore a scorebelow 100 demonstrates a better than average position.78Annual Report and Accounts 2012/13

Quality ReportThe Department of Health have alsorecently produced their own equivalent ofHSMR - the Summary Hospital MortalityIndicator (SHMI), which includes deathsin the 30 day period following dischargefrom an acute hospital.The chart above shows the mostrecent SHMI report available from theDepartment of Health for the Trust. ASHMI value of 1 represents an average“expected” value and therefore a scorebelow 1 demonstrates a better thanaverage position.The Trust has taken the opportunity towiden its review of mortality in 2012/13and has initiated a Mortality Improvementthrough Clinical Engagement (MICE)group, chaired by the Director of Nursingand Midwifery. This draws togetherseveral significant strands of workincluding the work of the Mortality Groupdescribed above. The other programmesdrawn under this umbrella includeSeven Day Working, End of Life Care,the Deteriorating Patient and SpecialistMortality Reviews.The current focus of the latter componenthas been our work in managing sepsis. ASepsis Group was formed in early 2012and has undertaken significant work in anumber or areas including:l Sepsis card introducedl New fluid chart introducedl Sepsis added to educationprogrammes for all medical staffThere has been a substantial reduction inmortality attributed to sepsis in 2012/13in an environment of an increase in thenumber of patients admitted with sepsiswithin their diagnosis. To ensure ongoingquality improvement the action plan forthe year ahead includes:l To continue to raise awarenessthrough education and training forclinical staffl Develop additional continuingmulti-professional education and skillslab trainingl Audit antibiotic arrangements andsepsis pathway management - withparticular focus on EmergencyDepartment proceduresl Development and introduction of asepsis management pack to supporttimely patient carel Arrange a Sepsis Champion forumto enable sharing and disseminationof quality improvement ideas andinitiativesl Undertaken regular audits to reviewpracticeAnnual Report and Accounts 2012/13 79

Quality ReportType of Guidance Published Applicable Compliant PartiallyCompliantNonCompliantClinical Guidelines 19 13 1 7 1 4TechnologyAppraisalsInterventionalProceduresPublic HealthGuidanceMedicalTechnologyGuidanceUnderReview28 22 18 0 1 329 3 3 0 0 06 4 2 2 0 04 0 0 0 0 0Quality Standards 12 11 5 1 0 5DiagnosticsGuidance4 2 1 0 1 0Total 102 55 30 10 3 12Ensuring compliance with NationalInstitute for Health and CareExcellence (NICE) GuidanceThe Trust Clinical Governance and RiskCommittee (CGRC) reviews compliancewith all new NICE Guidance issued eachmonth. For the period from April 2012 toMarch 2013 the CGRC reviewed a total of102 newly issued guidance documents.Compliance rates are shown in the tableabove.Where non or partial compliance has beenidentified this is reported to the TrustClinical Governance and Risk Committeeand an appropriate action plan agreed.Ensuring compliance with safetyalertsA total of 89 Medicines and HealthcareProducts Regulatory Agency (MHRA)Medical Device Alerts were issued andreceived in the year. Of these 27 appliedto medical devices used within the Trust.The Trust ensured compliance with allrelevant alerts.In addition, 3 NHS Estates Alerts wereissued and received in the year. Ofthese 3 were applicable to the Trust, 1required action which was completedand 2 currently have action plans whichare being completed within the timescaleallowed.The National Patient Safety Agency(NPSA) did not issue any new alerts in2012/13.Patient Reported OutcomeMeasures (PROMs)All NHS patients who are having hip orknee replacements, varicose vein surgeryor groin hernia surgery are being invitedto fill in Patient Recorded OutcomeMeasure (PROMs) questionnaires.PROMs is a method of measuring thefunctional activity level of a patientas recorded by the patient. The samequestionnaire is sent to the patient 6months post operation and the twoscores are recorded by an externalorganisation Quality Health (operating onbehalf of the Department of Health), withthe aim of helping the NHS to measureand improve the quality of the care itprovides.The Trust participates in all 4 NationalPROMs surveys. All patients whocome into hospital for one of the aboveprocedures are asked to fill in a PROMsquestionnaire before their operation.80Annual Report and Accounts 2012/13

Quality ReportIn May 2013, the Trust will become apilot site for Electronic Data Capture.The PROMs questionnaires will becompleted, by patients, through handheldtablets, similar to iPads. A volunteerhas already been recruited to assistpatients with the technology and one ofthe biggest advantages is that patients,on completion of their questionnaire willreceive feedback, as shown in the picture.The paper option will still be availablefor patients who prefer it and they willhave equal access to the services of thevolunteer.The Trust is judged on how well patientsare asked and the overall uptake rate.In Orthopaedics reports are publishedweekly, monthly, quarterly and annuallyto give regular feedback to the membersof staff collecting the scoresand to encourage somehealthy competition and pridein maintaining high levels ofcompliance.ComplianceRate2010/11ComplianceRate2011/12ComplianceRate2012/13NationalAverage2012/13PROMs for Groin Hernia 90% 59% 117.7%* 1 62.9%PROMs for Varicose Veins 86% 17% 9.8%* 2 33.3%PROMs for Total Knee replacement 79% 95% 96.5% 86.9%PROMs for Total Hip replacement 76% 97% 96.5% 79.5%The national average participation rate (as provided by Quality Health for theDepartment of Health, April 2012) is 72.6%. The Trust’s average participation rate forall 4 PROMs is 80.1%.*1 Participation rates of greater than 100% occur where the numbers of operations which actuallytake place are greater than that of the denominator. The denominator is determined as anaverage of the number of operations performed in the previous year.*2 The Trust compliance rate for 2012/13 for varicose veins is much lower than the nationalaverage. The denominator used in the calculation is the number of operations performed in theprevious year. The actual number of procedures performed in 2012/13 was significantly lowerthan the previous 2 years.Annual Report and Accounts 2012/13 81

Quality ReportImproving patient experienceMeasuring patient experience isparamount for the provision of a highquality service. It is important to ensurethat patients and the public are givenopportunity to comment on the quality ofthe services they receive.The Trust undertook a detailed reviewof patient engagement and patientexperience arrangements in July 2012and presented a report to the PatientExperience and CommunicationsCommittee (a sub-committee of theBoard of Directors).The current status of patient experiencework at the Trust can be summarised inthe following areas:l Trust level benchmarking -e.g. national annual inpatient andoutpatient surveys, cancer patientsurveys, Patient Reported OutcomeMeasures (PROMs) collectedlocally but reported nationally,Commissioning for Quality andInnovation (CQUIN) PaymentFramework patient experiencequestionsl In year progress on nationaland local priorities and internalbenchmarking - e.g. patientexperience cards, real time patientfeedbackl Rapid identification of emergingissues - e.g. real-time patientfeedback, Adverse Incident Reportforms, patient comment cards, trendsin formal and informal complaints,issues raised by letters andcompliments from patients, carers,relatives and the public, suggestionbox feedback, web based free textcomments, ward scorecards, staffsurveyl Personal Insights - e.g. mysteryshopper, patient stories, NHSChoices, letters and compliments,video vignettes, patient diaries,experience based design interviewsl In depth reviews - e.g. Focus groups,local surveys, stakeholder events,local forums e.g. young persons,learning disability, dementia and carereventsl Education - e.g. patient story bypatient at induction training, carerstory by carer at induction, patientstory by patient at Board of Directors’meetingsl Specific project groups - e.g.Learning Disabilities, Dementia,Medicine for the ElderlyPatient experience activity embracesdiversity in its entirety within all itsactions, for example key stakeholdergroups for patients and carers andthe carers forum. There is a Trust’scommitment to the diversity agendawhich is also represented in the TrustStrategy and by the Trust through its StaffHealth and Wellbeing Group.National Inpatient SurveyThe annual national patient survey is:l a public determinant of patientexperiencel a regulatory measure performanceanalysed by the CQCl a local performance measure includedin the CQUIN for our commissionersThe Care Quality Commission InpatientSurvey was undertaken in July 2012. Thesurvey, the 10th annual national inpatientsurvey, included the results from 156trusts based on 64,500 patients over theage of 16 years surveyed. There were 70questions in the survey that relate to thepatient experience, and 61 are included inthe results. The sample was taken in July2012 of patients who had spent at leastone night at the Trust.The Trust discharged 2,598 patients inJuly 2012, of which 850 patients wereidentified as eligible for the survey. 461patients returned surveys, a responserate of 55% which is against a nationalaverage of 48% (aggregated from69 trusts using the Picker Institute toadminister the surveys).82Annual Report and Accounts 2012/13

Quality ReportThe Trust’s overall performance is amberwhich identifies that in all 10 sections theTrust results are “about the same as otherTrusts in the survey” and amber in all 60questions with one exception.The results show that in comparison to2011 there is:l improvement on 18 questionsl statistically significant improvementon Q26: Doctors not talking in front ofpatients (2011 8.1; 2012 8.6)l statistically significant decrease onQ19: patients feeling threatened byother patients or visitors (2011 9.7;2012 9.5)l one question categorised as red,being “worse when compared to otherTrusts in the survey ”. This questionwas Q37: ‘were you given enoughprivacy when being examined ortreated’. The highest result from all156 trusts was a score of 9.8 and thelowest result was 9.1 which was theTrust’s result. Reviewing the nationalresults there is a 0.5 differencebetween the red and green categoriesfor this question.Since the July 2012 survey wasperformed, the Trust has undertakena number of actions and inititiatives toimprove the patient experience. This hasincluded:l Implementation of a new patientexperience governance frameworkl Ensuring accountablity within roles forpatient experiencel Establishing a Patient ExperienceAction Group reporting to the PatientExperience Performance Committeel Developing and implementing a wardscorecard and establishing regularsystematic feedback of patientexperience data at ward levell Presenting a monthly patientexperience summary Dashboard tothe Trust’s Healthcare AssuranceCommittee and Board of Directorsl Developing and implementing aTrust-wide patient feedback templatestructureFocus for 2013/14 will include actions toreview:l Response to call bellsl Reduction in noise at nightl Improved privacy and dignityl Patients being asked to give theirviews on the quality of their carel Information at the point of dischargel Same sex bathrooms/accomodationl Patients feeling threatened by otherpatients or visitorsAction plans will be discussed and agreedthrough the Patient Experience andCommunications Committee.Commissioning for Quality andInnovation (CQUIN) patientexperience questionsThe Commissioning for Quality andInnovation (CQUIN) payment frameworkutilises 5 standard questions fromthe national inpatient survey. Theframework ensures quality is part of everycommissioner-provider discussion.The chart below shows the Trust overallscore and a breakdown of each CQUINquestion score for 2012.Annual Report and Accounts 2012/13 83

Quality ReportThe Trust’s overall indicator score for2012 is 68.8 out of 100, the same scoreattained in 2011.Trust’s CQUIN results have been aboveboth the national and South WestStrategic Health Authority’s average since2010.The 2012 results showed that the Trusthad improved significantly from 2011 inrelation to two of the CQUIN questions:l Q32 Were you as involved as youwanted to be in decisions about yourcare and treatment?l Q56 Did a member of staff tell youabout your medication side effects towatch for when you went home?Picker Inpatient Survey July 2012The Trust participated in the PickerInstitute Inpatient Survey 2012. Theraw data from the survey is analysedseparately by the CQC as part of theNational Inpatient Survey 2012.A total of 850 patients from the Trust weresent a copy of the questionnaire, of which461 were returned, giving a response rateof 59%. The national average responserate was 48%.The survey highlighted many positiveaspects of the patient experience. TheTrust was significantly better than averageon 12 questions in comparison with 68Trusts administered by Picker.The first table on the following pageindicates the survey questions wherethe Trust was statistically better than theother participating trusts. The secondtable indicates the two questions where incomparison to other trusts our scores arestatistically lower.The Trust was statistically lower thannational average scores when patientsreported having to share bath or showerfacilities with members of the oppositesex and they did not feel they wereoffered enough food choices.Most patients were highly appreciativeof the care they receive. However, thesurvey results did identify some areasfor improving the patient experience.Action plans are in place to improveperformance.84Annual Report and Accounts 2012/13

Quality ReportCancer patient experienceA cancer patient experience surveypublished in September 2012demonstrated a wide variety of resultsin the individual clinical domains. Therewere 64 questions in the survey across15 domains. The Trust’s performance issummarised below:l 25 ‘green’ placing us in the top 20%of trusts nationally.l 5 areas show statistically significantimprovement based on the previoussurvey in 2012.l 2 ‘reds’ placing the Trust in the lowestscoring 20% of trusts nationally:l Patient offered written assessmentand care planl Staff explained how the operationhad gone in an understandablewayThe clinical nurse specialists in eachof the specialties have worked with themulti-disciplinary team and made sitespecific action plans. Key actions toaddress the two specific areas of concernincluded:l Ensuring all clinical nurse specialistsand clinicians had attended an‘advanced communication’ course.Throughout the autumn individualswere booked and attended theregionally available course andfurther courses are being provided in2013/14.l Identifying a lead and implementingthe Information PrescriptionProgramme. This is being led throughthe cancer nurse practitioner inthe Oncology Unit. It is a nationalprogramme aspiring to deliver apersonalised approach to informationgiving, based on need. This involvesselecting appropriate information froman ‘information pathway’ relevantfor the patient and constructingan individualised ‘informationprescription’.Annual Report and Accounts 2012/13 85

Quality ReportThe progression of action plansare monitored through the ClinicalNurse Specialist working group andsubsequently the Cancer PatientExperience Group chaired by the patientexperience lead clinician. A furthernational Cancer patient experience surveyis in progress and another focusing onchemotherapy is being undertaken.Trust patient survey cardResultsPatient experience card (PEC)In addition to responding to nationalpatient surveys, the Trust has an internalpatient experience card which is availablefor all inpatients and outpatients tocomplete. The cards are available in allareas for patients, relatives and/or carersto complete. There are 11 questions onone side, chosen in parallel with the CQCand CQUIN questions. The other side is afree text space for qualitative comments.The results are available to all staff andare collated and fed back quarterly to allparticipating areas.In 2012/13, 63% of patients completingthe patient survey card rated the Trust as“excellent” and 98 % said they felt safewhilst in our care. (The 2012/13 resultsrelate to March 2012 to December 2012data only as the PEC questions wereamended in January 2013).Friends and Family Test (FFT)using the patient experiencecardsThe implementation of the Friendsand Family Test (FFT) has been rolledout throughout the Trust to meet thecompliance requirements from theDepartment of Health. All patients whoattend the Emergency Department andthose who stay in a ward overnight withinthe set criteria are offered a PatientExperience Card to complete the FFT.There is an expectation that all clinicalareas will be included from October 2013.The PEC reporting template has beenredesigned to ensure that staff have clearvisibility of the FFT score in addition tothe survey questions. Training sessionson the FFT has been widely available tostaff from large group sessions includinginduction and preceptorship training, toclinical leaders and senior nurses to smallward based and individual sessions. Animplementation plan has been activatedand wards are aware on a monthly basisof their compliance data. Each clinicalarea has been visited daily to providesupport and advice.Excellent ...................................................................................Poor10 9 8 7 6 5 4 3 2 12010/11 62% 17% 11% 3% 1% 2% 0% 1% 1% 1%How would rate youroverall visit?2011/12 63% 16% 11% 3% 2% 1% 1% 1% 0% 2%2012/13 63% 17% 11% 3% 2% 1% 1% 1% 0% 1%2010/11 71% 12% 7% 3% 1% 2% 1% 0% 0% 1%How likely would yoube to recommend us?2011/12 73% 11% 8% 2% 1% 1% 0% 0% 0% 2%2012/13 74% 11% 7% 2% 2% 1% 0% 1% 0% 2%86Annual Report and Accounts 2012/13

Quality ReportReal time patient feedback (RTPF)‘Real time patient feedback’ is an inhousesurvey with data collected withhand-held terminals. RTPF is facilitatedthrough the Trusts trained volunteersand public governors. Patients are askeda series of standard questions throughface to face interviews and patient storiesand views collected. The survey datacollection process managed by the Headof Patient Engagement and data analysisis provided by an external provider whichis currently commissioned to provide theservice.The RTPF surveys are specific to theareas where patients access servicesincluding ward inpatient areas, theEmergency Department and outpatientdepartments. The surveys have beencustomised for their areas. The resultsare shared, with access for all clinicalareas involved, and will be incorporatedinto their clinical dashboards which arecurrently in development. Actions forimprovement of these methodologiesis currently through directorates and areview of this is currently in progress. Thisservice is also available online.Working in partnershipDuring 2012/13 the Trust has developedstronger partnerships with carers forums,local schools and LINks).The Trust has welcomed the opportunityto work with Bournemouth LINk on anumber of quality reviews this year.Bournemouth LINk have undertaken thefollowing projects:l “A problem has to fit in one box”- Research with young people inBournemouth. LINk undertooka survey of young people inBournemouth, including young carers,asking them for comments abouthealthcare services that they hadaccessed or were available. The report(issued in January 2013) provided theTrust with some very helpful feedbackand the opportunity to widen ourunderstanding of the needs of youngpeople locally. An action plan hasbeen developed around the responsesreceived and implementation willbe coordinated through the TrustSafeguarding Committee and PatientEngagement Team.l “Enter and View” - LINk visitedtwo inpatient wards at the RoyalBournemouth Hospital in January2013. LINk were able to observepractice and talk to patients, carersand visitors about their care andtreatment and gain feedback abouttheir experience of the Trust. Theresults were fed back to the Directorof Nursing and Midwifery andsubsequently shared with ward staff.LINk (Healthwatch Dorset from 1 April2013) have also been invited to comeand discuss their report at a TrustClinical Leaders meeting.l “People speak out” - LINk undertooka survey in January-February 2013of the views of hospital leavers. Astandard survey form was used andasked patients to comment abouttheir discharge experience. 500 surveyforms were given out with a responserate of 16.4%. It was positive to hearthat 91% of people responding saidthey were happy with the informationthey received on discharge. Howevera number of actions to further improvepatients’ experiences were identifiedand these are currently beingprogressed as part of the Trust’s widerPatient Engagement Strategy.The Trust has also held a number ofstakeholder style events in 2012/13including a public feedback event in May2012 and a learning disability feedbackevent for patients with a learning disabilityand their carers. A public and staff eventwas also held in March 2013 on NHSChange Day with feedback from patientsabout the care they had received andimprovement pledges from staff.Annual Report and Accounts 2012/13 87

Quality ReportLearning from and reducingcomplaintsComplaints made to the Trust aremanaged within the terms of the Trust’scomplaints procedure and nationalcomplaint regulations for the NHS. Theoverriding objective is to resolve eachcomplaint with the complainant throughexplanation and discussion.There were 303 formal complaints frompatients or their representatives duringthe year. This represents a decrease of0.3% (1 complaint) from last year’s totalof 304 complaints.Of the 303 formal complaints, 159(52%) of the completed investigationswere upheld or partially upheld, withthe necessary changes explained andappropriate apologies offered in the letterof response from the Chief Executive.At the time of preparing this report, 6complaint investigations were still to beconcluded and a decision on whetherthey were well founded had not beenreached.Subjects of complaintsThe main categories of complaint were as follows:SubjectNumber in2011/12Percentagein 2011/12Number in2012/13Percentagein 2012/13Administrative systems 19 6.3% 19 6.2%Attitude of staff 32 10.5% 38 12.5%Bed management 1 0.3% 4 1.3%Clinical treatment 177 58.2% 172 56.7%Communication/information 44 14.5% 35 11.5%Discharge arrangements 14 4.6% 15 4.9%Environment 2 0.6% 4 1.3%Equipment/facilities 0 0 1 0.3%Health and safety 7 2.3% 3 0.9%Privacy and dignity 2 0.7% 2 0.6%Medication 0 0 5 1.6%Availability of staff 1 0.3% 1 0.3%Policies and procedures 1 0.3% 1 0.3%Violent/Aggressive behaviour 0 0 0 0Transport 1 0.3% 0 0Theatre Management 3 1.0% 3 0.9%Total 304 100% 303 100%14 complaint resolution meetings were held with complainants and key staff to assistwith resolving complaints.88Annual Report and Accounts 2012/13

Quality ReportChanges resulting from complaintsOne of the main purposes in investigatingcomplaints is to identify opportunitiesfor learning and change in practice toimprove services for patients. Examplesof changes brought about throughcomplaints were:l Reception staff reminded by DeputyGeneral Manager of the standardsrequired in speaking to and advisingpatientsl Provision of suitable changing facilitiesfor disabled patients and others to beconsidered by Dementia and LearningDisability Group (Dignity in Care)l Multi-disciplinary action group led bythe Clinical Leader set up to changesupport to patients at mealtimesl Review of pharmacy waiting area toprovide better service to patientsl Plan in place to provide alternativestorage for mobility equipment insteadof in open ward area. Complaint usedas case study with ward team toimprove communication.l Training need identified on the useof specific equipment to transferpatients back to their bed following afall. Additional equipment and trainingimplemented.l Protocol introduced to prevent dataloss from 24 hour cardiac monitorsl Staff to have conflict resolutiontraining to manage stressful situationsl Education of medical staff on historytaking with HIV+ patientsl New cardiology protocol implementedfor pathways of post procedurepatientsl Appropriate risk assessment ofpatients requiring escort raised withward staffl Patient information leaflet regardingrisk of polyhyramnios and cordprolapse to be devised with leaflet forexpectant mothers on this subject.Referrals to the Health ServiceOmbudsmanComplainants who remain dissatisfiedwith the response to their complaint atlocal resolution level were able to requestan independent review to be undertakenby the Health Service Ombudsman.After receiving a response from the Trust,10 people chose to refer their concernsto the Parliamentary and Health ServiceOmbudsman during 2012/13 compared to19 in 2011/12. The Ombudsman declinedto investigate four complaints, referredthree back for further local resolution,and is undertaking one investigation of acomplaint which has not concluded. Twocomplaints are still being assessed by theOmbudsman.Compliance against nationalprioritiesThe Trust measures many aspects of itsperformance and this data is regularlyreviewed throughout the organisation.At Board level patient safety, quality andperformance dashboards are reviewedeach month and these include keymeasurements (metrics) for all nationaland local priorities.In accordance with statutory reportingrequirements, the following sectionprovides an overview of the Trust’sperformance in 2012/13 against the keynational priorities from the Department ofHealth’s Operating Framework. The tableincludes performance against the relevantindicators and performance thresholdsset out in Appendix B of Monitor’sCompliance Framework.Annual Report and Accounts 2012/13 89

Quality ReportNational Priority 2009/10 2010/11 2011/12 2012/13Target2012/13ActualClostridium difficile year on yearreduction44 46 62 38 31MRSA - hospital acquired 3 0 2 6 0Maximum cancer waiting time of 31 daysfrom decision to treat to start oftreatmentMaximum cancer waiting time of 31 daysfrom decision to treat to start ofsubsequent treatment: SurgeryMaximum waiting time of 31 days fromdecision to treat to start of subsequenttreatment: Anti cancer drug treatmentMaximum waiting time of 62 days fromurgent referral to treatment for allcancersMaximum waiting time of 62 daysfollowing referral from an NHS CancerScreening ServiceMaximum waiting time of two weeksfrom urgent GP referral to first outpatientappointment for all urgent suspectcancer referralsTwo Week Wait for Breast Symptoms(where cancer was not initiallysuspected)Maximum waiting time of four hours inthe Emergency Department from arrivalto admission, transfer or discharge97.71% 99.56% 96.7% 96% 96.4%99.2% 99.6% 99.2% 94% 98.8%100% 100% 100% 98% 100%88.26% 89.71% 87.3% 85% 88.6%96.30% 97.00% 94.6% 90% 98.6%94.11% 93.60% 94.2% 93% 93.6%86.26% 98.58% 99.1% 93% 97.0%99% 99% 97% 95% 97.2%18 week referral to treatment waitingtimes - admitted18 week referral to treatment waitingtimes - non admitted18 week referral to treatment waitingtimes - patients on an incompletepathwayn/a * n/a * 17.7weeksn/a * n/a * 14.2weeksn/a * n/a * 14.2weeks90% 94.5%95% 98.9%92% 97.1%Certification against compliance withrequirements regarding access tohealthcare for people with a learningdisabilityn/a n/a Compliancecertifiedn/aCompliancecertified*Note - In 2011/12 the Department of Health set percentile thresholds for 18 weekreferral to treatment waiting times monitoring but reverted back to percentages in2012/13.90Annual Report and Accounts 2012/13

Quality ReportCompliance against new Quality Account Core Standards 2012/13In addition to the above national priorities, for 2012/13 all trusts are required to alsoreport against a set of core standards, using a standardised statement set, identified inthe NHS (Quality Accounts) Amendment Regulations 2012.Quality Indicator Data Source percentage/proportion/score/rate/number for atleast the last 2 reportingperiodsNationalaveragevalueHighestvalueLowestvalueSummary hospital levelmortality indicator (SHMI)Health andSocial CareInformationCentre(HSCIC)Oct 11 - Sep 12: 1.01Jul 11 - Jun 12: 0.99Apr 11 - Mar 12: 1.001.00 1.21(Oct 11-Sep 12)0.6849(Oct11 -Sep 12)The percentage of patientdeaths with palliative carecoded at either diagnosisor speciality level for theTrustHSCICPalliative Care codingby speciality and/ordiagnosisOct 11- Sep 12: 24.28%Jul 11- Jun 12: 22.26%Apr 11- Mar 12: 21.5%19%(Oct 11 -Sep 12)43.3%(Oct 11 -Sep 12)0.2%(Oct 11-Sep 12)The Trust considers that the above data is as described for the reason of provenanceas the data has been extracted from available Department of Health informationsources.Patient Reported Outcome Measure ScoresQuality IndicatorPatient reported outcome measurescore for groin hernia surgeryPatient reported outcome measurescore for varicose vein surgeryPatient reported outcome measurescore for hip replacement surgeryPatient reported outcome measurescore for knee replacement surgeryData SourceThe Trust considers that the data below is as described forthe reason of provenance as the data has beenextracted from the Department of Health Information CentreHESonline - PROMs. The time periods presented are:2010-11 - April 2010-March 2011, published August 20122012 - April 2012-December 2012, published May 2013The data compares the post-operative (Q2) values, datacollected from the patients at 6 months post-operatively byan external company. The data is not case mix adjusted andincludes all NHS Trusts, Foundation Trusts, PCT and NHSTreatment Centre data. Private hospital data is omitted.Data Definitions and Outcome Measure descriptions usedEQ-VASIs a 0-100 scale measuring a patient’s pain, with scores closest to 0 representing leastpain experienced by the patient.EQ-5DIs a scale of 0-1 measuring a patient’s general health level and takes into accountanxiety/depression, pain/discomfort, mobility, self-care and usual activities. The closerthe score is to 1.0 the healthier the patient believes themselves to be.Oxford Hip and Oxford Knee ScoreMeasures of a patient’s experience of their functional ability specific to patients whoexperience osteoarthritis. The measure is a scale of 0-48 and records the patient’sability to perform tasks such as kneeling, walking without a limp, shopping and stairclimbing. The closer the score is to 48 the more functionally able the patient perceivesthemselves to be.Annual Report and Accounts 2012/13 91

Quality ReportVEINSRBCH2010-11NationalAverageHighestOutcomeLowestOutcomeRBCH2012NationalAverageHighestOutcomeLowestOutcomeEQ-VAS 82.630 79.155 69.974 86.075 Data settoo smallforreportingEQ-5D 0.862 0.855 0.939 0.716 Data settoo smallforreporting78.481 70.194 84.3500.834 0.903 0.717HERNIARBCH2010-11NationalAverageHighestOutcomeLowestOutcomeRBCH2012NationalAverageHighestOutcomeLowestOutcomeEQ-VAS 78.087 79.159 72.200 85.163 81.032 79.505 71.250 85.773EQ-5D 0.848 0.874 0.934 0.787 0.906 0.874 0.943 0.736HIPRBCH2010-11NationalAverageHighestOutcomeLowestOutcomeRBCH2012NationalAverageHighestOutcomeLowestOutcomeEQ-VAS 75.668 74.550 64.691 81.672 75.637 75.074 62.308 82.548EQ-5D 0.782 0.762 0.899 0.583 0.798 0.767 0.899 0.599OxfordHipScore38.358 37.977 43.079 31.307 38.381 38.060 43.837 32.250KNEERBCH2010-11NationalAverageHighestOutcomeLowestOutcomeRBCH2012NationalAverageHighestOutcomeLowestOutcomeEQ-VAS 72.771 70.913 60.387 78.246 71.983 71.827 64.094 79.182EQ-5D 0.727 0.705 0.810 0.539 0.694 0.709 0.822 0.526OxfordKneeScore34.208 33.724 38.351 25.531 34.433 33.863 39.225 28.67292Annual Report and Accounts 2012/13

Quality ReportQuality IndicatorDataSourceResults forreporting periodOct-Dec 2012Results forreporting periodJan - Mar 2013NationalaveragevalueHighestvalueLowestvalue% of patients readmittedto hospital within 28 daysof being dischargedHSCIC Q3 2012-201328279 admits1752 readmits6.2% readmit rateQ4 2012-201327779 admits1586 readmits5.7% readmitrateNotavailableNotavailableNotavailable% of patients admittedto hospital who wererisk assessed for venousthromboembolismHSCIC Q3 2012-2013No. Assessed 26291Admitted 2782794.5% AssessedQ4 2012-2013No. Assessed25801Admitted 2744094.0% AssessedNotavailableNotavailableNotavailableC difficile infection rateper 100,000 bed daysHSCIC Q3 2012-201352326 bed days6 C difficileRate =11.5Q4 2012-201353939 bed days13 C difficileRate = 24.1NotavailableNotavailableNotavailableThe Trust considers that this data is asdescribed for the reason of provenanceas the data has been extracted fromavailable Department of Healthinformation sources.Patient safety incidentsThis year is the first time that patientsafety incidents resulting in severeharm or death have been required to beincluded within the Quality Reportalongside comparative data provided,where possible, from the Health andSocial Care Information Centre (HSCIC).The National Reporting and LearningService (NRLS) was established in 2003.The system enables patient safetyincident reports to be submitted to anational database on a voluntary basisdesigned to promote learning. It ismandatory for NHS trusts in England toreport all serious patient safety incidentsto the Care Quality Commission as partof the Care Quality Commissionregistration process. To avoidduplication of reporting, all incidentsresulting in death or severe harm shouldbe reported to the NRLS who then reportthem to the Care Quality Commission.Although it is not mandatory, it iscommon practice for NHS trusts toreport patient safety incidents under theNRLS’s voluntary arrangements.As there is not a nationally establishedand regulated approach to reporting andcategorising patient safety incidents,different trusts may choose to applydifferent approaches and guidance toreporting, categorisation and validationof patient safety incidents. The approachtaken to determine the classification ofeach incident, such as those ‘resulting insevere harm or death’, will often rely onclinical judgement. This judgement may,acceptably, differ between professionals.In addition, the classification of theimpact of an incident may be subject toa potentially lengthy investigation whichmay result in the classification beingchanged. This change may not bereported externally and the data held by atrust may not be the same as that held bythe NRLS. Therefore, it may be difficult toexplain the differences between the datareported by the trusts as this may not becomparable.Annual Report and Accounts 2012/13 93

Quality ReportThe following table and charts provide the results from the most recent NRLS report.The report provides comparative data for April 2012 to September 2012. Full year datais not currently available.Quality IndicatorDataSourceTrust ResultsApril - Sept2012Nationalmediumacute TrustaveragevalueApril-Sept2012Highest valueApril-Sept2012LowestvalueApril-Sept2012Number of patient safety incidentsreported during the reporting periodNRLS 2876 2603 4552 843Rate of patient safety incidentsreported during the reporting periodNRLS 5.86/100admissions6.7/100admissions14.44/100admissions3.11/100admissionsNumber of patient safety incidentsreported during the reporting periodthat resulted in severe harm ordeath% of total number of patient safetyincidents reported during thereporting period that resulted insevere harm or deathNRLS 12 19 95 0HSCIC 0.4% 0.8% 3.1% 0NRLS Report on reporting rate - NRLS Data April 2012 - September 2012The Trust is in the middle quartile for reporting when compared to all other mediumacute trusts.94Annual Report and Accounts 2012/13

Quality ReportThe Trust has a similar reporting profile to other medium acute Trusts.Nationally 0.8 % of NRLS patient safety incidents were reported as severe harm ordeath. The Trust percentage was much lower than this at 0.4%.The Trust considers that this data is as described for the reason of provenance as thedata has been extracted from available Department of Health information sources.The Trust intends to maintain this position, and so the quality of its services, bycontinuing to support an open culture for incident reporting and investigation.Annual Report and Accounts 2012/13 95

Quality ReportAnnex A - Statementsfrom commissioners, localHealthwatch organisationsand scrutiny committeesThe following groups have had sight ofthe Quality Report and have been offeredthe opportunity to comment:l Health and Social Care Overview andScrutiny Committee, Borough of Poolel Bournemouth Borough Council’sHealth Overview and ScrutinyCommitteel The Royal Bournemouth andChristchurch Hospitals NHSFoundation Trust Council of Governorsl Healthwatch Dorsetl NHS Dorset Clinical CommissioningGroup.Comments received were as follows:Health and Social CareOverview and ScrutinyCommittee response to TheRoyal Bournemouth andChristchurch Hospitals NHSFoundation Trust’s QualityAccount 2012/13Members of Borough of Poole’s Healthand Social Care Overview and ScrutinyCommittee would like to thank the RoyalBournemouth and ChristchurchHospitals NHS Foundation Trust for theopportunity to comment on theirimpressive and comprehensive accountof activities undertaken to improveservices over the 2012/13 financial year.Demonstrating a clear commitment toquality improvement and patient safetyThe HSCOSC are encouraged to see thatthe Trust’s quality programme has beenenhanced by wide ranging patient safetyinitiatives and that it continues to be partof a Foundation Trust Patient SafetyCollaborative “NHS Quest” combining theshared experiences and learning from 13Acute Foundation Trusts across thecountry to promote and improve patientsafety.We note that in addition to patient safety,re-admissions and reducing mortality, theNHS Quest work has concentrated onimproving Harm Free Care in particularthe delivery of harm free care as definedby “the absence of pressure ulcers, harmfrom falls, catheter acquired urinary tractinfection and veno-thrombosis.” Weacknowledge the Trust’s performance in2012/13 and the decision to continue withthe “Harm free care” programme as apriority in 2013/14 with a view toensuring at least 95% harm free careacross all 4 types of harm in line with thenational target as well as a reduction inhospital acquired severe harms from fallsand pressure ulcers by 50%. TheHSCOSC members would be interestedto receive an update on progress in theseareas in due course.We commend the Trust for using a widerange of information sources to helpdetermine their approach in terms of96Annual Report and Accounts 2012/13

Quality Reportpriorities for the year ahead includinggathering the views of patients, publicand carers using real time feedback;collating information from claims,complaints and adverse incidentsand using the results of internal andexternal clinical audits and patientsurveys to inform performance in relationto patient care, experience and safety.It is pleasing to see that a recent CareQuality Commission re-inspection foundthe Trust compliant in outcomestandards for areas such as consent,care and welfare, safety and estatesand that the Trust was rated the secondbest hospital in England on quality in anindependent report.Thank you once again for the opportunityto comment on a well researched andcomprehensive Quality Account.Yours sincerelyCouncillor the Rev. Charles MeachinChairman Health and Social CareOverview and Scrutiny CommitteePoole Borough CouncilBournemouth BoroughCouncil’s Health Overviewand Scrutiny CommitteeThe Scrutiny Panel would like to thankthe Trust for giving them the opportunityto comment on the Trust’s Quality Audit,and in so doing engage with them overthe future delivery of quality services tothe local population.The Panel would also like to congratulatethe Trust on it’s achievements in 2012 -13, and endorse the quality improvementpriorities identified for 2013- 14. Throughsetting out the series of changes that theyhave put in place during the course ofthe year, and by listing their detailedaction plans for 2013 - 14 the Trustdemonstrates that they are anorganisation keen to put things rightand, are continuing to strive to makeimprovements to the patient experience.The Panel was asked to comment on thereport content and any omissions thatshould be included. The response that thePanel is able to give is limited as the draftdocument contained a number ofomissions, and the time given forresponse was very limited not allowingfor time to receive a presentation from,or have any discussions directly with theTrust.Comments are as follows:l The document would benefit fromhaving a clear executive summarywhich gives an overview of how theTrust performed against the areas forimprovement they set themselves for2012 / 13, and then states theoutcomes they will be striving toachieve in 2013 / 14. This would alsoserve as a frame of reference for therest of the document, giving contextto the wealth of information laterpresented.l The document might also benefit fromhaving some sort of index.Annual Report and Accounts 2012/13 97

Quality Reportl At times abbreviations are used andexplanations are not close to handmaking the text hard to follow.l The document presents the readerwith a wealth of information, at timescomplex, and it would be helpful ifthere was more explanatorynarrative clarifying how well the Trustwas performing against theirobjectives. At times the comparatorsare local and at others national, andagain this makes the documentdifficult to interpret, and makes it hardfor the reader to assess how well theTrust is performing.l The language is also quite technicalin places and perhaps could betempered in order to make thedocument more accessible and easyto read.The Panel will be giving thought as tohow better to engage with the Trust overthe course of the year, and will have theTrust’s Quality Account as an agendaitem at its Autumn meeting. In preparationfor that the Panel requests the following:l To be provided with a final version ofthe Quality Account 2012-13 as thereare a number of gaps in information inthe draft version.l To be appraised of the success of themeasures the Trust will be, and has,implemented as a result of the nationaland local clinical audits they reporton in this Quality Audit 2012 - 13, in 6months time.l To be informed of the outcome ofthe Trust’s contact with the CQC andMonitor in respect of their decision toadhere to the Charlson Index for thecoding standard that caused them tobe non compliant when theirInformation governance assessmentwas completed.l To be informed of the outcomeof the reports to the InformationCommissioner’s Office of the 3serious incidents that are referred toin the Quality Account 2012 -13.l To be informed as to the number ofcomplaints that were upheld in 2011-2012 and in 2012 - 2013.l To be informed of the outcome of thecomplaint that is being investigated bythe Ombudsman and of the twocurrently being assessed.The Royal Bournemouth andChristchurch Hospitals NHSFoundation Trust Council ofGovernorsThe Council of Governors hasappreciated that its views on thequality priorities for the Trust and theQuality Report itself are being requestedat an earlier stage so that it has greateropportunity to make a meaningfulcontribution through the consultationprocess. This year the process alsoinvolved a short questionnaire whichwas sent to the Council of Governorswhich asked for the Governors’ views onthe consultation process for setting the2012/13 quality priorities for the Trust andthe Trust’s performance and reportingagainst these. The survey also asked forthe Governors’ views on potentialquality objectives for 2013/14. TheCouncil of Governors supports thequality priorities which have been set andthe focus on a smaller number of keypriorities. The results of the surveyidentified that reporting on performancerelating to urinary tract infections couldbe improved and this was referred to theInfection Control Team and also a needfor greater awareness of the Trust’sperformance on implementing an end oflife care strategy and this is beingdeveloped through training for the Councilof Governors in 2013.However, the Council of Governors wasslightly disappointed that the ability of theCouncil of Governors to set a localindicator to be included in theindependent assurance report on theQuality Report to the Council ofGovernors was been replaced by anindicator mandated by Monitor. TheCouncil of Governors recognised the98Annual Report and Accounts 2012/13

Quality Reportimportance of gaining assurance onincidents resulting in severe harm topatients with the ability to benchmarkdata with other foundation trusts, as allfoundation trust would be using the samemandated indicator, but did not wantto impose the additional administrativeburden or cost of selecting a second localindicator.The Council of Governors, through itsScrutiny Committee, has alsocontributed to the quality assuranceprocess at the Trust through its ownaudits and was pleased to gain thesupport of the Board of Directors for therecommendations following its audit onpatient discharge letters presented during2012/13.Over the past year Royal Bournemouthand Christchurch Hospitals NHSFoundation Trust has striven to maintainits focus on improving the quality of careprovided to individuals. The keypriorities identified for 2012/13 focussedupon delivering harm free care. During theyear there was a recorded reduction inthe number of catheter associated urinarytract infections, with improvementinitiatives taking place to reduce harmfrom falls, pressure ulcers and venousthromboembolism.The CCG has not been actively engagedin the development of the QualityImprovement Priorities that the Trust hasset for 2013/4; these priorities have beenagreed following discussion withGovernors and Directors. The CCGsupports the decision to consolidate uponthe quality improvement work undertakenin 2012/13 and looks forward toworking with Royal Bournemouth andChristchurch Hospitals NHS FoundationTrust over the coming year.Bournemouth LINks Commentfor Royal Bournemouth &Christchurch Hospitals NHSFoundation Trust QualityAccount 2012Bournemouth LINks are pleased tocomment on their work with the RoyalBournemouth & Christchurch HospitalsNHS Foundation Trust over the last year.LINks welcomed the Trusts commitmentto improving the feedback that it receivedabout the Patient Experience, through itsown endeavours and by working with theLINk and other organisations, and usingthis feedback to help it make informeddecisions about changes to its services.In 2011, the LINk encouraged the Trustto be more pro-active about gatheringservice user feedback and using it to planand design services.In 2011 - 2012, the Trust hasimplemented a program of real timemonitoring and targeted patient surveysin relation to high priority issues andareas. We note that the information thathas been gathered to date, has beenused to as supporting evidence to changethe way that services are delivered withinthe Trust. We feel that by displaying thefeedback at the entrance of each ward/department, shows the transparency ofthe process and the Trusts commitmentto listening and acting upon, the patient’svoice.Working with the TrustIn the 2011 Quality Account - the LINkexpressed an interest in undertaking a“leaving hospital survey”. This piece ofwork was successfully undertaken in2012. The full report can be viewed byvisiting www.makesachange.org.ukThe LINk was very impressed with theTrusts response and action plan.Annual Report and Accounts 2012/13 99

Quality ReportIn 2012 - the Bournemouth LINkundertook an “Enter & View” visit tothe Royal Bournemouth Hospital.The report can be found atwww.makesachange.org.ukThe visit was very well received by bothpatients and hospital staff. The Trust werevery responsive to the recommendationsin the report and expressed a desire forHealthwatch to undertake a similar visit in2012 - 2013.The LINk undertook a piece ofengagement with Young People from2009 - 2012. Some of the comments thatwe received were relevant to the RoyalBournemouth Hospital. The report wasshared with the Trust who immediatelyput together a very detailed action plan todeal with the concerns expressed by theyoung people. The report and action plancan be viewed on the Bournemouth LINksweb site www.makesachange.org.ukThese three pieces of work are mentionedin this Quality Account on pages 59 & 60.As we mentioned in the 2011 QualityAccount we believe that the Trust shouldproduce an easy read version of theQuality Account, thus improving accessto this information for service users,carers and the public. We note that theTrust chose not to do this with the 2010account and hope that they will produceone for 2012.In 2011 the LINk suggested that theTrust should engage at an early stagewith Healthwatch Dorset. We note thatthere has been a real effort by the Trustto support Healthwatch Dorset andengage with them as they develop theirHealthwatch Champion networks.www.healthwatchdorset.co.ukThe Bournemouth LINk has had a goodworking relationship with the Trust duringthe last 5 years and is confident that thiswill continue as it develops its links withHealthwatch Dorset in 2013 and beyond.For more information about theBournemouth LINks, please go to:www.makesachange.org.uk100Annual Report and Accounts 2012/13

Quality ReportAnnex B - Statement ofdirectors’ responsibilities inrespect of the Quality ReportThe directors are required under theHealth Act 2009 and the National HealthService (Quality Accounts) Regulations2010 to prepare Quality Accounts foreach financial year. Monitor has issuedguidance to NHS foundation trust boardson the form and content of annualQuality Reports (which incorporate theabove legal requirements) and on thearrangements that foundation trustboards should put in place to supportthe data quality for the preparation of theQuality Report.In preparing the Quality Report, directorsare required to take steps to satisfythemselves that:l the content of the Quality Reportmeets the requirements set out in theNHS Foundation Trust AnnualReporting Manual 2012/13l the content of the Quality Report is notinconsistent with internal and externalsources of information including:l Board minutes and papers for theperiod April 2012 to June 2013l Papers relating to quality reportedto the Board over the period April2012 to June 2013l Feedback from commissionersdated 21/05/2013l Feedback from governors dated21/05/2013l Feedback from Local Healthwatchorganisations dated 22/05/2013l The Trust’s complaints reportpublished under regulation 18 ofthe Local Authority Social Servicesand NHS Complaints Regulations2009, dated 20/05/2013llllThe latest national inpatientsurveyThe latest national staff surveyThe Head of Internal Audits annualopinion over the Trusts controlenvironment dated 24/05/2012CQC quality and risk profilespublished April 2012, June 2012,July 2012, August 2012, October2012, November 2012, December2012, February 2013, March 2013.l the Quality Report presents abalanced picture of the Trust’sperformance over the period covered;l the performance information reportedin the Quality Report is reliable andaccurate;l there are proper internal controls overthe collection and reporting of themeasures of performance included inthe Quality Report, and these controlsare subject to review to confirm thatthey are working effectively inpractice;l the data underpinning the measuresof performance reported in the QualityReport is robust and reliable, conformsto specified data quality standards andprescribed definitions, is subject toappropriate scrutiny and review; andl the Quality Report has been preparedin accordance with Monitor’s annualreporting guidance (whichincorporates the Quality Accountregulations) (published atwww.monitor-nhsft.gov.uk/annualreportingmanual)as well as thestandards to support data quality forthe preparation of the Quality Report(available at www.monitor-nhsft.gov.uk/annualreportingmanual).Annual Report and Accounts 2012/13 101

Quality ReportThe directors confirm to the best of theirknowledge and belief they have compliedwith the above requirements in preparingthe Quality Report.By order of the BoardJane StichburyChairman24 May 2013Mr A SpotswoodChief Executive24 May 2013102Annual Report and Accounts 2012/13

Quality ReportAnnex C - IndependentAuditor’s Report to theCouncil of Governors of TheRoyal Bournemouth andChristchurch Hospitals NHSFoundation Trust on theQuality ReportWe have been engaged by the Councilof Governors of The Royal Bournemouthand Christchurch Hospitals NHSFoundation Trust to perform anindependent assurance engagement inrespect of The Royal Bournemouth andChristchurch Hospitals NHS FoundationTrust’s Quality Report for the year ended31 March 2013 (the “Quality Report”) andcertain performance indicators containedtherein.This report, including the conclusion, hasbeen prepared solely for the Council ofGovernors of The Royal Bournemouthand Christchurch Hospitals NHSFoundation Trust as a body, to assist theCouncil of Governors in reporting TheRoyal Bournemouth and ChristchurchHospitals NHS Foundation Trust’s qualityagenda, performance and activities. Wepermit the disclosure of this report withinthe Annual Report for the year ended31 March 2013, to enable the Councilof Governors to demonstrate they havedischarged their governanceresponsibilities by commissioning anindependent assurance report inconnection with the indicators. To thefullest extent permitted by law, we do notaccept or assume responsibility toanyone other than the Council ofGovernors as a body and The RoyalBournemouth and Christchurch HospitalsNHS Foundation Trust for our work or thisreport save where terms are expresslyagreed and with our prior consent inwriting.Scope and subject matterThe indicators for the year ended 31March 2013 subject to limited assuranceconsist of the national priority indicatorsas mandated by Monitor are as follows:l C Difficile; andl 62 day cancer wait times from urgentreferral until treatment.We refer to these national priorityindicators collectively as the “indicators”.Respective responsibilities ofthe directors and auditorsThe directors are responsible for thecontent and the preparation of the QualityReport in accordance with the criteria setout in the NHS Foundation Trust AnnualReporting Manual issued by Monitor.Our responsibility is to form a conclusion,based on limited assurance procedures,on whether anything has come to ourattention that causes us to believe that:l the Quality Report is not prepared inall material respects in line with thecriteria set out in the NHS FoundationTrust Annual Reporting Manual;Annual Report and Accounts 2012/13 103

Quality Reportl the Quality Report is not consistent inall material respects with the sourcesspecified in the Detailed Guidancefor External Assurance on QualityReports; andl the indicators in the Quality Reportidentified as having been the subjectof limited assurance in the QualityReport are not reasonably stated inall material respects in accordancewith the NHS Foundation TrustAnnual Reporting Manual and the sixdimensions of data quality set out inthe Detailed Guidance for ExternalAssurance on Quality Reports.We read the Quality Report and considerwhether it addresses the contentrequirements of the NHS FoundationTrust Annual Reporting Manual, andconsider the implications for our reportif we become aware of any materialomissions.We read the other information containedin the Quality Report and considerwhether it is materially inconsistent withthe documents specified within thedetailed guidance. We consider theimplications for our report if we becomeaware of any apparent misstatements ormaterial inconsistencies with thosedocuments (collectively the “documents”).Our responsibilities do not extend to anyother information.We are in compliance with the applicableindependence and competencyrequirements of the Institute ofChartered Accountants in England andWales (ICAEW) Code of Ethics. Our teamcomprised assurance practitioners andrelevant subject matter experts.Assurance work performedWe conducted this limited assuranceengagement in accordance withInternational Standard on AssuranceEngagements 3000 (Revised) -“Assurance Engagements other thanAudits or Reviews of Historical FinancialInformation” issued by the InternationalAuditing and Assurance Standards Board(“ISAE 3000”). Our limited assuranceprocedures included:l Evaluating the design andimplementation of the key processesand controls for managing andreporting the indicators.l Making enquiries of management.l Testing key management controls.l Analytical procedures.l Limited testing, on a selective basis, ofthe data used to calculate the indicatorback to supporting documentation.l Comparing the content requirementsof the NHS Foundation Trust AnnualReporting Manual to the categoriesreported in the Quality Report.l Reading the documents.A limited assurance engagement issmaller in scope than a reasonableassurance engagement. The nature,timing and extent of procedures forgathering sufficient appropriate evidenceare deliberately limited relative to areasonable assurance engagement.104Annual Report and Accounts 2012/13

Quality ReportLimitationsNon-financial performance information issubject to more inherent limitations thanfinancial information, given thecharacteristics of the subject matter andthe methods used for determining suchinformation.The absence of a significant body ofestablished practice on which to drawallows for the selection of different butacceptable measurement techniqueswhich can result in materially differentmeasurements and can impactcomparability. The precision of differentmeasurement techniques may also vary.Furthermore, the nature and methodsused to determine such information, aswell as the measurement criteria and theprecision thereof, may change over time.It is important to read the Quality Reportin the context of the criteria set out in theNHS Foundation Trust Annual ReportingManual.ConclusionBased on the results of our procedures,nothing has come to our attention thatcauses us to believe that, for the yearended 31 March 2013:l the Quality Report is not prepared inall material respects in line with thecriteria set out in the NHS FoundationTrust Annual Reporting Manual;l the Quality Report is not consistent inall material respects with the sourcesspecified in the Detailed Guidancefor External Assurance on QualityReports; andl the indicators in the Quality Reportsubject to limited assurance have notbeen reasonably stated in all materialrespects in accordance with the NHSFoundation Trust Annual ReportingManual.The scope of our assurance work has notincluded governance over quality or nonmandatedindicators which have beendetermined locally by The Royal Bournemouthand Christchurch Hospitals NHSFoundation Trust.Deloitte LLPChartered AccountantsSouthampton24 May 2013Annual Report and Accounts 2012/13 105

Governance Report6. Governance Report6.1 Board of DirectorsThe Board of Directors is made up ofexecutive and non-executive directors.The Board of Directors is responsiblefor the day-to-day running of the Trustand the delivery of the Trust’s objectivesand wider strategy. Much of this workis done by the executive directors whowork closely with the clinical directors,clinical leaders and managers throughoutthe organisation. The Board of Directorsalso works closely with the Council ofGovernors.The Board of Directors meets on thesecond Friday of every month exceptAugust and at other times as necessary.Part 1 of the meeting is open to thepublic. Against each name in the tablebelow is shown the number of meetingsat which the director was present andin brackets the number of meetingsthat the director was eligible to attend.The number of meetings includes bothscheduled and special/extraordinarymeetings.Attendance at Meetings of the Board of DirectorsName Title AttendanceKaren Allman Director of Human Resources 13 (14)Mary Armitage Medical Director 11 (14)David Bennett Non-Executive Director 11 (14)Pankaj Davé Non-Executive Director 12 (14)Brian Ford Non-Executive Director 14 (14)Stuart HunterDirector of Finance(formerly Director of Finance and IT)14 (14)Helen Lingham Chief Operating Officer 13 (14)Steven Peacock Non-Executive Director 12 (14)Alex PikeNon-Executive Director(Deputy Chairman and Senior IndependentDirector)8 (14)Richard Renaut Director of Service Development 14 (14)Paula Shobbrook Director of Nursing and Midwifery 13 (14)Tony Spotswood Chief Executive 12 (14)Jane Stichbury Chairman 14 (14)Ken Tullett Non-Executive Director 12 (14)106Annual Report and Accounts 2012/13

Governance ReportNon-ExecutiveDirectorWhen appointedTerm of officeDavid Bennett 01.10.2009 4 yearsPankaj Davé 01.02.2011 3 yearsBrian Ford 01.04.2005 (reappointed 01.10.2009,01.04.2012 and 01.04.2013)1 yearSteven Peacock 01.10.2009 4 yearsAlex Pike22.06.2006 (reappointed as a Non-ExecutiveDirector on 21.06.2010 and as SeniorIndependent Director on 09.10.2011)3 years asNon-ExecutiveDirector2 years as SeniorIndependentDirectorJane Stichbury 01.04.2010 4 yearsKen Tullett 01.04.2005 (reappointed 01.10.2009,01.04.2012 and 01.04.2013)1 yearAll of the non-executive directors areconsidered to be independent by theBoard of Directors. This includes BrianFord and Ken Tullett who have servedon the Board of Directors for more thansix years from the date of their firstappointment and have been reappointedby the Council of Governors for a furtherperiod of one year beginning on 1 April2013. The reappointment of Brian Fordand Ken Tullett for a further period of oneyear was made as these reappointmentswere viewed as necessary in orderto provide continuity for the Board ofDirectors due to the proposed merger.The decision also recognised thedifficulty there would be in recruiting newindividuals to non-executive directorroles for a potentially short period andto allow sufficient time for them tobegin to operate at full effectiveness,given the merger was scheduled to takeeffect in November 2013 at the time thereappointments were made.In determining their independence, theBoard of Directors considered whethertheir previous tenure as non-executivedirectors of the Trust might affect theirindependence. The Board’s conclusion,based on a number of factors includingtheir experience and knowledge fromother senior executive and non-executiveroles and the fact that they have alwaysexercised a strongly independentjudgment during the preceding period oftenure as non-executive directors, wasthat the independence of their characterand judgement was not compromised.The terms of office and the periodof appointment of the non-executivedirectors is set out in the table aboveand are approved by the Council ofGovernors.The Board of Directors has given carefulconsideration to the range of skills andexperience required for the running of afoundation trust and it confirms that thenecessary balance and completenesshas been in place during the year underreport.The performance of the non-executivedirectors and the Chairman wasevaluated during the year. The Chairmanled the process of evaluation of thenon-executive directors and the seniorindependent director undertook theevaluation of the performance ofthe Chairman. The outcome of bothprocesses was shared with the Councilof Governors and the governors alsocontributed to the appraisal of theAnnual Report and Accounts 2012/13 107

Governance ReportChairman. The Chief Executive undertookperformance appraisals of the executivedirectors and the Chief Executive’sperformance was appraised by theChairman.The Board of Directors, and each ofits committees, evaluates its ownperformance annually and undertake amore formal evaluation every three years.Each director has declared their interestsat a public meeting. The register ofinterests is held by the Trust Secretaryand is available for inspection byarrangement. This includes the othersignificant commitments of the Chairmanwhich have not changed during the yearunder report.The Board of Directors considers theTrust to be fully compliant with theprinciples of The NHS Foundation TrustCode of Governance as well as with theprovisions of the Code in all respects,save as to paragraphs A1.3, A3.2 andC2.2 where there are other arrangementsin place.6.2 Audit CommitteeThe Trust’s Audit Committee meetsat least quarterly and representativesof external audit, internal audit andthe counter fraud service attend thesemeetings. The Director of Finance,Director of Nursing and Midwifery andrepresentatives from the risk managementteams also regularly attend meetings atthe request of the chairman. The ChiefOperating Officer will also regularly attendmeetings going forward and the ChiefExecutive, Director of Human Resourcesand Director of Service Developmenthave attended meetings at the requestof the Chairman. The Audit Committeemet five times during the year. Thecommittee members are all non-executivedirectors and include the Chairman of theHealthcare Assurance Committee. During2012/13 the members were:Meetings of the Audit CommitteeNameMeetingsattendedSteven Peacock (Chairman) 5David Bennett 3Pankaj Davé 4The Audit Committee’s duties cover thefollowing areas:Internal control risk managementand corporate governanceThe committee reviews the establishmentand maintenance of an effective systemof internal control, risk management andcorporate governance, with particularreference to the Trust’s AssuranceFramework.In particular, the committee reviews theadequacy of:l all risks and control related disclosurestatements, together with anyaccompanying Head of Internal Auditstatement, prior to endorsement bythe Boardl the structure, processes andresponsibilities for identifying andmanaging key risks facing theorganisationl the operational effectiveness ofrelevant policies and proceduresincluding those related to fraud andcorruption and economy, efficiencyand effectiveness in the use ofresourcesl the scope, maintenance and use ofthe Assurance Frameworkl the Trust’s clinical audit programmeInternal auditThe committee:l appoints the internal auditors, sets theaudit fee and resolves any questionsof resignation and dismissall ensures that the internal auditfunction is adequately resourced andhas appropriate standing within theorganisation108Annual Report and Accounts 2012/13

Governance Reportl reviews the internal audit programme,considers major findings ofinternal audit investigations (andmanagement’s response), and ensuresco-ordination between the internal andexternal auditorsl reports non-compliance with, orinadequate responses to, internal auditreports to the Board of Directorsl utilises internal audit reports to provideassurance to the Board of Directorson the governance of the Trust’sHealthcare Assurance Committee.The Healthcare Assurance Committeeprovides assurance to the Board ofDirectors on the quality and safety ofservices which the Trust providesExternal auditThe committee:l considers the appointment of theexternal auditors, the audit fee and anyquestions of resignation and dismissalbefore making a recommendation tothe Council of Governorsl discusses with the external auditors,before the audit commences, thenature and scope of the audit,and ensures co-ordination, asappropriate, with internal audit and therepresentative from the counter fraudservicel reviews external audit reports,together with the managementresponsel reports non-compliance with, orinadequate responses to, externalaudit reports to the Board of Directorsl determines the policy on which theexternal auditors may providenon-audit services to the TrustCounter fraud serviceThe committee:l appoints the counter fraud service,sets the fee and resolves anyquestions of resignation and dismissall ensures that the counter fraud functionhas appropriate standing within theorganisationl reviews the counter fraud programme,considers major findings ofinvestigations (and management’sresponse) and ensures co-ordinationbetween the internal auditors andcounter fraudl reports non-compliance with, orinadequate responses to, counterfraud reports to the Board of DirectorsFinancial reportingThe committee reviews the annualfinancial statements beforerecommendation to the Board ofDirectors, focusing particularly on:l changes in, and compliance with,accounting policies and practicesl major judgemental areasl significant adjustments resulting fromthe auditl the impact of the Trust’s costimprovement programme on clinicalriskWhistleblowingThe committee will review arrangementsby which staff of the Trust may raise, inconfidence, concerns about possibleimproprieties in matters of financialreporting and control, clinical quality,patient safety or other matters toensure that arrangements are in placefor the proportionate and independentinvestigation of such matters and forappropriate follow-up action.In carrying out its duties the committee isauthorised by the Board to:l recommend actions to the Boardl oversee the investigation of anyactivities within its terms of referencel seek any information it requires fromany employee of the Trust whichmay include requiring attendanceat its committee meetings and allemployees have been directed tocooperate with any requestsl obtain outside legal or otherprofessional advice on any matterwithin its terms of referenceAnnual Report and Accounts 2012/13 109

Governance ReportThe Audit Committee has approved apolicy which governs the provision ofany non-audit services by the externalauditors. The policy sets out limits onthe services which may be providedby the external auditors so as not toimpair their objectivity or independencewhen reviewing the Trust’s financialstatements but does not restrict the Trustfrom purchasing other services fromthe external auditors where this is in thebest interests of the Trust. Any non-auditservices provided by the external auditorsare reported to the Audit Committeewhich is responsible for reviewing theobjectivity and independence of theexternal auditors.6.3 Remuneration ReportRemuneration CommitteesThe Trust operates two separatecommittees to make decisions orrecommendations relating to theremuneration of executive andnon-executive directors.The remuneration of executive directorsis considered by a committee consistingof all seven non-executive directors. TheRemuneration Committee determines thefinal salaries of the executive directorsand makes recommendations to theBoard of Directors on annual pay awardsand remuneration policies for all otherstaff. Details of the membership, numberof meetings and attendance at meetingsof the Remuneration Committee areshown in the table on the right.The remuneration of non-executivedirectors is considered by a committeecomprised of four governors who havebeen elected by their fellow governors.The Non-Executive Director RemunerationCommittee monitors the performanceof the non-executive directors andmakes recommendations to the Councilof Governors on the total level ofremuneration to be paid to non-executivedirectors. Details of the membership,number of meetings and attendance atmeetings of the Non-Executive DirectorRemuneration Committee are shown inthe table on page 111.The Non-Executive Director RemunerationCommittee is advised by the Directorof Human Resources on market ratesand relativities (based on researchcommissioned by the Trust and carriedout and reported upon by NHS partners).The Remuneration Committee is advisedby the Chief Executive on performanceaspects, by the Director of Finance onthe financial implications of remunerationor other proposals and by the Directorof Human Resources on personnel andremuneration policy. John Langranof John Langran Human ResourcesConsulting also prepared a report forthe Remuneration Committee on theremuneration of the Trust’s executivedirectors relative to the external marketfor similar posts taking into account thesize and nature of the Trust. The TrustSecretary attends meetings of bothcommittees to record the proceedings.Attendance at meetingsAgainst each name is shown the numberof meetings of the committees at whichthe non-executive director or governorwas present and in brackets the numberof meetings that the non-executivedirector or governor was eligible to attendas a member of the committee during2012/13.Meetings of the Executive DirectorRemuneration CommitteeNameMeetingsattendedJane Stichbury (Chair) 2 (2)David Bennett 2 (2)Pankaj Davé 2 (2)Brian Ford 2 (2)Steven Peacock 2 (2)Alex Pike 2 (2)Ken Tullett 1 (2)110Annual Report and Accounts 2012/13

Governance ReportMeetings of the Non-Executive DirectorRemuneration CommitteeNameMeetingsattendedSue Bungey (Chair) 2 (2)Sharon Carr-Brown 2 (2)Lee Foord 2 (2)Alf Hall 2 (2)Summary and explanation ofpolicy on duration of contracts,notice periods and terminationpaymentsExecutive directorsInformation relating to executive directorsis included in the notes to the table onpage 112.ExpensesThe expenses of directors and staffgovernors are reimbursed in accordancewith the Trust’s policy on expensesfor all staff. Travel and other costs andexpenses for all other governors arereimbursed in accordance with a separatepolicy approved by the RemunerationCommittee, which is comprised ofnon-executive directors. Governorsare volunteers and do not receive anyremuneration for performing their role.There are no provisions in place fortermination payments, other than throughlegal compromise agreements.Non-executive directorsArrangements for the termination ofthe appointment of a non-executivedirector are set out in the Trust’sconstitution. In relation to the mostrecent reappointments of non-executivedirectors, the terms of appointmenthave incorporated a notice period ofthree months during the one year termof appointment in the event that theproposed merger takes place within thecurrent year.The remuneration of executive andnon-executive directors is not includedwithin Agenda for Change. Whenreviewing the remuneration of executiveand non-executive directors, theRemuneration Committees review payawards and increases made to staffwithin the Trust and nationally alongsideinformation on remuneration for directorsat other comparable NHS organisations,taking account of overall and individualperformance, with the aim of ensuringthat their remuneration is fair andappropriate.Annual Report and Accounts 2012/13 111

Governance ReportSenior manager remuneration (subject to audit)Name Title 2012/13 2011/12Salary OtherRemunerationTotal Salary OtherRemuneration(bands of£5000)£’000(bandsof £5000)£’000(bands of£5000)£’000(bands of£5000)£’000(bands of£5000)£’000Total(bands of£5000)£’000Executive MembersMr A Spotswood Chief Executive (see note 5) 190-195 5-10 195-205 170-175 0 170-175Mrs H Lingham Chief Operating Officer 130-135 0 130-135 120-125 0 120-125Mr S Hunter Director of Finance and130-135 0 130-135 115-120 0 115-120Commercial ServicesMrs M Armitage Medical Director (see note 3) 115-120 65-70 180-190 115-120 90-95 205-215Mr R Renaut Director of Service110-115 0 110-115 95-100 0 95-100DevelopmentMrs K Allman Director of Human Resources 110-115 0 110-115 100-105 0 100-105Mrs P Shobbrook Director of Nursing and110-115 0 110-115 55-60 0 55-60Midwifery (see note 1)Miss B Atkinson Director of Nursing and0 0 0 40-45 0 40-45Midwifery (see note 2)Board MemberMr P Gill Director of Informatics (see note 4) 20-25 0 20-25 0 0 0Non-Executive MembersMrs J Stichbury Chairman 50-55 0 50-55 45-50 0 45-50Mr P Davé Non-Executive Director 15-20 0 15-20 10-15 0 10-15Mr B Ford Non-Executive Director 15-20 0 15-20 15-20 0 15-20Mrs A Pike Non-Executive Director 15-20 0 15-20 15-20 0 15-20Mr D Bennett Non-Executive Director 10-15 0 10-15 10-15 0 10-15Mr S Peacock Non-Executive Director 10-15 0 10-15 10-15 0 10-15Mr K Tullett Non-Executive Director 10-15 0 10-15 15-20 0 15-20Band of highest paid director 190-195 170-175Median Total Remuneration 25,040 23,215Ratio 7.7 7.4Notes:1. Mrs P Shobbrook commenced her post as Director of Nursing and Midwifery on 5 September2011.2. Miss B Atkinson retired from her post as Director of Nursing and Midwifery on 31 August2011.3. The salary shown against Mrs M Armitage represents her Medical Director post for the Trust; the‘Other Remuneration’ represents her post as a medical consultant.4. Mr P Gill holds a joint Director of Informatics post with Poole Hospital NHS Foundation Trust(employing body) from 19 November 2012, and was recharged to the Trust on a half-timebasis.5. The ‘Other Remuneration’ for Mr A Spotswood relates to payment for annual leave which was nottaken during the financial year and was made in accordance with the Trust’s policy for staff.6. All other senior manager remuneration arrangements are determined through a documented jobevaluation policy, in line with the NHS Agenda for Change pay terms and conditions.7. Senior manager remuneration does not include performance components.8. No individual named above received any benefit in kind during the financial year ended 31 March2013.Summary of policy in relation to the duration of contracts; notice periods; and terminationpayments:- All Executive Directors are required to provide six months’ written notice, however in appropriatecircumstances this could be varied by mutual agreement.- All senior manager contracts are permanent.- All senior managers appointed on a permanent contract are required to provide three months’written notice.112Annual Report and Accounts 2012/13

Governance ReportMedian Total Remuneration:The HM Treasury FReM requires disclosure of the median remuneration of the reporting entity’sstaff and the ratio between this and the mid-point of the banded remuneration of the highest paiddirector. The calculation is based on full-time equivalent staff of the reporting entity at the reportingperiod end date on an annualised basis.Senior manager pension entitlements (subject to audit)NameTitle(as at 31 March 2013)RealIncrease inPensionand RelatedLump Sum atage 60(Bands of£2500)TotalaccruedPension andRelatedLump Sum atage 60 at 31March 2013(Bands of£5000)CashEquivalentTransferValue at 31March 2013CashEquivalentTransferValue at 31March 2012(Inflated)RealIncreasein CashEquivalentTransferValueEmployer-Fundedcontributionto growth inCETV for theyear£’000 £’000 £’000 £’000Mr A Spotswood Chief Executive 27.5-30 290-295 1,367 1,197 170 96Mrs H Lingham Chief Operating Officer 12.5-15 140-145 670 594 76 43Mr S Hunter Director of Finance and 15-17.5 200-205 936 837 99 56Commercial ServicesMr R Renaut Director of Service 15-17.5 85-90 284 226 58 33DevelopmentMrs K Allman Director of Human7.5-10 50-55 250 202 48 27ResourcesMrs P Shobbrook Director of Nursing and 7.5-10 130-135 491 421 70 39MidwiferyMrs M Armitage Medical Director - 305-310 1,574 1,574 - -Notes:1. Non-Executive Directors do not receive pensionable remuneration, and as such, there are noentries in respect of pensions for Non-Executive Directors.2. Mr P Gill holds a joint Director of Informatics post with Poole Hospital NHS Foundation Trust(employing body) the accounts of which include his pension entitlement.Further details on the Trust’s accounting policies for pensions are set out in note 1 to the accounts.Cash Equivalent Transfer ValuesA Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pensionscheme benefits accrued by a member at a particular point in time. The benefits valued are themember’s accrued benefits and any contingent spouse’s pension payable from the scheme. A CETVis a payment made by a pension scheme, or arrangement to secure pension benefits in anotherpension scheme or arrangement when the member leaves a scheme and chooses to transfer thebenefits accrued in their former scheme. The pension figures shown relate to the benefits that theindividual has accrued as a consequence of their total membership of the pension scheme, notjust their service in a senior capacity to which the disclosure applies. The CETV figures, and from2004/5 the other pension details, include the value of any pension benefits in another scheme orarrangement which the individual has transferred to the NHS pension scheme. They also includeany additional pension benefit accrued to the member as a result of their purchasing additionalyears of pension service in the scheme at their own cost. CETVs are calculated as prescribed by theInstitute and Faculty of Actuaries.Real Increase in CETVReal Increase in CETV - This reflects the increase in CETV effectively funded by the employer.It takes account of the increase in accrued pension due to inflation, contributions paid by theemployee (including the value of any benefits transferred from another pension scheme orarrangement) and uses common market valuation factors for the start and end of the periiod.Mr A Spotswood, Chief Executive24 May 2013Annual Report and Accounts 2012/13 113

Governance Report6.4 Council of GovernorsThere are 30 members of the Council ofGovernors. The Council of Governors’principal responsibilities are:l to appoint or remove the Chairmanand the other non-executive directorsl to approve an appointment (by thenon-executive directors) of the ChiefExecutivel to decide the remuneration andallowances, and the other terms andconditions of office, of thenon-executive directorsl to appoint or remove the Trust’sauditorsl to be presented with the annualaccounts, any report of the auditors onthem and the annual reportl to provide their views to the Board ofDirectors during the Trust’s forwardplanning processl to determine whether it is satisfied thatthe carrying on of activities other thanthe provision of goods and servicesfor the purposes of the health servicein England proposed in the forwardplan will not to any significant extentinterfere with the fulfilment by theTrust of its principal purpose or theperformance of its other functionsl to approve the implementation ofany increase of 5% or more in theproportion of the Trust’s total incomein any financial year attributable toactivities other than the provision ofgoods and services for the purposesof the health service in Englandl to respond as appropriate whenconsulted by the Board of Directors inaccordance with the constitutionl to undertake such functions as theBoard of Directors shall from time totime requestl to prepare and from time to timeto review the Trust’s membershipstrategy and its policies for thecomposition of the Council ofGovernors and non-executivedirectors and make recommendationsThe role and principal responsibilitiesof the Council of Governors have beenfurther extended with effect from 1 April2013 as a result of the provisions ofthe Health and Social Care Act 2012.The Council of Governors now has twostatutory duties to hold the Non-ExecutiveDirectors to account for the performanceof the Board of Directors and to representthe interests of members and the public.Additional responsibilities include:l to approve the application for anymerger, acquisition, separation,dissolution or the entering into of anysignificant transaction by the Trustl to approve changes to the constitutionl to vote on whether to approve thereferral of a question to any panelappointed by Monitor as to whetherthe Trust has failed or is failing to actin accordance with the constitutionl to require one or more of the directorsto attend a general meeting of theCouncil of Governors for the purposeof obtaining information about theTrust’s performance of its functionsor the directors’ performance of theirdutiesl to decide whether to propose avote on the Trust’s or directors’performanceIn 2012/13 the Council of Governors wasmade up as follows:Public governors - Bournemouth andPoole constituency (elected)Judith AddaJayne BakerDavid BellamyGlenys BrownSharon Carr-BrownCarole DeasDerek DundasKeith MitchellDavid Triplow114Annual Report and Accounts 2012/13

Governance ReportPublic governors - Christchurch andDorset County constituency (elected)Sue Bungey, Lead Governor and DeputyChairman of the Council of GovernorsDerek ChaffeyMichael DesforgesEric FisherAlf HallDoreen HolfordPublic governors - New Forest,Hampshire and Salisbury constituency(elected)Mike AllenBob GeeGraham SwetmanStaff governors (elected)David DicksonDean Feegrade(re-elected from October 2012)Richard Ford (until December 2012)Claire StalleyEmma Willett (formerly Emma Vickers)(from July 2012)Nominated governors (appointed bytheir respective organisations)John Adams, Bournemouth BoroughCouncilLee Foord, Internal Hospital Volunteers(re-appointed from January 2013)David Fox, Dorset County Council(until February 2013)Ken Hockey, NHS Bournemouth andPoole and NHS Dorset clusterJenny Hodges, Borough of Poole(appointed June 2012 until July 2012)Colin Jamieson, Dorset County Council(from February 2013)Carol Linnard, NHS Bournemouth andPoole and NHS Dorset cluster(appointed June 2012)Gail Thomas, Bournemouth UniversityThere were the following vacancies on theCouncil of Governors at the end of theyear under report.Staff GovernorAppointedGovernorEstates and AncillaryBorough of PoolePublic and staff governors are electedby secret ballot of the relevant publicconstituency or staff class using the firstpast the post system. Each governor iselected for a term of three years. LeeFoord’s most recent appointment wasfor a term of six months pending theoutcome of the proposed merger.At each meeting of the Council ofGovernors, a declaration of any interestsheld which may conflict with the role ofany governor is recorded. A copy of thedeclaration of interest is included in thepapers for each meeting of the Councilof Governors which are available on theTrust’s website and can be inspected byarrangement with the Trust Secretary.Executive and non-executive directorsattend the public meetings of the Councilof Governors both to report on mattersand take questions from the governorsand to develop a deeper understandingof the views of governors and members.Governors also attend the publicmeetings of the Board of Directors andhave the opportunity to ask questionsof the Board of Directors at the end ofthese meetings. The Council of Governorsand Board of Directors also have jointseminars to consider and discuss issuesof concern to the directors and governors.The Council of Governors met seventimes in 2012/13 and attendance atthese meetings is set out in the table (onnext page). Against each name is shownthe number of meetings of the Councilof Governors at which the governor ordirector was present and in brackets thenumber of meetings that the governoror director was eligible to attend during2012/13. The number of meetingsincludes both scheduled and special/extraordinary meetings.Annual Report and Accounts 2012/13 115

Governance ReportAttendance at meetings of the Council of GovernorsName Title Constituency/class/appointing AttendanceorganisationJane Stichbury Chairman 7 (7)John Adams Appointed Governor Bournemouth Borough Council 3 (7)Judith Adda Public Governor Bournemouth and Poole 5 (7)Mike Allen Public Governor New Forest,3 (7)Hampshire and SalisburyJayne Baker Public Governor Bournemouth and Poole 6 (7)David Bellamy Public Governor Bournemouth and Poole 5 (7)Glenys Brown Public Governor Bournemouth and Poole 6 (7)Sue Bungey Public Governor Christchurch and Dorset County 7 (7)Sharon Carr-Brown Public Governor Bournemouth and Poole 7 (7)Derek Chaffey Public Governor Christchurch and Dorset County 7 (7)Carole Deas Public Governor Bournemouth and Poole 6 (7)Michael Desforges Public Governor Christchurch and Dorset County 5 (7)David Dickson Staff Governor Registered Medical Practitioners 3 (7)and Registered DentistsDerek Dundas Public Governor Bournemouth and Poole 6 (7)Dean Feegrade Staff Governor Administrative and Clerical/ 4 (7)ManagementEric Fisher Public Governor Christchurch and Dorset County 5 (7)Lee Foord Appointed Governor Royal Bournemouth and7 (7)Christchurch HospitalsVolunteers GroupRichard Ford Staff Governor Hotel Services and Estates 4 (5)(until December 2012)David FoxAppointed Governor Dorset County Council 1 (6)(until February 2013)Bob Gee Public Governor New Forest, Hampshire and 7 (7)SalisburyAlf Hall Public Governor Christchurch and Dorset County 7 (7)Ken Hockey(until 31 March 2013)Jenny Hodges(from June 2012until July 2012)Appointed GovernorNHS Bournemouth and Pooleand NHS Dorset cluster4 (7)Appointed Governor Borough of Poole 0 (1)Doreen Holford Public Governor Christchurch and Dorset County 6 (7)Colin Jamieson Appointed Governor Dorset County Council 0 (1)(from February 2013)Carol Linnard Appointed Governor NHS Bournemouth and Poole 3 (6)(from June 2012)and NHS Dorset clusterKeith Mitchell Public Governor Bournemouth and Poole 5 (7)Claire Stalley Staff Governor Allied Health Professionals 0 (7)Graham Swetman Public Governor New Forest, Hampshire andSalisbury7 (7)116Annual Report and Accounts 2012/13

Governance ReportName Title Constituency/Class/AppointingOrganisationAttendanceGail Thomas Appointed Governor Bournemouth University 2 (7)David Triplow Public Governor Bournemouth and Poole 6 (7)Emma Willett Staff GovernorNursing and Midwifery (including 4 (5)(from July 2012)Healthcare Assistants)Directors:Karen AllmanDirector of HumanResourcesMary Armitage Medical Director 0 (4)David Bennett Non-Executive Director 0 (4)Pankaj Davé Non-Executive Director 0 (4)Brian Ford Non-Executive Director 1 (4)Stuart Hunter Director of Finance 4 (4)Helen Lingham Chief Operating Officer 4 (4)Steven Peacock Non-Executive Director 0 (4)Alex PikeNon-Executive Director3 (4)and Vice ChairmanRichard Renaut Director of Service1 (4)DevelopmentPaula Shobbrook Director of Nursing and3 (4)MidwiferyTony Spotswood Chief Executive 2 (4)1 (4)Ken Tullett Non-Executive Director 2 (4)ElectionsElections were held in two staff classes during the year. Efforts to maximisenominations included articles in staff publications and on the Trust’s intranet andmeetings prior to nomination. Both elections were uncontested. The elections to theCouncil of Governors were held in accordance with the Constitution.Date of election Staff ClassNumber ofmembers inconstituencyNumber ofseatscontestedNumber ofcontestantsElectionturnout (%)Uncontested Nursing andMidwifery (includinghealthcare assistants)Uncontested Administrative andClerical/ Management533 1 1 Uncontested201 1 1 UncontestedAnnual Report and Accounts 2012/13 117

Governance Report6.5 Nomination CommitteeThe Nomination Committee is acommittee of the Council of Governorswith responsibility for:l reviewing the number of, and skillsrequired, for the non-executivedirectors in the context of the overallBoard composition and makingrecommendations to the Council ofGovernors on any changesl developing succession plans fornon-executive directors, takinginto account the challenges andopportunities facing the Trustl selecting candidates to fill vacanciesamong the non-executive directorsand recommending them to theCouncil of Governors for appointmentl making recommendations to theCouncil of Governors concerning there-appointment of any non-executivedirectors at the conclusion of theirspecified term of officeThe Nomination Committee met twice in2012/13 to consider the re-appointmentof three non-executive directors: two foran additional period of one year fromMarch 2013 and one for an additionalperiod of up to one year from June2013. There were no new appointmentsof non-executive directors in 2012/13;however candidates for non-executivedirectorship are identified in a numberof ways including advertisements inrelevant publications and external searchagencies.The table on the right shows the numberof meetings of the committee at whichthe non-executive director or governorwas present and in brackets the numberof meetings that the non-executivedirector or governor was eligible to attendas a member of the committee during2012/13.NameJane Stichbury(Chairman)Meetingsattended2 (2)Judith Adda 1 (2)Derek Dundas 2 (2)Ken Hockey 1 (1)6.6 MembershipDuring 2012/13 the governors havecontinued to develop their existingmembership strategy using health talks,constituency events and the quarterlymembership newsletter to engagewith existing members and recruit newmembers. The strategy has also beendeveloped to focus on recruitmentof members from groups which havehistorically been under-represented inthe Trust membership: younger peopleand minority ethnic groups. Throughpresentations and attendance at careersevents at local schools, the Trust hasbegun to recruit younger members and isseeking to engage with local authoritiesin its public constituencies to reachminority ethnic groups. The membershipstrategy set a recruitment target of 250new public members for 2012/13 and theperformance against that target is shownin the table on page 119.Over the next 12 months the governorswill:l continue local constituency meetingsand set up a programme of othermeetings with interest groups acrossthe constituenciesl provide more information in the FTFocus quarterly publication aboutgovernors’ activitiesl incorporate membership developmentin the Trust’s Annual Plan for 2013/14l try to increase the awareness andunderstanding of members and thelocal community of the NHS andfoundation trusts and the benefits offoundation trust membership.118Annual Report and Accounts 2012/13

Governance ReportAs at 31 March 2013 there were 12,610 members in the following constituencies:Public constituency Last year (2012/13) Next year (2013/14)(estimated)At year start (1 April) 11,227 11,255New members 668 300Members leaving 640 200At year end (31 March) 11,255 11,355Staff constituency Last year (2012/13) Next year (2013/14)(estimated)At year start (1 April) 872 1,355New members 799 50Members leaving 316 200At year end (31 March) 1,355 1,205Analysis of membership in constituencies (as at 31 March 2013)PublicStaffBournemouth and Poole 9,014 Medical and Dentistry 163Christchurch and Dorset County 1,686 Allied Healthcare Professionals,Scientific and Technicians222New Forest, Hampshire andSalisbury555 Nursing and Midwifery 554Administrative, Clerical andManagement288Estates and Ancillary 128Notes:l Members of staff on fixed term or temporary contracts who have been continuouslyemployed by the Trust for at least 12 months and who commenced employmentfrom 1 January 2010 are eligible to become members of the staff constituency.It is not possible to identify all these staff and therefore there may be more staffmembers than are included in the table.Annual Report and Accounts 2012/13 119

Governance ReportAnalysis of current public membership (as at 31 March 2013)Public constituency Number of members Eligible membershipAge (years):0-16 67 247,27517-21 263 90,29022+ 9,448 1,030,803Ethnicity:White 10,701 1,256,864Mixed 55 10,405Asian or Asian British 49 13,705Black or Black British 25 4,410Other 44 8,023Socio-economic groupings:ABC1 6,768 445,461C2 1,966 153,064D 1,902 144,762E 619 38,020Gender analysis:Male 4,751 669,672Female 6,504 698,696Notes:l The analysis above excludes 1,477 public members with no stated date of birth and381 members with no stated ethnicity.l Socio-economic data should be completed using profiling techniques (e.g.postcode) or other recognised methods. Socio-economic data is only collected forworking age individuals as it is a classification based on occupation. To the extentsocio-economic data is not already collected from members, it is not anticipatedthat NHS foundation trusts will make a direct approach to members to collect thisinformation.l The population data used to calculate Eligible membership in the table above maydiffer as a result of using the most reliable source for this data. This may lead tovariations in the total of eligible members provided under each section of the table,primarily due to the currency of the data.Members who wish to communicate with their governors should contact:Governor Co-ordinator (B28)The Royal Bournemouth and Christchurch Hospitals NHS Foundation TrustCastle Lane East, Bournemouth BH7 7DWor email: ftmembers@rbch.nhs.uk120Annual Report and Accounts 2012/13

Financial AccountsFinancial StatementsFor the year ended 31st March 2013Annual Report and Accounts 2012/13 1

Financial AccountsContentsFinancial AccountsPage numbersThe Foundation Trust 3Foreword 4Accounting Officer’s Statement 5Annual Governance Statement 6Auditors’ Report 15The Primary StatementsStatement of Comprehensive Income 17Statement of Financial Position 18Statement of Changes in Taxpayers’ Equity 19Statement of Cash Flows 20Notes to the accountsNote 1: Accounting policies 21Note 2: Operating segments 32Note 3: Income generation activities 32Note 4: Operating income 32Note 5: Private patient cap 33Note 6: Mandatory and non-mandatory income from activities 33Note 7: Operating expenses 34Note 8: Operating leases 35Note 9: Staff costs and numbers 36Note 10: Retirements due to ill-health 37Note 11: The Late Payment of Commercial Debts (Interest) Act 1998 37Note 12: Investment revenue 37Note 13: Finance costs 37Note 14: Intangible assets, property, plant and equipment 38Note 15: Impairment of property, plant and equipment 39Note 16: Capital commitments 39Note 17: Inventories 39Note 18: Trade and other receivables 40Note 19: Cash and cash equivalents 41Note 20: Trade and other payables 41Note 21: Borrowings 42Note 22: Finance lease obligations 42Note 23: Prudential borrowing limit 43Note 24: Provisions for liabilities and charges 44Note 25: Related party transactions 44Note 26: Post statement of financial position events 46Note 27: Financial risk management 46Note 28: Financial instruments 47Note 29: Intra-government and NHS balances 48Note 30: Losses and special payments 49Note 31: Judgement and estimations 49Note 32: Senior manager remuneration 50Note 33: Senior manager pension entitlements 502Annual Report and Accounts 2012/13

Financial AccountsThe Foundation TrustNHS Foundation Trust Code:Registered Office:Executive Directors:RDZRoyal Bournemouth HospitalCastle Lane EastBournemouthBH7 7DWMr A Spotswood Chief ExecutiveMrs H Lingham Chief Operating OfficerMr S Hunter Director of Financeand Commercial ServicesMr R Renaut Director of Service DevelopmentMrs K Allman Director of Human ResourcesMrs P Shobbrook Director of Nursing and MidwiferyMrs M Armitage Medical DirectorNon-Executive Directors:Trust Secretary:Mrs J StichburyMr B FordMrs A PikeMr K TullettMr S PeacockMr P DavéMr D BennettMs K FlahertyChairmanNon-Executive DirectorNon-Executive DirectorNon-Executive DirectorNon-Executive DirectorNon-Executive DirectorNon-Executive DirectorTrust SecretaryBankers:Solicitors:Internal Auditors:External Auditors:NatWest (The Royal Bank of Scotland)Chandlers FordDAC Beachcroft LLPWinchesterPricewaterhouseCoopers LLPSouthamptonDeloitte LLPSouthamptonAnnual Report and Accounts 2012/13 3

Financial AccountsForeword to the accountsThese accounts for the year ended 31 March 2013 for The RoyalBournemouth and Christchurch Hospitals NHS Foundation Trust(the “Foundation Trust”) have been prepared in accordance withparagraphs 24 and 25 of Schedule 7 of the National Health ServiceAct 2006, and comply with the annual reporting guidance for NHSFoundation Trusts within the NHS Foundation Trust FinancialReporting Manual (FT FReM) for the financial year.Mr A SpotswoodChief Executive24 May 20134Annual Report and Accounts 2012/13

Financial AccountsAccounting Officer’s StatementStatement of the chief executive’sresponsibilities as the accountingofficer of The Royal Bournemouthand Christchurch Hospitals NHSFoundation Trust.The National Health Service Act 2006states that the Chief Executive is theAccounting Officer of the NHS foundationtrust. The relevant responsibilities ofthe accounting officer, including theirresponsibility for the propriety andregularity of public finances for whichthey are answerable, and for the keepingof proper accounts, are set out in theNHS Foundation Trust Accounting OfficerMemorandum issued by the IndependentRegulator of NHS Foundation Trusts(“Monitor”).Under the National Health Service Act2006, Monitor has directed The RoyalBournemouth and Christchurch HospitalsNHS Foundation Trust to prepare for eachfinancial year a statement of accounts inthe form and on the basis set out in theAccounts Direction. The accounts areprepared on an accruals basis and mustgive a true and fair view of the state ofaffairs of The Royal Bournemouth andChristchurch Hospitals NHS FoundationTrust and of its income and expenditure,total recognised gains and losses andcash flows for the financial year.In preparing the accounts, the AccountingOfficer is required to comply with therequirements of the NHS FoundationTrust Annual Reporting Manual and inparticular to:l observe the Accounts Directionissued by Monitor, including therelevant accounting and disclosurerequirements, and apply suitableaccounting policies on a consistentbasis;l make judgments and estimates on areasonable basis;l state whether applicable accountingstandards as set out in the NHSFoundation Trust Annual ReportingManual have been followed, anddisclose and explain any materialdepartures in the financial statements;andl prepare the financial statements on agoing concern basis.The Accounting Officer is responsiblefor keeping proper accounting recordswhich disclose with reasonable accuracyat any time the financial position of theNHS foundation trust and to enable himto ensure that the accounts comply withthe requirements outlined in the abovementioned Act. The Accounting Officeris also responsible for safeguarding theassets of the NHS Foundation Trust andhence for taking reasonable steps for theprevention and detection of fraud andother irregularities.To the best of my knowledge andbelief, I have properly discharged theresponsibilities set out in Monitor’s NHSFoundation Trust Accounting OfficerMemorandum.Mr A SpotswoodChief Executive24 May 2013Annual Report and Accounts 2012/13 5

Financial AccountsAnnual Governance StatementScope of responsibilityAs Accounting Officer, I haveresponsibility for maintaining a soundsystem of internal control that supportsthe achievement of the NHS FoundationTrust’s policies, aims and objectives,whilst safeguarding the public fundsand departmental assets for which I ampersonally responsible, in accordancewith the responsibilities assigned to me.I am also responsible for ensuring thatthe NHS Foundation Trust is administeredprudently and economically and thatresources are applied efficiently andeffectively. I also acknowledge myresponsibilities as set out in the NHSFoundation Trust Accounting OfficerMemorandum.The purpose of the system ofinternal controlThe system of internal control is designedto manage risk to a reasonable levelrather than to eliminate all risk of failure toachieve policies, aims and objectives; itcan therefore only provide reasonable andnot absolute assurance of effectiveness.The system of internal control is basedon an ongoing process designed toidentify and prioritise the risks to theachievement of the policies, aims andobjectives of The Royal Bournemouth andChristchurch Hospitals NHS FoundationTrust, to evaluate the likelihood of thoserisks being realised and the impact shouldthey be realised, and to manage themefficiently, effectively and economically.The system of internal control has beenin place in The Royal Bournemouth andChristchurch Hospitals NHS FoundationTrust for the year ended 31 March 2013and up to the date of approval of theannual report and accounts.Capacity to handle riskAs Accounting Officer I have ultimateresponsibility for ensuring that there isan effective risk management system inplace within the Foundation Trust and formeeting all statutory responsibilities andadhering to guidance issued by Monitorin respect of governance. The executivewith specific responsibility for risk isthe Director of Nursing and Midwifery.However, the requirement to managerisk more effectively is a responsibilityaffecting all staff in every part of theFoundation Trust, from the controlof finance, through all the disciplinessupporting and delivering the environmentof care, to the direct delivery of clinicalcare itself, risk management is everyone’sresponsibility. The Foundation Trust’sRisk Management Strategy clearly definesthese responsibilities and providesguidance for the fulfilment of these roles.The Trust has an accredited IOSH riskmanagement training course in placeand it is mandatory for all managers andstaff in a managerial role to attend. TheBoard of Directors has undertaken IOSHDirecting Safely training. The trainingprovides staff with the skills requiredto recognise, manage and monitor riskwithin their areas of responsibility. Riskmanagement and health and safetytraining is also including on inductionand mandatory training programmesfor all staff. Formal training is thensupported by a variety of other resourcesthat seek to promote and facilitateindividual, departmental, directorateand organisational learning. As anexample, the Clinical Governance & RiskCommittee produce a quarterly ClinicalGovernance report which highlightspatient safety, patient experience andpatient outcome trends for the period.The report includes the results ofcomplaints, claims and adverse incidentinvestigations and notes examplesof, and recommendations for, qualityimprovement and safe practice. Theserecommendations are fed throughfor discussion at directorate clinicalgovernance groups, senior nurses andclinical leader meetings.6Annual Report and Accounts 2012/13

Financial AccountsThe risk and control frameworkIn compliance with statutory controls,the Foundation Trust has developed astandard matrix for measuring risk anddetermining the level of risk that canbe accepted at the key managementlevels within the organisation. Detailedguidance and advice on assessing,quantifying and managing risk iscontained within the FoundationTrust’s Risk Management Strategy (andassociated Risk Assessment Policy andProcedures). Under the Strategy, GeneralManagers and Directors are responsiblefor maintaining Directorate Risk Registersand for bringing significant risks to theattention of the Clinical Governance &Risk Committee and/or appropriate subcommitteesof the Foundation Trust’sBoard of Directors. In turn the subcommitteeswill bring important mattersto the attention of the Board of Directors.The Foundation Trust continuouslymonitors risk control systems in placeand utilises the assurance frameworkprocess to monitor, develop, implement,demonstrate and promote continuousimprovement and learning. Theeffectiveness of the assurance frameworkand its application has been reviewed bythe Healthcare Assurance Committee andverified by Internal Audit and the AuditCommittee.There is a strategic co-ordinatedapproach to the Trust’s clinical auditactivities to ensure that the clinical auditcycle is complete and therefore leadsto improvement in patient care. Thereis a Consultant lead for Clinical Audit, aClinical Effectiveness Manager who ispart of the Clinical Governance Team, andClinical Audit leads in each directorate.An annual audit plan is developed withineach directorate with audits prioritised inrelation to national requirements, Trustobjectives, contractual and statutoryduties and local requirements. Toprovide focus on the audit priorities andcompletion of the plan the directorateshave identified a clinical audit leadconsultant, which has a role profile. Thisapproach has been approved by theTrust Management Board. The committeefor coordinating the Trust’s strategyfor clinical effectiveness and clinicalaudit is the Clinical Governance & RiskCommittee, which provides oversightthat systems are in place and used tosupport, monitor and disseminate auditwithin the Trust. The Clinical Governanceand Risk Committee formally reports tothe Healthcare Assurance Committeeand recommends approval of the ClinicalAudit Programme prior to submission tothe Trust Management Board and theBoard of Directors. Directorates reviewtheir progress against the audit plan ona quarterly basis and provide a reportfor the Clinical Governance and RiskCommittee. Progress against the annualaudit plan is reviewed quarterly and aclinical audit report presented to theHealthcare Assurance Committee andthe Trust’s Board as part of the ClinicalGovernance Quarterly report. A quarterlyreport is also provided to the AuditCommittee. The Trust has recognisedover the last year that the processes canbe further improved through securingmore senior clinical time within theleadership of clinical audit and is currentlyimplementing this new process.In line with statutory requirements, theBoard of Directors has reviewed theFoundation Trust’s principal corporateand strategic objectives and identifiedmitigating strategies for any risks tothe delivery of those objectives viathe Assurance Framework process.The development of the assuranceframework has involved considerationof all objectives (strategic, quality,financial, corporate, business, clinical,human resources etc.) and all risks. Inaddition, a comprehensive review hastaken place of the Trust’s committeestructure and its ability to provide thenecessary assurance to the Board insupport of the assurance framework. Theframework is specifically linked to theTrust’s strategic objectives and to theregulatory requirements of Monitor andthe Care Quality Commission. Within theAssurance Framework, principal risksare identified and key risk controls put inplace to provide necessary assurancesAnnual Report and Accounts 2012/13 7

Financial Accountson identified gaps in control systemsand action plans to further reducerisk are mapped out against identifiedobjectives. The Assurance Frameworkis populated from the Foundation TrustRisk Register with risk reduction beingachieved through a continuous cycle ofthe identification, assessment, controland review of risk.Risks may be entered onto theFoundation Trust Risk Register as aresult of risk issues being raised oridentified by: employees, directorates,external or internal reviews, internal orexternal audits, incident investigations,complaints reviews and commentsfrom public stakeholders and/or servicedevelopments. Risks may also be raisedby the Board’s sub-committees and/orby specialist sub-committees of these.These include the Healthcare AssuranceCommittee, Finance Committee,Information Governance Committee,Infection Control Committee, ClinicalGovernance & Risk Committee andHealth & Safety Committee. All risksentered onto the Risk Register arecategorised according to the Trust’sRisk Management Strategy using astandard risk matrix. The risk ratingvalue is a combination of likelihood andconsequence. All risks are assigned acurrent risk score and a target risk scorefollowing action plan and mitigation. Allaction plans have a responsible leadand timeframe noted. All significant andcorporate level are also assigned anExecutive Director lead.Significant risks on the FoundationTrust Risk Register which feeds theAssurance Framework are reviewedby the Healthcare AssuranceCommittee monthly. Membership ofthe Healthcare Assurance Committeeincludes representation from theBoard of Directors and the Council ofGovernors. The Clinical Governance& Risk Committee also reviews allnew clinical risks monthly, providingfeedback to directorates as appropriate.The Assurance Framework dashboard“Heat Map” is reviewed monthly by theHealthcare Assurance Committee and8Board of Directors. The full AssuranceFramework is reviewed at least annually.An annual review is also incorporatedwithin the Internal Audit programme andapproved by the Audit Committee. New,closed and significant risks are reportedto the Board of Directors each month.In line with Monitor’s guidance, risksto data security are being managedand controlled through the InformationGovernance infrastructure establishedby the Foundation Trust’s InformationGovernance Strategy. The InformationGovernance Toolkit is used to assesshow well the Foundation Trust complieswith the relevant legal and regulatoryrequirements and guidance. TheFoundation Trust achieved at leastLevel 2 on all but one of the standardsin the Information Governance Toolkitself-assessment for 2012/13 and wastherefore rated as “Unsatisfactory” interms of compliance with the InformationGovernance Toolkit. On the remainingstandard the Foundation Trust achievedLevel 1 as it failed to meet the percentageaccuracy scores required in the clinicalcoding audit using the Clinical CodingAudit Methodology set out by the NHSClassifications Service. A decision wastaken by the Foundation Trust to codeco-morbidities according to the Charlsonindex rather than the methodologyspecified in the relevant standard ofthe Information Governance Toolkitin order to meet the requirements forcoding of co-morbidities used by DrFoster. The level of error recordedas attributable to this decision wouldmean that the Foundation Trust wouldmeet the percentage accuracy scoresrequired if the decision was reversed.As well as aiming to continually improvethe accuracy of all clinical coding whichshould assist in addressing this area ofnon-compliance, the Foundation Trustis also highlighting the issue of thediscrepancy between the various codingmethodologies with relevant regulatorssince this has resulted in the FoundationTrust failing this particular standarddespite having high levels of accuracy inrelation to clinical coding.Annual Report and Accounts 2012/13

Financial AccountsThere has been an increase in the numberof Information Governance incidentsreported, which demonstrates growingawareness of Information Governanceas a result of mandatory training. Thisincluded three serious incidents whichhave subsequently been reported tothe Information Commissioner’s Office.The Information Commissioner’s Officehas decided to take no further actionat this time in relation to two of theseincidents and has not yet concluded itsinvestigation of the third incident.At the end of the financial year, theTrust was in the process of recalling anumber of patients who had previouslybeen treated at the Royal BournemouthHospital. This was due to the concernsraised by the consultants who run thebreast clinic regarding a junior doctor,who is no longer working in the Trust, andthe way in which an initial assessment ofsome patients may have been carried out.This assessment potentially did not meetthe Trust’s usual high standards and asubsequent external review of processeshas been commissioned.The organisation’s major risks arecategorised below in terms of current andfuture risks:Current risks:Control of Exposure to Legionella riskon two Medicine for the Elderly wards.Positive sample results continue tobe detected in samples pre and postchlorination. The risk to patients andstaff is very low due to current controls inplace. However the results are above the1000 action limit therefore in accordancewith the Trust’s Safe Water Policy therisk assessment will remain “High” until asufficient number of negative results areobtained. Re-piping of the affected area isplanned for summer 2013.Risk that the Competition Commissionmay not grant approval for mergerresulting in financial instability. A detailedaction plan is in progress monitored bythe Joint Programme Board.High levels of Emergency Activity. Actionplans are in place and reviewed weekly bythe Chief Operating Officer. A detailed riskassessment against the CQC Outcomeshas been developed and will be reviewedregularly at the Trust’s PerformanceManagement Group. Detailed actionplans are in place with ExecutiveDirector leadership provided by the ChiefOperating Officer.Loss of Cellular Pathology CPAAccreditation status resulting in potentialloss of contractual work and income.The Trust is currently appealing the CPAdecision to downgrade and is activelyworking with them to re-establishaccreditation status and all relevantparties have been informed. No risk toclinical care.18 week admitted Referral to TreatmentPerformance - Risk of breaching 90%contracted required per speciality.Significant risk in Upper GI and Urology.The action plan includes further additionalWaiting List Initiative lists to increasecapacity in Urology and Upper GI, jobplanning in relation to a new theatretimetable, a new theatre timetable/increase in theatre capacity andconsideration of outsourcing.Nursing skills in the Acute MedicalUnit fall below the Society for AcuteMedicine recommendations and currentstaffing levels restrict the unit’s abilityto train staff. All vacancies are currentlybeing advertised. The staffing templatenow includes supervisory time for theclinical leader and the nurse resourcepool is being used to support shortfalls.Mentorship is being provided to the unitClinical Leader and Senior Nurse supporthas been initiated.Future risks:Control of Exposure to Legionella risk.The risk assessment will remain “High”until a sufficient number of negativeresults are obtained. As indicated in thecurrent risk identified above, re-piping ofthe affected area is planned for summer2013.Annual Report and Accounts 2012/13 9

Financial AccountsRisk that delays to the proposed mergercould lead to delayed decisions on therequired changes to inpatient serviceconfiguration, meaning that the Trust isnot able to respond in a timely way tothe need for centralisation, more 24/7consultant delivered care and associatedsavings. An action plan is in place toagree with Monitor and the CompetitionCommission, that allows the IntegratedBusiness Plan to be considered by theCouncil of Governors. A robust supportmechanism is in place to supporta granular Cost Improvement Plan,identifying the requisite savings.Potential for the demand for unscheduledcare exceeding projected levels setout in the commissioning contract,resulting in implications for meeting keytargets, including the 62 day cancerstandard, the 4 hour wait time in theEmergency Department and the 18 weekreferral to treatment time. In additionto these targets there is the potentialrisk to patients through treatmentdelays, escalated beds and delays todischarge. The other element of riskrelates to the ability to live within financialparameters. The Trust monitors activitymonthly through the commissioningprocess and performance targets arerigorously managed weekly throughthe Performance Management Group.The Trust has agreed with the ClinicalCommissioning Group a non-recurrentfunding source, whereby if non-electiveactivity continues, health economyactions will be funded outside of the maincontract.Risk of financial instability through tariffreduction. As the tariff will reduce year onyear, the Trust needs to meet the nationalmandated efficiency assumptions.Plans are place for 2013/14 and will bemonitored monthly through the FinanceCommittee and work is ongoing toidentify plans for the following two years.The cost improvement schemes are alsorobustly scrutinised through a qualityimpact assessment process to identifyany adverse impact on quality.Further risk of financial instability throughthe Clinical Commisioning Group’sambitions to move care out of thehospital setting and into the community,potentially leaving unviable services atthe Trust. The Trust is monitoring theimplications of the proposals closelythrough the various committees andexploring other opportunities.The Foundation Trust is fully compliantwith the registration requirements ofthe Care Quality Commission. There isa monitoring framework in place thatsets out each of the CQC outcomes andthe individuals and committees that areresponsible for monitoring the Trustscompliance with them. The Director ofNursing and Midwifery chairs a quarterlyreview meeting with CQC outcomeleads to monitor progress. The terms ofreference for the monitoring committeesinclude responsibilities for monitoringand reviewing CQC compliance.Provider Compliance Assessments arecompleted at least annually for eachoutcome and reviewed via the respectivemonitoring committee. A six monthlycompliance report is presented to theHealthcare Assurance Committee andAudit Committee. An annual review isalso incorporated within the InternalAudit programme and approved bythe Audit Committee. Compliance withCQC outcomes is also reviewed at adirectorate level at the executive-leddirectorate performance reviews.The Trust is in dialogue to activelymanage risks with public stakeholders.Examples of this dialogue include theChief Operating Officer attending thehealth economy urgent care board toensure stakeholders are involved inmanaging the risks of rising emergencyactivity at the trust. The merger process isbeing overseen by the Joint ProgrammeBoard which also incorporatesstakeholders from other organisations.The Director of Nursing and Midwiferyalso presents to the Council ofGovernors the quarterly significant risksand discusses mitigating actions. Thetrust also undertakes monthly contract10Annual Report and Accounts 2012/13

Financial Accountsmonitoring meetings with the ClinicalCommissioning Group where quality,activity, performance, finance andrisk management are presented anddiscussed.As an employer with staff entitledto membership of the NHS PensionScheme, control measures are in placeto ensure all employer obligationscontained within the Scheme regulationsare complied with. This includes ensuringthat deductions from salary, employer’scontributions and payments in to theScheme are in accordance with theScheme rules, and that member PensionScheme records are accurately updatedin accordance with the timescalesdetailed in the Regulations.The Foundation Trust has undertakenrisk assessments and Carbon ReductionDelivery Plans are in place in accordancewith emergency preparedness and civilcontingency requirements, as basedon UKCIP 2009 weather projects, toensure that this organisation’s obligationsunder the Climate Change Act and theAdaptation Reporting requirements arecomplied with. The Carbon ReductionGroup for the Trust is in place andhas agreed delivery plans for carbonreduction measures.Control measures are in place to ensurethat all the organisation’s obligationsunder equality, diversity and humanrights legislation are complied with.Equality Impact Assessments (EIA’s)are carried out on all Trust policies andservice developments. A toolkit hasbeen developed and is available on theTrust intranet and results of EIA’s arealso shown on the Trust website. TheFoundation Trust has an Equality andDiversity Committee which is chairedby a Board Director and has widerepresentation from across the Trust.Sub-groups report into the Equalityand Diversity committee and have anagreed work plan which ensures that theFoundation Trust meets its obligations.Data is used throughout the trust’sgovernance processes and is largelyhandled by the Trust’s informationdepartment and finance function. Thetrust utilises a data warehouse, whichincorporates daily feeds from the patientadministration system and other clinicaland operational systems. Informationreporting is therefore largely from asingle point of reference providing agreater degree of assurance. In additionto the data warehouse there are also thestandard internal and external qualitychecking and control processes.Review of economy, efficiencyand effectiveness of the use ofresourcesThe Foundation Trust employs a numberof internal mechanisms and externalagencies to ensure the best use ofresources.Executive and senior managers in theorganisation have responsibility for theeffective management and deploymentof their staff and other resourcesto maximise the efficiency of theirdirectorates or departments.The Board of Directors considers theTrust to be fully compliant with theprinciples of The NHS Foundation TrustCode of Governance as well as with theprovisions of the Code in all respects,save as to paragraphs A1.3, A.3.2 andC2.2 where there are other arrangementsin place.The Foundation Trust achieved a financialrisk rating of 3, demonstrating a stronglevel of financial performance andmanagement of the organisation andalso showed that we represent valuefor money and make good use of publicmoney in the planning and delivery of ourservices. The trust also received fundingfrom the Strategic Health Authority during2012/13, to support the costs incurredin relation to the merger and for specificpressures in relation to the significantlevel of non-elective patients experiencedduring the winter period.Annual Report and Accounts 2012/13 11

Financial AccountsThe Head of Internal Audit providesan annual opinion, based upon andlimited to the work performed, on theoverall adequacy and effectiveness ofthe organisation’s risk management,control and governance processes. Thisis achieved through a risk-based planof work, agreed with the managementand approved by the Audit Committeewhich should provide a reasonable levelof assurance. The Head of Internal Auditopinion states that ‘There is generallya sound system of Internal Control,designed to meet the organisation’sobjectives and that controls are generallybeing applied consistently. However,some weaknesses in the design and/orinconsistent application of controls, putsthe achievement of particular objectivesat risk. Using the terminology set outin the Department of Health guidanceto Heads of Internal Audit, this opinionwould equate to ‘Significant Assurance’.Internal Audit identified 3 high risk reportsto improve weaknesses in the design ofcontrols and /or operating effectiveness.The first item relates to InformationGovernance and this has been set outearlier in the statement and the seconditem related to the governance ofsoftware asset management and whilethere is a general awareness withinthe IT function of the requirementsfor appropriately managing softwarelicensing and the associated risks,policies and procedures are generallyinformal and immature in nature. TheDirector of Informatics is addressing thisshortfall. The other area of risk, relatesto the patient experience and the lackof a formal mechanism for reporting andmonitoring completion of the actionsand appropriateness of the plans atCommittee level. The opinion alsosuggests that further improvement can bemade to the Board dashboard to includetargeted focus on areas taken from thereal time patient feedback. The Trust willimplement the recommendations.As part of their role, the external auditorreviews the work of the internal auditorin order to determine what reliance canbe placed on the internal audits carriedout during the year. The external auditorwill conclude their overall work throughtheir annual report and present this to theAudit Committee for recommendation tothe Board of Directors.A non-executive director chairs the AuditCommittee. It met five times duringthe year. Representatives of externalaudit and internal audit attended. Thecommittee reviewed and accepted theaudit plans of both internal and externalaudit. The plans specifically includeeconomy, efficiency and effectivenessreviews. The committee received regularupdates on counter fraud matters. TheAudit Committee also met separatelywith representatives of external auditand internal audit without any executivemanagement present.A non-executive director chairs theHealthcare Assurance Committee. TheCommittee met twelve times during theyear and received reports related tointernal control, risk management andassurance and ensured that action plans,where remedial action was required, wereimplemented.A non-executive director chairs theFinance Committee. The Committeemet fourteen times during the yearand reviewed the Trust’s businessplans, budgets, cash flow, treasurymanagement, reporting arrangementsand efficiency savings programme.The Board of Directors receivedperformance and financial reports duringthe year at its meetings and received theminutes of the following sub-committeesto which it has delegated powers andresponsibilities:l Audit Committeel Trust Management Boardl Healthcare Assurance Committeel Infection Control Committeel Finance Committeel Patient Experience andCommunications Committeel Workforce Strategy Committee12Annual Report and Accounts 2012/13

Financial AccountsAnnual Quality ReportThe directors are required under theHealth Act 2009 and the National HealthService (Quality Accounts) Regulations2010 (as amended) to prepare QualityAccounts for each financial year. Monitorhas issued guidance to NHS foundationtrust boards on the form and content ofannual Quality Reports which incorporatethe above legal requirements in theNHS Foundation Trust Annual ReportingManual.The production of the Quality Reportis overseen by the Director of Nursingand Midwifery and co-ordinated by theAssociate Director of Clinical Governance.This team leads on all regulatoryquality assessments for the Trust andis experienced in this type of work. Toensure a balanced approach, inputto the report is obtained from a widerange of sources within the organisationthrough the governance infrastructure,and external opinion has been soughtfrom the Trust’s lead commissioners,three local health scrutiny panels, theLocal Involvement Network and theFoundation Trust’s Council of Governors.The production processes have mirroredthose used for all quality assessmentsand aspects of these have been regularlyaudited and subject to validation bythe internal auditors. The audits haveprovided substantial assurance to theBoard that the controls and proceduresupon which the organisation reliesto manage these areas are effective.This has been supported by externalfeedback, for example the Care QualityCommission’s Quality and Risk Profile,the NHS Litigation Authority and regularpatient/service user feedback. Data tosupport the Quality Report is largelyhandled by the Trust’s InformationDepartment, Risk ManagementDepartment and the Clinical EffectivenessDepartment, all of which are subject tointernal and external quality checking andcontrol.Review of effectiveness of thesystem of internal controlAs Accounting Officer, I haveresponsibility for reviewing theeffectiveness of the system of internalcontrol. My review of the effectiveness ofthe system of internal control is informedby the work of the internal auditors,clinical audit and the executive managersand clinical leads within the NHSFoundation Trust who have responsibilityfor the development and maintenanceof the internal control framework. I havedrawn on the content of the qualityreport attached to this annual report andother performance information availableto me. My review is also informed bycomments made by the external auditorsin their management letter and otherreports. I have been advised on theimplications of the result of my reviewof the effectiveness of the system ofinternal control by the Board, the AuditCommittee and the Healthcare AssuranceCommittee and a plan to addressweaknesses and ensure continuousimprovement of the system is in place.Both the Assurance Framework andthe Trust Risk Register are reviewed ona regular basis through the committeestructure outlined above. The Trustcurrently holds full registration with theCare Quality Commission and the Qualityand Risk Profile is reviewed on a monthly/bi-monthly basis as published by the CareQuality Commission. The most recentissue (March 2013) indicates a low riskof non-compliance with the EssentialStandards.The effectiveness of the system of theinternal control has been reviewed bythe Audit Committee and further workto refine and develop our assuranceprocesses is in progress and will bereviewed and evaluated on an ongoingbasis.Annual Report and Accounts 2012/13 13

Financial AccountsConclusionThe Head of Internal Audit states in hisreport that significant assurance canbe given that there is generally a soundsystem of internal control, designedto meet the organisation’s objectivesand that controls are being appliedconsistently. Although this provides ahigh level of assurance there were foursignificant internal control issues, threeof which were identified through InternalAudit. As discussed earlier in the report,the three risk areas related to informationgovernance, software asset managementand the patient experience all of whichare in the process of being resolved. Theother item of risk identified in the ‘risk andcontrol framework’ section of the reportabove, sets out the concerns regardinga junior doctor and the way in whichan initial assessment of some patientsmay have been carried out. The Trust isundergoing a recall of those patients whohad been treated at the hospital where,potentially the quality of treatment didnot meet the Trust’s usual high standardsand has subsequently commissioned anexternal review.Mr A SpotswoodChief Executive24 May 201314Annual Report and Accounts 2012/13

Financial AccountsAuditors’ ReportIndependent Auditors’ Reportto the Council of Governors andBoard of Directors of The RoyalBournemouth and ChristchurchHospitals NHS FoundationTrust.We have audited the financial statementsof The Royal Bournemouth andChristchurch Hospitals NHS FoundationTrust for the year ended 31 March2013 which comprise the Statement ofComprehensive Income, the Statementof Financial Position, the Statementof Changes in Taxpayers’ Equity, theCash Flow Statement and the relatednotes 1 to 33. The financial reportingframework that has been applied intheir preparation is applicable law andthe accounting policies directed byMonitor - Independent Regulator of NHSFoundation Trusts.This report is made solely to the Councilof Governors and Board of Directors (“theBoards”) of The Royal Bournemouth andChristchurch Hospitals NHS FoundationTrust, as a body, in accordance withparagraph 4 of Schedule 10 of theNational Health Service Act 2006. Ouraudit work has been undertaken sothat we might state to the Boards thosematters we are required to state to themin an auditors’ report and for no otherpurpose. To the fullest extent permittedby law, we do not accept or assumeresponsibility to anyone other than thetrust and the Boards as a body, for ouraudit work, for this report, or for theopinions we have formed.Respective responsibilitiesof the accounting officer andauditorAs explained more fully in the AccountingOfficer’s Responsibilities Statement, theAccounting Officer is responsible for thepreparation of the financial statementsand for being satisfied that they give atrue and fair view. Our responsibility isto audit and express an opinion on thefinancial statements in accordance withapplicable law, the Audit Code of NHSFoundation Trusts and InternationalStandards on Auditing (UK and Ireland).Those standards require us to complywith the Auditing Practices Board’sEthical Standards for Auditors.Scope of the audit of thefinancial statementsAn audit involves obtaining evidenceabout the amounts and disclosuresin the financial statements sufficientto give reasonable assurance that thefinancial statements are free from materialmisstatement, whether caused by fraudor error. This includes an assessmentof: whether the accounting policies areappropriate to the trust’s circumstancesand have been consistently applied andadequately disclosed; the reasonablenessof significant accounting estimatesmade by the Accounting Officer; andthe overall presentation of the financialstatements. In addition, we read all thefinancial and non-financial informationin the annual report to identify materialinconsistencies with the audited financialstatements and to identify any informationthat is apparently materially incorrectbased on, or materially inconsistentwith, the knowledge acquired by us inthe course of performing the audit. If webecome aware of any apparent materialmisstatements or inconsistencies weconsider the implications for our report.Annual Report and Accounts 2012/13 15

Financial AccountsOpinion on financial statementsIn our opinion the financial statements:l give a true and fair view of the state ofthe trust’s affairs as at 31 March 2013and of its income and expenditure forthe year then ended;l have been properly prepared inaccordance with the accountingpolicies directed by Monitor -Independent Regulator of NHSFoundation Trusts; andl have been prepared in accordancewith the requirements of the NationalHealth Service Act 2006.Opinion on other mattersprescribed by the NationalHealth Service Act 2006In our opinion:l the part of the Directors’Remuneration Report to be auditedhas been properly prepared inaccordance with the National HealthService Act 2006; andl the information given in the Directors’Report for the financial year for whichthe financial statements are preparedis consistent with the financialstatements.Matters on which we arerequired to report by exceptionWe have nothing to report in respect ofthe following matters where the AuditCode for NHS Foundation Trusts requiresus to report to you if, in our opinion:l the Annual Governance Statementdoes not meet the disclosurerequirements set out in the NHSFoundation Trust Annual ReportingManual, is misleading or inconsistentwith information of which we areaware from our audit. We are notrequired to consider, nor have weconsidered, whether the AnnualGovernance Statement addressesall risks and controls or that risks aresatisfactorily addressed by internalcontrols;l proper practices have not beenobserved in the compilation of thefinancial statements; orl the NHS foundation trust has notmade proper arrangements forsecuring economy, efficiency andeffectiveness in its use of resources.CertificateWe certify that we have completed theaudit of the accounts in accordance withthe requirements of Chapter 5 of Part 2of the National Health Service Act 2006and the Audit Code for NHS FoundationTrusts.Susan Barratt, BA, ACA(Senior Statutory Auditor)for and on behalf of Deloitte LLPChartered Accountants and StatutoryAuditorSouthampton, UK24 May 201316Annual Report and Accounts 2012/13

Financial AccountsStatement of ComprehensiveIncomeNotes 2012/13 2011/12£’000 £’000Operating income from continuing operations 4 249,180 239,763Operating expenses of continuing operations 7 (241,482) (231,180)OPERATING SURPLUS 7,698 8,583FINANCE COSTSFinance income: interest receivable 12 391 539Finance expense: Finance lease interest 13 (57) (62)Finance expense: Unwinding of discount onprovisions24 (11) (11)Public Dividend Capital: Dividends payable (4,387) (4,533)SURPLUS FOR THE YEAR 3,634 4,516Other comprehensive incomeImpairment losses on property plant and equipment (2,250) 0Revaluation gains on property, plant and equipment 454 289TOTAL COMPREHENSIVE INCOME FOR THEYEAR1,838 4,805The notes on pages 21 to 50 form part of these accounts.Annual Report and Accounts 2012/13 17

Financial AccountsStatement of Financial PositionNotes 31 March 2013Restated31 March 2012£’000 £’000Non-current assetsIntangible assets 14 628 734Property, plant and equipment 14 144,424 148,256Total non-current assets 145,052 148,990Current assetsInventories 17 4,106 3,870Trade and other receivables 18 10,862 8,015Cash and cash equivalents 19 54,200 45,510Total current assets 69,168 57,395Current liabilitiesTrade and other payables 20 (25,208) (19,707)Borrowings 21 (433) (423)Provisions 24 (2,190) (152)Total current liabilities (27,831) (20,282)Total assets less current liabilities 186,389 186,103Non-current liabilitiesTrade and other payables 20 (1,113) (1,142)Borrowings 21 (1,191) (1,620)Provisions 24 (524) (1,618)Total non-current liabilities (2,828) (4,380)Total Assets Employed: 183,561 181,723Taxpayers' EquityPublic Dividend Capital 78,674 78,674Revaluation reserve 64,488 68,500Income and expenditure reserve 40,399 34,549Total Taxpayers' Equity: 183,561 181,723The notes on pages 21 to 50 form part of these accounts.The financial statements comprising the Statement of Comprehensive Income,Statement of Financial Position, Statement of Changes in Taxpayers’ Equity, andStatement of Cash Flows were approved by the Foundation Trust Board on 24 May2013 and signed on its behalf by:Mr A Spotswood, Chief Executive 24 May 201318Annual Report and Accounts 2012/13

Financial AccountsStatement of Changes inTaxpayers’ EquityPublicDividendCapitalRevaluationReserveIncome andExpenditureReserveTotalReserves£’000 £’000 £’000 £’000Taxpayers' equity at 1 April 2012 78,674 68,500 34,549 181,723Surplus for the year 0 0 3,634 3,634Impairment losses on property, plant and equipment 0 (2,250) 0 (2,250)Revaluation gains on property, plant and equipment 0 454 0 454Transfer of the excess of current cost depreciation0 (2,216) 2,216 0over historical cost depreciation to the Income andExpenditure ReserveTaxpayers' equity at 31 March 2013 78,674 64,488 40,399 183,561Prior YearTaxpayers' equity at 1 April 2011 78,674 70,933 27,311 176,918Surplus for the year 0 0 4,516 4,516Revaluation gains on property, plant and equipment 0 289 0 289Transfer of the excess of current cost depreciation0 (2,722) 2,722 0over historical cost depreciation to the Income andExpenditure ReserveTaxpayers’ equity at 31 March 2012 78,674 68,500 34,549 181,723The notes on pages 21 to 50 form part of these accounts.Annual Report and Accounts 2012/13 19

Financial AccountsStatement of Cash FlowsNotes2012/13Restated2011/12£’000 £’000Cash flows from operating activitiesOperating surplus 7,698 8,583Non-cash income and expenseDepreciation and amortisation 14 7,824 8,831Impairments 14 214 923Loss on disposal 147 185Non-cash donations/grants credited to income (1,313) (429)Interest accrued and not paid 1 6Dividends accrued and not paid or received (481) 346Increase in Trade and Other Receivables (2,847) (2,545)(Increase)/Decrease in Inventories (236) 320Increase in Trade and Other Payables 6,107 106Increase in Provisions 944 1,164Other movements in operating cash flows (11) (11)10,349 8,896Net cash generated from operations 18,047 17,479Cash flow from investing activitiesInterest received 390 533Purchase of intangible assets 14 (171) (106)Purchase of Property, Plant and Equipment (5,194) (7,307)Net cash flow from investing activities (4,975) (6,880)Cash flow from financing activitiesCapital element of finance lease rental payments (419) (481)Other capital receipts 0 1,004Interest element of finance lease 13 (57) (62)PDC Dividend paid (3,906) (4,879)Net cash flow used in financing activities (4,382) (4,418)Net increase in cash and cash equivalents 8,690 6,181Cash and cash equivalents at beginning of year 45,510 39,329Cash and cash equivalents at end of year 19 54,200 45,510The notes on pages 21 to 50 form part of these accounts.20Annual Report and Accounts 2012/13

Financial AccountsNotes to the accounts1 Accounting policies1.1 Accounting policiesMonitor has directed that the financialstatements of the NHS Foundation Trustshall meet the accounting requirementsof the NHS Foundation Trust AnnualReporting Manual which shall be agreedwith HM Treasury. Consequently, thefollowing financial statements havebeen prepared in accordance with the2012/13 NHS Foundation Trust AnnualReporting Manual issued by Monitor.The accounting policies contained inthat manual follow International FinancialReporting Standards (IFRS) and HMTreasury’s Financial Reporting Manualto the extent that they are meaningfuland appropriate to the FoundationTrust. The accounting policies havebeen applied consistently in dealing withitems considered material in relation tothe accounts. The Foundation Trust is asingle entity, therefore no consolidation isrequired in these accounts.Accounting conventionThese financial statements have beenprepared under historical cost conventionmodified to account for the revaluation ofproperty, plant and equipment, intangibleassets, and certain financial assets andfinancial liabilities.Acquisitions and discontinuedoperationsActivities are considered to be ‘acquired’only if they are taken from outside thepublic sector. Activities are considered‘discontinued’ if they transfer from onepublic body to another. The FoundationTrust has no acquisitions or discontinuedoperations to report within theseaccounts.Critical accounting judgementsand key sources of estimationuncertaintyIn the application of the FoundationTrust’s accounting policies, managementis required to make judgements,estimates and assumptions about thecarrying amount of assets and liabilitiesthat are not readily apparent from othersources. The estimates and associatedassumptions are based on historicalexperience and other factors that areconsidered to be relevant. Actual resultsmay differ from those estimates. Theestimates and underlying assumptions arecontinually revised if the revision affectsonly one period, or in the period of therevision and future periods, if the revisionaffects both current and future periods.Details of key accounting judgements andestimations are contained within Note 31to these accounts.Operating segmentsOperating segments are reported ina manner consistent with the internalreporting provided to the chief operatingdecision maker. The chief operatingdecision maker, who is responsiblefor allocating resources and assessingperformance of the operating segments,has been identified as the FinanceCommittee that makes strategicdecisions.Recently issued IFRS AccountingStandardsThe following standards, amendmentsand interpretations have been issued bythe International Accounting StandardsBoard (IASB) and International FinancialReporting Interpretations Committee(IFRIC) but have not yet been adoptedin the Annual Reporting Manual. Monitordoes not permit the early adoption ofaccounting standards, amendmentsand interpretations that are in issueat the reporting date but effective at asubsequent reporting period.Annual Report and Accounts 2012/13 21

Financial Accountsl IAS 27 Separate Financial Statementsl IAS 28 Associates and Joint Venturesl IFRS 9 Financial Instrumentsl IFRS 10 Consolidated FinancialStatementsl IFRS 11 Joint Arrangementsl IFRS 12 Disclosure of Interests inOther Entitiesl IFRS 13 Fair Value Measurementl IPSAS 32 Service ConcessionArrangementsThe directors do not expect that theadoption of these standards andinterpretations will have a materialimpact on the financial statements infuture periods. All other revised and newstandards have not been listed here asthey are not considered to have an impacton the Foundation Trust.Prior year restatementsEach year, the reporting requirements ofFoundation Trusts are refreshed, and asa result, some income and expenditureclassifications may be updated toimprove transparancy. In these instances,both the current year and the prior yeardisclosures are updated. In addition, ifin preparing the accounts, correctionsare identified to prior year classifications,these will be updated and clearly markedas “restated”.1.2 IncomeIncome in respect of services provided isrecognised when, and to the extent that,performance occurs and is measuredat the fair value of the considerationreceivable. The main source of incomefor the Foundation Trust is contracts withcommissioners in respect of healthcareservices.Where income is received for a specificactivity which is to be delivered in thefollowing financial year, that income isdeferred.Patient related revenueRevenue is recognised when the servicehas been delivered, that is, in the periodwhen the services were provided. Atthe end of the financial year, a revenueestimate is recognised for patients whoare in hospital and have not completedtheir period of treatment (an incompletespell). This revenue estimate is based onthe level of treatment provided to date.Education and trainingRevenue is recognised when theconditions of education and trainingcontracts have been met.Non patient care servicesThis is the income in relation to theeducation and training of specific staffgroups. Income is recognised whenthe Foundation Trust has achievedits objectives as set out in the annualcontract.InterestInterest revenue is accrued on a timebasis, by reference to the principaloutstanding and interest rate applicable.Catering servicesThe Foundation Trust operates canteenservices for employees and patients.Revenue is recognised when theFoundation Trust sells to the employeesand the public. Canteen sales are usuallyby cash or by debit card.Rental incomeThe Foundation Trust owns someresidential properties which are let outto members of staff and related parties.Rental income is recognised on astraight-line basis over the term of thelease. Car park fees are recognised whenthe public have used the FoundationTrust’s facilities and are usually receivedin cash.Income from sales ofnon-current assetsIncome from the sale of non-currentassets is recognised only when allmaterial conditions of sale have been met,and is measured as the sums due underthe sale contract.22Annual Report and Accounts 2012/13

Financial Accounts1.3 Expenditure on employeebenefitsShort-term employee benefitsSalaries, wages and employment-relatedpayments are recognised in the periodin which the service is received fromemployees. The cost of annual leaveentitlement earned but not taken byemployees at the end of the period isrecognised in the financial statements tothe extent that employees are permittedto carry forward leave into the followingperiod.Pension costsPast and present employees are coveredby the provisions of the NHS PensionsScheme. Details of the benefits payableunder these provisions can be foundon the NHS Pensions website at www.nhsbsa.nhs.uk/pensions. The Scheme isan unfunded, defined benefit scheme thatcovers NHS employers, GP practices andother bodies, allowed under the directionof the Secretary of State, in Englandand Wales. The scheme is not designedto be run in a way that would enableNHS bodies to identify their share of theunderlying scheme assets and liabilities.Therefore, the scheme is accounted for asif it were a defined contribution scheme:the cost to the NHS Body of participatingin the scheme is taken as equal to thecontributions payable to the scheme forthe accounting period.In order that the defined benefitobligations recognised in the financialstatements do not differ materially fromthose that would be determined at thereporting date by a formal actuarialvaluation, the FReM requires that “theperiod between formal valuations shall befour years, with approximate assessmentsin intervening years”. An outline of thesefollows:Accounting valuationA valuation of the scheme liability iscarried out annually by the schemeactuary as at the end of the reportingperiod. Actuarial assessments areundertaken in intervening years betweenformal valuations using updatedmembership data and are acceptedas providing suitably robust figuresfor financial reporting purposes. Thevaluation of the scheme liability as at 31March 2013, is based on the valuationdata as 31 March 2012, updated to 31March 2013 with summary global memberand accounting data. In undertaking thisactuarial assessment, the methodologyprescribed in IAS 19, relevant FReMinterpretations, and the discount rateprescribed by HM Treasury have alsobeen used.The latest assessment of the liabilities ofthe scheme is contained in the schemeactuary report, which forms part of theannual NHS Pension Scheme (Englandand Wales) Pension Accounts, publishedannually. These accounts can be viewedon the NHS Pensions website. Copiescan also be obtained from The StationeryOffice.Full actuarial (funding) valuationThe purpose of this valuation is to assessthe level of liability in respect of thebenefits due under the scheme (takinginto account its recent demographicexperience), and to recommend thecontribution rates.The last published actuarial valuationundertaken for the NHS Pension Schemewas completed for the year ending 31March 2004. Consequently, a formalactuarial valuation would have beendue for the year ending 31 March 2008.However, formal actuarial valuations forunfunded public service schemes weresuspended by HM Treasury on value formoney grounds while consideration isgiven to recent changes to public servicepensions, and while future scheme termsare developed as part of the reforms topublic service pension provision due in2015.The Scheme Regulations were changedto allow contribution rates to be setby the Secretary of State for Health,with the consent of HM Treasury, andconsideration of the advice of the SchemeActuary and appropriate employee andAnnual Report and Accounts 2012/13 23

Financial Accountsemployer representatives as deemedappropriate.The next formal valuation to be used forfunding purposes will be carried out at asat March 2012 and will be used to informthe contribution rates to be used from 1April 2015.Scheme provisionsThe NHS Pension Scheme provideddefined benefits, which are summarisedbelow. This list is an illustrative guideonly, and is not intended to detail all thebenefits provided by the Scheme or thespecific conditions that must be metbefore these benefits can be obtained:The Scheme is a “final salary” scheme.Annual pensions are normally based on1/80th for the 1995 section and of thebest of the last three years pensionablepay for each year of service, and 1/60thfor the 2008 section of reckonable payper year of membership. Memberswho are practitioners as defined by theScheme Regulations have their annualpensions based upon total pensionableearnings over the relevant pensionableservice.With effect from 1 April 2008 memberscan choose to give up some of theirannual pension for an additional tax freelump sum, up to a maximum amountpermitted under HMRC rules. Thisnew provision is known as “pensioncommutation”.Annual increases are applied to pensionpayments at rates defined by thePensions (Increase) Act 1971, and arebased on changes in retail prices in thetwelve months ending 30 September inthe previous calendar year. From 2011-12 the Consumer Price Index (CPI) will beused to replace the Retail Prices Index(RPI).Early payment of a pension, withenhancement, is available to membersof the scheme who are permanentlyincapable of fulfilling their dutieseffectively through illness or infirmity.A death gratuity of twice final year’spensionable pay for death in service, andfive times their annual pension for deathafter retirement is payableFor early retirements other than thosedue to ill health the additional pensionliabilities are not funded by the scheme.The full amount of the liability for theadditional costs is charged to theemployer.Members can purchase additional servicein the NHS Scheme and contributeto money purchase AVC’s run by theScheme’s approved providers or byother Free Standing Additional VoluntaryContributions (FSAVC) providers.1.4 Expenditure on other goodsand servicesExpenditure on goods and services isrecognised when, and to the extentthat they have been received, and ismeasured at the fair value of those goodsand services. Expenditure is recognisedin operating expenses except where itresults in the creation of a non-currentasset such as property, plant andequipment.1.5 Property, plant andequipmentRecognitionProperty, plant and equipment iscapitalised where:l it is held for use in delivering servicesor for administrative purposes;l it is probable that future economicbenefits will flow to, or servicepotential be provided to, theFoundation Trust;l it is expected to be used for more thanone financial year;l the cost of the item can be measuredreliably;l the item individually has a cost of atleast £5,000; orl collectively, a group of items have acost of at least £5,000 and individuallyhave a cost of more than £250,where the assets are functionallyinterdependent, they have broadlysimultaneous purchase dates, are24Annual Report and Accounts 2012/13

Financial Accountsanticipated to have simultaneousdisposal dates, and are under singlemanagerial control; orl form part of the initial equipping andsetting-up cost of a new building,refurbishment of a ward or unitirrespective of their individual orcollective cost.Where a large asset, for examplea building, includes a number ofcomponents with significantly differentasset lives e.g. plant and equipment,then these components are treated asseparate assets and depreciated overtheir own useful economic lives.ValuationAll property, plant and equipment assetsare measured initially at cost, representingthe costs directly attributable to acquiringor constructing the asset and bringing itto the location and condition necessaryfor it to be capable of operating in themanner intended by management. Theyare subsequently measured at fair value.Non-current assets are stated at the lowerof replacement cost and recoverableamount. The carrying values of property,plant and equipment are reviewedfor impairment in periods if events orchanges in circumstances indicate thecarrying value may not be recoverable.The costs arising from the financingof the construction of fixed assets arenot capitalised but are charged to theStatement of Comprehensive Income inthe year to which they relate.All land and buildings are revalued usingprofessional valuations in accordancewith IAS 16 every five years. A threeyearly interim valuation is also carried out.Professional valuations are carried out bythe District Valuer of the Valuation OfficeAgency. The valuations are carried outin accordance with the Royal Institute ofChartered Surveyors (RICS) Appraisal andValuation Manual. A full asset valuation(excluding Assets Under Construction/Work In Progress) has been undertakenas at 31 March 2013 and is includedin the closing Statement of FinancialPosition.The valuations are carried out primarilyon the basis of Modern Equivalent forspecialised operational property andExisting Use Value for non-specialisedoperational property. The value of landfor existing use purposes is assessed atExisting Use Value. For non-operationalproperties including surplus land, thevaluations are carried out at Open MarketValue.Assets in the course of construction arevalued at current cost. Larger schemesare valued by the District Valuer oncompletion or when brought into use,and all schemes are valued as part of thethree/ five yearly revaluation.Operational equipment is valued at netcurrent replacement cost.Subsequent expenditureSubsequent expenditure relating to anitem of property, plant and equipment isrecognised as an increase in the carryingamount of the asset when it is probablethat additional future economic benefitsor service potential deriving from thecost incurred to replace a component ofsuch item will flow to the enterprise andthe cost of the item can be determinedreliably.Where a component of an asset isreplaced, the cost of the replacementis capitalised if it meets the criteria forrecognition above. The carrying amountof the part replaced is derecognised.Other expenditure that does not generateadditional future economic benefits orservice potential, such as repairs andmaintenance, is charged to the Statementof Comprehensive Income in the period inwhich it is incurred.DepreciationItems of property, plant and equipmentare depreciated over their remaininguseful economic lives in a mannerconsistent with the consumption ofeconomic or service delivery benefits.Freehold land is considered to have aninfinite life and is not depreciated.Annual Report and Accounts 2012/13 25

Financial AccountsThe estimated useful lives of assets are summarised below:Minimum Life(years)Maximum Life(years)Buildings and Dwellings 10 90Furniture / Fittings 10 10Set-up Costs 10 10Medical and other Equipment 5 10Vehicles 7 10Radiology Equipment 5 7IT Equipment 3 5Property, plant and equipment whichhas been reclassified as ‘Held for Sale’ceases to be depreciated upon thisreclassification. Assets in the course ofconstruction are not depreciated until theasset is brought into use.Revaluation gains and lossesRevaluation gains are recognised inthe revaluation reserve, except where,and to the extent that, they reverse arevaluation decrease that has previouslybeen recognised in operating expenses,in which case they are recognised inoperating income.Revaluation losses are charged to therevaluation reserve to the extent thatthere is an available balance for the assetconcerned, and thereafter are charged tooperating expenses.Gains and losses recognised in therevaluation reserve are reported in theStatement of Comprehensive Income asan item of ‘other comprehensive income’.ImpairmentsIn accordance with the Foundation TrustAnnual Reporting Manual, impairmentsthat are due to a loss of economicbenefits or service potential in the assetsare charged to operating expenses. Acompensating transfer is made fromthe revaluation reserve to the incomeand expenditure reserve of an amountequal to the lower of (i) the impairmentcharged to operating expenses; and (ii)the balance in the revaluation reserveattributable to that asset before theimpairment.An impairment arising from a loss ofeconomic benefit or service potential isreversed when, and to the extent that, thecircumstances that gave rise to the lossis reversed. Reversals are recognised inoperating income to the extent that theasset is restored to the carrying amountit would have had if the impairment hadnever been recognised. Any remainingreversal is recognised in the revaluationreserve. Where, at the time of the originalimpairment, a transfer was made fromthe revaluation reserve to the incomeand expenditure reserve, an amountis transferred back to the revaluationreserve when the impairment reversal isrecognised.Other impairments are treated asrevaluation losses. Reversals of ‘otherimpairments’ are treated as revaluationgains.De-recognitionAssets intended for disposal arereclassified as ‘Held for Sale’ once all ofthe following criteria are met:l the asset is available for immediatesale in its present condition subjectonly to terms which are usual andcustomary for such sales;26Annual Report and Accounts 2012/13

Financial Accountsl the sale must be highly probable, forexample:- management are committed toa plan to sell the asset;- an active programme has begun tofind a buyer and complete the sale;- the asset is being actively marketedat a reasonable price;- the sale is expected to be completedwithin twelve months of the date ofthe classification as ‘Held for Sale’;and- the actions needed to complete theplan indicate it is unlikely that theplan will be dropped or significantchanges made to it.Following reclassification, the assets aremeasured at the lower of their existingcarrying amount and their ‘fair value lesscosts to sell’. Depreciation ceases to becharged. Assets are de-recognised whenall material sale contract conditions havebeen met.Property, plant and equipment which isto be scrapped or demolished does notqualify for recognition as ‘Held for Sale’and instead is retained as an operationalasset and the asset’s economic life isadjusted. The asset is de-recognisedwhen scrapping or demolition occurs.Donated, government grant andother grant funded assetsDonated and grant funded property, plantand equipment assets are capitalised attheir fair value on receipt. The donation/grant is credited to income at the sametime, unless the donor has imposeda condition that the future economicbenefits embodied in the grant are to beconsumed in a manner specified by thedonor, in which case, the donation/ grantis deferred within liabilities and is carriedforward to future financial years to theextent that the condition has not yet beenmet.The donated and grant funded assets aresubsequently accounted for in the samemanner as other items of property, plantand equipment.1.6 Intangible assetsRecognitionIntangible assets are non-monetaryassets without physical substance whichare capable of being sold separatelyfrom the rest of the Foundation Trust’sbusiness or which arise from contractualor other legal rights. They are recognisedonly where it is probable that futureeconomic benefits will flow to, or servicepotential be provided to, the FoundationTrust and where the cost of the asset canbe measured reliably.Internally generated intangibleassetsInternally generated goodwill, brands,mastheads, publishing titles and similaritems are not capitalised as intangibleassets.Expenditure on research is notcapitalised.Expenditure on development iscapitalised only where all of the followingcan be demonstrated:l the product is technically feasible tothe point of completion and will resultin an intangible asset for sale or use;l the Foundation Trust intends tocomplete the asset and sell or use it;l the Foundation Trust has the ability tosell or use the asset;l how the intangible asset will generateprobable future economic or servicedelivery benefits;l adequate financial, technical andother resources are available to theFoundation Trust to complete thedevelopment and sell or use the asset;andl the Foundation Trust can measurereliably the expenses attributable tothe asset during development.SoftwareSoftware which is integral to the operationof hardware (for example, an operatingsystem) is capitalised as part of therelevant item of property, plant andequipment. Software which is not integralAnnual Report and Accounts 2012/13 27

Financial Accountsto the operation of hardware (for example,application software) is capitalised as anintangible asset.MeasurementIntangible assets are recognised initiallyat cost, comprising all directly attributablecosts needed to create, produce andprepare the asset to the point that itis capable of operating in the mannerintended by management.Subsequently, intangible assets aremeasured at fair value. Revaluation gainsand losses and impairments are treatedin the same manner as for property, plantand equipment.Intangible assets held for sale aremeasured at the lower of their carryingamount or ‘fair value less costs to sell’.AmortisationIntangible assets are amortised overtheir expected useful economic lives in amanner consistent with the consumptionof economic or service delivery benefits.The estimated useful live of assets aresummarised below:Minimum Life(years)Maximum Life(years)Software 3 51.7 Revenue government andother grantsGovernment grants are grants fromGovernment bodies other than incomefrom primary care trusts or NHS trusts forthe provision of services. Where a grantis used to fund revenue expenditure it istaken to the Statement of ComprehensiveIncome to match that expenditure.1.8 InventoriesInventories are valued at the lower of costand net realisable value. Due to the highturnover of stocks within the FoundationTrust, current cost is used as a fairestimate of current value.1.9 Financial instruments andfinancial liabilitiesRecognitionFinancial assets and financial liabilitieswhich arise from contracts for thepurchase or sale of non-financial items(such as goods or services), which areentered into in accordance with theFoundation Trust’s normal purchase, saleor usage requirements, are recognisedwhen, and to the extent which,performance occurs i.e. when receipt ordelivery of the goods or services is made.Financial assets and financial liabilities inrespect of assets acquired or disposedof through finance leases are recognisedand measured in accordance with theaccounting policy for leases describedbelow.All other financial assets and financialliabilities are recognised when theFoundation Trust becomes a party to thecontractual provisions of the instrument.De-recognitionAll financial assets are de-recognisedwhen the rights to receive cash flows fromthe assets have expired or the FoundationTrust has transferred substantially all ofthe risks and rewards of ownership.Financial liabilities are de-recognisedwhen the obligation is discharged,cancelled or expires.Classification and measurementFinancial assets are categorised as‘Loans and receivables’. Financialliabilities are classified as ‘other financialliabilities’.Loans and receivablesLoans and receivables are non-derivativefinancial assets with fixed or determinablepayments which are not quoted in anactive market. They are included incurrent assets.The Foundation Trust’s loans andreceivables comprise financial assets,cash and cash equivalents, NHSreceivables, accrued income and otherreceivables.28Annual Report and Accounts 2012/13

Financial AccountsLoans and receivables are recognisedinitially at fair value, net of transactioncosts, and are measured subsequentlyat amortised cost, using the effectiveinterest method. The effective interestrate is the rate that discounts exactlyestimated future cash receipts throughthe expected life of the financial asset or,when appropriate, a shorter period, to thenet carrying amount of the financial asset.Interest on loans and receivables iscalculated using the effective interestmethod and credited to the Statement ofComprehensive Income.Other financial liabilitiesAll other financial liabilities are recognisedinitially at fair value, net of transactioncosts incurred, and are measuredsubsequently at amortised cost using theeffective interest method. The effectiveinterest rate is the rate that discountsexactly estimated future cash paymentsthrough the expected life of the financialliability or, when appropriate, a shorterperiod, to the net carrying amount of thefinancial liability.They are included in current liabilitiesexcept for amounts payable more than 12months after the Statement of FinancialPosition date, which are classified as noncurrentliabilities.Interest on financial liabilities carried atamortised cost is calculated using theeffective interest method and charged tothe Statement of Comprehensive Income.Impairment of financial assetsAt the Statement of Financial Positiondate, the Foundation Trust assesseswhether any financial assets, other thanthose held at ‘fair value through incomeand expenditure’ are impaired. Financialassets are impaired and impairmentlosses are recognised if, and only if, thereis objective evidence of impairment asa result of one or more events whichoccurred after the initial recognition ofthe asset and which has an impact on theestimated future cashflows of the asset.For financial assets carried at amortisedcost, the amount of the impairment loss ismeasured as the difference between theasset’s carrying amount and the presentvalue of the revised future cashflowsdiscounted at the asset’s original effectiveinterest rate. The loss is recognised inthe Statement of Comprehensive Incomeand the carrying amount of the asset isreduced directly.1.10 LeasesFinance leasesWhere substantially all risks and rewardsof ownership of a leased asset areborne by the Foundation Trust, theasset is recorded as property, plant andequipment and a corresponding liabilityis recorded. The value at which both arerecognised is the lower of the fair valueof the asset or the present value of theminimum lease payments, discountedusing the interest rate implicit in the lease.The asset and liability are recognisedat the commencement of the lease.Thereafter the asset is accounted for asan item of property, plant and equipment.The annual rental is split between therepayment of the liability and a financecost so as to achieve a constant rateof finance over the life of the lease.The annual finance cost is chargedto Finance Costs in the Statement ofComprehensive Income. The lease liabilityis de-recognised when the liability isdischarged, cancelled or expires.Operating leasesOther leases are regarded as operatingleases and the rentals are chargedto operating expenses on a straightlinebasis over the term of the lease.Operating lease incentives received areadded to the lease rentals and chargedto operating expenses over the life of thelease.Leases of land and buildingsWhere a lease is for land and buildings,the land component is separated from thebuilding component and the classificationfor each is assessed separately. Leasedland is treated as an operating lease.Annual Report and Accounts 2012/13 29

Financial Accounts1.11 ProvisionsThe Foundation Trust recognises aprovision where it has a present legal orconstructive obligation of uncertain timingor amount; for which it is probable thatthere will be a future outflow of cash orother resources; and a reliable estimatecan be made of the amount. The amountrecognised in the Statement of FinancialPosition is the best estimate of theresources required to settle the obligation.Where the effect of the time value ofmoney is significant, the estimated riskadjustedcash flows are discounted usingthe discount rates published by HMTreasury.Clinical negligence costsThe NHS Litigation Authority (NHSLA)operates a risk pooling scheme underwhich the Foundation Trust pays anannual contribution to the NHSLA,which, in return, settles all clinicalnegligence claims. Although the NHSLAis administratively responsible for allclinical negligence cases, the legal liabilityremains with the Foundation Trust.The total value of clinical negligenceprovisions carried by the NHSLAon behalf of the Foundation Trust isdisclosed at note 24 but is not recognisedin the Foundation Trust’s accounts.Non-clinical risk poolingThe Foundation Trust participates inthe Property Expenses Scheme andthe Liabilities to Third Parties Scheme.Both are risk pooling schemes underwhich the Foundation Trust paysan annual contribution to the NHSLitigation Authority and in returnreceives assistance with the costs ofclaims arising. The annual membershipcontributions, and any ‘excesses’ payablein respect of particular claims, arecharged to operating expenses when theliability arises.1.12 ContingenciesContingent assets (that is assets, arisingfrom past events whose existence willonly be confirmed by one or more futureevents not wholly within the FoundationTrust’s control) are not recognisedas assets, but are disclosed by notewhere an inflow of economic benefits isprobable.Contingent liabilities are not recognised,but are disclosed by note unless theprobability of a transfer of economicbenefits is remote. Contingent liabilitiesare defined as:l possible obligations arising frompast events whose existence will beconfirmed only by the occurrence ofone or more uncertain future eventsnot wholly within the FoundationTrust’s control; orl present obligations arising from pastevents but for which it is not probablethat a transfer of economic benefitswill arise or for which the amount ofthe obligation cannot be measuredwith sufficient reliability.1.13 Public Dividend Capital(PDC) and PDC DividendPublic dividend capital (PDC) is a type ofpublic sector equity finance based on theexcess of assets over liabilities at the timeof establishment of the predecessor NHSTrust. HM Treasury has determined thatPDC is not a financial instrument withinthe meaning of IAS 32.A charge, reflecting the cost of capitalutilised by the Foundation Trust, ispayable as public dividend capitaldividend. The charge is calculated atthe rate set by HM Treasury (currently3.5%) on the average relevant netassets of the Foundation Trust duringthe financial year. Relevant net assetsare calculated as the value of all assetsless the value of all liabilities, exceptfor (i) donated assets (including lotteryfunded assets), (ii) net cash balances heldwith the Government Banking Services(GBS), excluding cash balances held inGBS accounts that relate to short-term30Annual Report and Accounts 2012/13

Financial Accountsworking capital facility, and (iii) any PDCdividend balance receivable or payable.In accordance with the requirements laiddown by the Department of Health (as theissuer of PDC), the dividend for the yearis calculated on the actual averagerelevant net assets as set out in the‘pre-audit’ version of the annual accounts.The dividend thus calculated is notrevised should any adjustment to netassets occur as a result of the audit of theannual accounts.1.14 Value added taxMost of the activities of the FoundationTrust are outside the scope of VAT and,in general, output tax does not apply andinput tax on purchases is not recoverable.Irrecoverable VAT is charged to therelevant expenditure category or includedin the capitalised purchase cost of fixedassets. Where output tax is charged orinput VAT is recoverable, the amounts arestated net of VAT.1.15 Corporation taxUnder current legislation, FoundationTrusts are not liable for corporation tax.1.16 Foreign exchangeThe functional and presentation currencyof the Foundation Trust is sterling.A transaction which is denominated ina foreign currency is translated into thefunctional currency at the spot exchangerate on the date of the transaction.1.17 Third party assetsAssets belonging to third parties (suchas money held on behalf of patients) arenot recognised in the accounts sincethe Foundation Trust has no beneficialinterest in them. However, they aredisclosed within Note 19 to the accountsin accordance with the requirements ofHM Treasury’s FReM.1.18 Losses and specialpaymentsLosses and special payments areitems that Parliament would not havecontemplated when it agreed funds forthe health service or passed legislation.By their nature, they are items that ideallyshould not arise. They are thereforesubject to special control procedurescompared with the generality ofpayments. They are divided into differentcategories, which govern the way thatindividual cases are handled. Lossesand special payments are chargedto the relevant functional headingsin expenditure on an accruals basis,including losses which would have beenmade good through insurance cover hadthe Foundation Trust not been bearingits own risks (with insurance premiumsthen being included as normal revenueexpenditure).However, the losses and specialpayments note is compiled directly fromthe losses and compensations registerwhich reports on an accruals basis withthe exception of provisions for futurelosses.1.19 Going concernAfter making enquiries, the directorshave a reasonable expectation that theFoundation Trust has adequate resourcesto continue in operational existence forthe foreseeable future. For this reason,they continue to adopt the going concernbasis in preparing the accounts.Annual Report and Accounts 2012/13 31

Financial Accounts2 Operating segmentsThe Foundation Trust has determined the operating segments based on the reportsreviewed by the Finance Committee that are used to make strategic decisions.The Finance Committee considers the Foundation Trust’s business from a servicesperspective as “Healthcare” and only one segment is therefore reported.The segment information provided to the Finance Committee for the reportablesegments for the year ended 31 March 2013 is as follows:Healthcare 2012/13 Healthcare 2011/12£’000 £’000Segment revenue 249,180 239,763Patient and other income 249,180 239,763It is appropriate to aggregate these as, in accordance with IFRS 8: OperatingSegments, they are similar in each of the following respects:l the nature of the products and services;l the nature of the production processes;l the type of class of customer for their products and services;l the methods used to distribute their products or provide their services; andl the nature of the regulatory environment.3 Income generation activitiesThe Foundation Trust does not undertake any other income generation activities withan aim of achieving profit.4 Operating income4.1 Income from patient related activitiesContinuingOperations2012/13RestatedContinuingOperations2011/12£’000 £’000Foundation Trusts 3,726 3,619Primary Care Trusts 223,474 216,213Non NHS:- Private Patients 3,166 2,335- NHS Injury Scheme income 501 715- Other 0 52230,867 222,934The NHS Injury Scheme income above is reported net of a 12.6% doubtful debtprovision (2011/12 10.5%).32Annual Report and Accounts 2012/13

Financial Accounts4.2 Other operating incomeContinuingOperations2012/13RestatedContinuingOperations2011/12£’000 £’000Research and development 1,988 1,559Education and training 5,268 5,207Charitable and other contributions to capital1,313 398expenditureNon-patient care services to other bodies 5,379 5,002Income from operating leases 675 721Other:NHS Drug sales 113 155Car Parking 1,405 1,071Catering Services 896 848Miscellaneous other 1,276 1,86818,313 16,829Total (note 4.1 & note 4.2) 249,180 239,7635 Private patient capThe statutory limitation on private patient income as set out within Section 44 of theNational Health Service Act 2006 was repealed with effect from 1 October 2012 by theHealth and Social Care Act 2012. As a result, the financial statements disclosures thatwere provided previously are no longer required.The Foundation Trust has met the requirement in section 43(2A) of the National HealthService Act 2006 (as amended by the Health and Social Care Act 2012) which requiresthat the income from the provision of goods and services for the purposes of the healthservice in England must be greater than its income from the provision of goods andservices for any other purposes.6 Mandatory and non-mandatory income from activities2012/13 2011/12£’000 £’000Mandatory 236,135 228,141Non-mandatory 13,045 11,622249,180 239,763Annual Report and Accounts 2012/13 33

Financial Accounts7 Operating expensesContinuing Operations2012/13Restated2011/12£’000 £’000Services from NHS Foundation Trusts 2,463 2,963Services from other NHS Bodies 1,334 1,402Employee Expenses - Executive directors 1,158 1,163Employee Expenses - Non-executive directors 147 160Employee Expenses - Staff 141,836 139,215Employee Expenses - Redundancy paid (see note) 132 0Drug costs 23,477 23,380Supplies and services - clinical (excluding drug costs) 32,290 31,437Supplies and services - general 3,984 3,468Establishment 1,902 1,817Research and development 448 373Transport 727 703Premises 12,828 9,472Decrease in bad debt provision (383) (650)Increases in other provisions 44 0Inventories written down 86 208Operating lease payments 231 346Depreciation on property, plant and equipment 7,464 8,430Amortisation on intangible assets 360 401Impairments of property, plant and equipment 214 923External audit services - financial statement audit 46 62External audit services - audit-related assurance services 13 6External audit services - other non-audit services 35 0Clinical negligence premium 2,163 1,879Loss on disposal of land and buildings 35 185Loss on disposal of other property, plant and equipment 112 0Legal fees 241 309Consultancy costs (including internal audit services) 2,990 1,432Training, courses and conferences 782 495Other services, e.g. external payroll 540 187Losses, ex gratia & special payments 8 115Other 3,775 1,299Total 241,482 231,180Other restructuring amounts provided in the year are disclosed in note 24.34Annual Report and Accounts 2012/13

Financial Accounts8 Operating leases8.1 Operating leases as lesseeThe Foundation Trust leases some medical equipment and vehicles under noncancellableoperating leases. The leases are between 3-5 years. None of the leasesinclude contingent rents or onerous restrictions on the Foundation Trust’s use of theassets concerned. The expenditure charged to the Statement of ComprehensiveIncome during the year is disclosed below:2012/13 2011/12£’000 £’000Total operating leases 231 346The future aggregate minimum lease payments undernon-cancellable operating leases are as follows:No later than one year 59 99Between 1 and 5 years 201 60Over 5 years 43 0Total 303 1598.2 Operating leases as lessorThe Foundation Trust owns some properties from which rental income is derived.These are properties are leased out to members of staff and the contracts are normallybetween one and six months. The Foundation Trust also leases some office spacesto some contractors and service providers at the hospital sites. None of the leasesinclude contingent rents and there are no onerous restrictions. The income recognisedthrough the Statement of Comprehensive Income during the year is disclosed as:2012/13 2011/12£’000 £’000Accommodation operating leases 675 721The future aggregate minimum lease paymentsunder non-cancellable operating leases are as follow:No later than one year 673 686Between one and five years 420 420Over 5 years 445 494Total 1,538 1,600Annual Report and Accounts 2012/13 35

Financial Accounts9 Staff costs and numbers9.1 Staff costs2012/13 2011/12£’000 £’000Salaries and wages 119,362 117,205Social security costs 8,873 8,727Employer’s contributions to NHS Pensions 13,216 12,876Termination benefits 132 0Agency/contract staff 1,543 1,570Total 143,126 140,3789.2 Average number of persons employed2012/13 2011/12Number NumberMedical and dental 408 414Administration and estates 1,116 1,081Healthcare assistants and other support staff 606 580Nursing, midwifery and health visiting staff 1,065 1,063Scientific, therapeutic and technical staff 396 383Bank and agency staff 109 112Total 3,700 3,633This note excludes Non-Executive Directors, in line with national guidance.9.3 Staff exit packages2012/13 2012/13Number £’000Less than £10,000 1 5£10,001 - £25,000 3 45£25,001 - £50,000 2 82Over £50,000 0 0Total 6 132There were no staff exit packages in 2011/12.36Annual Report and Accounts 2012/13

Financial Accounts10 Retirements due to ill-healthThere were three early retirements from the Foundation Trust agreed on the groundsof ill-health (2011/12: three). The estimated additional pension liabilities of these illhealthretirements will be £169,000 (2011/12: £640,000). The cost of these ill-healthretirements will be borne by the NHS Pensions Agency.11 The Late Payment of Commercial Debts (Interest) Act 1998There were no payments of interest for commercial debts.12 Investment revenue2012/13 2011/12£’000 £’000Interest receivable 391 539Total 391 53913 Finance costs2012/13 2011/12£’000 £’000Finance leases 57 62Total 57 62Annual Report and Accounts 2012/13 37

Financial Accounts14 Intangible assets, property, plant and equipmentIntangible Tangible TOTALSoftwareLicences(incl Work inprogess)Land(Freehold)Buildingsexcludingdwellings(Freehold)Dwellings(Freehold)Assets UnderConstruction/ Work InProgressPlant andMachineryTransportEquipmentInformationTechnologyFurnitureand fittings£’000 £’000 £’000 £’000 £’000 £’000 £’000 £’000 £’000 £’000Gross cost at 1 April 2012 as previously stated 4,311 27,792 112,346 4,073 689 32,098 187 3,103 639 185,238Additions - purchased 171 0 1,678 200 238 2,175 17 143 108 4,730Additions - donated 0 0 0 0 0 1,193 0 120 0 1,313Impairments 0 (2,250) 0 0 0 0 0 0 0 (2,250)Reclassifications 83 0 469 0 (656) 91 0 13 0 0Revaluations 0 0 (9,366) (107) 0 0 0 0 0 (9,473)Adjustments 0 0 123 35 (2) (151) 5 (87) (5) (82)Disposals 0 0 (33) 0 0 (1,166) (13) (3) 0 (1,215)Cost or valuation at 31 March 2013 4,565 25,542 105,217 4,201 269 34,240 196 3,289 742 178,261Accumulated depreciation at 1 April 2012 as previously stated 3,577 0 4,935 141 0 24,383 87 2,820 305 36,248NonCurrentAssetsProvided during the year 360 0 4,534 147 0 2,592 14 131 46 7,824Impairments 0 0 214 0 0 0 0 0 0 214Revaluations 0 0 (9,639) (288) 0 0 0 0 0 (9,927)Adjustments 0 0 (8) 0 0 12 (6) (3) 0 (5)Disposals 0 0 (7) 0 0 (1,128) (7) (3) 0 (1,145)Accumulated depreciation at 31 March 2013 3,937 0 29 0 0 25,859 88 2,945 351 33,209Net book valuePurchased 734 27,792 102,816 3,932 689 4,181 81 283 325 140,833Finance lease 0 0 0 0 0 2,103 0 0 0 2,103Donated 0 0 4,595 0 0 1,431 19 0 9 6,054NBV total at 31 March 2012 734 27,792 107,411 3,932 689 7,715 100 283 334 148,990Purchased 628 25,542 100,618 4,201 269 4,643 91 236 383 136,611Finance lease 0 0 0 0 0 1,672 0 0 0 1,672Donated 0 0 4,570 0 0 2,066 17 108 8 6,769NBV total at 31 March 2013 628 25,542 105,188 4,201 269 8,381 108 344 391 145,052The asset classifications are as follows:- Protected 0 22,200 100,538 0 0 0 0 0 0 122,738- Unprotected 628 3,342 4,650 4,201 269 8,381 108 344 391 22,314628 25,542 105,188 4,201 269 8,381 108 344 391 145,052Plant and equipment include the following amounts where the Foundation Trust is lessee under finance leases.2012/13 2011/12£'000 £'000Cost 4,490 4,490Accumulated depreciation 2,818 2,387Net book value 1,672 2,103The reclassification of software licences of £83,000 relates to assets brought into use during the year which were held under tangible assets under construction as at 1 April 2012.The Foundation Trust leases various medical equipment/ IT under non-cancellable finance lease agreements. The lease terms are between five and seven years.The above includes £920,000 of restricted use of the Heart Club, which is leased to the Bournemouth Heart Club until the year 2046.38Annual Report and Accounts 2012/13

Financial Accounts15 Impairment of property, plant and equipmentChanges in market price(as advised by the District Valuer)31 March 2013 31 March 2012£’000 £’000214 923Total 214 92316 Capital commitments31 March 2013 31 March 2012£’000 £’000Property plant and equipment 1,698 1,391Total 1,698 1,39117 Inventories31 March 2013 31 March 2012£’000 £’000Drugs 1,232 1,347Consumables 2,874 2,523Total 4,106 3,87017.1 Inventories recognised in expenses31 March 2013 31 March 2012£’000 £’000Inventories recognised as an expense in the period 31,351 32,059Write-down of inventories (including losses) 86 208Total 31,437 32,267Annual Report and Accounts 2012/13 39

Financial Accounts18 Trade and other receivables18.1 Amounts falling due within one year:31 March 2013 31 March 2012£’000 £’000NHS Receivables - Revenue 6,799 4,992Other receivables with related parties - revenue 0 4Provision for impaired receivables (819) (1,602)Prepayments 1,458 1,234Accrued income 1,421 1,036PDC dividend receivable 13 494VAT Receivable 130 216Other receivables - Revenue 1,860 1,641Total 10,862 8,01518.2 Age analysis of trade and other receivablesRestated31 March 2013 31 March 2012£’000 £’000Age of impaired receivables:0 - 30 days 134 1,26631 - 60 days 261 061 - 90 days 36 6691 - 180 days 126 42over 180 days 262 228Sub Total 819 1,602Age of non-impaired receivables:0 - 30 days 8,956 6,03831 - 60 days 811 24661 - 90 days 28 12991 - 180 days 99 0over 180 days 149 0Sub Total 10,043 6,413Total 10,862 8,01540Annual Report and Accounts 2012/13

Financial Accounts18.3 Provision for impairment of receivables31 March 2013 31 March 2012£’000 £’000At 1 April 1,602 3,112Increase in provision 670 1,108Amounts utilised (400) (860)Unused amounts reversed (1,053) (1,758)At 31 March 819 1,60219 Cash and cash equivalents31 March 2013 31 March 2012£’000 £’000Balance 1 April 45,510 39,329Net movement in year 8,690 6,181Balance at 31 March 54,200 45,510Made up of:Cash at commercial banks and in hand 48 (2,161)Cash with the Government Banking Service 54,152 47,671Cash and cash equivalents 54,200 45,510The patient monies amount held on trust was £3,990 (2011/12 £1,923) which is notincluded in the above figures.20 Trade and other payablesRestated31 March 2013 31 March 2012£’000 £’000Amounts falling due within one year:NHS payables - revenue 2,522 2,611Other Trade payables - capital 814 1,449Other trade payables - revenue 10,110 9,264Accruals (restated) 11,762 6,383Total 25,208 19,707Amounts falling due over one year:Other trade payables 1,113 1,142Total 26,321 20,849This includes outstanding pensions contributions at 31 March 2013 of £1,796,000(2011/12 £1,620,000).Annual Report and Accounts 2012/13 41

Financial Accounts21 BorrowingsFinance lease liabilities31 March 2013 31 March 2012£’000 £’000- Current 433 423- Non current 1,191 1,620Total 1,624 2,04322 Finance lease obligationsThe Foundation Trust operates as lessee on a number of medical equipment leases.These leases generally run for between 5 - 7 years with options to extend the terms atthe expiry of the initial period. None of the leases include contingent rents or onerousrestrictions on the Foundation Trust’s use of assets concerned.Amounts payable under finance leasesGross lease payments31 March 2013 31 March 2012£’000 £’000Within one year 529 476Between one and five years 1,250 1,567After five years 0 158Less future finance charges (155) (158)Total 1,624 2,04342Annual Report and Accounts 2012/13

Financial Accounts23 Prudential borrowing limit31 March 2013 31 March 2012£’000 £’000Limit Utilised Limit UtilisedTotal long-term borrowing limit 45,600 1,624 43,200 2,043Working capital facility 0 0 0 0Prudential borrowing limit set by Monitor 45,600 1,624 43,200 2,043Ratios 2012/13 2011/12Approved Actual Approved ActualMinimum dividend cover > 1x 3.7x > 1x 4.2xMinimum interest cover > 3x 284x > 3x 307xMinimum debt service cover > 2x 40x > 2x 48xMaximum debt service to revenue < 2.5% 0.0% < 2.5% 0.0%The Foundation Trust is required to comply and remain within a prudential borrowinglimit. This is made up of two elements:l the maximum cumulative amount of long-term borrowing. This is set by referenceto the five ratio tests set out in Monitor’s Prudential Borrowing Code. The financialrisk rating set under Monitor’s Compliance Framework determines one of the ratiosand therefore can impact on the long-term borrowing limit.l the amount of any working capital facility approved by Monitor.Further information on the Foundation Trusts’ Prudential Borrowing Code andCompliance Framework can be found on the website of Monitor, the IndependentRegulator of Foundation Trusts.Annual Report and Accounts 2012/13 43

Financial Accounts24 Provisions for liabilities and chargesEarlyRetirement31 March2013£’000 £’000 £’000 £’000LegalclaimsRestructuringOtherAt 1 April 2012, as restated 162 531 1,077 0 1,770Change in the discount rate 0 (35) 0 0 (35)Arising during the year 16 71 504 755 1,346Utilised during the year - cash (18) (87) (132) 0 (237)Reversed unused 0 0 (141) 0 (141)Unwinding of discount 4 7 0 0 11At 31 March 2013 164 487 1,308 755 2,714Expected timing ofcashflows:Within one year 18 109 1,308 755 2,190Between one and five years 72 65 0 0 137After five years 74 313 0 0 387164 487 1,308 755 2,714Legal claimsLiability to Third Party and Property Expense Schemes:The Foundation Trust has liability for the excess of each claim.The calculation is based on estimated claim values and probability of settlement.Injury BenefitThe provision for permanent injury benefit has been created as at 31 March 2004and is calculated using the award value and life tables discounted over the period.£11,749k is included in the provisions of the NHS Litigation Authority at 31 March2013 in respect of clinical negligence liabilities of the Foundation Trust (£11,272k at 31March 2012).Total25 Related party transactionsThe Foundation Trust is a body corporate established by order of the Secretary ofState for Health.During the year none of the Board Members or parties related to them has undertakenany material transactions with the Foundation Trust.44Annual Report and Accounts 2012/13

Financial AccountsDuring the year the Foundation Trust has had a number of material transactions withpublic organisations together with other government bodies that fall within the wholeof the government accounts boundary. Entities are listed below where the transactiontotal (excluding recharges) exceeds £500,000:£’000 £’000 £’000 £’000Income Expenditure Receivables PayablesBournemouth and Poole PCT 113,028 33 117 0Dorset PCT 65,912 137 498 102Hampshire PCT 28,548 64 259 2Bristol PCT (South West SCG) 13,361 0 2,211 0Wiltshire PCT 1,033 0 0 256Poole Hospital NHS FT 5,496 3,390 2,776 1,672University Hospitals of Bristol NHS FT 1,322 13 0 5Dorset Healthcare University NHS FT 830 503 250 13South West Ambulance Service NHS FT 116 765 3 47South Central Strategic Health Authority 621 6 86 4South West Strategic Health Authority 4,712 4 0 1National Insurance Fund 0 8,873 0 0NHS Pensions Agency 0 13,216 0 0NHS Litigation Authority 0 2,104 0 0NHS Blood and Transplant Agency 4 1,393 6 45Bournemouth Borough Council 0 1,277 0 0HM Revenue and Customs (taxes and duties) 1,705 0 130 0NHS Business services Authority 0 3,919 0 6Other entities with transaction total less than 1,752 2,174 606 369£500,000238,440 37,871 6,942 2,522The Foundation Trust is an agent on behalf of employees and below are materialtransactions exceeding £500,000:£’000 £’000 £’000 £’000Income Expenditure Receivables PayablesNHS Pensions Agency 0 7,668 0 661HM Revenue and Customs 0 18,404 0 1,594National Insurance Fund 0 7,538 0 6460 33,610 0 2,901The Foundation Trust has also received revenue and capital payments from a numberof charitable funds; the material related parties are:l The Royal Bournemouth & Christchurch Hospitals NHS Foundation TrustCharitable FundThe Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust is theTrustee of the above fund.l Macmillan Caring LocallyMr. B Ford who is Treasurer of Macmillan Caring Locally is also a member of theBoard of Directors of the Foundation Trust.Annual Report and Accounts 2012/13 45

Financial Accounts26 Post statement of financialposition eventsThere are no post Statement of FinancialPosition events to report within theseaccounts.27 Financial risk managementThe Foundation Trust can borrow withinthe limits set by Monitor’s PrudentialBorrowing Code. The Foundation Trust’sposition against its prudential borrowinglimit is disclosed in Note 23.All other financial instruments are held forthe sole purpose of managing the cashflow of the Foundation Trust on a dayto-daybasis or arise from the operatingactivities of the Foundation Trust. Themanagement of risks around thesefinancial instruments therefore relatesprimarily to the Foundation Trust’s overallarrangements for managing risks inrelation to its financial position.Market riskInterest rate riskThe Foundation Trust has no other loansto repay, (other than the capitalisedfinance lease obligations which have fixedinterest rates) therefore any interest ratefluctuations will only affect its ability toearn additional interest on its short-terminvestments.The Foundation Trust earned interest of£391,000 during 2012/13, therefore if theinterest rate should change by 0.5%, thenthis would affect the amount earned byapproximately £261,000.Currency riskThe Foundation Trust has minimal risk ofcurrency fluctuations. Most transactionsare in sterling, although there are somepurchases of goods from Ireland whereprices are based on the Euro and allpayments are made in sterling.Other riskThe inflation rate on NHS service levelagreements is based on the NHS fundedinflation and therefore there is a small riskof budgetary financial pressure.The majority of pay award inflation isbased on the national agreed rate forAgenda for Change bands and althoughfunding through the Payment by Results(PbR) tariff will not cover all the cost(assumed additional cost improvementsavings within the Foundation Trust), thisrepresents a small risk.Credit riskDebtor ControlThe Foundation Trust has a treasuryfunction which includes a creditcontroller. It actively progresses debtsand uses an external company to supportit on selective older debts.The majority of the FoundationTrust’s payables are short term and itparticipates in the national NHS payablesreconciliations at 31 December and 31March each year. This helps to identifyany major NHS receivable queries.Provision for doubtful debtsThe Foundation Trust reviews Non NHSreceivables that are in excess of threemonths old as at 31 March and hasprovided £213,000. A further £79,000has been provided for in relation to theNHS Injury Scheme in accordance withscheme guidance.The Foundation Trust has also reviewedany significant NHS receivables andhave provided for doubtful debt to atotal of £527,000. This represents eitherits maximum or probable risk in specificareas and reflects the uncertainty of thefinancial climate of the healthcare market.Liquidity riskLoansThe Foundation Trust has no loans torepay.CreditorsThe Foundation Trust has a surplus in thecurrent financial year and on the retainedearnings reserve. The Foundation Trusthas a cash and investment balance of£54.2m and an authorised borrowing limitof £45.6m. Therefore it is at minimal riskto its payables.46Annual Report and Accounts 2012/13

Financial Accounts28 Financial instruments28.1 Financial assets31 March 2013 31 March 2012Loans andreceivables£’000 £’000Loans andreceivablesAssets as per the Statement of Financial PositionTrade and other receivables excluding non financial9,391 6,287assetsOther Financial Assets 1,458 1,234Cash and cash equivalents at bank and in hand 54,200 45,510Total 65,049 53,031Assets held in £ sterling 65,049 53,031The above amount excludes PDC receivables of £13k (2011/12 £494k).28.2 Financial liabilitiesRestated31 March 2013 31 March 2012£’000 £’000OtherfinancialliabilitiesOtherfinancialliabilitiesLiabilities as per the Statement of FinancialPositionObligations under finance leases 1,623 2,043NHS Trade and other payables excluding non2,522 2,611financial assetsNon-NHS Trade and other payables excluding non19,030 14,797financial assetsProvisions under contract 2,714 1,770Total 25,889 21,221Liabilities held in £ sterling 25,889 21,221The above figures excludes statutory / non contracted payables of £4,769k(2011/12 £ 4,518k).Annual Report and Accounts 2012/13 47

Financial Accounts28.3 Financial assets / liabilities - fair values31 March 2013£’000 £’000BookValueFairValueFinancial assetsReceivables over one year 0 0Investments 0 0Other 0 0Total 0 0Financial liabilitiesNon current trade and other payables excluding1,113 1,113non financial liabilitiesProvisions under contract (Early Retirement) 2,714 2,714Loans 0 0Total 3,827 3,82729 Intra-Government and NHS balancesReceivables:amounts falling duewithin one year31 March 2013Payables:amounts falling duewithin one year£’000 £’000Foundation Trusts 3,149 1,851NHS and Department of Health 3,663 671Local Government 0 0Central Government 130 0Total 6,942 2,52231 March 2012Foundation Trusts 2,300 2,130NHS and Department of Health 2,692 481Local Government 4 3Central Government 216 4,563Total 5,212 7,17748Annual Report and Accounts 2012/13

Financial Accounts30 Losses and special paymentsThere were 140 cases of losses andspecial payments totalling £238,000approved during 2012/13 (2011/12: 74cases, £116,000).There were no cases where the netpayment exceeded £100,000.Note: The total costs included in thisnote are on a cash basis and will notreconcile to the amounts in the notes tothe accounts which are prepared on anaccruals basis.31 Judgement and estimationsKey sources of estimationuncertainty and judgementsIn the application of the FoundationTrust’s accounting policies, theFoundation Trust has made estimatesand assumptions in a number of areas,as the actual value is not known withcertainty at the Statement of FinancialPosition date. By definition, theseestimations are subject to some degreeof uncertainty; however in each case theFoundation Trust has taken all reasonablesteps to assure itself that these items donot create a significant risk of materialuncertainty. Key areas of estimationinclude:l Expenditure ‘accruals’ are includedwithin the total expenditure reportedwith these financial statements.These accruals represent estimatedcosts for specific items of committedexpenditure for which actual invoiceshave yet to be received, together withthe estimated value of capital workscompleted, but not formally valuedas at 31 March 2013. Estimates arebased on the Foundation Trust’scurrent understanding of the actualcommitted expenditure.l An estimate of £1,324,000 is madein relation to the income due fromincomplete patient spells as at 31March 2013 as the true income inrelation to these episodes of care willnot be know with certainty until thepatient is discharged. This estimateis based on historic trend analysis,together with other relevant factors.l An estimate of £433,000 is made inrelation to the value of unpaid annualleave outstanding as at 31 March 2013for which the Foundation Trust has acurrent liability. This estimate is basedon completed returns received fromeach Directorate within the FoundationTrust.l An estimate is made for depreciation/amortisation of £7,823,000. Eachcapital or donated asset is added tothe asset register and given a uniqueidentifier. The value and an estimatedlife is assigned (depending on thetype of asset) and value dividedby the asset life (on a straight-linebasis) is used to calculate an annualdepreciation charge.l An estimate is made for theimpairment of land and buildingsof £2,010,000 of which £214,000has been included within operatingexpenditure. This was advised bythe District Valuer under the ModernEquivalent Valuation method.l An estimate is made for provisionfor doubtful receivables of £819,000.NHS and Non-NHS receivables arereviewed, together with guidance forspecific areas of income, which reflectthe uncertainty of the financial climateof the healthcare and commissioningmarket.l The Foundation Trust has madeprovision within the 2012/13 annualaccounts for restructuring costs asa result of the proposed merger withPoole Hospital NHS Foundation Trust.32 Senior manager remunerationAnnual Report and Accounts 2012/13 49

Financial Accounts32 Senior manager remunerationDirectors’ remuneration totalled £1,305,000 in 2012/13 (2011/12: £1,323,000). Fulldetails are given in the Remuneration Report.33 Senior manager pension entitlementsThere were benefits accruing to six of the Foundation Trust’s Executive Directorsunder the NHS Pensions Scheme in 2012/13. Full details are given in the RemunerationReport.50Annual Report and Accounts 2012/13

The Royal Bournemouth and Christchurch HospitalsNHS Foundation TrustThe Royal Bournemouth HospitalCastle Lane EastBournemouthBH7 7DWChristchurch HospitalFairmile RoadChristchurchBH23 2JXFurther copies of this Report can be found onlineat www.rbch.nhs.ukIf you would like a copy of the Annual Report and Accountsin a different format please contact the Communications Departmenton 01202 704271.