Item 8 - Sheffield Health and Social Care

ANNUAL REPORT AND ACCOUNTS2012 – 2013Sheffield Health and Social Care NHS Foundation TrustFulwood HouseOld Fulwood RoadSheffield S10 3THPRINTER TO PLACEFSC LOGO TO BEPOSITIONED HERESHEFFIELD HEALTH AND SOCIAL CARE NHS FOUNDATION TRUST ANNUAL REPORT & ACCOUNTS 2012-2013

Mick Rodgers’ retirement eventOur close partnership with SheffieldCity Council and other organisationsAs a provider of integrated health and social care,we work in partnership with Sheffield City Counciland have formal agreements with the council toprovide a range of social care services on its behalf.Through these arrangements, we have made goodprogress in developing an integrated range ofservices that we deliver to the people of Sheffield– an important goal that is shared by ourselves andthe city council.We attach great importance to working inpartnership with other organisations as well.This has enabled us to work effectively in meetingthe needs of the diverse communities that makeup the population of the City of Sheffield.SECTION 2.0Directors’ ReportService User artwork78

2.0 Directors’ Report2.1 Foundation Trust Chair’s statementIt is a great pleasure to introduce SheffieldHealth and Social Care NHS FoundationTrust’s Annual Report and Accounts for2012/13. The Trust has now completedfive years as an NHS Foundation Trust (FT)and has made further substantial progresstowards delivering the improved serviceuser outcomes that were the main reasonfor applying to become an FT.I apologise for the fact that this Annual Report islooking more and more like a doorstep as eachyear passes. However, there are many aspects thatwe are legally obliged to report on. Also there arenumerous excellent service developments that wesimply must draw attention to. Please take sometime to examine the information summarised hereabout the Trust’s performance (as assessed byexternal regulators). The overall picture is extremelypositive and, in the third quarter of the financialyear, SHSC was awarded Monitor’s top ratings forboth finance and governance.Like the rest of the NHS, this Trust faces a hugelychallenging financial context. The Governmentexpects the NHS, nationally, to save some £20billionfrom its budget by 2014/15. For SHSC, this meansaround £16million over this period, or just over£5million per year. The Trust’s total annual incomefor 2012/13 was £128 million which means thatthis has to be reduced by approximately 13%.I hardly need to say that this is very difficult to dowhen most of that expenditure is on staff and thesereductions come on top of more than a decadeof annual efficiency savings targets. In addition,the demand for the Trust’s services is increasingconstantly, for example, because of populationageing and the survival of more babies with highlycomplex disabilities. Responding to these hugechallenges takes a great deal of effort on the part ofthe Trust Board, Clinicians and Managers. The viewtaken by the Board of Directors is that this circle canonly be squared by reconfiguring services, with theprimary aim of improving recovery for service userswhile trying to save money at the same time.Despite the scale of the challenge faced by the Trust,I am confident that it is possible to deliver improvedservices while reducing costs in some areas. Thisconfidence is based, first, on the track record of thisTrust. We have overcome previous obstacles becauseof strength of purpose, dedication to patients andservice users and sheer quality of staff throughoutthis organisation. Secondly, our partnership withservice users and carers gets stronger and stronger.It is this, above all else, that will guarantee theresponsiveness and quality of the Trust’s services.Third, I expect a close partnership to developbetween SHSC and the new Clinical CommissioningGroup (CCG) in Sheffield. Many staff in the Trustalready work closely with primary care and we willseek to extend that as much as possible. Breakingdown barriers between primary and secondary care,and between health and social care, is essential tomaintain and strengthen SHSC services. Therefore,I am confident that this Trust can combine majorservice improvements with a sound financialbalance, as it has done in the past.This Annual Report contains a great deal ofinformation about the quality of the Trust’s services.To most members this will be the main point ofinterest and rightly so. SHSC is required to beregistered with the Care Quality Commission (CQC)and, unlike some other Trusts, is registered withoutconditions. During 2012/13 the CQC did not takeany enforcement actions against the Trust, nor hasit taken part in any special reviews or investigationsby the CQC. The CQC does monitor and reviewthe Trust’s services as it does for all Trusts. During2012/13 the CQC visited seven service locations toreview their compliance with essential standardsof quality and safety. All but one of the servicesinspected were fully compliant and the exceptionhad two relatively minor compliance actions toaddress. Action plans were put in place, reviewedby the CQC and full compliance was achieved.During 2012/13 the CQC also undertook nine visitsto inspect the delivery of care and treatment topeople detained under the Mental Health Act. Theyreview care processes, the environment in whichcare is delivered and meet privately with inpatients.No undue areas for concern relating to compliancewith essential standards have been identified.(There is also a team of Associate Mental HealthAct Managers who review the reasons for detentionunder the Mental Health Act). As noted above,in the third quarter of 2012/13, the FT RegulatorMonitor awarded SHSC its top ratings for financialrisk and for governance risk.As a Foundation Trust we are committed to a constantincrease in membership and this now totals 12630excluding staff. The Trust is very keen to hear fromand be responsive to its members. This helps us to beresponsive to the needs of the communities we serveand to represent those needs to the commissionersof services. Also important is the representation ofmembers provided by the Council of Governorsbecause they speak on behalf of the membershipwhen they contribute to the development of theTrust’s plans (and they do so actively). One of themain opportunities for members to interact withGovernors is the Annual Members’ Meeting, heldeach September. Last year’s meeting again brokeprevious records with over 280 participants.Governors play a crucial role in the life of the Trust.They hold the Board of Director’s to account for themanagement of the Trust and the achievement of itsobjectives, which they also play a big role in setting.We are very fortunate to have a tremendous groupof Governors who are all highly committed to thevalues of the Trust and, especially, to improving thelives of service users and carers. They do criticisethe Trust on various fronts but they do so in a veryconstructive and ultimately supportive way. Atits best this is a highly effective partnership andI am proud of the way that SHSC works with itsGovernors. No praise can do justice to the role thatSam Stoddart plays in achieving this partnership.During 2012/13 we said goodbye to 11 Governorswhose terms of office had expired or who resignedfor other reasons. I want to express the thanks ofthe whole Trust for their contributions to improvingthe quality of SHSC services.Also during 2012/13 one of the NHS’s andSheffield’s most outstanding health servicesmanagers, Mick Rodgers retired after 42 years ofservice. It is impossible to summarise the immensecontribution that Mick made to the NHS in Sheffieldas both a manager of Mental Health and LearningDisability Services, and as a Finance Director. Heserved with distinction in every post he workedin and always put service users and carers first.He ended his NHS career as Finance Director andDeputy Chief Executive. He was crucial in the Trustbecoming an FT in 2008. His leaving event wasvastly oversubscribed and, as speaker after speakerpaid tribute to his professionalism and personalqualities, it was a fitting tribute to this very specialperson. The history of the NHS in Sheffield willalways have to have a chapter devoted to MickRodgers. Thousands and thousands of service users,who have never heard of him, have cause to bethankful for the compassion that led Mick into theNHS in the first place and which made him striveconstantly to improve services. As a Finance Directorhe never lost sight of what the finance is for.During 2012/13 three Non Executive Directorswere reappointed following external competitionand a competitive selection process. They are TonyClayton, Sue Rogers and Mervyn Thomas, and theymake major contributions to the work of the Trust.I have indicated that the next few years are going tobe extremely difficult for this Trust, for its staff andfor the service users and carers it serves. There willbe less funding and increasing demand. We knowthat at times of economic downturn, the numbersof people with mental health and substance misuseproblems increases. In partnership with primary careand the local authority, we will have to try hard torespond to this demand while also balancing ourbudget. We will do it but only with the hard workand dedication of staff and with the continuedsupport of service users and carers. The ability torise above adversity is the defining spirit of the NHSand this Trust in particular. It is this spirit that willprevail and ensure that the Trust is able to respondimaginatively to the challenges it faces.Professor Alan WalkerChair910

2.3 The Board of DirectorsThe Board of Directors provides a wide range ofexperience and expertise that is essential to theeffective governance of the Trust. Its memberscontinue to demonstrate the visionary leadershipand oversight that enables the organisation tofulfil its ambition.At the end of 2012/13, the Board of Directorscomprised of six Non-Executive Directors, includingthe Chair, and five Executive Directors, including theChief Executive.2.3.1. The Non-Executive Team• Professor Alan Walker (Chair)• Susan Rogers MBE (Vice – Chair)• Councillor Mick Rooney(Senior Independent Director)• Martin Rosling• Mervyn Thomas• Anthony Clayton2.3.2. The Executive TeamAt the end of 2012/13 the Executive Teamconsisted of:• Kevan Taylor (Chief Executive)• Clive Clarke (Deputy Chief Executive)• Professor Tim Kendall (Executive Medical Director)• Liz Lightbown (Chief Operating Officer/Chief Nurse)• Paul Robinson (Executive Director of Finance)During 2012/13 the following also held a positionon the Board of Directors:• Mick Rodgers (Deputy Chief Executive andExecutive Director of Finance) retired on the28th February 2013Further and more detailed information about theBoard of Directors and the changes during 2012/13can be found in Section 7 of this report.2.3.3. Directors’ statement as to disclosureto the AuditorsFor each individual who is a Director at the timethat this Annual Report was approved, so far asthe Directors are aware, there is no relevant auditinformation of which the Trust’s Auditor is unaware;and the Directors have taken all the steps that theyought to have taken as Directors in order to makethemselves aware of any relevant audit informationand to establish that the Trust’s Auditor is aware ofthat information.2.3.4. Going concernAfter making enquiries, the Directors havea reasonable expectation that the Trust hasadequate resources to continue in operationalexistence for the foreseeable future. For thisreason, they continue to adopt the goingconcern basis in preparing the accounts.2.3.5. Accounting policies statementAccounting policies for pensions and otherretirement benefits are set out in the AnnualAccounts in Section 15 (note 1) of this reportand details of senior employees’ remunerationcan be found in the Remuneration Report inSection 3 of this report.2.3.6. Our AuditorsExternal audit services were previously provided tothe Trust by The Audit Commission. When this wasdisbanded in 2012, the staff previously engaged onour contract were transferred to KPMG. Thereforewe novated the current contract across to KPMGfor the remainder of the contract (until 31st March2015). The Council of Governors approved thedecision, on the basis that it was the best optionin terms of providing continuity, and also due toKPMG providing a similar service to the other NHSorganisations in Sheffield.2.4 Operating and Financial Review2.4.1 An overview of our principle activitiesWe provide mental health, learning disability,substance misuse, community rehabilitation andprimary care services to the people of Sheffield.We also provide some of our specialist services tothe wider region. We are a provider of integratedservices that meet people’s mental, physical,psychological and social care needs. An overviewof our principle activities over the year issummarised in the sections below.2.4.1.1 Acute and Inpatient DirectorateThe Acute and Inpatient Directorate manages theinpatient services at the Michael Carlisle Centre atNether Edge, The Longley Centre on the NorthernGeneral Hospital site and the Forest Close site onMiddlewood Road. The services included in thedirectorate provide care and treatment in residentialsettings for people of all ages with acute mentalhealth problems, those with longer term mentalhealth needs, and also has a number of beds forpeople in a low-security forensic setting.2012/13 has seen a number of significantdevelopments and achievements in thedirectorate which are outlined below:• In the last year we have taken on theresponsibility for commissioning services forpeople who have been previously managed outof the city. This is providing an opportunity todeliver services closer to home, ensuring highquality standards and saving money to reinvestin mental health provision in Sheffield• 2012/13 has seen the directorate focus ondelivering Respect training for all staff. Thistraining emphasises the importance of staffde-escalating situations and being able to providesafe methods for managing any challengingbehaviour. The training has been providedfor staff alongside service users who havecontributed to the planning and delivery of thetraining. The feedback from staff who haveparticipated in the training has been very positive.There has been an overall reduction in the use ofseclusion for service users since this training hasbeen delivered. This is part of the directorate’sfocus on delivering compassionate care for allthe people who use our inpatient wards• The focus on enhancing the compassionate carewe deliver in the year ahead will continue to beparamount to the services we deliver. We willcontinue to develop the support and supervisionwe offer to all staff, the directorate will buildon developments in psychology in the last yearto ensure that all service users have access totrained psychologists, and we will listen and acton the views of service users and their carers• Risk assessment and management are keyto delivering safe and effective care. Thedirectorate has continued to train all staff inassessing and managing risk. We have reviewedthe forms for monitoring risk and planning withthe aim that staff only spend the necessarytime completing forms to provide effectivesystems. This has included the implementationof electronic record keeping on all our inpatientwards. The directorate is developing careplanning to ensure good engagement of serviceusers with meaningful recovery care plans• The 22 beds provided at Forest Lodge forlow-secure forensic service users have beenreviewed as part of the Royal College ofPsychiatrists National Accreditation Programme.This external review identified that the service isproviding a high standard of care. Forest Lodgeis commissioned regionally and has achievedall the quality standards identified through thecontract monitoring processCommunal area on Rowan Ward1314

• The directorate manages beds for rehabilitationand recovery at Forest Close and PinecroftWard. These services have continued to providelong term care and have successfully supportedservice users back into community living.We have also been working on our Acute CareReconfiguration project, which has seen progressin the following areas:• The acute inpatient services are currentlyundergoing a reorganisation to ensure thatwe can deliver the highest standard of careand treatment for inpatients. This has alreadyincluded the review of and changes to theacute care pathway to ensure clear processesfrom community through to inpatient stay anddischarge home for all our service users• We have started the process of building a newpsychiatric intensive care unit that will open inApril 2014. The Trust is also reviewing the estatefor all the acute inpatient services with a viewto providing a high quality environment that weaspire to be at a national benchmark standard• April 2013 will see the opening of a new CrisisHouse that has been commissioned by the Trustand is being provided by Rethink. This modelof care provides a high quality communityalternative to inpatient admission for thoseservice users who require residential careaway from home but do not require anadmission to hospital.2.4.1.2 Community Services DirectorateThe Community Services Directorate providescommunity-based services mainly to adultsof working age, and during the last year alsoincorporated the Homeless and Traveller’s Service.Most of these services are for secondary care whichsupports individuals with complex mental healthproblems. These services are mainly deliveredthrough our Community Mental Health Teams(CMHTs), multi-disciplinary teams made up ofhealth, social care and other allied professionals andsupport staff. They receive referrals from primarycare and other sources, and carry out assessments,provide interventions and care co-ordination forpeople with complex mental health problems.We also provide social care services that help serviceusers with practical support and developing dayto-dayliving skills, re-engaging with social andoccupational activities, and planned and emergencyrespite. The way that these services are fundedhas changing significantly with the introduction ofSelf-Directed Support (SDS). SDS is the process bywhich service users who are eligible for social carefunding receive individual budgets to assist themin meeting their social care needs. The SDS processcan take time to work through but it can also deliversignificant benefits to service users, giving them morechoice and control over the services that they receiveand thereby enabling them to develop much moreinnovative ways of meeting their social care needs.Homeless and Traveller Health team stand at the Annual Members MeetingThe Directorate also includes primary care-basedservices such as Improving Access to PsychologicalTherapies (IAPT) which is aimed at providing timelimited,evidence-based psychological therapiesfor people suffering from depression and anxiety,through the provision of psychological therapies.Most of the service users seen within the directoratereceive treatment from the IAPT service.During 2012/13, significant service developmentshave been as follows:• The Directorate has implemented thereconfiguration of Community Mental HealthTeams (CMHTs) which brings together thedifferent elements of community mental healthservices into a locality based team. As wellas making significant financial savings, thesechanges are designed to enable better accessto the service from primary care, and smootherworking across acute and community teams.This has been a year of significant change forthe teams, and over the next year we will workto evaluate and further embed these changes• Last year we continued to roll out the ScheduledCare Pathway across all of our adult CMHTs. Thisprovides a consistent approach to the standardsof care for non-crisis referrals to mental healthservices. It works in conjunction with the AcuteCare Pathway which is designed for crisis mentalhealth referrals. It will be further developed to takeaccount of SDS and aims to streamline paperworkfor front-line staff• We had a major celebration in January 2013 in aidof the Sheffield Works, a comprehensive pathwaycombining health and employment interventionssupporting unemployed people with severeand enduring mental health conditions to moveforwards into work, as part of their recovery. Weare also finalising new forward-thinking proposalsfor Vocational Services that will soon be consideredby the Trust’s Board of Directors• The IAPT service was selected this year to be anational pathfinder site for working with patientswith long term physical health conditions, ormedically unexplained symptoms, as well asdepression and anxiety. Depression and anxietyare commonly linked with long term physicalconditions, and we know that where peoplesuffer from these problems together, theiroutcomes are likely to be worse. Therefore, wehave been training all of our IAPT staff to betterwork with this group of patients, and haveworked with Health and Medical Psychologists inprimary care. This will be evaluated, both locallyand nationally, in the next six months, and we willthen be looking at the learning from this projectas we develop our services in the future• Our SPACES service has developed a RecoveryEducation Programme, a 14 week recoverybased programme which service users canaccess either as a stand-alone service or as partof a wider care package. This has generatedsome excellent service user feedback so far,and the number of people accessing the servicecontinues to grow. We will be working over thenext year to develop this further.As well as the things mentioned above, in theforthcoming year we expect to:• Facilitate major service user and staff surveys forNHS and social care funded services, as part ofactively listening to what our service users andstaff tell us• Increase our focus on national and localquality measures and how we both meetand record them• Continue to work with the Right First TimeProgramme, looking at people who suffer fromcommon mental health problems and have longterm physical health problems as well, and alsolooking at the physical health of people whosuffer from serious mental illness• Evaluate recent service developments within thedirectorate such as the CMHT Reconfiguration• Seek to expand the Recovery EducationProgramme within SPACES, a programme thatprovides short term intensive support for peopleto get back on track as part of their mentalhealth recovery• The Specialist Psychotherapy service will be onthe move, going from working across three sites(St. Georges, Brunswick House and the MichaelCarlisle Centre) to one, as they will all be housedat St. Georges1516

• Develop provision within our popular mentalhealth respite facility at Wainwright Crescentin light of the new Crisis House opening inSheffield in spring 2013. This will build on thesuccessful development last year of step-downbeds at Wainwright Crescent• Further implement Self-Directed Support. Thereare now over 445 people who have an agreedsupport plan in place and 823 others who havean identified indicative budget and are in theprocess of developing their support plan. This is asignificant increase on what we achieved last year,and well towards our expected number of 1500people across Sheffield by the 31st March 2016• Submit a tender for the Mental Health FloatingSupport Service. This service aims to delivershort term (up to 6 months) intensive support toservice users with mental health problems. Thesupport relates to housing issues, to make surepeople have sustainable tenancies and includesfocusing on crisis situations, hospital dischargeetc. This support to clients compliments thework of CMHTs• Seek to expand the Home Environment Servicethat helps clients with cleaning support as partof their Recovery, within the Mental HealthFloating Support Service.Beighton Road Learning Disabilities Service2.4.1.3 Learning Disabilities DirectorateThe Learning Disabilities Directorate works inpartnership with the Local Authority to providespecialist services as part of the Joint LearningDisabilities Service. The services provided consist of:• Specialist challenging behaviour and mentalhealth services• Community multi-disciplinary health supportas part of integrated Community LearningDisability Teams• Accommodation and support services:– Nursing and registered care homes inpartnership with housing associations– Supported living services– Tenancy support• Respite care for people with complexneeds, including profound and multiplelearning disabilities• Case Register• Older Carers Support Service.The following is a summary of our main activityduring the 2012/13 period:• This year has been a period of considerablechange and development for the specialistservices – previously the Improving MentalWellbeing Team, the Community Assessmentand Intensive Support Service (CAISS team, forchallenging behaviour), and the Assessmentand Treatment Unit (ATU). Based on a businesscase developed to deliver best practice in a newmodel of community-focussed services, thethree services have come together to create theIntensive Support Service (ISS). The focus is onensuring local capacity to support people withcomplex needs and maintain provider capabilityto reduce out of city placements. A new buildinghas been commissioned to replace the currentATU and provide the community base for theISS, scheduled for opening in May 2013.The accommodation services have performedwell over the year with all inspected servicesachieving full compliance with the CQC.They are all part of a commissioning-ledreconfiguration programme that is aiming toreduce costs and modernise services. Options arebeing explored for all these services to enablethem to be more personalised, giving peoplemore choice and independence. This will lead tosome refurbishments and some restructuring ofpremises to provide more individualised services.New models of support and staffing structureshave been developed and implemented tohelp meet the aims of the programme, whilstmaintaining quality service provision• New business has been developed to respondto the demand for support for people withcomplex needs who have personal budgets.We have successfully developed a flexible andresponsive service that can provide short or longterm support. For example, this has includedresponding to a crisis need for someone withcomplex behaviour at risk of having to be placedout of city, as well as long term support forsomeone coming through the transition fromchildren’s to adult’s services• The Community Learning Disability Teamshave focussed on developing care and supportpathways to ensure effective and timelydiagnosis and interventions. These havebeen completed for dementia, challengingbehaviour and autism, with others currentlyin development, leading to the developmentof professional practice as well as improvedsupport for carers and providers• Investment from the PCT to reduce out of cityplacements has enabled the multidisciplinaryOut of City Team to successfully return a numberof people with Learning Disabilities to Sheffield.In partnership with the Local Authority, providershave been supported to set up new specialistservices for some of the people with the mostcomplex needs. This will be an on-goingprogramme and includes assessing everyoneplaced out of city and ensuring quality andappropriate services regardless of whetheror not they intend to return to the city.As with the other directorates, we face severalcurrent challenges and issues for the future:• A new requirement for registration with theCQC led to pressures and challenges for someof the services. The premises for the ATU andthe specialist respite services based at theNorthern General Hospital site were consideredinsufficient and non-compliant with registrationrequirements. This was not a new issue and soplans for replacement buildings were already indevelopment and have been accepted by theCQC. The new building for the ISS will bring thatservice into full compliance, however the solutionfor the respite service is more elusive and remainsa pressure. Active negotiations are underway withpotential partners for alternative premises• There are uncertainties around the futureof the accommodation services as the LocalAuthority considers the best options for eachscheme in the reconfiguration programme. TheTrust Board has also been considering the bestoptions for the future services of the Trust andconcluded that it should not continue to provideregistered care home services but should focuson services that provide specialist support forpeople with more complex needs. Plans arebeing put in place to de-register the remainingregistered care homes, but it is not yet certainhow contracts for support will be agreed andmanaged in the longer term. To mitigate theuncertainty the Trust is currently negotiatingnew contracts and is an active partner inexamining alternatives for the future of directlyprovided services with the Local Authority1718

• Changes in demand are starting to berecognised now that Self Directed Support hasbeen established in the Local Authority. Blockcontracted provision is less likely to be part ofthe future picture and the local commissioninglandscape envisages a tapering of blockcontracts as individual budgets replace them.As personal health budgets are likely to be afeature during 2013/14 the service has beenfocussing on understanding future demand.In particular this is likely to have an impacton respite servicesThe Trust does have the potential to respond tothe needs of people with the most complex needsand their families, and the demographics indicatethat this is an area of increasing demand. Workis underway to discover the potential choices andpreferences in the future and services are lookingto develop flexible and affordable models of servicearound this.2.4.1.4 Specialist Services DirectorateA range of services are hosted under the umbrella ofthe Specialist Services Directorate. These include:• Community and bed-based mental health andsocial care services for older people, includingthose with dementia• Screening, assessment, harm reduction andprescribing services to people who experienceproblems as a result of alcohol and drug use• Specialist health services, including PerinatalMental Health; Aspergers and Eating Disorders• Relationship, sexual and gender identity services• Psychological Services to Sheffield andsurrounding districts• Therapy Services including OccupationalTherapists, Physiotherapists, Speech & LanguageTherapists, Dietetics and Chaplaincy• Services for people with a neurological injury ordisease that causes long term restrictions in thescope and quality of their everyday lives.The Specialist Directorate has achieved against anumber of significant objectives during 2012/13,including the following:• We have retained all of our existing servicecontracts and expanded in a number ofkey areas. Funded via the city’s Right FirstTime initiative (a city-wide project looking attransforming Sheffield’s health services) wehave the ability to provide a multi-disciplinaryolder adult liaison service to older people usingSheffield Teaching Hospitals Foundation Trust(STHFT). This is supported by increased capacityin the community to avoid unnecessary hospitaladmissions and support earlier discharge.Substance Misuse Services have seen theinvestment of specialist posts in A&E Liaison,GP Alcohol Liaison and Dual Diagnosis tosupport its core portfolio. Our Memory Servicehas had additional investment to support thetransfer of non-complex service users to receivetheir routine reviews by their own GPs• We have continued to be successful ingenerating external income from other NHSTrusts and commissioning authorities. This hasbeen particularly true in Psychological Servicesto Rotherham, Aspergers, Gender Identity andChaplaincy services to Alpha Healthcare• The Directorate continues to plan for growthopportunities; we have been particularlyfocusing on Aspergers, Autism & ADHD, GenderIdentity and Substance Misuse Services• We have continued to look at the way weprovide services to ensure they meet the needs ofservice users, their carers and our commissioners.Detailed work has been undertaken to explorethe future configuration of our DementiaResource Centres which will see less of a relianceon building-based services and more communityworking as we move into 2013/14• We have also been looking at the way in whichwe provide services to people with Long TermNeurological Conditions and our input toCommunity and bed-based Intermediate CareServices, hosted via Therapy Services. Thesereviews help to shape the way in which wefuture configure and provide services to meetthe increasing needs of Sheffield’s population• In order to respond to the challenging publichealth agenda on alcohol misuse, our SubstanceMisuse Services have been showcasing excitingdevelopments made in-house of an electronicscreening and assessment tool which hassparked significant interest regionally andnationally. 2013/14 will see furtherdevelopment of this initiative• We have continued to develop our services sothat we are able to support more people in thecommunity or in their own homes• Our Psychological Services provision has grownduring 2012/13 in areas such as physical healthcare in Rotherham, and we have been reviewingthe way in which we deliver other services. Twoexamples of this are the Pathfinder pilot withEating Disorders TeamSubstance Misuse stand at the Annual Members Meeting1920

IAPT, working in a stepped care manner withpeople with Long Term Conditions or MedicallyUnexplained Symptoms in primary care; and thereconfiguration of some older adult psychologysessions to provide a specialist clinicalneuropsychology service to stroke patients inthe community. This latter development enablesa greater number of patients to be seen in atimely manner in community settings. Withthe aim of improving access to psychologicalcare across care pathways, we have carriedout a review of our senior clinical psychologyposts in adult mental health and also put someinvestment into the Acute Mental Health Wardsin the last year. We have also held successfulpractice development events on Consultationand Supervision & Case management inresponse to governance processes• The Functional Intensive Community SupportService (FICS) became operational during 2012,working with older people whose hospitaladmission can be avoided with more intensivecommunity support and also aiding earlierdischarge from hospital• Our Memory Service was accredited as“Excellent” in 2012/13 by the Royal College ofPsychiatrists’ National Accreditation Programme• The Directorate met its Cost Improvement Planfor 2012/13 and managed an under-spendposition due to fortuitous savings and incomegeneration opportunities in 2012/13• The Directorate continued to review all serviceareas to identify efficiencies and shape plans forfuture financial years.Other Strategic Achievements in 2012/13 are:• The reconfiguration of the Older People’sFunctional Mental Illness and DementiaResource Centres, resulting in more peoplebeing supported by community alternatives• The reconfiguration of Older People’s functionalmental illness day hospitals, which resulted inthe proposal for the new Functional IntensiveCommunity Service• Board approval for the formation ofRecovery Enterprises• The continued growth of specialist mentalhealth, relationship, sexual and gender identityservices, psychological & therapy services andSubstance misuse services to Sheffield and itssurrounding districts• New staffing and clinical service models beingnegotiated to provide high quality enhancedcare. This follows NHS Sheffield’s decision tocontinue to provide Birch Avenue & WoodlandView Nursing Homes.Going forward, we continue to face the followingrisks and uncertainties which will challenge thefuture provision of our services:• The continued increase in competition andre-tendering of core services in a time offinancial uncertainty and reduced publicsector budgets• The need to ensure services are able to meetthe demand of our service users in line withcontinued advances in self directed supportand payment by results• Unprecedented budget reductions.Other trends and factors that are likely to affectthe future development of our Directorate’sbusiness include:• The expected rise in the number of older peoplewithin the city• The continuing need to work across primary andsecondary care services and develop and expandour expertise as a reputable provider of primarycare solutions• Further partnership working with the LocalAuthority and not-for-profit sector to deliverhigh quality and affordable services• Continuing to build on our interface with STHFTto increase the provision of services to peoplepresenting in crisis and in need of our support• Increasing opportunities to generate incomein our specialist mental health services,relationship, sexual and gender identity services,substance misuse, psychological and therapyservices, through understanding the needsof our customers and ensuring the proactivemarketing of our services to external customers.2.4.1.5 Clover GroupThe Clover Group Practices are four GP practicesbased in Darnall, Tinsley, Jordanthorpe and MulberryStreet in the city centre, which merged to form one‘super practice’ in May 2011. The practices servesome of the city’s most vulnerable areas and alsorun a specialist service for asylum seekers. We havea three year Alternative Provider of Medical Services(APMS) Contract and currently have over 15000registered patients.The Clover Group’s six key priorities during 2012/13have been to:1. Continue to develop the Clover modeland implement a strong clinical andmanagement structure2. Work as a key stakeholder in the localcommissioning agenda3. Improve the quality, safety and experience of ourservices for the people who use our services andtheir carers by engaging patients in the deliveryof services4. Develop locally accessible services and increasethe delivery of enhanced services5. Support the delivery of high quality care byrecruiting and retaining high calibre clinical staff6. To achieve continued high performance againstbest practice and regulatory standards.New Darnall GP practice buildingThe following are some of the Clover Group’s keyachievements in the past year:• The Clover Group Practices are developing as anAPMS multi-site flagship that others can learnfrom. We are looking at the efficiencies whichcan be achieved through redesigning bothadmin and management structures• We have a Patient Participation Group withover 80 patient members with whom we meetregularly, to enable us to increase awareness ofneeds and improve health outcomes for hard toreach, BME and vulnerable groups• The Clover Group continues to provide consistentenhanced service delivery and look for newoptions to increase our income. We achievedhigh standards in the Quality and OutcomesFramework and are the first practice in Sheffieldto work on Key Performance Indicators, whichare a set of areas in which we are monitored onour clinical performance.The following is considered the main strategic risk anduncertainty that the Clover Group currently faces:• The contract value decreasing due to meetingefficiency savings, putting the three year APMScontract at risk. The risk of reduced staffing dueto cost improvements has the potential to reduceaccess to our services and patient satisfaction.2122

2.5 An overview of our arrangementsfor quality governanceThe Trust has produced an Annual GovernanceStatement which describes our arrangements forquality governance. This is contained in Section13 of this report.2.6 How we use our Foundation Truststatus to improve patient careFoundation Trust status enables us to engageGovernors and members, who represent thecommunities that we serve, in the developmentof our services and the improvement of patientcare. The Quality Report, contained in Section 11of this report, shows some of the ways in whichour Governors and members have been involvedin shaping the way that we have delivered ourservices over the last 12 months.2.7 How we involve patients and thepublic in improving servicesThe involvement of service users, carers and thepublic in helping to improve and develop ourservices is shown in more detail in the QualityReport. One example of an innovative project isinvolving our service users and carers in mock CQCvisits. The Partners in Improving Quality group hasbeen in existence since 2009, and was originally setup to look at how SHSC involved its service usersin reviewing the quality of its services, with a focuson CQC standards. The group is made up of awide range of service users and carers from a rangeof directorates within the Trust, including peoplewith learning disabilities. The group are currentlyembarking on more CQC mock visits in a widevariety of different locations.2.8 How we monitor improvementsin service qualityWe monitor improvements in service quality throughour governance systems and the Quality Report. TheBoard and its Quality Assurance Committee receiveregular reports on service quality and improvements.The Quality Improvement Group provides anopportunity for clinical staff, managers, Boardmembers, Governors and others to hear, in detail,about quality improvement projects, and share ideasfor innovation and best practice.We also report externally to our commissioners on:the quality of services that we provide; the serviceimprovements that we make; our progress inachieving the various quality targets that are set forus annually in our contracts with our commissionersand; our performance in the additional arrangementsthat our commissioners use to incentivise us to makequality improvements in areas that they prioritise.These arrangements are known as Commissioningfor Quality and Innovation (CQuINS).Further information is available in the AnnualGovernance Statement, the Quality Report and ourperformance reports which are contained in furthersections of this report.2.9 How we are improving Patient/Carer InformationInformation is an integral part of the service userjourney and is fundamental to the overall qualityof each service user’s own personal experience ofthe NHS. Improving information for service usersis a commitment in the NHS constitution, and isalso cited in the document ‘NHS 2010 – 2015:from good to great. Preventative, people centredproductive’ (2009), and was also part of therecommendations in the Francis Report (2013).During 2012/13 the Trust has been involved in arange of initiatives that have helped to improve theway we are providing information to those peoplewho use our services, and their carers. These include:• Throughout 2012/13 our service users andcarers have been a part of reading panels, andthey have been instrumental in helping to bothshape and change a wide range of documents,which include: policies, ward leaflets, bookletsand posters. One of our service users whois a prominent member of The Creative ArtsSteering Team (CAST) has worked collaborativelywith both the Patient and Public InvolvementManager and the Infection Control team indesigning the Trust’s new Hand Hygiene posters,which can be seen throughout the Trust’s sites• Embracing co-production and workingcollaboratively with a very wide range of serviceusers and carers, including people with learningdisabilities. The Partners In Improving Quality Grouphas been asked to utilise their own expertise andlived experiences and have designed ‘easy- ead’pictorial versions of a range of documents, leafletsand reports. Their knowledge is invaluable inhelping us to personalise our information to adaptand suit the groups it is meant to serve• The information that is gleaned from specificprojects such as the Quality and Dignity projectwill be collated, written and also presented byour service users and carers. This informationwill be written from their own analysis of thefindings of questionnaires and will be interpretedusing their own words. The Quality and DignityProject is an excellent example of a project that isbeing led by service users and carers. The findingsfrom the questionnaires are displayed within theward environments so that everyone can see theimprovements that are taking place.2.10 How we handle complaintsand concernsThe Trust is committed to ensuring that all concernsand complaints are dealt with promptly andinvestigated thoroughly and fairly.Both local and national research indicates thatwhen things go wrong, individuals expect Truststo recognise and acknowledge errors; to offer anapology, to give an explanation for what took place;and to give assurance that measures have been putin place to prevent a recurrence.Service users, carers, or members of the public whoraise concerns can be confident that their feedbackwill be taken seriously and that any changes madeas a result of the findings of the investigations willbe fed back in order that services can learn thelessons and make necessary changes.During 2012/13 the Trust received 133 formalcomplaints and 241 informal complaints. Weresponded to an estimated 83% of the formal2%complaints within our timescale of twenty five7%working days, and we responded to 100% ofthe informal concerns within our timescale of9%five working days.During the same period the Trust received 1,2556%compliments in relation to Trust services and our staff.More information is provided in our comprehensive67%10%Annual Complaints and Compliments Report &Complainant Survey which is available on our websiteand which can be accessed via the following link:www.shsc.nhs.uk/about-us/complaints.2.11 Who our main commissioners areAs an NHS Foundation Trust we provide a rangeof services, covering direct care services, training,teaching and support functions. The maincommissioners of our clinical services during2012/13 are NHS Sheffield, Sheffield City Counciland other NHS Primary Care Trusts.Our non-patient care services are commissioned byNHS Sheffield, other NHS Foundation Trusts, NHSTrusts and Whole Government Accounts (WGA)organisations, along with other NHS PrimaryCare Trusts.The Strategic Health Authorities, Primary Care Trustsand Department of Health commission education,training, research and development from us.Housing Associations commission our residentialcare services.Total Income by Commissioner6%10%9%7%2%67%2324

2.12 Our performance against keyhealthcare targetsWe have performed well and achieved all requiredhealthcare targets. The information about howwe did against different targets for our servicesis contained in our Quality Report in Section 11.In summary we achieved:• All targets for mental health services required byFoundation Trusts, and by the Departmentof Health• All targets to improve access to psychologicaltherapies for common mental health problemswithin primary care• The standards for childhood immunisation, andour performance improved within our GeneralPractice services in respect of primary care andstandards for vaccinations• National targets for the effectiveness oftreatment for substance misuse services• Required standards of care in respect of thequality of food, privacy and dignity and theenvironments in which we deliver our services.2.13 How we monitor improvementstowards meeting national andlocal targetsOur performance framework ensures we are ableto effectively monitor progress against national andlocal targets. The framework is based upon:• Clear accountability throughout the organisationensuring we are aware of what is expected of us• Established performance measures andindicators that will enable us to assess ourachievement in delivering high quality care andour overall strategic aims• The provision of appropriate information toenable reviews of local and organisationalperformance and on-going decision making.The Board of Directors receives a range of performancedata and information within a planned reportingframework to ensure monitoring and evaluationof progress and outcomes is undertaken andimprovement interventions are directed when required.2.14 Significant changes we havemade to existing services and newservices we are providingDetailed information regarding the range and scopeof the changes we have introduced to improve anddevelop our services is outlined in section 2.4 ofthis report. At an organisation-wide level, the moresignificant changes that have been made to ourservices are summarised as follows:• We began building our new community centre tosupport people with learning disabilities who alsohave challenging behaviours. We have investedover £3 million in a new centre at Roewood tosupport the delivery of integrated care, supportand treatment. This new service will integrateour community and inpatient teams so that careand support can be provided seamlessly acrosscommunity and residential settings. We are excitedand proud of this long overdue development.The standard of the care we have provided at ourprevious service, the ATU, has been recognised bythe CQC as being of a very high standard, but in apoor quality environment. We look forward to ournew purpose-built facility supporting the service todeliver even better support in the future• We changed the way we provide our CMHTservices. Following consultation in 2011/12 wecombined our different teams into an integratedservice. We now have four teams, each coveringa different area of Sheffield. Each team providesfor new assessments, liaison and consultationwith primary care and short term interventions,crisis support and home treatment and ongoingrecovery support and treatment whereneeded. These changes were introduced overthe summer and autumn of 2012 and earlyevaluation of the impact has been positive• Towards the end of 2011/12 we combined ourpreviously separate day hospitals and dischargesupport teams for older adults into an integratedcrisis and home treatment support team. Thistype of support was available for working agedadults but not older adults within Sheffield.The new service fully started from April 2012onwards. The purpose of the service is to providecommunity based intensive support for people ina crisis as an alternative to hospital admission• As part of a national pilot our IAPT serviceshave been identified as one of seven Pathfindersites in the country. The pilot has aimed toexplore how best to support people with longterm physical health problems, and people withmedically unexplained symptoms through betteraccess to psychological therapies. The formalevaluation of the full pilot will not concludeuntil next year. Initial and emerging resultsfrom the pilot indicate that this developmenthas had a real and significant impact on thelives of people in Sheffield• Under the Sheffield-wide developmentprogramme, Right First Time, we have pilotednew services into Sheffield Teaching HospitalsNHS Foundation Trust. These services havelooked to expand and support the provisionof advice, assessment and after care providedto older people with mental health problems,particularly dementia, who have been admittedfor general hospital care• We have developed a new service throughour SPACES service. The Recovery EducationProgramme (REP) is a short-term intensiveeducation programme designed to help peopleget back on track as part of their mental healthrecovery. The programme deals with a widerange of issues focussing on the challenges thatoften block a person’s recovery. This approach ispart of our overall recovery agenda, to promoteand develop ways in which we can help peopleto better equip themselves to develop their ownplans to achieve their own goals• Following an engagement and consultationprogramme led by the Council, we implementedour plan to provide better quality and intensiverespite support for people who experienceemergencies with their support arrangements.Our plans aim to support people to stay athome rather than being admitted to hospital ora care home. We aim to deliver this through asmaller but higher quality respite service, andby supporting more people than at present withindividual care packages that are focussed onsocial and community engagement, deliveringrespite support in a non-residential way. Partof this plan has brought together servicespreviously provided by the Norbury and HurlfieldView resource centres, and as a result Norburywas closed in March 2013.2.15 How we work with our partnersWe work in partnership with the organisations thatcommission our services, namely NHS Sheffield,the emerging Clinical Commissioning Groupand Sheffield City Council. This allows us tounderstand the health and social care needs in thewider population, to influence the commissioningapproach taken and to develop new services for thebenefit of the people of Sheffield.We work in partnership with a diverse groupof interested parties across the public and thirdsector, voluntary and local community groups. Thisallows us to develop better relationships with otherorganisations who support people in Sheffield andfosters better collaborative working between us.We use these opportunities to promote the needsand interests of the people that we serve andto reduce some of the barriers people can oftenexperience in accessing the services that they need.We also provide a number of services in partnershipwith other organisations.2.15.1 Delivering integrated healthand social careWe have a formal partnership agreement withSheffield City Council to deliver integrated mentalhealth services across health and social care forworking aged adults (people aged between 18 – 65years of age). Under this partnership, Sheffield CityCouncil has formally delegated to us its statutoryresponsibilities for the provision of services coveredby the partnership agreement. This partnershiphas been in place for over 10 years and has beeninstrumental in allowing us to develop and providethe services that we deliver. The people who use ourservices have benefited from our ability to developand deliver genuine integrated models of servicesthat provide seamless care pathways across healthand social care.Through our partnership arrangements with SheffieldCity Council, we also deliver integrated services forpeople with learning disabilities. Together we haveestablished a single joint service model across healthand social care.During this year we entered into a new partnershipwith Rethink, for the delivery of a Crisis Houseservice in Sheffield. We have commissioned Rethinkto provide a Crisis House, run and staffed by themand it is scheduled to open in April 2013.2526

This development is an important step in the waywe are improving how we support people whoexperience a crisis with their mental health. Itprovides more choice for people about how wecan support them. Rethink have a lot of experiencein providing crisis house services elsewhere in thecountry, and we are pleased to be developing thisimportant service in partnership with them.2.15.2 Intermediate careWe work in partnership with Sheffield TeachingHospitals NHS Foundation Trust to provideoccupational therapy and mental health servicesinto the intermediate care services they provide.2.15.3 Improving service user experienceIn partnership with MAAT Probe and other serviceusers we have continued the implementation ofRESPECT training following extensive review of ourservices in 2011/12 focussing on the prevention andmanagement of violence and aggression. By workingin partnership in this way we have been able to effectsignificant and positive change to our practice inthis challenging area. Information regarding this isprovided in more detail in Section 11.Sheffield Wednesday’s Rob Jones helpinglaunch the 12 for 12 campaign2.15.4 Partnerships with the people whouse our servicesMost importantly, we work in partnership withthe people who use our services, our membersand Governors who represent them. We worktogether in monitoring and evaluating the currentperformance of our services and in planning theirdevelopment in the future. Numerous examplesthat illustrate how we have benefited from thisare outlined in the Quality Report in Section 11.2.16 Valuing our staffSupporting Staff through ChangeThe drive to improve and respond positively tochanges in our social and economic environmenthas continued over the past year. Inevitably this hasinvolved both challenge and change. The Trust‘spolicies and procedures to help and support staffcontinue to be applied, and adapted as necessary, tomeet these requirements. The Trust’s redeploymentprocess in particular has been successful in helpingto ensure that the retention of staff is maximizedconsistent with skills and service requirements.The Trust also regularly provides the opportunity forstaff wishing to apply to leave employment underthe Mutually Agreed Resignation Scheme (MARS).This is based on a national model and so far therehave been 5 rounds of this scheme since it wasintroduced in April 2011. This has helped to reducethe headcount across the Trust consistent with thefinancial plans and situation.The CMHT reconfiguration has progressed successfullythough not without its’ challenges, and across theTrust there are a number of similar but smaller scaleprojects taking place. Currently the Trust is workingwith other Trusts in the city to re-orientate thearrangements relating to the provision of a numberof facilities management and other contracts.Throughout these processes the Trust has workedclosely in conjunction with Staff Side.The restructuring of Clinical Directorates last yearled to the development of closer integration of oursenior/middle managers (both between themselvesand with the HR team) to enable greater sharingof knowledge and experience as well as helpingto ensure common issues are highlighted andaddressed. The Executive Team has also reconfiguredsome of its roles and responsibilities to better matchinternal and external requirements.The coming year will see further considerationbeing given as to how to help facilitate changemanagement, including the provision of additionaltraining, tools and techniques. This is in anticipationand recognition of further changes includingthose relating to acute care and our social careestablishments. More broadly, the Trust has takenforward the development of its Training Prospectuswhich has assisted staff in ensuring that they havethe right skills and competencies for their role.The recognition of the importance of work-lifebalance has been demonstrated by our 12 for 12Campaign to improve staff health and well-being,which concluded in Autumn 2012. This involved12 sets of activities over 12 months picking up thetheme of the Olympic Games. It actively encouragedstaff to participate in activities such as cycling,walking, stress reduction, eating well and dancingamong other events. The Trust already has a numberof existing health and wellbeing initiatives e.g.Workplace Wellbeing, Mindful Employer and staffhealth and wellbeing web pages on the ‘Working forthe Trust’ section of the SHSC internet site. Howeverwe decided that we needed to consider further waysto engage staff around their health and wellbeing. A15 month ‘task and finish’ group was established andchaired by Sue Rogers, Non Executive Director. Thegroup had representatives from all the key sites acrossthe Trust including communications, estates, inpatientareas and community teams. The remit of this groupwas to develop staff engagement around health andwellbeing, review progress of the Boorman reportwithin the Trust and take forward some practicalideas. By offering a variety of experiences aimed atappropriate times of the year over a focused period,we hoped there would be something for most staffand that some would continue with activities afterthe events. With no NHS funding allocated to theproject we successfully applied for £3,000 from theSheffield Charitable Trust to support ‘12 for 12’.About 935 people took part in the activities (basedon attendances at events, bookings and participationin activities). Whilst we are aware that some of thisnumber were repeat participants, we also knowthat there were others who accessed the websiteand used the information but did not attend events.Indeed, the web pages acquired 3560 hits duringthe campaign period. The Trust was awarded a silvercertificate from the NHS Sport & Physical ActivityChallenge, a scheme inspired by the 2012 Gamesto promote a healthy lifestyle and encourage andsupport staff to get more physically active.Work-life balance was also addressed through theintroduction of our Additional Leave Scheme during2012/13. This has provided staff with the scope toapply for up to 30 days additional leave as part of asalary exchange agreement. The scheme has provedvery successful in terms of take-up with 95 stafftaking on average around two additional weeksholiday. This has also contributed significantly tocost savings within the Trust. It has been agreed torun a similar scheme for the 2013/2014 financialyear. In addition to this new scheme, the Trust alsoupdated its Flexible Working Policy and renewed theVoluntary Reduction in Hours Scheme.As part of the 12 for 12 Campaign the Trustintroduced a salary exchange scheme for thepurchase of cycles. This scheme has been renewedand the Trust is currently in the process of extendingsalary-exchange schemes to other areas such asmobile phones and computers.2.16.1 Equal opportunity statementWe believe in fairness and equality and aim to valuediversity and promote inclusion in all that we do.This is demonstrated in our strategic vision, which isthat people who use our services will achieve theirfull potential, living fulfilled lives in their community.Valuing the diversity of people who work in ourservices and prioritising equal opportunity isessential to meeting this aim.We are committed to eliminating discrimination,promoting equal opportunity and doing all thatwe can to foster good relations in the communitiesin which we provide services and within our staffteams, taking account of gender, race, colour,ethnicity, ethnic or national origin, citizenship,religion, disability, mental health needs, age,domestic circumstances, social class, sexualorientation, marriage or civil partnership, beliefsand trade union membership. Everyone who comesinto contact with our organisation can expect tobe treated with respect and dignity and to haveproper account taken of their personal, culturaland spiritual needs.2728

Within our teams valuing difference is fundamental;it enables staff to create respectful workenvironments and to deliver high quality care andservices whilst giving service users the opportunityto reach their full potential.If unjustified discrimination occurs it will be takenvery seriously and may result in formal action beingtaken against individual members of staff, includingdisciplinary action.2.16.2 Equality and diversityIn 2012 we published Equality Objectives whichhave replaced the objectives in the Trust SingleEquality Scheme.Our Equality Objectives are:• Equality Objective 1 – To improve how we recordwhen service users have physical impairments• Equality Objective 2 – To improve how we recordsexual orientation• Equality Objective 3 – To improve staffsatisfaction for staff from black and minorityethnic (BME) groups• Equality Objective 4 – To improve informationabout staff who are carers• Equality Objective 5 – To identify at least oneequality objective annually through the Trustannual quality objective settingEquality and Diversity certificate of achievement• Equality Objective 6 – To share equalityobjectives with other local health andsocial care organisations.More information about how our Equality Objectiveswere identified and agreed and how we plan toachieve them can be found on the Trust’s website at:http://www.shsc.nhs.uk/about-us/Equality-Diversity-Human-Rights/Our-Equality-Objectives and in theTrust 2011/12 Annual Equality and Human RightsReport which is published on the Trust website at:http://www.shsc.nhs.uk/about-us/Equality-Diversity-Human-Rights/Meeting-our-Equality-DutiesThe Public Sector Equality Duty means that the Trusthas to have ‘due regard’ in all that it does to:• Eliminate discrimination, harassmentand victimisation• Advance equality of opportunity betweenpeople protected by the Equality Act and others• Foster good relations between people protectedby the Equality Act and others.The Trust’s Equality and Human Rights reportincludes information about the actions that theTrust has taken to support this Duty and to meetthe goals that the NHS has set in the NHS EqualityDelivery System to promote equality.Equality and Diversity Highlights of 2012/13Eliminating discrimination, harassmentand victimisation• In 2012 the Trust updated the range ofinformation published in our Annual Equalityand Human Rights reports to include moreinformation about the people who use ourservices. This information can be found on theTrust’s website in the Equality and Human RightsReport – Supplementary Data Report:http://www.shsc.nhs.uk/about-us/Equality-Diversity-Human-Rights/Meeting-our-Equality-DutiesAdvancing equality of opportunity forprotected groups• The Trust continued to develop three StaffNetwork Groups, and in 2012 an event was heldto mark the official launch of the Trust’s BME staffnetwork group. The event was a great success,with accounts from senior staff in the Trust abouttheir personal and professional experiences and aninspiring keynote speech from Uduak ArchibongPhD, Professor of Diversity at the University ofBradford. Kevan Taylor, Chief Executive, openedthe event and it was also attended by the DeputyChief Executive Mick Rodgers• A new policy on Gender Reassignment Supportin the Workplace was drafted• A survey of staff carers took place, i.e. staff whocare for a relative or friend. We received over100 responses and have developed an actionplan based on these responses• We started to develop a new strategyframework to promote equality of opportunityfor BME staff and service usersFostering good relations between people inprotected groups and others• We attended the Sheffield Lesbian, Gay, Bisexualand Transgender Pride event with colleaguesfrom NHS Sheffield to promote our mentalhealth services and anti-stigma work• The Trust continued its involvement inthe development of the city-wide EqualityEngagement group – this group aims to be afocus for engagement with groups protectedunder equality legislation and an opportunity towork in partnership with other NHS Trustsin Sheffield, and Sheffield Local Authority.2.16.3 Disability employmentIn 2012 we renewed our ‘two ticks’ standard andmaintained our action plan to support the Trust as aMindful Employer. In 2012, 4.69% of staff reportedthat they have a disability, a slight increase from4.23% in 2011.2.16.4 Staff engagement and working withStaff Side (Trade Unions)Engagement with staffWe have a workforce of over 3,000 staff (includingour flexible workforce). As a Trust we recognise thatthe right staff are our most valuable asset and weare committed to working in partnership with themin order to ensure that they are properly informedand engaged.We have a variety of mechanisms for engaging withour members of staff and we continue to abide by andsupport the NHS Constitution which applies to all NHSorganisations and sets out the principles and values ofthe NHS, its pledges to the public, service users andstaff as well as their rights and responsibilities.In 2012/2013, the Trust has worked in partnershipwith Staff Side in a number of areas. This includesupdating or introducing policies relating toCapability, Flexible Working, Social Media, GenderRe-Assignment, the Management of SicknessAbsence and Whistleblowing. This latter policyhas been significantly updated in line with currentguidance and will be further reviewed in linewith the recommendations of the Francis Report.Agreements were reached on a new ProtectionPolicy, on revised pay arrangements for our flexibleworkers and on the leave arrangements for theQueen’s Diamond Jubilee in June 2012. Therewere two separate national days of action calledduring the year by Unite and by the British MedicalAssociation. In both cases the Trust worked with thebodies concerned to ensure that patient safety wasnot compromised.The Trust also worked with the British MedicalAssociation to put in place the necessary elementsfor the revalidation of doctors, including a newAppraisal Policy for senior medical staff, andintroducing a process for remediation, i.e. thearrangements to apply where there are concernsabout the performance of a doctor.The Trust retains its commitment to work with StaffSide during this challenging period for the NHS.2930

2.16.5 Sickness AbsenceThe Trust recognises that in our empowered,committed and team-based workforce, the issueof staff absence is a complex and multi-facetedone. People can be absent for many reasons, andthe Trust has attempted to put in place a range ofdifferent responses, such as Occupational Healthservices, Workplace Wellbeing services, consistentReturn to Work and staff support plans. The Trusthas also improved its’ policy on the managementof the issue so that it requires improvements inattendance from the relatively small number of staffaffected by the formal process, and so that it alsoaddresses the different approaches to short termand long term absence.The Trust has Board support for establishing ajoint Management and Staff-side ‘task and finish’working group to analyse and investigate thereasons for absence and to reinforce an‘attendance culture’.We review the causes of absence, have establishedsuitable and achievable targets for the Trust, teamsand individuals and these are regularly monitored.We are working with Trust managers to recognisegood attendance and address those individuals withpoor attendance, whilst supporting staff genuinelyaffected by stress (the Trust has a Stress policy andan integral stress measurement tool), along withwork redesign and adjustments.We will continue to treat genuine sickness absencewith fairness and compassion and to promote thisculture, and to reduce absence figures.Sickness absence figures 2012/13%7655.85Apr6.07MayJun5.865.55JulAug5.726.02Sep2.16.6 Occupational HealthThe Trust approach to Occupational Health involvesthe following strands:• The Occupational Health Service – this isundertaken via a contract with SheffieldTeaching Hospitals NHS Foundation Trust• Workplace Wellbeing – this is our own freeconfidential staff counselling and consultationservice which is available to individuals andgroups of staff• Health and wellbeing – we provide a dedicatedsection on our Trust website which helps direct staffto a range of useful local, regional and nationalresources and tools to assist with promoting ahealthy and active lifestyle. During 2012/13 theseweb pages were viewed almost 1700 times• Training – we provide specific training onkey health related areas such as back care/manual handling and stress awareness/dealingwith conflict• Specific projects – this encompasses both regularinitiatives such as the annual flu immunisationcampaign as well as one-off initiatives such asthe “12 for 12 campaign”.We have been working with our OccupationalHealth provider to try and both improve and extendour current provision. We are actively looking at theintroduction of electronic referrals to help speed upthe referral process but also help with compilingmore refined data regarding incidence. There havealso been discussions regarding the potential forsetting up more rapid treatment relating to mentalhealth and musculo-skeletal problems.6.25Oct6.03 6.04NovDec6.53Jan5.82Feb5.59MarThis year also saw the culmination of our successful“12 for 12 campaign” which was referred to earlier.This was a one-off task and finish project but theTrust will be giving further consideration as to howto help maintain the momentum and keep healthinitiatives on staff’s own agendas.The Trust has also significantly increased thepercentage of front-line staff that have chosento receive the flu vaccination.2.16.7 VolunteersDuring 2012/13 the Volunteer DevelopmentGroup completed its work on developing andimplementing the new volunteer policy, recruitingto the new volunteer coordinator post and revisingthe training and support requirements for volunteersto ensure areas such as safeguarding are adequatelydealt with.The further development of the Trust’s use of, andwork with, volunteers now sits within the Patientand Public Involvement department, reporting toboth the Quality Assurance Committee and theHR and Workforce governance meetings.A dedicated web page has been developed(www.shsc.nhs.uk/patients-and-carers-intro/getinvolved-2/Volunteering)with information onvolunteering opportunities which the publiccan access.2.16.8 CommunicationsThe Trust produced a large amount of proactivepublicity during 2012/13 about various aspects of itswork and services. Service user and carer case studieshave been used to raise awareness with the public,and to contribute to reducing the stigma associatedwith mental health and related issues. We haveachieved good media coverage with case studies in theareas of Spirituality, Transgender services, Service UserEmployment, Chronic Fatigue and Eating Disorders.This year we have also been named as one of thetop nine Provider Trusts in the country in a studycarried out by Manchester Business School, andreceived positive media attention on this issue.We will continue to work hard to get our positivePR taken up by the media, and minimise negativepublicity over the next year in order to furthergrow the services and build on our reputation.The Trust has maintained its Social Media presenceduring the year (a term covering websites andonline tools which allow users to interact witheach other in some way) via Facebook and Twitteraccounts. These are regularly updated with news,events and photos, and are growing in popularityand cultivating an online dialogue.Website: www.shsc.nhs.ukFacebook: www.facebook.com/shscftTwitter: www.twitter.com/shscft or @SHSCFT2.16.9 Education, Training and DevelopmentThe Education, Training and DevelopmentDepartment (ETD) is committed to recoveryprinciples and our courses are increasingly beingdeveloped with a recovery focus, to meet theessential training and development requirementsof Trust staff in their various job roles.The Trust Training Prospectus has been developedto provide an up-to-date catalogue of Trust trainingcourses and E-learning packages for Mandatoryand Non Mandatory training, and the electronicnomination form is now available on the Intranetwithin the ETD pages. A selection of service userartwork has been included in the prospectus tomake it more visual and engaging and it has beenwell received.E-learning has been established at 13 sites acrossthe city, giving Trust staff an alternative and flexibleway of completing their mandatory training.E-learning is user friendly and can be accessedat any time, meaning learners can fit it aroundtheir working day in the clinical environment.In 2012/13 we have seen an increase of staff attendingtraining: the available places increased from the previousyear from 7031 up to 9375. We were successful inachieving 80% Trust compliance in Respect Level 3 andFire training, and made a significant impact in otherareas such as Core Mandatory Training, Clinical Risk,and Respect Level 2 training.We have introduced mandatory update days duringthe year, currently including basic life support, firesafety, healthcare records, slips, trips and falls, handhygiene and waste management, so that staff canachieve their mandatory compliance in an efficientone day format.We have also introduced TurningPoint, aninteractive evaluation system that enables staff toanswer questions about the training delivered usinga handheld device. We currently use this in ourMandatory update day, Core Mandatory Trainingand Respect Training.3132

We have continued to build on our past successwith apprenticeships. Ten apprentices completedtheir training this year with four gaining substantiveposts at SHSC, two in other NHS Trusts and fourgoing on to non-NHS employment or highereducation. Twenty-five people have startedapprenticeships this year across pharmacy, businessadministration, health and social care and cleaningsupport services. These are a combination of newrecruits and existing staff updating their skills.In addition to the apprenticeships, forty-threemembers of staff have enrolled on vocationalcourses and qualifications this year.2.17 Our financial performance andother disclosures in the public interestWe have now been established as Sheffield Healthand Social Care NHS Foundation Trust for over fouryears. Through strong financial performance, wehave successfully maintained a Financial Risk Ratingof 4 with Monitor, our independent regulator.In respect of the year 2012/13, we exceeded ourplanned forecast of a £2,545,000 surplus andachieved a surplus of £3,512,000 with Earnings BeforeInterest, Tax, Depreciation and Amortisation (EBITDA)of £8,876,130 (against a plan of £6,888,688).As an NHS Foundation Trust, we are able to carryforward any financial surplus monies that we havegenerated. These surpluses will be used to maintainand, where appropriate, enhance the quality of theservices that we provide. The surpluses will also helpto secure our future financial stability, especially overthe next few years, in order to mitigate the adverseimpact of the current economic climate.We are pleased to report that the surplus has exceededthe target identified in the Annual Plan, and this hasbeen achieved through rigorous expenditure controland tight management of our efficiency programmes.We have maintained our surplus to enable us toachieve the minimum Financial Risk Rating of 4 whichprovides Monitor with assurance that a FoundationTrust is in good financial health.Our present Financial Risk Rating has come about dueto the effective delivery of our Annual Plan objectivesand focus on our Integrated Business Plan, which wesubmitted as part of our Foundation Trust application.Both the Annual Plan and the Integrated BusinessPlan objectives have been delivered.Whilst the targets of our Cost ImprovementPlans have been met for 2012/13, some of thisdelivery (approximately, £1.6 million) was throughnon-recurrent measures.The NHS Foundation Trust enablement to retaincash has allowed us to maintain a healthy bankbalance. This will remain so for the coming year,although our commitment to achieving ourNational Efficiency Savings targets over thenext two years will involve capital spending.The following sections provide our commentaryon the Trust’s financial performance and anoverview of our accounting processes, capitalplans, income and expenditure.The Accounts for the period commencing from1st April 2012 to 31st March 2013 are includedin full under Section 15 of this Annual Report.2.17.1. Financial risk ratingPart of the NHS Foundation Trust governanceframework requires NHS Foundation Trusts tosubmit to Monitor, an Annual Plan as well asquarterly and other ad hoc reports on their financialperformance, governance and mandatory services.On the basis of these submissions, Monitor assignsa quarterly or annual risk rating (as the case may be)to each NHS Foundation Trust.The risk ratings are designed to indicate the risk ofan NHS Foundation Trust’s failure to comply with itsterms of authorisation, which form the basis uponwhich they derive their mandate to operate.In its regulatory oversight in the area of finance,Monitor uses a risk rating scale of 1 to 5, where1 represents the highest risk and 5 representsthe lowest risk of failure to comply with an NHSFoundation Trust’s terms of authorisation.Sheffield Health and Social Care NHS FoundationTrust achieved a Financial Risk Rating of 4throughout the year 2012/2013.As a Trust, we have a rigorous performancemonitoring system in place through the structureof our operational committees, committees ofthe Board of Directors, right through to the Boardof Directors itself where performance reports aremonitored and reviewed on a monthly basis.2.17.2. Our income and expenditure positionIn the 12 months covered by this report, the Trust generated an income totalling £128,382,000.A summary of the position is provided below:Total1st April 2012 – 31stMarch 2013 (£ 000s)Total1st April 2011 – 31stMarch 2012 (£ 000s)Income from activities 93,276 86,961Other operating income 34,788 35,513Total income 128,064 122,474Operating expenses (122,994) (118,466)Profit on disposal of property, plant and equipment 318 73Interest received and other financial costs 130 101Movement in fair value of investment property (20) 0Public dividend payable (1,986) (2,191)Surplus for the year 3,512 1,9912.17.3. Disclosure in relation to other incomeThe composition of other operating income isdisclosed in note 3.1 to the Annual Accountscontained in Section 15 of this report.2.17.4. Cash flow managementWe continue to review our Treasury ManagementPolicy and cash and working capital management.Our aim is to ensure that cash managementcontinues to be in line with Foundation Trustrequirements, which are based on commercialcash management arrangements.Our cash balance at the end of March 2013 was£22.731 million and the Trust has a contractedworking capital facility of £2.5 million. During theyear, the Trust did not need to use its workingcapital facility.2.17.5. Capital expenditureThe Trust’s investment in capital expenditure for2012/13 was £2.901 million. The spending ofcapital has been minimal this year as we continueto review our existing estates strategy. A majorpart of this review relates to the Acute CareReconfiguration of mental health services.The planning and development of the PsychiatricIntensive Care Unit (PICU) commenced in 2012/13,although the majority of expenditure for this willoccur in 2013 – 14. The site has been identified,plans drawn up and building work is due tocommence in May 2013.The development of the Intensive Support ServiceUnit (ISSU), within the Learning Disabilities Servicecommenced in 2012/13, although some of theexpenditure will occur in 2013/14. The building isprogressing to the timescales agreed and will beoperational in 2013 – 14.With the exception of the PICU and ISSU, themajority of capital funds are being retained untilthe estate strategy review is complete.2.17.6. Long term borrowingMonitor, the independent regulator for NHSFoundation Trusts, sets the approved prudentiallong term borrowing limits for all NHS FoundationTrusts from the date of their authorisation. Theselimits are revised every year. Our approved longterm borrowing limit for 2012/13 was set at £24.9million. During the year, we have not borrowedagainst this limit.3334

2.17.7. Key financial risks and challengesfor 2013/14 onwardsPrice riskAs a Foundation Trust, we have relatively lowexposure to price risk for a number of reasons:i. Salary costs are the single biggest componentof our costs and our staff are on Agenda forChange terms and conditions of service. Themajority of Trust staff will receive a 1% Agendafor Change inflationary pay award for 2013/4ii. A large proportion of our income is derivedfrom NHS Commissioners and the incomeassumptions are set out each year in the NHSOperating Framework. For 2013/14, there isa national efficiency requirement of 4%, withpay and price inflation uplifts at 2.7%. Theapplication of this formula gives a net reductionfor NHS commissioned services of 1.3%. Thislevel of reduction has been taken into accountin our refreshed Financial Plan and goingforward, the Trust’s Financial Risk Ratingwill be a minimum of 3iii. Robust contracting arrangements are in place withCommissioners and clauses for over-performanceagainst contracted targets continue to be furtherclarified and refined to give the Trust addedfinancial stability. The Trust’s response to the CarePathways and Packages initiative in respect of futurecontracting arrangements is being well co-ordinatedwith a clear project structure, and reportingarrangements are in place. The financial impact ofcosting on a cluster basis is neutral at present, asthis will be in shadow form for 2013/14.Credit riskThis is minimal as the majority of the Trust’s incomecomes from contracts with other public sectororganisations, namely NHS organisations and theLocal Authority (see also note 20 to the AnnualAccounts in Section 15).Liquidity riskLiquidity risks are felt to be relatively low due to the factthat the net operating costs are incurred under contractswith NHS and other Government bodies that are, inturn, financed from money received from Parliament.Assumptions regarding additional income in 2013/14have been incorporated into our Financial Plan and thisincome mainly derives from NHS Commissioners (seealso note 20 to the Annual Accounts in Section 15).Cash flow riskThe main sources of income and expenditure arerelatively predictable. The Trust currently has asound cash position with a balance of £22.731mat 31st March 2013. The Trust is not expectingproblems with its cash flow, and cash holdings willbe maintained and maximised going forward. A12-month rolling cash flow forecast is provided aspart of the monthly Board financial reporting process.Other financial risks/challengesAlong with all other NHS and public sectororganisations operating in the current economicclimate, the Trust will be facing a series ofchallenges for the coming year. Our mainchallenges are as follows:• Achieving a further Cost Improvement Plan (CIP)target of around £8.2 million in 2013/14• Ensuring that we deliver the sign-off forrecurrent savings required for our efficiency plan• Introducing Service Line Reporting within theorganisation. Service Line Reporting will improveour strategic and clinical decision-making byproviding a breakdown of the operational andfinancial performance of each service• The Trust is required to deliver in shadow form,in 2013/14, in conjunction with its servicecommissioners, the proposed currency modelfrom the Care Pathways and Packages (CPP)Consortium to support and inform currencydevelopment as part of the national roll-out ofits implementation. This will involve conversionof existing contract values into CPP currency andwill run in shadow form in 2013 – 14 alongsideexisting currency arrangements to ensure thatthe implementation of the National Paymentby Results (PbR) Policy for Mental Health iseffectively managed locally. This will bereviewed throughout the year• The increasing choice and personalisationagenda may shift purchasing and budgets forcertain types of care to the individual, andthis does present some financial risks for theTrust over the next two years. Developmentprogrammes and structures are in place forSelf-Directed Support packages and pathwaysand defined services have completed marketassessment and customer care reviews. In orderto mitigate against any income loss, additionalservice redesign plans are in place to focus oncore business alternatives and specialist carere-enablement, or provision of high quality careand support for people with complex needs.2.17.8. Cost allocation and charging requirementsThe Trust has complied with the cost allocation andcharging requirements set out in HM Treasury andOffice of Public Sector Information Guidance.2.17.9. Additional pension liabilities incurredIt is considered best practice for NHS FoundationTrusts to disclose the number of, and averageadditional pension liabilities for, individuals whoretired early on ill-health grounds during the year.These disclosures are made in note 5.5 in theAnnual Accounts based on figures suppliedby NHS Pensions.2.17.10. Better payment practice codeOur compliance with the national Better PaymentPractice Code (which requires the organisation topay all valid non-NHS invoices within 30 days ofreceipt, or their due date) is 85% in terms of thenumber of invoices paid and 85% in terms of thevalue of invoices paid.2.17.11. Countering fraud and corruptionSheffield Health and Social Care NHS FoundationTrust fully subscribes to mandatory requirementson countering fraud and corruption across the NHSand is committed to the elimination of fraud withinthe Trust. Where fraud is proven, we ensure thatwrongdoers are appropriately dealt with and stepsare taken to recover any assets lost due to fraud.The Trust has a nominated Local Counter FraudSpecialist (LCFS) carrying out a range of activitiesthat are overseen by the Audit Committee. A fraudrisk assessment is carried out annually and proactivefraud exercises are undertaken based on this riskassessment. Where fraud is identified or suspectedan investigation is carried out in accordance withthe Trust’s Fraud Policy and Response Plan.This year, proactive counter fraud work has focussedon preventative action to ensure the Trust does notfall victim to the current and real threat of organisedhigh value NHS fraud. In the last year the LCFS hasformally investigated eleven cases of alleged fraudat the Trust.The Annual Counter Fraud Report concludes thatstaff, management and executives have continuedto strongly support counter fraud work across thewhole organisation in what has been a positiveyear for counter fraud work at the Trust.2.17.12 Health and Safety PerformanceThe Trust recognises its responsibilities for ensuringthe health, safety and welfare of our employees,as well as our responsibility to others who may beaffected by its work activities. The Trust approach tohealth and safety is based on risk assessment, whichaims to identify, assess and minimise the potentialfor injury and ill health.The Health and Safety Committee, chaired by theExecutive Director with responsibility for Health andSafety, has met regularly during the last 12 months.Thisis a joint meeting with representatives from Staff Sideand all Trust services. The Committee has overseen thecompletion of several areas of work including:• Updating the Display Screen Equipment Policy• Updating the Security Policy to take account ofterrorism threats e.g. bomb scares; improvisedexplosive devices (IEDs)• Review of an earlier (2007) report fromthe Health & Safety Executive to ensure allrecommendations had been fully addressed• Further roll out of the Trust’s ‘Red Box’ systemwhich is an auditing and assurance processrelated to health & safety issues linked toour buildings• Introduction of a health & safety inspectionscheme by the Health & Safety Advisor at allTrust sites to identify and resolve any localissues as well as acting as an ‘early warning’of any organisational systems problems orsignificant matters• Consideration of implications of the Lofstedt Report• Consideration of the Health & Safety Executive’sintroduction of a cost recovery scheme andidentification of actions to be taken by theTrust to manage this change of approach• Ratification of actions being taken by EstateServices to ensure compliance with the EUBiocidal Products Directive (cessation of useof copper ionisation in legionella control).3536

The Trust employs competent people to providespecialist advice in managing health and safetyand related matters, including members of theRisk Management and Clinical Governance Service;a Senior Infection Control Nurse and a Fire andSecurity Officer (who also acts as the Local SecurityManagement Specialist). The Trust’s Health & SafetyAdvisor is managed via the Facilities Directorate buthas a Trust-wide remit for instigating a proactiveapproach to health and safety. The FacilitiesDirectorate has specific responsibility for ensuringconsideration of health and safety in all aspectsof premises maintenance and design, and forcompliance with a range of statutory requirements.During 2011/12 the Trust introduced a revised riskbasedapproach to fire safety training which hasproved to be successful, and overall numbers of staffattending face-to-face training or completing e-basedtraining during 2012/13 has increased significantly.We have also introduced key operated fire alarmpoints in most of the inpatient wards, which hasreduced the number of unwanted fire signals (falsealarms) caused by service users inappropriatelyactivating the break glass fire alarm points.2.17.13 Consultations we have completedWe have not undertaken any formal consultationsduring the year about proposed service changes.2.17.14 Consultations we have in progressAt the time of confirming this Annual Report therewere no formal consultations in progress.2.17.15 Consultations we have plannedfor next yearIn line with our established Annual plan for2013 – 14 we may consult on the developmentof new acute care services across community andinpatient settings supported by an estate improvementand redesign programme. We will consider the needand requirements for consultation once the optionshave been reviewed during the year.2.17.16 Significant research and developmentactivities we have undertakenThe Trust sees research activity as an importantelement of ensuring quality, supporting innovationand improving productivity, as well as beingcommitted to offering service users access to newtreatments and care.The number of research projects on the NationalInstitute for Health Research (NIHR) National Portfoliounderway in the Trust and number of our serviceusers recruited to studies has increased significantlyover the last three years. Over the last 12 months inparticular, research development activity has focussedon increasing high quality commercial studies on theNIHR portfolio underway in the Trust and developingapplications to NIHR funding programmes sponsoredby the Trust. In these areas, the Trust was selectedas one of five sites in the UK for an internationalPhase 2 clinical trial of a potential new treatmentfor negative symptoms in schizophrenia. The Trust isalso the sponsor of an application to the NIHR HTAprogramme for a trial of a non-pharmacologicalintervention to reduce weight gain in severe mentalillness – this has been short-listed to the finalapplication stage. Both of these projects feed intoquality improvement areas highlighted in the NationalAudit of Schizophrenia and to the health inequalitiesthat are shown by different physical health outcomesfor those with severe mental illness.2.17.17 Serious incidents involving data lossor breaches of confidentialityThe Trust had no serious incidents involving dataloss or breaches of confidentiality during the period1st April 2012 to 31st March 2013.2.17.18. Political or charitable donationswe have madeThe Trust has not made any political or charitabledonations during the year 2012/13 as it is not lawfulfor an NHS Foundation Trust to make such donations.2.17.19. Significant differences in marketvalues of fixed assetsThe Directors consider that the methodology usedto determine the carrying value of the property,plant and equipment base as at 31st March 2013 isappropriate as it has been determined in accordancewith the Foundation Trust Annual Reporting Manual2012/13 and through the application of approvedInternational Financial Reporting Standards (IFRS)based accounting policies.The Directors have also considered the possibilityof impairment on the carrying value of the Trust’sproperty as at 31st March 2013. They considerthat the current valuation does not materiallymisrepresent a fair presentation of the accounts.The Board of Directors ratified these statementsat their meeting held on the 1st May 2013.2.17.20. Significant events affecting us afterthe end of the financial yearThese are disclosed in note 23 in the AnnualAccounts contained in Section 15.2.17.21. Future developments that are likelyto affect usThe following are the significant developments likelyto affect us in the future:• Potential agreements to take on responsibility forthe Clinical Commissioning Group’s C.H.C budget• Potential funding for transforming DementiaServices located within the Sheffield TeachingHospitals NHS Foundation Trust to be transferredinto the community settings run by us• The reconfiguration of our acute psychiatricservices and our older people’s mentalhealth services, which will bring separateaccommodations into a single site and theupgrading of the ward sites and will includethe introduction of a Crisis House• Completion of the new Psychiatric IntensiveCare Unit (PICU) building.3738

SHSC Headquarters at Fulwood House3.0 Remuneration ReportExecutive Directors’ RemunerationThere is a Remuneration and NominationsCommittee of the Board of Directorscomprising all Non-Executive Directors(including the Trust Chair). When it isappropriate, the Chief Executive attends theCommittee’s meetings in an advisory capacity.The Committee meets at least once a year to decideon the appropriate remuneration and terms andconditions of service of the Executive Directors.These terms and conditions are determined by thecommittee and include all aspects of remuneration,provisions for other benefits (such as pensionsand cars) and arrangements for termination ofemployment or other contractual terms.The Committee is responsible for monitoring theperformance of the Chief Executive, based on anannual review provided by the Trust Chair, and ofall the other Executive Directors based on an annualreport provided by the Chief Executive. Details ofthe Committee’s meetings during the past year arereported in Section 7 of this report.The Executive Directors are on permanent contracts,and six months’ notice is required by either party toterminate the contract. The only contractual liabilityon the Trust’s termination of an Executive’s contractis six months’ notice. Any other liability, such asunfair dismissal compensation, would depend on thecircumstances of the case. The table on the followingpage provides details of Executive Directors’ contracts.The Chief Executive undertakes annual appraisalswith all Executive Directors, and progress onobjectives is assessed at monthly one-to-onemeetings with each Executive Director.The Chief Executive reports the outcomes ofthese appraisals to the Board’s Remuneration andNominations Committee. The Chief Executive’s ownperformance is monitored by the Chair at regularone-to-one meetings and he is subject to annualappraisal by the Chair who reports the outcomeof his appraisal to the Board’s Remuneration andNominations Committee.SECTION 3.0Remuneration ReportMayfield Conference Suite at Fulwood House3940

Table of Executive Directors’ contractsA) Salaries and allowancesExecutive Director Date of contract Unexpired terms (Years to age 65)Kevan Taylor February 2003 13Mick Rodgers April 2003 (retired Feb 2013) 3Clive Clarke April 2003 16Liz Lightbown April 2011 19Prof Tim Kendall April 2003 10Paul Robinson February 2013 19The Board’s Remuneration and NominationsCommittee reviews the remuneration of ExecutiveDirectors annually, taking into account informationon remuneration rates for comparable jobs in theNational Health Service.The Executive Directors’ remuneration levels arebased on a percentage of the Chief Executive’sremuneration. Performance-related pay is notapplied under current arrangements.Non-Executive Directors’RemunerationThere is a Nominations and Remuneration Committeeof the Council of Governors whose responsibility,amongst others, is to make recommendations tothe Council of Governors on the remuneration,allowances and other terms and conditions of officeof the Chair and all Non-Executive Directors. It is forthe Council of Governors, in general meeting, todetermine the remuneration, allowances and otherterms and conditions of office of the Chair and theNon-Executive Directors, taking into account therecommendations made to it by the Nominationsand Remuneration Committee.It is the responsibility of the Council of Governors’Nominations and Remuneration Committee tomonitor the performance of the Trust Chair andNon-Executive Directors. The Committee may,in appropriate cases, or, if specifically requestedby the Council of Governors to do so, report itsfindings to the Council. Details of the activities ofthe Nominations and Remuneration Committee’sactivities for the past year are reported on inSection 5 of this report.Details of the remuneration paid to all of the Directorsduring 2012/13 are shown in Table A on the followingpage. The Non-Executive Directors’ duration of office isreported in Section 7 of this report.Directors’ Remuneration andpension entitlementsAll Executive Directors are contributing membersof the NHS-defined benefit pension scheme andare eligible for a pension of up to half of final salaryon retirement. The scheme provides a lump sum ofthree times the final salary on retirement. ExecutiveDirectors in the scheme receive the same benefitsas other staff members. The ‘Pension Benefits’Table B provides details of the current pensionand lump sum position for each Director.Name and titleSalary(bands of£5000) £000Period 1.4.12 to 31.3.13 Period 1.4.11 to 31.3.12OtherRemuneration(bands of£5000) £000Benefitsin kind(rounded tothe nearest£00)Salary(bands of£5000) £000OtherRemuneration(bands of£5000) £000Prof. A Walker, Chairman 25 - 30 25 - 30Cllr. M Rooney,10 - 15 10 - 15Non-Executive DirectorM Rosling,10 - 15 10 - 15Non-Executive DirectorA Clayton,10 - 15 10 - 15Non-Executive DirectorM Thomas,10 - 15 10 - 15Non-Executive DirectorS Rogers,10 - 15 10 - 15Non-Executive DirectorK Taylor, Chief Executive 135 - 140 135 - 140C Clarke, Deputy Chief Executive 100 - 105 100 - 105and Social Care LeadM Rodgers,95 - 100 105 - 110Executive Director of Financeand Deputy Chief ExecutiveP Robinson, Executive Director 15-20 -of FinanceDr T Kendall,60-65 125-130 60 - 65 125 - 130Executive Medical DirectorE Lightbown, Chief OperatingOfficer/Chief Nurse100 - 105 100 - 105Band of Highest Paid Director’s 190-195 185 - 190Total (Remuneration £000)Median Total Remuneration 19,077 21,798Ratio of Median Remunerationto Midpoint of the Highest PaidDirector’s Band9.8 8.6Benefitsin kind(rounded tothe nearest£00)In accordance with the Hutton Review of Fair Pay, reporting bodies are required to disclose the relationship between theremuneration of the highest paid director in their organisation and the median remuneration of the organisation’s workforce.The median remuneration is based on full time equivalent directly employed staff as at 31st March 2013, excluding thehighest paid director (as per the guidance).Total remuneration includes salary, non-consolidated performance related pay, benefits in kind as well as severancepayments. It does not include employer pension contributions and the cash equivalent transfer value of pensions.The highest paid director is also the highest paid employee. The median is the middle number in a sorted list of numbers.The ratio is the number of times the median can be divided into the highest paid director’s total remuneration.4142

B) Pension benefitsAs Non-Executive members do not receive pensionable remuneration, there will be no entries in respect ofpensions for Non-Executive members.Nameand titleK Taylor,ChiefExecutiveC Clarke,DeputyChiefExecutiveand SocialCare LeadM Rodgers,ExecutiveDirectorof Financeand DeputyChiefExecutiveP Robinson,ExecutiveDirector ofFinanceDr T Kendall,ExecutiveMedicalDirectorL Lightbown,ExecutiveDirector ofNursing andIntegratedGovernanceRealincreasein pensionat age 60(bands of£2,500)£000Realincreasein pensionlump sumat age 60(bands of£2,500)£000Totalaccruedpension atage 60 at31 March2013(bands of£5.000)£000Lump sumat age 60related toaccruedpension at31 March2013(bands of£5,000)£000Cashequivalenttransfervalue at31 March2013£000Cashequivalenttransfervalue at31 March2012£000Realincreasein cashequivalenttransfervalue£000Employer’scontributiontostakeholderpension£0000-2.5 0-2.5 45-50 140-145 893 823 27 00-2.5 0-2.5 15 - 20 50-55 300 266 34 0(2.5) -0 7.5-10.0 55 - 60 170-175 0 0 0 0(2.5)-0 (2.5)-0 35-40 110-115 592 557 50-2.5 0-2.5 50-55 155-160 1,098 1,011 35 00-2.5 2.5-5.0 25-30 75-80 423 370 34 0Off-payroll arrangementsAs part of the Review of Tax arrangements of Public Sector Appointees published by the Chief Secretaryto the Treasury on 23rd May 2012, NHS Foundations Trusts are required to present data in respect ofoff-payroll arrangements.The Trust had 5 off-payroll arrangements in place at 31st January 2013 that each cost over £58,200per annum. Changes between January 31st and March 31st are shown below:Number of cases at 31st January 2013 6Of which;Number that have since come onto the Organsiations payroll 0Of which:No that have since been re-negotiated/re-engaged to include contracual clauses allowing0the Trust to seek assurance as to their tax obligationsNo that have not been successfully re-negotiated, and therefore continue without0contractual clauses allowing the Trust to seek assurance as to their tax obligations.No. that have come to an end. 1Total balance 5The Trust had 8 new off-payroll engagements between 23rd August 2012 and 31stMarch 2013, for more than £220 per day and more than 6 months.Number of new engagements 8Of which: 0No of new engagements which include contractual clauses giving the department theright to request assurance in relation to income tax and National Insurance obligations0Of which:No. for whom assurance has been accepted and received 0No. for whom assurance has been accepted and not received 0No. that have been terminated as a result of assurance not being received. 0Total balance 84344

4.0 NHS Foundation TrustCode of GovernanceOur commitment to good GovernanceThe Board of Directors recognises theimportance of the principles of goodcorporate governance and is committedto improving the standards of corporategovernance followed by all those who playa part in the conduct of the Trust’s business.The Board recognises that the purpose of the NHSFoundation Trust Code of Governance (the ‘Code’)(which is published by Monitor, the independentRegulator of NHS Foundation Trusts) is to assistNHS Foundation Trust Boards and their Governorsto improve their governance practices by bringingtogether the best practices from the public andprivate sectors.Application of the main andsupporting principles of theCode of GovernanceThe Board implements the main and supportingprinciples of the Code through a number ofkey governance documents, policies andprocedures, including:• The Trust’s Constitution• The Standing Orders of the Board of Directorsand the Council of Governors• The Scheme of Reservation and Delegationof Powers of the Board of Directors• The Standing Financial Instructions• The Annual Governance StatementQuilt made by theSUKOON craft groupat the Longley CentreArt therapy sessionon Ward G1• Codes of Conduct and Standards ofBusiness Conduct• The Annual Plan and the Annual Report• Authority structures and terms of reference forthe Committees of the Board of Directors andCouncil of Governors.Compliance with the provisionsof the CodeIn view of the above, the Board of Directorsconsiders that the Trust has complied with therequirements of the Code.Disclosure of corporategovernance arrangementsIn accordance with the disclosure requirementsof the Code, the Board of Directors makes thefollowing disclosures:Statements on how the Board of Directors and theCouncil of Governors operate, including high levelstatements of which types of decisions are to be takenby each one of them and which are to be delegatedto the management by the Board of Directors, arecontained in Sections 5 and 7 of this report.The names of the Chair, the Vice-Chair, theChief Executive, the Senior Independent Director,Chairs and members of the Board of Directors’Remunerations and Nominations Committee, theCouncil of Governors’ Nominations and RemunerationCommittee, the Audit and Assurance Committee arecontained Sections 5 and 7 of this report.Arts & WellbeingConference 2012The number of meetings of the Board of Directors, itsCommittees and the attendance by individual Directorsare shown in Section 7 of this report. The Boardconsiders the following Non-Executive Directorsto be independent in character and judgement:i. Professor Alan Walkerii. Martin Roslingiii. Anthony Claytoniv. Mervyn Thomasv. Susan Rogersvi. Councillor Mick RooneyThe Board holds this view in relation to all of theabove-mentioned Directors for the following reasons:i. None of them is employed by the Trust or hasbeen in the last five yearsii. None of them has, or has had, within the lastthree years, a material business relationshipwith the Trust, either directly or as a partner,shareholder, director or senior employee of abody that has such a relationship with the Trustiii. None of them has received or receives additionalremuneration from the Trust apart from theirdirector’s fee. They do not participate in anyperformance-related pay as no such scheme isrun by the Trust nor are they a member of theTrust’s pension schemeiv. None of them has close family ties with any ofthe Trust’s advisers, Directors or senior employeesv. None of them holds cross-directorships or hassignificant links with other Directors throughinvolvement (with those other Directors) in othercompanies or bodiesvi. None of them is a member of the Councilof Governorsvii. None of them has served on the Board of thisNHS Foundation Trust for more than nine years.Other information relating to the Directorsis as follows:• A description of each Director’s expertise andexperience is contained in Section 7 of this report• A statement on the Board of Directors’ balance,completeness and appropriateness is containedin Section 7 of this report• The names of the Governors and details of theirconstituencies, whether they are elected orappointed and the duration of their appointmentis contained in Section 5 of this report• The number of meetings of the Council ofGovernors and the individual attendance byGovernors and Directors is contained in Section5 of this report• The Trust Chair’s other significant commitmentsand any changes to them during the year arecontained in the Directors’ Register of Interestsreferred to in Section 7 of this report• The work of the Nominations andRemunerations Committee of the Council ofGovernors, including the process it used inrelation to Board appointments together withan explanation of whether a search consultancywas used in the appointment of the Chair or theNon-Executive Directors, is contained in Section5 of this report• A statement on how the performance of theBoard, its Committees and individual Directors wasevaluated is contained in Section 7 of this report• No Executive Director who serves as a Non-Executive Director elsewhere earns any incomefrom their Non-Executive Directorship. In theevent of this occurring, the Board would treateach case according to its own merits• An explanation from the Directors of theirresponsibility for preparing the accounts and astatement by the auditors about their reportingresponsibilities is contained in Sections 2 and 14of this report• A statement from the Directors that the businessis a going concern, together with supportingassumptions or qualifications as necessary, iscontained in Section 2 of this report• A report that the Board has conducted a reviewof the effectiveness of the Trust’s system ofinternal controls is contained in Section 13of this report• The Council of Governors has not refused toaccept the recommendation of the Audit andAssurance Committee on the appointment orre-appointment of an external auditor, and thismatter is therefore not reported on4748

Governors at the Annual Members meeting• The Trust’s auditors do not provide anynon-audit services to the Trust and thismatter is therefore not reported on• Members wishing to communicate withGovernors and/or Directors may do so byinforming the Trust’s Membership Manageror the Trust’s Company Secretary• Non-Executive Directors attend meetings of theCouncil of Governors, and Board members arefurther informed of the views of the Governorsat their monthly board meetings. Updates onthe affairs of the Council of Governors and theTrust’s members are a standing item on theBoard’s agenda. During the year, members ofthe Board of Directors and Council of Governorsmet on several occasions to share ideas onhow the two groups could enhance theircollaborative working relationship. Details ofthese are disclosed in Section 5 of this report.For instance, every formal Council of Governors’meeting is preceded by an informal meetingbetween Governors and the Non-ExecutiveDirectors. The topics of the meetings areopen-ended allowing Non-Executive Directorsand Governors to discuss as wide a range ofconcerns as possible. There is a Membershipand Communication Sub-Group at whichmembers and Governors meet to express theirareas of concern. Issues raised by members andGovernors are, at the request of members ofthe sub-group, communicated to the Boardof Directors.SECTION 5.0Council of Governors4950

5.0 Council of Governors5.1 The role of the Councilof GovernorsGovernors play a vital role in the Trust’sgovernance arrangements. They primarilycarry out their role through the meetingsof the Council of Governors, of which therewere five in 2012/13. Please see Table 1 fora breakdown of the number of meetingsattended by each governor.All meetings of the Council of Governors are opento members of the public, except in instances wherethere are confidential matters which need to bediscussed. In these circumstances members of thepublic are excluded for the confidential item only.Whilst responsibility for the Trust’s management andperformance rests with the Board of Directors, theCouncil of Governors has specific decision-makingpowers conferred upon it by the Trust’s constitution.These include:• The power to appoint and remove the Trust’sChair and other Non-Executive Directors• The power to appoint, from amongst the Non-Executive Directors, the Vice Chair of the Trust• The power to set remuneration and other termsand conditions of service of the Trust’s Chair andother Non-Executive DirectorsCouncil ofGovernors meetingDavid Hardy, a staff awardwinner at the AnnualMembers Meeting• The power to appoint and remove the Trust’sexternal auditors• The power to approve the appointment of theTrust’s Chief Executive.In 2012/13, the Council of Governors reappointedAnthony Clayton, Mervyn Thomas and SueRogers as Non-Executive Directors and set theirremuneration and terms and conditions.The Council of Governors also plays other importantroles in the governance of the Trust by:• Assisting the Board of Directors in setting thestrategic direction of the Trust• Monitoring the activities of the Trust with aview to ensuring that they are being carried outin a manner that is consistent with the Trust’sConstitution and its terms of authorisation• Receiving the Trust’s Annual Report andAccounts and the auditor’s report on theAnnual Accounts• Representing the interests of members andpartner organizations• Providing feedback to members• Developing the Trust’s membership strategy.In doing all these, the Council of Governors ensuresthat the Board of Directors is held to account by theTrust’s key stakeholders.Stanage Ward5.2 Composition of the Council of GovernorsThe Council of Governors comprises 43 seats, 32 of which are elected from the membership.Governors are elected for a period of 3 years and can hold their position for a total of 9 years, ifre-elected. Eleven of the seats are for organisations with whom the Trust works, or ‘stakeholderorganisations’ as they are called. These positions also have a 3 year term.The Council of Governors is chaired by Professor Alan Walker who is also the Chair of the Boardof Directors. It is his responsibility to ensure that governor’s views are represented at the Board ofDirectors and that information from the Board is fed back to the council. He fulfils this responsibilitythrough a monthly letter to governors as well as providing updates at each council meeting.In 2011 John Kay, Service User Governor was elected as the Lead Governor. This is a role required by Monitor.Table 1 shows a breakdown of seats on the council and associated governors as at 31st March 2013,including their attendance record at council meetings.Table 1Number ofseats8 Public seats(Elected)10 Serviceuser seats(Elected)Name Constituency DateappointedfromDate term ofoffice endsDorothy Cook Public South East 01.07.2010 30.06.2013 5/5Jules Jones Public South East 01.07.2011 30.06.2014 5/5Brandon Public South West 01.07.2010 30.06.2013 5/5AshworthVacancy Public South WestDave Jones Public North East 01.07.2011 30.06.2013 5/5TrudiePublic North East 01.07.2011 30.06.2013 4/5SmallwoodPaul Harvey Public North West 01.07.2011 30.06.2014 5/5Susan Wood Public North West 01.07.2010 30.06.2013 4/5Dean Chambers Service User 01.07.2010 30.06.2013 3/5Tyrone Colley Service User 01.07.2011 30.06.2014 5/5Shamshad Service User 01.07.2011 30.06.2014 2/5HussainJohn Kay Service User 01.07.2010 30.06.2013 5/5Patrick Moran Service User 20.03.2013 30.06.2014 0/0Sue Sibbald Service User 21.03.2012 20.03.2015 5/5Kate Steele Service User 01.07.2011 30.06.2014 4/5Vacancy Service UserNev Wheeler Service User 01.07.2010 30.06.2013 3/5OBEMyra Wilson Service User 01.07.2011 30.06.2014 5/5Meetingsattended overtotal numberof meetingseligible toattend5152

Number ofseats2 YoungService user/Carer seats(Elected)4 Carer seats(Elected)8 Staff seats(Elected)11 Appointedgovernors(Stakeholders)Name Constituency DateappointedfromAbbey GeorgeVacancyYoung ServiceUser/CarerDate term ofoffice ends27.07.2012 30.06.2014 2/3Leon Ballin Carer 01.07.2011 30.06.2014 3/5Ian Downing Carer 01.07.2010 30.06.2013 5/5Jean Nicholson Carer 01.07.2011 30.06.2014 3/5Lindsay Oldham Carer 01.07.2010 30.06.2013 0/5Mia Bajin Clinical Support 15.12.2010 14.12.2013 2/5StaffVacancy Nursing StaffElaine Hall Allied Health 01.07.2011 30.06.2014 4/5ProfessionalsElliott Hall Central Support 01.07.2011 30.06.2014 5/5StaffIngrid King Psychology Staff 01.07.2011 30.06.2014 0/5Geraldine Social Work Staff 01.07.2011 30.06.2014 4/5MountainPaul Miller Medical & Clinical 01.07.2011 30.06.2014 4/5StaffStephanie Support Work 01.07.2011 30.06.2014 1/5Pursehouse StaffProfessor PeterWoodruffJoan HealeyUniversity ofSheffieldSheffield HallamUniversity24.08.2011 23.08.2014 2/529.09.2011 28.09.2014 5/5Sue Highton Staffside (Unions) 01.07.2011 30.06.2014 1/5Vacancy Age UK SheffieldJanet Sullivan Sheffield MENCAP 01.07.2011 30.06.2014 3/5Dr Abdul Rob Pakistan Muslim 24.01.2011 23.01.2014 2/5CentreDavid Bussue SACMHA 30.07.2012 29.07.2015 1/3Cllr DavidBarkerSheffield CityCouncil31.07.2012 30.07.2015 2/3Cllr RogerDavidsonCllr CliveSkeltonDr Amir AfzalSheffield CityCouncilSheffield CityCouncilClinicalCommissioningGroup14.11.2012 13.11.2015 1/231.07.2012 30.07.2015 1/301.04.2012 31.03.2015 1/5Meetingsattended overtotal numberof meetingseligible toattend5.3 Changes to the Council of GovernorsAt the 1st April 2012 there were 41 governors in post. There have been a number of changes throughoutthe year and at 31st March 2013, there were 38 governors in post. Table 2 shows the governors who leftthe council during 2012/13.Table 2Name Constituency Name ConstituencyPatrick Anyomi Voluntary, Community & Nicky Hindmarch Public South WestFaith Sector (SACMHA)Cllr Ali Qadar Sheffield City Council Natasha Elliott Young Service User/CarerCllr Jack Scott Sheffield City Council Gemma Wake Young Service User/CarerCllr Ibrar Hussain Sheffield City Council Jim Buck Staff – NursingAnnette Phillips Service User Graham Harris Voluntary, Community &Faith Sector (Age UK)Jim Tattersall Service UserIn addition to the governors who left, Table 3 shows new governors to the Council during 2012/13 andtheir method of appointment. Their terms of office are shown in Table 1.Table 3Name Constituency Method of appointmentAbbey George Young Service User/Carer Elected (polled 2nd highest votes and asper the constitution, was asked to take upthe remainder of the term following theresignation of the incumbent)David Bussue SACMHA AppointedCllr David Barker Sheffield City Council AppointedCllr Roger Davidson Sheffield City Council AppointedCllr Clive Skelton Sheffield City Council AppointedDr Amir Afzal Clinical Commissioning Group AppointedPatrick Moran Service User Elected (polled 2nd highest votes and asper the constitution, was asked to take upthe remainder of the term following theresignation of the incumbent)5354

5.4 Governor activities in 2012/13The relationship between the Board of Directors andCouncil of Governors is an important one and itsdevelopment was supported by sessions betweenthe two and regular meetings with Non-ExecutiveDirectors. One of these included the annualdevelopment session between Board and Councilin which the Board accounts to governors and isquestioned by governors on the Trust’s performancein the previous year. Support for governors and theirdevelopment is provided throughout the year. Atraining event to help governors understand newcommissioning arrangements was held as well as asession to explain the new Health and Social CareAct and its implications for governors.In December 2012 discussions took place betweenthe Board and Council on the Trust’s business andquality objectives for 2013/14. Governors providedtheir thoughts but also sought members’ viewson the Trust’s objectives via an online survey, towhich 159 people responded. This information wascollated and presented to the Board by governors.In addition to their statutory duties, governors areinvolved in a number of other areas of the Trust.These include:• Acute Care Reconfiguration• Creative Arts Steering Group (CAST)• Crisis House/Telephone Helpline project group• Finance Executive Director Interview Panel• Finance Sub Committee(to appoint external auditors)• Human Resources & Workforce Group• Involve Editorial Group• Membership & Communications Sub Group• Nominations and Remunerations Committee• Personality Disorder Strategy Team• Planning Priorities Group• Recovery Strategy Team• Service User Experience Monitoring Unit TrainingDevelopment Programme• Service User Safety Group• Spirituality Strategy Group• SUN:RISE Arts and Wellbeing Network• Supporting the Chaplains in their roles• Sustainability & Cost Savings Group.Governors have brought their influence to bearthrough the Council and by asking questions atthe Board of Directors meeting on a number ofissues including:• Both challenging and supporting the Trust’scommitment to energy efficiency• Challenging volunteer dependability at Boardlevel and helping the Chaplaincy Department toaccess more funding to employ further chaplains• Identifying the need to address the issue ofthe quality and quantity of paperwork inCMHTs and contributing to streamliningand improving processes• New Trust telephone system• Raising the profile of spirituality within care• Staff appraisal.As well as working inside the Trust, governors arerepresentatives on a number of external Committeesand groups and attend external events including:• 50+• Carers Café• Cathedral Archer Project• Chair – Carers and Young Carers Board• Chair – LDS Partnership Board• Council for Independent Living• Foundation Trust Network event.• Local Involvement Network• Mental Health Information Project Group• Mental Health Partnership Board• Patient Group at the Flowers Medical• Peoples Parliament for Learning Disabilities• Physical Health Event with David Shiers• Public Health Working Group• Reflections in Health• Safer and Stronger Communities Scrutiny Board• Sheffield Anglican Diocese’s Board of Faithand Justice including their ethnic minority andmental health subgroups (the latter presents upto 5 mental health study days per year).Through this wide variety of groups, governors makesure that their views, and the views of their membersare heard and listened to – they exert their influence.Governors are required to declare any material orfinancial interests in the Trust. For a copy of theregister of interests, please contact Karen Jones byemailing Karen.jones@shsc.nhs.uk or telephoning(0114) 2716747.5.5 The Nominations andRemuneration Committeeof the Council of GovernorsWhilst the appointment of the Trust Chair andother Non-Executive Directors is the responsibilityof the Council of Governors, the process ofselecting suitable candidates to be recommendedfor appointment by the Council is delegated to aCommittee of the Council of Governors known asthe Nominations and Remuneration Committee.In addition, the Committee has responsibility formonitoring the performance evaluation of theTrust Chair and the Non-Executive Directors.The Trust Chair presides over the meetings of theCommittee, except in instances where there wouldbe a conflict of interest, in which case, the ReserveChair (who is a member of the Councilof Governors) presides.Table 4In 2012/13 a recruitment process was held for3 Non-Executive Director posts whose terms wereat an end. The process was formal and rigorous,and is summarised below.The posts were advertised by the Committee in thelocal media, in addition to NHS Jobs and the NEDLink website (NHS Confederation). Applications wereshortlisted, and the shortlisted candidates invitedto focus group sessions with Governors, and theremaining Non-Executive and Executive Directors.The evaluations from the focus group sessions weresummarised and shared with the full Nominationsand Remunerations Committee, prior to individualpanel interviews with representatives from theNominations and Remunerations Committee. TheCommittee successfully selected three candidates forappointment as Non-Executive Directors of the Trust.These were recommended for appointment to theCouncil of Governors, and the Council accepted theCommittee’s recommendations.During 2012/13 the following changes have takenplace in the membership of the Committee:• Sue Wood retired from the Committee• Abbey George, Dave Jones, Sue Sibbald,Professor Peter Woodruff and Paul Harvey joinedthe Committee following their appointment bymembers of the Council of GovernorsThe attendance of the members of the Committeeat its meetings that were held during 2012/13 isshown as follows:Name Position Number of meetings attended out of total number of thosethat could possibly be attended by each Committee MemberAlan Walker Chair 3/3John Kay Reserve Chair 2/3Brandon Ashworth Committee Member 2/3Geraldine Mountain Committee Member 1/2Lindsay Oldham Committee Member 1/3Paul Harvey Committee Member 2/2Abbey George Committee Member 1/2Professor Peter Woodruff Committee Member 1/2Dave Jones Committee Member 0/2Sue Sibbald Committee Member 2/2Sue Wood Committee Member 1/1Note: The Committee held a total number of three meetings during the period covered by this report.5556

6.0 MembershipFoundation Trust status gives us theadvantage of being closely influenced bythe people who live in the communitiesthat we serve. This is well reflected in thediversity of the constituencies into whichour membership base is divided.6.1 Constituencies, eligibility criteriaand membership numbersThere are 3 elected membership constituencies, eachof which has a number of classes within. Table 1details each one and its eligibility criteria and whereapplicable, the number of members in the class.Table 1SECTION 6.0MembershipSheffield Wellbeing Festival 2012Constituency Class Number of CriteriamembersSouth West 3139 Must live in the following electoral wards:Gleadless Valley, Dore & Totley, Fulwood,Graves Park, Nether Edge, Ecclesall,Beauchief & Greenhill, CrookesPublicSouth East 2581 Must live in the following electoral wards:Darnall, Manor Castle, Arbourthorne,Richmond, Birley, Mosborough,Beighton, WoodhouseNorth West 2345 Must live in the following electoral wards:Stocksbridge & Upper Don, Stannington,Hillsborough, Walkley, Broomhill, CentralNorth East 2415 Must live in the following electoral wards:West Ecclesfield, East Ecclesfield, Southey, FirthPark, Burngreave, Shiregreen & BrightsideService User 1004 Must have received a service or servicesfrom the Trust within the last 5 yearsService userCarer 654 Must have cared for someone who hasreceived a service from the Trust in thelast 5 yearsStaffYoung Service Useror CarerAllied HealthProfessionalsCentral Support Staff 318Clinical Support Staff 630Medical & Clinical 188Nursing 568Psychology 194Social Work 82Support Work 1097108 As service user and carer, but must be35 years old or younger177Must have either worked for the Trustcontinuously for at least 12 months orhave a contract of no fixed term(Please note that these staff figures arebased on an 11 month period, Apr 2012– Feb 2013. March 2013 figures were notavailable at the time of going to print).5758

Constituency Class Number ofmembersVoluntary, Community& Faith SectorOrganisationsUniversity of SheffieldAppointed Sheffield Hallam Not applicableUniversityStaffside (unions)Local CouncillorsNHS SheffieldCriteriaNot applicableTable 2White (incl White Irishand White other)Membership as at 31.3.2013 Sheffield demographic87.91% 83.7%Mixed 1.38% 2.4%Asian or Asian British 4.9% 8%Black or Black British 3.78% 3.6%Other 2.02% 2.2%Of the new members recruited in 2012/13, 20.8% were from black and minority ethnic backgrounds.At the end of March 2013 there were a total of12,630 members (excluding staff) compared to12,299 at the same time the previous year. Thenumber of new members recruited was 951.However, the final membership number reflectsthe number of discontinued members whichtotalled 598.6.2 Developing arepresentative membershipAs a successful Foundation Trust, it is our aim tomaintain and further develop a membership thatinvolves and reflects a wide representation of ourlocal communities. We have set out how we intendto do this through our membership strategy. It is theresponsibility of the Council of Governors, throughthe Membership & Communications Committee, toimplement and review this strategy on an annual basis.As well as defining the membership, this strategyoutlines how we plan to:• Benefit from being amembership-based organisation• Communicate with and support thedevelopment of its membership• Make sure that the membership is reflectiveof Sheffield’s diversity• Provide opportunities for our members tobecome involved with the Trust in ways thatsuit their needs and wishes.Some of the actions identified to achieve thesefour points are:• Publicising widely the opportunities andbenefits of membership• Recruiting members from across thewhole community• Targeting hard to reach groups specifically,supported by appropriate communication• Developing and supporting effective channelsof communication and engagement betweengovernors and members• Ensuring membership is a worthwhile experiencefor individuals through engaging individuals inways that they have said will suit them.The Trust was successful fulfilling these actionsduring 2012/13. See Section 6.3 for details ofhow this was achieved.According to the 2011 census 16.2% of Sheffield’spopulation is from an ethnic background. 2.9% isfrom a white background that is not British. TheTrust has 12.09% (see Table 2) of members fromethnic backgrounds. However, this increases to14.41% when White Irish and White Othergroups are taken into consideration.6.3 Membership Recruitmentand EngagementIn line with the Trust’s membership strategy toboth recruit and engagement members fromacross Sheffield, governors and staff participatedin 26 community events, specifically targetingones in areas of the city with a high ethnicity andalso targeting specific groups such as learningdisabilities. Some of the events included:• Sheffield Pride• SADACCA Health Day• Pakistani Advice Centre Health Days• Weston Park Whit FayreSHSC Governors atSheffield WellbeingFestival 2012Entertainment atSheffield WellbeingFestival 2012• Darnall Information Day• Sheffield Wellbeing Festival• Firth Park Christmas Festival• Sheffield Mencap Gateway• Deaf Advisory Service AGM.The Trust held a very successful Annual Members’Meeting in 2012 which over 200 staff and membersattended. The event celebrated the excellenceof staff and volunteers as well as providing anopportunity for members to learn more about theTrust and its services. Governors presented a reporton their activities to members.Members event ‘AllAbout Dementia’5960

Service User artwork at Moncrieffe RoadThe Trust continued to respond to and engage withmembers’ issues by holding three very successfulmembership events on eating disorders, alcoholand dentistry plus dental phobias to which over 400people attended in all. A programme of events willcontinue throughout 2013/14, again to reflect theissues members have told us are important to them.As well as keeping a public profile, the Trust’sprimary focus of communication is through Involve,our membership magazine. Both governors andmembers sit on the editorial group to make surethat it keeps its focus on those issues that areimportant to members. The editorial group alsomakes sure that the magazine gives informationon all aspects of the Trust’s services.The Trust website also provides members withupdated information and ensures that they caneasily communicate with both the Trust andgovernors if they want to.If you want to contact your governor,you can telephone (0114) 2718825,email governors@shsc.nhs.uk or write to:The Council of GovernorsFREEPOSTSHSC NHS FOUNDATION TRUSTSECTION 7.0Board of Directors61

7.0 Board of Directors7.1 The Role of the Board of DirectorsThe responsibility for exercising the powers of theTrust rests with the Board of Directors. These powersare set out in the National Health Service Act, 2006and are subject to the restrictions set out in theTrust’s terms of authorisation.The Board is responsible for:• Promoting the success of the Trust by directingand supervising the organisation’s affairs• Providing proactive leadership of the Trust withina framework of prudent and effective controlswhich enable risk to be assessed and managed• Setting the Trust’s strategic aims and ensuringthat the necessary financial and humanresources are in place for the organisationto meet its objectives• Overseeing the organisation’s progress towardsattaining its strategic goals• Monitoring the operational performance ofthe organisation.The Board may delegate any of the powersconferred upon it to any Committee of Directors orto an Executive Director. The Standing Orders of theBoard of Directors provide for the manner in whichthe Board may arrange the delegation of its powers.The ‘Scheme of Reservation and Delegation ofPowers’ (which forms part of the Board of Directors’Standing Orders) sets out, in detail, those powerswhich the Board has reserved to itself and those ithas delegated and to whom.The Chair of the Trust presides over the meetingsof the Board of Directors and the Council ofGovernors. The Chair is responsible for:• Providing leadership to the Board of Directorsand the Council of Governors• Ensuring that the Board of Directors and theCouncil of Governors work effectively together• Enabling all Board members to make a fullcontribution to the Board’s affairs and ensuringthat the Board acts as an effective team• Leading the Non-Executive Directors through theBoard of Directors’ Remuneration and NominationsCommittee in setting the remuneration of the ChiefExecutive and (with the Chief Executive’s advice) theother Executive Directors.The Senior Independent Director is responsiblefor leading the Non-Executive Directors in theperformance evaluation of the Trust Chair. The TrustChair is responsible for carrying out the performanceevaluation of the Non-Executive Directors. Bothprocesses are overseen by the Council of Governors’Nominations and Remunerations Committee.During 2012/13, the Board met every month (exceptAugust) in meetings which were open (in part) tomembers of the public and the press. Elements ofthe Board’s business that were of a confidentialnature and/or commercially sensitive weretransacted in private, and the Board hasbeen very open about the need to do this.7.2 Composition of theBoard of Directors7.2.1 Non-Executive teamThe Board comprises six Non-Executive Directors(including the Trust Chair). During 2012 3 Non-Executive Director’s terms came to an end. Followinga formal recruitment process, the 3 outgoingNon-Executive Directors were appointed to serve afurther term of 3 years. Further information on therecruitment process can be found in Section 5.5 ofthis report.7.2.2 Executive teamFive Executive Directors (including the ChiefExecutive) make up the Board’s Executive team.There are also two Associate Directors, in place tosupport the effective functioning of the Board.There have been several changes within theExecutive team during 2012/13.Mr Mick Rodgers, Deputy Chief Executive andExecutive Director of Finance, retired on the 28thFebruary 2013. Mr Rodgers had worked for theTrust since 1970, starting off as an AccountancyAssistant at Lodge Moor Hospital and working inseveral roles in the Finance Department over thefollowing years. He became the Director of Financein 1989, and added to this the role of Deputy ChiefExecutive in 2002.The Board wishes to thank Mr Rodgers for hisunfailing hard work, support and dedication to theNHS over his 42 years of service, he really will bemissed. The Board would also like to welcomeMr Paul Robinson, who was appointed to the roleof Executive Director of Finance and took up post on1st March 2013 following a handover period, andlooks forward to working with him in the future.Due to Mr Rodgers’ retirement, changes to othermembers’ roles within the Executive team havetaken place:• Clive Clarke (previously Executive Director ofOperational Delivery and Social Care) becameDeputy Chief Executive Designate in November2012 and then Deputy Chief Executive from1st March 2013Mick Rodgers’ retirement event• Liz Lightbown (previously Executive Directorof Nursing and Integrated Governance)became Chief Operating Officer/ChiefNurse in November 2012.All Board members use their expertise, experienceand interest to help set the strategic direction ofthe Trust, as well as to monitor its management andperformance. A full list of all the Directors who haveserved on the Board during 2012/13, including theirattendance at the Board’s meetings, is set out on thefollowing page.6364

Name Position Term Number of meetingsattended out of thetotal number that couldpossibly be attendedby each DirectorAlan Walker Chair 3 year11/11appointmentfrom 1/07/10Kevan Taylor Chief Executive N/A 11/11Mick RodgersClive ClarkeLiz LightbownDeputy Chief Executive andExecutive Director of FinanceExecutive Director of OperationalDelivery and Social Care (Apr– Feb)/Deputy Chief ExecutiveDirector (Mar – present)Executive Director of Nursingand Integrated Governance (Apr– Oct)/Chief Operating Officer/Chief Nurse (Nov – present)N/A (retired 28th 10/10Feb 2013)N/A 10/11N/A 9/11Professor Tim Kendall Medical Director N/A 10/11Paul Robinson Executive Director of Finance N/A 3/3 (attended twomeetings as Directorof Finance Designate)Councillor Mick Rooney Non-Executive Director andSenior Independent Director3 yearappointmentfrom 1/11/1111/11Sue RogersNon-Executive Directorand Vice Chair3 yearappointmentfrom 01/12/12Martin Rosling Non-Executive Director 3 yearappointmentfrom 1/11/11Anthony Clayton Non-Executive Director 3 yearappointmentfrom 01/12/12Mervyn Thomas Non-Executive Director 3 yearappointmentfrom 01/12/1211/1110/1110/1110/117.3 Board CommitteesThe Board has several Committees to whom itdelegates authority to carry out some of its detailedwork. These are discussed further below.7.3.1. Audit and Assurance CommitteeThe Audit and Assurance Committee providesindependent and objective oversight on theeffectiveness of the governance, risk managementand internal control systems of the Trust.The Committee’s membership comprises all theNon-Executive Directors of the Board (excludingthe Trust Chair). The meetings of the Committeeare chaired by one of the Non-Executive Directorsdrawn from its membership. The current chair ofthe Committee is Mr Martin Rosling.The Committee has met on seven occasions during2012/13 and details of members’ attendance at itsmeetings are as shown in the table below.Also in attendance at the Committee’s meetingsare the Executive Director of Finance, the ExecutiveDirector of Nursing and Integrated Governance,the Foundation Trust Company Secretary, the Headof Integrated Governance and other ExecutiveDirectors (except for the Chief Executive) as andwhen necessary, along with representatives frominternal and external Audit and the Trust’s LocalCounter-Fraud Specialist.Name Position Number of meetings attended out oftotal number of those that could possiblybe attended by each Committee memberMartin RoslingCommittee Chair and7/7Non-Executive DirectorAnthony Clayton Committee Member and6/7Non-Executive DirectorMervyn ThomasCommittee Member and6/7Non-Executive DirectorCouncillor Mick Rooney Committee Member and5/7Non-Executive DirectorSusan RogersCommittee Member andNon-Executive Director6/7The Management TeamThe Board of Directors delegates the day-to-day management of the operational activities of the Trust to theExecutive Directors Group (EDG). The EDG comprises the Executive Directors and the Associate Directors.The EDG meets on a weekly basis to ensure that its delegated duties are appropriately discharged.6566

7.3.2. Quality Assurance CommitteeIn response to the recommendations containedin the Francis Report (on the service failures atMid-Staffordshire NHS Foundation Trust), theBoard established another Committee known asthe Quality Assurance Committee and appointedMervyn Thomas to be the Committee’s chair.This Committee started operating from April 2011.It is responsible for providing assurance to theBoard on the effectiveness of the Trust’s systemsand processes for safeguarding and improvingthe quality of the Trust’s services. Members of theCommittee include all the Non-Executive Directors(except for the Trust Chair), the Executive MedicalDirector, the Executive Director of Nursing andIntegrated Governance, the Executive Director ofFinance and the Executive Director of OperationalDelivery and Social Care.Also in attendance at the Committee’s meetingsare the Foundation Trust Company Secretary,who serves as the secretary to the Committee,the Director of Quality, the Head of IntegratedGovernance, the Director of Planning andPerformance and a representative of NHS Sheffield,the main commissioners of the healthcare serviceswhich the Trust provides. Other people, includingsenior members of staff within the Trust attend asand when required to do so by the Committee.The Committee met on ten occasions in the courseof 2012/13 and details of members’ attendance atits meetings are shown in the table below:Name Position Number of meetings attendedout of total number of those thatcould possibly be attended by eachCommittee memberMervyn Thomas Committee Chair and9/10Non-Executive DirectorMartin RoslingCommittee Member and9/10Non-Executive DirectorAnthony Clayton Committee Member and9/10Non-Executive DirectorCouncillor Mick Rooney Committee Member and8/10Non-Executive DirectorSusan RogersCommittee Member and9/10Non-Executive DirectorProfessor Tim Kendall Committee Member and7/10Executive Medical DirectorLiz LightbownCommittee Member and8/10Executive Director of Nursingand Integrated Governance (Apr– Oct)/Chief Operating Officer/Chief Nurse (Nov – present)Clive ClarkeExecutive Director of Operational10/10Delivery and Social Care (Apr– Feb)/Deputy Chief ExecutiveDirector (Mar – present)Mick RodgersDeputy Chief Executive and8/8Executive Director of FinancePaul Robinson Executive Director of Finance 2/27.3.3. Finance and Investment CommitteeThe Finance and Investment Committee of the Boardmaintains oversight of the Trust’s financial processesand quarterly submissions on the Trust’s financialperformance to Monitor, the independent regulatorfor NHS Foundation Trusts. The Committee ensuresthat the Trust’s finances are managed within theallocated resources in order to deliver an effectiveand efficient service.The Committee’s membership comprises bothNon-Executive and Executive Directors. Also inattendance at the Committee’s meeting are theDeputy Director of Finance and the FoundationTrust Company Secretary. The current Chair ofthe Committee is Mr Anthony Clayton.The Committee met on 12 occasions during2012/13 and Committee members’ attendancesat its meetings are as shown in the table below:Name Position Number of meetings attendedout of total number of those thatcould possibly be attended by eachCommittee memberAnthony Clayton Committee Chair and11/12Non-Executive DirectorMervyn Thomas Committee Member and11/12Non-Executive DirectorMick RodgersDeputy Chief Executive and10/11Executive Director of FinanceSusan RogersCommittee Member and11/12Non-Executive DirectorClive ClarkeExecutive Director of Operational11/12Delivery and Social Care (Apr– Feb)/Deputy Chief ExecutiveDirector (Mar – present)Liz LightbownCommittee Member and8/12Executive Director of Nursingand Integrated Governance (Apr– Oct)/Chief Operating Officer/Chief Nurse (Nov – present)Paul Robinson Executive Director of Finance 3/36768

7.3.4 Remuneration and Nominations CommitteeThe Remuneration and Nominations Committee ofthe Board of Directors comprises the Non-ExecutiveDirectors. The Committee is chaired by ProfessorAlan Walker, the Trust Chair.The Committee is responsible for determining theremuneration and terms and conditions of serviceof the Executive Directors (including the ChiefExecutive) in order to ensure that they are properlyrewarded having regard to the Trust’s circumstances.The Chief Executive attends the Committee’smeetings in an advisory capacity. The AssociateDirector of Human Resources and the CompanySecretary attend the Committee’s meetings to provideadvice and professional support to its members.Further details on the remuneration of membersof the Board of Directors are provided within theRemuneration Report contained in Section 3 ofthis report.The Committee met on two occasions during2012/13 and Committee members’ attendancesat its meetings are as shown in the table below:Name Position Number of meetings attendedout of total number of those thatcould possibly be attended by eachCommittee memberProfessor Alan Walker Committee Chair 2/2Anthony Clayton Committee Member and2/2Non-Executive DirectorMartin RoslingCommittee Member and2/2Non-Executive DirectorMervyn Thomas Committee Member and2/2Non-Executive DirectorSusan RogersCommittee Member and2/2Non-Executive DirectorCouncillor Mick Rooney Committee Member andNon-Executive Director2/27.4 Executive and Non-Executive Directors’ qualifications and experienceProfessor Alan WalkerBA (Hons), D.Litt, Hon D. Soc Sci, AcSS, FRSAChairProfessor Walker is a widely celebrated and published academic in social policy with a very high globalstanding. He has extensive experience in the health service having served as a Non-Executive Directorand Chair in Community Health Sheffield and Sheffield Care Trust.His wide academic and NHS Board-level experience give him an intimate understanding of the challengeswhich the Trust must face to meet the needs of the people who use its services. This experience is a highlyvalued part of Professor Walker’s ability to lead the Board in setting the organisation’s priorities.The appointment of Professor Walker for a term of three years from 1st July 2010 followed a rigorouslycompetitive recruitment and selection process. It also demonstrates the Council of Governors’ confidencein his ability to provide clear leadership to the Board and the Council.Professor Walker served as the Trust’s initial Chair from 1st July 2008 (for a term of one year which wasextended for another period of 12 months).Among other awards that he has received, Professor Walker is the recipient of the Social Policy Association’sLifetime Achievement Award (2007).Tenure of office: 1st July 2010 to 30th June 2013.Kevan TaylorBA (Dual Honours) Degree in Sociology and Social AdministrationChief ExecutiveAppointed as the Trust’s initial Chief Executive with effect from 1st July 2008, Kevan Taylor has a firm baseof NHS executive directorship experience.Prior to his appointment as the Trust’s Chief Executive, he served as the Chief Executive of the predecessorTrust and prior to that as Executive Director of Planning and Performance Management of Sheffield CareTrust. He also served as Head/ Director of Commissioning of the Sheffield Health Authority. Kevan has abackground as a practitioner in Social Care and as a Local Authority Manager. He is heavily involved injunior football and serves as Club Welfare Officer at Hallam and Redmires Rangers.Sally Bramley receiving anNHS Heroes award6970

Mick RodgersCPFA, MAAT, MIHSMExecutive Director of Finance and Deputy Chief Executive (retired Feb 2013)Professor Tim KendallMB ChB, B Med Sci, FRC Psych.Executive Medical DirectorMick Rodgers was appointed as the Trust’s initial Executive Director of Finance with effect from 1st July2008. He had over 40 years’ experience in NHS Finance and General Management.Mick served as an NHS Executive Director of Finance for more than 22 years and as Deputy Chief Executive forSheffield Care Trust since 2001. His professional qualifications included membership of the Chartered Instituteof Public Finance and Accountancy (CIPFA), the Association of Accounting Technicians (AAT), and the Instituteof Health Service Managers (IHSM). Mick also serves as an advisor to the Board of Age UK, Sheffield.Mick retired from the Trust in Feb 2013.Clive ClarkeDiploma in Social Work (CQSW)Executive Director of Operational Delivery and Social Care (April 2012 – Feb 2013)Deputy Chief Executive Designate (Nov 2012 – Feb 2013)Deputy Chief Executive (March 2013 – present)Clive Clarke was appointed as an initial Executive Director of the Trust with effect from 1st July 2008.A qualified nurse and social worker, Clive Clarke brings the benefit of more than 28 years’ experience inhealth and social care provision. He has served as Director of Adult Mental Health Services and as Headof Social Services in Sheffield Care Trust.Since November 2012 Clive took on the role of Deputy Chief Executive Designate with responsibility forPlanning & Performance, Commercial Relations, Estates, IT (which includes information governance) andClinical and Corporate governance, a responsibility he shares at Board Level with Prof. Tim Kendall. Thenew role enables Clive to continue to drive the closer working relationship between clinical services andcorporate/support services with the aim of improving service quality.Clive was a participant in the 2001 King’s Fund Top Managers Leadership Programme.Professor Tim Kendall was appointed as the Trust’s initial Executive Medical Director with effect from 1stJuly 2008, when the organisation attained Foundation Trust status. Prior to that, he served as ExecutiveMedical Director of Sheffield Care Trust since 2003 and has practised as a Consultant Psychiatrist withinSheffield Care Trust (and, subsequently, the Foundation Trust) since 1992. He is also Director of theNational Collaborating Centre for Mental Health (NCCMH) at the Royal College of Psychiatrists, andvisiting Professor at University College London.Professor Kendall previously chaired the first National Institute for Health and Clinical Excellence (NICE)guideline launched in December 2002 on the management of schizophrenia. Since then, the NCCMHhas produced more than 20 NICE guidelines covering most of mental health. Professor Kendall has anational and international reputation and some of his work has been adopted in other countries, includingAustralia, California and Italy. Professor Kendall chaired the first National Quality Standard (Dementia),and has carried out work with NICE International in Turkey and Georgia, which represents the first NICEguideline and quality standard developed outside the UK.His work extends to Holland and other European countries where he collaborates on the production ofinternational guidelines. He has published articles and papers in a range of medical, scientific and socialscience journals, magazines and other publications. He also represents the NCCMH, NICE or the RoyalCollege of Psychiatrists in the media. In 2004, Professor Kendall, along with others from the NCCMH,was awarded the “Lancet Paper of the Year” for publishing work on Selective erotonin ReuptakeInhibitors (SSRIs) and the Treatment of Childhood Depression.Liz LightbownRegistered Mental Health Nurse, BSc Behavioural Sciences, MSc Health Planningand Financing, , Diploma in Public HealthExecutive Director of Nursing and Integrated Governance (April 2012 – Nov 2012)Chief Operating Officer/Chief Nurse (Nov 2012 – present)Liz Lightbown joined the Trust on 21st April 2010, initially on secondment. She was subsequentlyappointed on a permanent basis in April 2011. She is a Registered Mental Health Nurse and holds aBachelor of Science Degree in Behavioural Sciences, a Masters Degree in Health Planning and Financing,and a Diploma in Public Health. She was a participant on the King’s Fund National Nursing LeadershipProgramme and is Prince 2 (Project Management) qualified.In November 2012 Liz took over the role of Chief Operating Officer/Chief Nurse.7172

Paul RobinsonACMA, CGMAExecutive Director of FinanceCouncillor Mick RooneyNon-Executive Director (Senior Independent Director)Paul has over 20 years experience in NHS Finance serving in provider and commissioning organisations inSouth Yorkshire, Derbyshire and Lincolnshire. Prior to his appointment he was the inaugural Director ofFinance & Deputy Chief Executive for Lincolnshire Community Health Services NHS Trust which he helpedto establish as a standalone organisation in 2011.Susan RogersMBE, BA (Hons) History, Certificate of EducationNon-Executive Director (Vice – Chair)Councillor Mick Rooney was appointed as an initial Non-Executive Director of the Trust when it attainedFoundation Trust status on 1st July 2008. He was reappointed to serve for a further term of three yearsin 2011. As a serving Councillor for Sheffield City Council, he brings to his role a wealth of experience inlocal government. He is actively involved in the work of other bodies that seek to promote the health andwell-being of the people of Sheffield.Councillor Rooney is currently the Chair of the Health and Community Care Scrutiny Board and a memberof the South-East Community Assembly.His extensive experience in dealing with health and social care issues has given him an excellentunderstanding of the breadth of the Trust’s services. He is able to use this experience to help shapethe strategic direction of the Trust.Tenure of office: 1st November 2011 to 31st October 2014.Sue Rogers has extensive experience in the teaching profession, as well as industrial relations. She hasserved at the highest level of NASUWT (National Association of Schoolmasters Union of Women Teachers),the largest teachers’ trade union in the United Kingdom, both as President and Treasurer.From 2005 to 2009, Sue served as the Chair of AQA (Assessment and Qualifications Alliance), the largestunitary awarding body for public examinations in the United Kingdom.Sue was awarded an MBE for her services to the Trade Union movement. She currently serves as a memberof the Employment Tribunals and continues to work for international solidarity for trade union developmentin Iraq.Sue served a three year term as a Non-Executive Director from 2009 to 2012. Following the advertisementof the post on the NHS Jobs website, the Nominations and Remunerations Committee formally interviewedher for the post and recommended that she be appointed as a Non-Executive Director of the Trust.The Council accepted this recommendation and appointed Sue for a further term of three years witheffect from 1st December 2012.Her appointment has enhanced the Board’s ability to address the organisation’s human resource needsand its strategic capacity in general.Tenure of office: 1st December 2012 – 30th November 2015.Anthony ClaytonMBA, MSc in Marketing Practice, DMS Postgraduate Diploma in Management Studies,DCR Diploma to the College of RadiographersNon-Executive Director (Chair of the Finance and Investment Committee)Anthony Clayton was appointed with effect from 1st September 2009 for a term of three years. He bringsto the Board the benefit of his extensive commercial experience gained from working at senior managerialand directorship levels in organisations operating in domestic and international healthcare markets.His strong commercial flair and outlook have added strength to the Board’s ability to reap the commercialadvantages which Foundation Trust status offers. Tony Clayton’s commercial strengths are buttressed by hisfirm academic credentials, being a holder of a Master of Business Administration (MBA) Degree, a Masterof Science Degree in Marketing Practice, a Postgraduate Diploma in Management Studies and a Diplomato the College of Radiographers.Tony served a three year term as a Non-Executive Director from 2009 to 2012. Following the advertisement ofthe post on the NHS Jobs website, the Nominations and Remunerations Committee formally interviewed him forthe post and recommended that he be appointed as a Non-Executive Director of the Trust. The Council acceptedthis recommendation and appointed Tony for a further term of three years with effect from 1st December 2012.Tenure of office: 1st December 2012 – 30th November 2015.7374

Martin RoslingCPFANon-Executive Director(Chair of the Audit and Assurance Committee)A qualified accountant by profession, Martin Rosling was appointed as an initial Non-Executive Director ofthe Foundation Trust with effect from 1st July 2008 up to 31st October 2010, which was extended for afurther period of 12 months. He was reappointed to serve for a further term of three years in 2011.Martin has held a range of senior financial roles in the public and commercial sectors. His strong careertrack record is supported by his professional membership of the Chartered Institute of Public Finance andAccountancy (CPFA). Martin’s financial expertise is invaluable to the Board, where he currently serves asChair of the Audit and Assurance Committee.Tenure of office1st November 2011 to 31st October 2014.Mervyn ThomasBA (Hons) Politics, MA Social Policy, CQSW (Certificate in the Qualificationof Social Work), FRSANon-Executive Director (Chair of the Quality Assurance Committee)Appointed with effect from 1st September 2009 (for a term of three years), Mervyn Thomas brings awealth of experience from the health and social care sectors, giving him a perfect fit with the strategicneeds of the Trust.His experience as a serving Non-Executive Director in two other organisations in the health and probationservices is complemented by his extensive past experience at senior managerial levels in local government.Mervyn Thomas holds a Bachelor of Arts Degree in Politics, a Master of Arts Degree in Social Policy and aCertificate of Qualification in Social Work. He is a Fellow of the Royal Society of the Arts.Mervyn served a three year term as a Non-Executive Director from 2009 to 2012. Following theadvertisement of the post on the NHS Jobs website, the Nominations and Remunerations Committeeformally interviewed him for the post and recommended that he be appointed as a Non-Executive Directorof the Trust. The Council accepted this recommendation and appointed Mervyn for a further term of threeyears with effect from 1st December 2012.Tenure of office: 1st December 2012 – 30th November 2015.7.4.1. Directors’ interestsUnder the provisions of the Trust’s Constitutionand the Board of Directors’ Standing Orders, we arerequired to have a register of interests to formallyrecord declarations of interests made by membersof the Board of Directors. In particular, the registerwill include details of all directorships and otherrelevant material interests which both Executiveand Non-Executive Directors have declared.Members of the Board of Directors must declare anyinterests which might create, or be seen to create aconflict or potential conflict between their personalor private interests and those of the organisation ortheir duties as members of the Board of Directors.They are also required to declare any conflicts ofinterest that arise in the course of conducting Trustbusiness, specifically at each meeting of the Board.The Register of Interests is maintained by theFoundation Trust Company Secretary and is availablefor inspection by members of the public on request.Please submit any requests to Clive Clarke, DeputyChief Executive, by ringing 0114 2263978 or emailclive.clarke@shsc.nhs.uk.7.4.2 Board EvaluationThere were six Board development sessions thisyear which aimed to build the strategic capabilityof the Board. The development sessions informedthe development of Trust strategy, annual andfinancial plans. Sessions were designed to includekey changes in the external context, such as theHealth and Social Care Act 2012. One session wasdedicated to improving the service user experience.The Board also has an annual development sessionwith the Governors which included a presentationand Question and Answer session where theGovernors hold the Board to account for theyear’s performance.Members of the Board’s Audit and AssuranceCommittee, and its Finance and InvestmentCommittee have completed questionnaires and areusing the responses to these to help to inform themon the degree of their effectiveness in dischargingtheir respective functions.The Quality Assurance Committee evaluated theeffectiveness with which it carries out its role againstthe criteria set by Monitor’s Quality GovernanceFramework and its members were confident that it isproperly carrying out its functions. An evaluation of theBoard’s Remuneration and Nominations Committeetook place during 2012/13 during which the membersdiscussed the operation of the Committee. It wasagreed that the Committee continues to dischargeits duties effectively and efficiently.The Trust Chair will be carrying out performanceevaluations of each of the Non-Executive Directorsduring 2013/14.The formal evaluation of the Chair’s performancebegan with Board members and Governorsresponding to a formal questionnaire on the Chair’sperformance in various aspects of his role. Thequestionnaire responses were then considered bythe Reserve Chair/Lead Governor and the SeniorIndependent Director, and a report will be presentedto a formal meeting of the Council of Governors.The evaluation of the performance of theExecutive Directors is carried out by the ChiefExecutive during his monthly one-to-one meetingsand annual reviews with them. As stated inSection 3, the evaluation of the Chief Executive’sperformance is carried out by the Trust Chair inhis one-to-one meetings with the Chief Executive.The Board is satisfied that the composition of itsmembership is balanced, complete and appropriateand this can be seen in the biographical details ofBoard members as set out above.7576

8.0 Staff SurveyThe Trust employs around 3,000people and as part of our responsibilitytowards enhancing staff loyalty andmotivation, we carry out an annualNHS Staff Survey programme.We then develop action plans that are based on theoutcomes of this survey and share details with allstaff through our regular communication channels.The NHS Staff Survey provides us with feedback onthe Trust’s performance across a range of relevantareas. The results are focused on the pledges to staffcontained in the NHS Constitution, which are:Pledge 1: to provide all staff with clear roles;responsibilities and rewarding jobsPledge 2: to provide all staff with personaldevelopment, access to appropriate training fortheir jobs and line management support to succeedPledge 3: to provide support and opportunities forstaff to maintain their health, wellbeing and safetyPledge 4: to engage staff in decisions that affectthem and the services they provide, as well asempowering them to put forward ways to deliverbetter and safer services.The NHS Staff Survey attempts to identify themajor factors contributing to staff engagement andmotivation. By focusing on these, the Trust aims toenhance the high quality care it offers to the peoplewho use its services.Creative Potters’ turtle at theLongley CentreSECTION 8.0Staff SurveyService Users and staff on Stanage Ward7778

8.1 Survey results 2012The Trust has maintained its high score in respect of overall staff engagement, including the questionrelating to staff recommending the Trust as a place to work or receive treatment.The top 5 / bottom 5 ranking scores are set out below:Top five ranking scoresBottom five ranking scoresTrust score for 2012National Av for mental health/learning disability TrustsTrust score for 2012National Av for mental health/learning disability TrustsKF5 The % of staff working extra hoursKF6 The % of staff receiving job-relevant training,learning or development in last 12 monthsKF10 % of staff receiving health and safetytraining in last 12 monthsKF26 % of staff having equality and diversitytraining in last 12 months64%85%50%38%70%82%73%59%%%%%KF3 Work pressure felt by staffKF23 Staff job satisfactionKF7 % of staff appraised in last 12 monthsKF11 % of staff suffering work-related stressin the last 12 months2.933.7279%46%3.023.6687%41%Low workpressureHigh workpressureDissatisfiedstaffSatisfiedstaff%%KF21 % of staff reporting good communicationbetween senior management and staffKF4 Effective team working3.7735%3.8330%%Ineffectiveteam workingEffectiveteam working7980

Art therapy session on ward G1In addition, the percentage of staff agreeingthat their role makes a difference to patientsand the percentage agreeing that they feel ableto contribute towards improvements at work wereboth above average.Although the Trust still needs to significantlyimprove in respect of certain elements of its training,the survey shows the Trust as being amongst thebest 20% in terms of receiving job-relevant training,learning or development in the last 12 months.On appraisal, the Trust’s relative ranking hasdeclined, however, although there was a slightimprovement in the percentage figure, the rateof improvement fell below that of other Trusts.A further area for continued consideration is thepercentage of staff reporting work-related stress.However at the same time the largest change sincethe 2011 survey is in respect of the improvement instaff satisfaction; with the Trust now being in thetop 20% of comparable Trusts.SECTION 9.0Regulatory Ratings8182

9.0 Regulatory RatingsThe Care Quality Commission (CQC) registers, and therefore licenses us as a providerof care services as long as we meet essential standards of quality and safety. The CQCmonitors us to make sure we continue to meet these standards. We have remainedcompliant with the terms of our registration during the year. Information about theCQC’s visits and inspections of our services is provided in Section 11.Our performance against the regulatory requirements set for is by Monitor, the independent regulatorof NHS Foundation Trusts over the year 2012/13 is summarised as follows:Financialrisk ratingGovernancerisk ratingAnnual Plan2012/132012/13 risk ratings compared to annual planQuarter 12012/13Quarter 22012/13Quarter 32012/13Quarter 42012/134 4 4 5 4Green Green Amber/Green Green GreenWe performed well during the year. We failed to achieve one of the quality targets required of us in thesecond quarter of the year. Information about this is provided in Section 11.SECTION 10.0SustainabilityThe gardens at Beighton Road8384

10.0 Sustainability ReportOur approach to sustainability is reflectedin our Sustainable Development Policy. Theobjectives of the policy are for the Trust tocontinually improve upon and manage itsenvironmental impact wherever possible,while taking value for money into accountThis will include conservation of water, energyand other resources; appropriate waste disposal;monitoring discharges and emissions with the aim ofreducing pollution and greenhouse gases; promotingrecycling, and training and educating staff, involvingthem in developing new ideas and initiatives.The intended outcomes will be the ability to meetlegislative and regulatory requirements; contributeto the NHS carbon reduction target; demonstratethe Trust’s commitment to other organisations,and have better engaged and informed staffwho actively contribute to the outcomes.The Trust has taken a number of actions during2012/13 to improve its sustainability performance.We have introduced a Sustainability & Cost SavingsWorking Group, comprising of management andstaff members, as well as staff and public governorrepresentatives. The Group has overseen severalareas of work including:• Energy and sustainability roadshow displaysat the Trust’s Annual Members Meeting andseveral of our main sites• Implementation of a revised ‘water flushingprocedure’ (legionella control) to reducewastage of water• Building on the success of a Voltage OptimisationUnit (VOU) installed at our headquarters buildingin 2011/12, a further 4 VOUs have recently beeninstalled at other sites. There is an early indicationthat these units will also reduce electricityconsumption by around 10% at each site• Working with the cleaning/catering contractorfor Fulwood House (Sodexo), paper handtowels on this site have been replaced withhot air hand dryers. This simple change hasreduced cleaning costs by £13,000 per annum,and waste disposal costs by nearly £3,000 perannum – all by ceasing purchase and disposalof paper hand towels• Sodexo have worked in partnership withthe Trust to improve their own sustainabilitypractices including offering used coffee groundsfor staff to take away as garden mulch, andintroducing an incentive for staff to bring theirown mugs when purchasing hot drinks from thecafé, in return for a reduced-price drink. Thisreduces the quantity of disposable cups used• “Paper lite” meetings have been adopted forseveral Trust meetings (members are requestednot to print out all papers and these are displayedduring the meeting via audio-visual equipment).We are obtaining costs for installing audio-visualequipment in the Tudor Boardroom at FulwoodHouse which would enable meetings such as theTrust Board to minimise the use of paper• Establishment of an intranet page for staff toaccess information related to sustainability.In addition to this, the Transport Service hascontinued to replace older vehicles with smaller,more efficient models and to review its practicesto minimise the number of vehicles required toprovide a range of services.Reporting Table/MetricsArea Type Non-financialinformationGreenhouseGas EmissionsWaste Minimisationand ManagementDirect Greenhouse Gas EmissionsIndirect Energy EmissionsOfficial Business Travel EmissionsDomestic Waste:For 2012/13 the figures for DomesticWaste are as follows: Total WasteArising: 492,457 kgWaste to Landfill: 128,900 kgWaste Recovered/Recycled: 363,557 kgWaste Incinerated: 0 kgHealthcare Waste:For 2012/13 the figures for HealthcareWaste are as follows: Total WasteArising: 14,404 kgWaste Incinerated: 2,870 kgFinite Resources In 2012/13 the Trust consumed 35,586m3 of water and sent away 33,807 m3in the form of sewageIn 2012/13 the Trust consumed13,549,645 kWh of Gas whichequates to 2791 tonnes of Co2e*In 2012/13 the Trust consumed3,356,717 kWh of Electricity whichequates to 1803 Tonnes of Co2e*Grey Fleet (inc Lease CarMileage)**: In 2011/12***mileage travelled by the GreyFleet amounted to 1,703,395miles. The figure for Co2e isnot currently available.Financial informationIn 2012/13 the Trust spent£454,093 purchasing GasIn 2012/13 the Trust spent£348,212 purchasing ElectricityGrey Fleet (inc Lease Cars):In 2011/12 the Trust spent£728,910.05 on mileage for theGrey Fleet.Domestic Waste: In 2012/13 thecost of disposing of DomesticWaste was £76,715Healthcare Waste: In 2012/13 thecost of disposing of HealthcareWaste was £15,098In 2012/13 the total water andsewage cost was £97,884* Co2e = Carbon Dioxide Equivalent which is a way of reporting all greenhouse gas emissions or reductions as one standard unit** Grey Fleet = employee-owned (or leased) vehicles used for Trust business purposes (home visits, meetings, conferences etc)*** The last year for which figures are available for this metricFuture Priorities and TargetsWe are developing several bids for a Departmentof Health capital fund for energy efficiency projectswhich has recently been made available. The majorityof planned bids relate to replacement of outdatedand inefficient boiler plant, as well as schemes toreplace lighting at our Headquarters building. Weplan to replace some of the boilers with CombinedHeat and Power (CHP) units which would also reduceour electricity consumption from the national grid.We will know later in the year if any of the bidshave been successful.We will also be reviewing the potential to introducesmall changes such as devices to reduce waterconsumption in washrooms, and to reduceelectricity consumption by commercialrefrigerator and freezer appliances.Grenoside Grange8586

Art therapy session on Ward G111.0 Quality reportSECTION 11.0Quality reportPart 1: Quality account2012/13 Chief Executive’swelcomeI am pleased to present the SheffieldHealth and Social Care NHS FoundationTrust Quality Account for 2012/13.This Quality Account is our way of sharing withyou our ongoing commitment to achieve betteroutcomes and deliver better experiences for ourservice users and their carers.In this report we will outline our progress against thepriorities we set last year, and look ahead to the areaswe will continue to focus on for the coming year.Through the report we aim to be transparent andaccountable for the quality of service that we provide.Our vision is that people who use our services willachieve their full potential, living fulfilled lives in theircommunity. We will deliver our vision by providingservices that are world class in terms of quality,safety, efficiency and choice. Our services will deliveroutcomes for individuals that are world class in termsof effectiveness of treatment, experience of care,recovery, independence and social inclusion.The information in this Quality Accountdemonstrates how we are working to deliver this.We achieve many improvements in quality bychanging how we deliver services across the city.We may expand services, re-organise how we providethem, develop better partnerships with other servicesin Sheffield. Change and improvements are deliveredin this way, and you will find information about thesechanges in our full Annual Report for 2012/13.There is also significant potential to deliverimprovements in quality, safety, effectivenessand experience through focussing on qualityimprovements within the day to day care and supportwe provide. Our ongoing challenge and commitmentis to reflect on what we learn about the experiencesof those who use our services and identify how itcould be improved. Across the Trust we have manyinitiatives and development programmes which aredesigned to improve quality and you will find manyexamples detailed in this Quality Account.When we look at how we are doing against most ofthe ways we evaluate our services, we are providinga good standard of care, support and treatment.This is something we are rightly proud about.However we also know we can do better, and needto do better. We have much to do to ensure thequality of what we provide is of a consistent highstandard, every time, for every person in respectof safety, effectiveness and experience.This Quality Account reflects our determination todevelop our understanding and measurement ofquality as experienced by the people who use ourservices, and our ambition to deliver continuousquality improvement in all our services.In publishing this report the Board of Directors havereviewed its content and verified the accuracy of thedetails contained in it. Information about how theyhave done this is outlined in Annex B to this report.To the best of my knowledge the informationprovided in this report is accurate and representsa balanced view of the quality of services thatthe Trust provides. I hope you will find it bothinformative and interesting.Kevan TaylorChief ExecutiveAdelaide Mukasa,Rowan Ward ManagerBeighton Road, LearningDisability ServiceService User pottery atMoncrieffe Road8788

Part 2A: A review ofour priorities for qualityimprovement in 2012/13and our goals for 2013/14We established our priorities for quality improvementin February-March of 2012. The people who useour services and the membership of our foundationtrust have been instrumental in deciding what ourpriorities are. When we identified our priorities weagreed a two year plan to deliver improvementsover the longer term.In order to establish these areas as our prioritiesour Board of Directors:• Reviewed our performance against a rangeof quality indicators• Considered our broader vision and plansfor service improvement• Continued to explore with our Council ofGovernors their views about what they feltwas important• Engaged with our staff to understand theirviews about what was important and whatwe should improve.This report confirms how we have progressed overthe first year of our two year plan. It also confirmswhat actions we will continue to take and focus onnext year to make further progress and improvement.In reviewing our progress over the first year andfinalising our plans for next year we have continuedto engage with our members. Our Governorshave undertaken this on our behalf and we havereceived comments and feedback from over 150of our members about our proposals for next year.From this review the Council of Governors havereviewed our plans and we have taken on boardtheir feedback.Through next year we will report on progressagainst our quality improvement objectivesthrough the following ways:• The Board’s Quality Assurance Committee• The Board of Directors• To our Council of Governors formally at theirmeetings during the year• To our Commissioners.We identified 5 quality improvement prioritiesfor this year and the year ahead. They cover thefollowing areas:Quality objective 1: To reduce thenumber of falls that cause harmto service usersWe chose this priority becauseFalls cause direct harm to service users because ofinjury, pain, restrictions on mobility and communityparticipation. This harm impacts on people’s qualityof life and well-being. Three years ago, the NationalFalls and Bone Health Audit in 2011 showed thatduring 2010/11 falls were higher in the Trust’s olderpeople’s inpatient areas than the national averagerate of falls. There were 13.5 falls per 1000 bednights compared with 8.4 falls nationally.Our own data showed that during 2011/12 1,605incidents of slips, trips and falls for service userswere reported by the Trust. 32.1% (n=516) resultedin harm or injury to the service user concerned.Guidance was available on how to reducethe severity, frequency and impact of falls fromNICE. We believed there were clear opportunitiesto deliver real improvements in this importantarea. This was also a priority area for SheffieldClinical Commissioning Group who incentivisedimprovement in this area under the Cquin scheme)(see section 2.3 within this Quality Report).We said we wouldIntroduce a two year plan that started in 2012/13and will continue into 2013/14. Within this planwe said we would:• Implement MFRA (Multi-factorial RiskAssessment) screening tool for falls for allolder people admitted to inpatient areas• Carry out environmental falls risk assessmentsin all inpatient and residential areas• Identify appropriate training packages for staffand deliver a programme of training.The outcome we wanted to achieve was• To reduce the number of falls that result in harmto service users by 5% by the end of this yearand by 10% next year• To reduce the level of harm experiencedby service users from falls, as measured byreduction in number of falls resulting in A&Eor hospital admission• That by the end of this year all older peopleadmitted to inpatient areas will be assessed tosee if they are vulnerable to experiencing a fall.We then consulted on our proposed areasfor quality improvement with a range of keystakeholders. These involved our local ClinicalCommissioning Group, Sheffield City Counciland members of LINk (now Healthwatch).Improving safetyImproving clinical effectivenessImproving the delivery of positiveservice user experiencesImproving access, equality and inclusionQuality objective 1: To reduce the number of fallsthat cause harm to service usersQuality objective 2: To reduce the incidence ofviolence and aggression and the subsequent use ofrestraint and seclusionQuality objective 3: To improve the identificationand assessment of physical health problems in at-riskclient groupsQuality objective 4: To improve the experience offirst contact with the Trust’s servicesQuality objective 5: To improve access to the right carefor people with a dementiaBeighton Road, Learning Disability Service8990

How did we do?We have made really good progress. We have introduced screening for falls within 72 hours ofadmission, Personal Falls Plans, improved assessment of our building environments for falls hazards andhazard reduction opportunities. We have supported our staff through better training and are exploringways to use Assistive Technology to reduce falls (for example, using alarms and sensors in beds andchairs so we know when someone is getting up).The consistent approach to assessing people’s needs, along with the staff support provided has madea clear difference this year. However we need to establish better ways of monitoring that this happens.In 2011/12 there were 516 falls that resulted in harm. This year we wanted to reduce that by 5%to 490. The number of falls resulting in injury has reduced by 21% to 403 this year.Service User falls that resulted in harm 2012/135004003002001000516490Falls with injury 2011/12 Our target for 2012/13Falls with injury 2012/13Of those who experienced harm from a fall, 52 people needed to attend hospital or A&E for treatment,compared to 61 in 2011/12.Next year we intend toContinue with our plans, as they have had a positive effect this year. We plan to• Ensure falls that result in harm do not exceed 439 (our original two year target)• Ensure people admitted to our older adult wards are assessed for risk of falling and monitor this effectively• Evaluate the use of assistive technology, such as the bed and chair sensors• Implement the risk assessment process (MFRA) to the residential care services that we provide support to.403Quality objective 2: To reduce theincidence of violence and aggressionand the subsequent use of restraintand seclusionWe chose this priority becauseWhen violence or the potential for violencehappens, it causes harm, distress, anxiety and fearfor both service users and our staff. This will clearlyhave an impact on how people feel in receiving careor providing care within our inpatient services. It isin everyone’s interest to reduce violence and the fearand anxiety associated with violence.In the past we have reported lower rates of violenceand aggression when compared to other mentalhealth trusts. Benchmarking information fromthe National Patient Safety Agency for the first 6months of 2011/12 showed that 15.5% of patientsafety incidents reported by the Trust were relatedto disruptive, aggressive behaviour, in comparisonwith 19% of incidents reported by mental healthtrusts nationally.However, our own data showed that violentincidents made up a large proportion of our overallincidents. As well as this the CQC Staff Surveyfor 2011 showed the Trust fell into the highest(worst) 20% of staff from all areas of the trust whoreported that they had experienced physical violencefrom patients, relatives or the public in the previousyear. The proportion of staff who said they hadexperienced harassment, bullying or abuse frompatients, relatives or the public in the previous12 months was also above the national average.We said we wouldWe have introduced a programme called RESPECTwhich is an ethical approach to managing aggressionand violence.Its aim is to support staff to empathise with theservice user, to understand that the service usermay well be frightened and that may be whatis informing their aggressive presentation. Theprogramme promotes early recognition of thesigns of pending aggression which supports moreappropriate de-escalation approaches but alsoacknowledges that, on occasion, violence will beinstrumental and that intervening physically willbe the only safe response.We have trained our staff to respond to thesecircumstances safely and with sensitivity. Theprogramme will touch everyone in the organisationas it also focuses on exploring the environment andthe context that the aggression is displayed withinand what we can do to make improvements to theway we provide our care generally.Through this programme, during 2012/13 ourplans were to:• Continue to deliver the Respect training forall of our ward staff by the end of this year• Continue to monitor the incidents of violenceand aggression at team level, and analysetrends over time• Establish reliable and consistent methods forthe recording of restraint and seclusion on allinpatient areas, and establish clear baselinesto inform ongoing evaluations• Establish service level plans for the reductionof the use of restraint and seclusion in allinpatient areas• Establish reliable and consistent reporting onthe use of restraint in our community settings,establish baselines and set local reductiontargets and agree actions.The outcome we wanted to achieve wasBy the end of this year we wanted to ensure allinpatient nursing and support worker staff withinour inpatient services had been trained in theRespect Approach.Through this year and by the end of next yearwe wanted to:• To reduce the use of seclusion and the useof restraint• To increase the percentage of service users inacute wards who report experiencing a safeenvironment in local surveys• To reduce the number of staff reporting thatthey have experienced physical violence andharassment, bullying or abuse from service users,relatives or the public in the CQC Staff Survey.9192

How did we do?We believe we are making good progress in delivering real improvements for the longer term. Over theyear the data is varied in what it shows across the different indicators.The extensive staff development work we have done has had a positive impact in conveying expectationsand the need to ensure all types of violence are accurately captured to ensure we fully understand day today circumstances.We believe at this stage that this is the main reason why reported incidents of violence towards staff has beenincreasing, especially over the last year. Detailed analysis highlights that the vast majority of these incidents are‘lower level’ types of violence, such as pushing and shoving, that may well have not been reported previously.The practice development work we have done, through the RESPECT programme and the introductionin some areas of designated spaces and facilities to support people to work through their agitation(such as ‘Green Rooms’) are showing positive results with reduced use of seclusion and restraint.Incident type 2010/11 2011/12 2012/13Incidents reported where service usershad been• Secluded918071• Restrained16810585• Assaulted398387386• Caused harm from assault788972Proportion of all reported patient safety incidentsrelated to disruptive• Within our Trust15.5% 20.6%• National averages for mental health trustsNPSA Benchmarking data19% 18.2%Percentages of service users who report feelingunsafe in local surveys 25% 25%Incidents reported where staff working ininpatient services• Had been assaulted324364• Caused harm from assault97110Number of staff who reported to the nationalCQC staff survey that they had experiencedfrom patients, relatives or visitors• Physical violence17%17%• Harassment, bullying or abuse19%19%32% July23% DecThis is a complex issue to report on. The threat of violence and actual violence clearly causes fear andpsychological distress. The impact and consequences for people are individual to them. Reporting throughdata about incidents does not capture this fully, yet it is important to have an awareness of overall incidentlevels. That is what we report on here.Overall at this stage in our development plan we believe we have made good and positive progress.This puts us in a positive position to continue to deliver improvements into next year and beyond.60810122%30%Next year we intend to• Reduce further the incidents of seclusion andrestraint from the levels in 2012/13• Continue with our investment in the Respectdevelopment programme• Implement a range of new policy guidancethat defines and supports expected practice,incorporating all our learning over the last 2 years• Implement a programme of practice reviewsfocussing on seclusion, de-escalation, physicalhealth monitoring, post-incident reviews, useof green rooms• Continue with our staff training programme• Undertake a review of staff experiences ofdelivering care and how we can better supportthem to deliver respectful and compassionate care• Complete an initial assessment of the experiencesof service users and staff in our non-residentialand inpatient settings.Quality objective 3: To improve theidentification and assessment ofphysical health problems in at-riskclient groupsWe chose this priority becausePhysical health was a priority for our governors andservice users, as many of our service users are athigher risk of developing physical health problems.The evidence clearly shows that people with severemental illness and people with learning disabilitieshave reduced life expectancy and greater morbidity,as do people who are homeless and people whomisuse drugs and alcohol.We were already working on a number ofprogrammes to make improvements e.g. physicalhealth checks on wards, use of early warning signstoolkit, link nurses for illnesses such as diabetes,smoking cessation, health facilitators and health actionplans, staff training in ‘healthy chats’. The introductionof physical reviews for people with long term mentalhealth problems in primary care presented additionalopportunities to make further improvements.Audits of care records across our mental health andlearning disability services in November 2011 showedoverall in 78% of service users’ records their physicalhealth status was checked and documented. Thiswas less across our community mental health serviceareas. Our GP services performed well across a rangeof areas in meeting the physical health care needsof people with mental health problems, althoughperformance was poor for people newly diagnosedwith dementia.We said we would• Implement the electronic Medical Examinationon Admission and Lifestyle Assessment acrossall relevant services• Train additional 30 staff to become ‘healthychat’ key trainers with roll out training to afurther 180 staff• Develop and roll-out obesity care pathwaysupported by patient information resources,improved menu labelling and healthier setmenus for inpatient services• Ensure smoking status of all inpatients isrecorded, with an increase in referrals toStop Smoking Service and the introduction toinpatient services of smoking cessation experts• Our GP services would improve the recording ofBMI in people with psychosis and the completionof physical health checks for people newlydiagnosed with dementia.The outcome we wanted to achieve was• ‘Health chat’ key trainers to cascade traininginto clinical settings and become ‘champions’for these settings• 90% of people to have physical health checksrecorded in all relevant service areas• Improved awareness of peoples smokingcircumstances with appropriate support provided• Diabetes link nurses in all inpatient areas• Measure of better communication betweenSHSC and primary care on physical healthkey information e.g. blood pressure• Clover group to improve performance andachieve the QOF targets on physical health checksfor dementia and BMI for people with psychosis.9394

How did we do?We continue to implement an Annual Physical Health Work Plan that looks to focus on the following areas:• Smoking, Alcohol, Obesity, Diabetes, Physical Health Check recording, Annual Health ChecksDuring the year we have developed, piloted and introduced an innovative on-line screening tool thatprovides access to advice and assessment of peoples alcohol use. This has been a really positive andexciting development that allows people receiving support from across GP surgery’s, Pharmacists, otherhealth and social care services to get quick and tailored advice along with information about supportservices should they be needed. Over this year 914 people have benefitted from advice in this way.We have also made progress in the following areas:• 39 ‘health chat’ key trainers have been trained• 99% of sampled care plans in pilot services had evidence of health checks being done• Our knowledge of peoples’ smoking status increased from 55% in April 12 to 95% in December 12• We have introduced diabetes link nurses within 10 of our Wards• Our Clover Group of GP practices had completed 84% of physical health checks for people withdementia – against a target of 70%• Completed 84% of BMI assessments of people with a psychosis – against a target of 90%.OT exercise session at the Longley CentreNext year we intend toContinue our current plans to bring togetherachievable actions within the Trust and external topartner organisations. We will build on existing andplanned developments to ensure that we and ourpartner organisations work collaboratively to ensurehealth of service users continues to improve.The priorities for this year are continued work toimprove the physical health of service users byfocussing on:• Smoking - Offering advice guidance andreferrals to the smoking cessation serviceto decrease smoking amongst service users• Alcohol - Provide alcohol screening across servicesto ensure timely referral to appropriate services• Obesity - provide advice and support to addressthe issue of poor lifestyle choices, encouraginghealthy diet and exercise• Diabetes - To ensure those at risk, in particular thoseindividuals who may experience weight gain due totheir medication or lifestyle choices, are effectivelyscreened for the risks of diabetes and are offeredappropriate treatment, advice and guidance• Dental - To ensure that Dental Care is included inboth physical and lifestyle assessments and thataccess to dental care is made more readily available• Physical Health Checks and annual healthchecks for vulnerable service users - Ensure thatall service users have appropriate physical healthchecks, whether completed by our services orwithin our partner organisations.Quality objective 4: To improve theexperience of first contact with theTrust’s services.We chose this priority becauseOur Governors and service users had identified thisissue as a priority for positively influencing the serviceusers’ overall experience of the services we provide.Although the CQC Community Mental Health serviceuser survey indicates that service users feel they aretreated with dignity and respect in most instances,complaints about staff attitude are still received.Following low scores on the CQC AnnualCommunity Mental Health for questions abouta 24 hour phone line, the Trust had piloted anout-of-hours phone line to give advice and help toservice users and carers, in partnership with Rethink.We were keen to learn from the pilot and provideongoing support to service usersThe Respect training which is being implemented forall staff (see objective 2) includes key elements abouttreating service users with dignity and respect. Initialfeedback indicates a positive impact on staff attitude,and we wanted to support this programme to deliverimprovements to the day to day experiences of ourservice users.We said we would• Pilot an out of hours telephone helpline,evaluate how it worked and develop a planfor a sustainable service• Deliver RESPECT training for all inpatient staff• Review and revise standard communicationsrelating to first contact including initialappointment letters and information leafletssent out with initial appointments, and wardwelcome packs• Implement 15 Steps Challenge with our non-executive directors, staff and service users ininpatient areas and 1 community team.The outcome we wanted to achieve was• Improved awareness of services users about thesupport available through the crisis helpline• More staff trained in customer care as part ofthe roll out of Respect training• Better information provided to support serviceusers entering our services• To remain in top 20% of mental health trusts inCQC Annual Community Mental Health Surveyfor being treated with dignity and respect.9596

How did we do?We have made positive progress with our helpline services, which have continued over this year. We willhave opened a new Crisis House service, in partnership with Rethink, in April 2013. We expect it to providesupport to over 300 people a year as an alternative to needing hospital care. As part of that service we havecommissioned Rethink to provide the helpline service for our service users.All inpatient staff have benefited from the RESPECT development and training programme by thesummer of 2012, and it is having a positive effect across our services. We continue to provide thetraining to support new staff who have since joined the service, and to provide updates to existingstaff who have been trained previously.Areas of experience 2010/11 2011/12 2012/13Awareness of crisis support available throughtelephone helpline (National Patient Survey)Ensure all inpatient staff have benefited fromRespect development programmeService users reporting they are treated withrespect (National Patient Survey)51 out of 100 5.0 out of 10 n/a see note*Note: We will use the national patient survey as a way of assessing feedback and progress over this year. Unfortunately the national survey hadnot been completed in time for us to include the results in this Report.We did not make the progress we wanted to regarding reviewing the information we share with serviceusers. We will address this better next year.Next year we intend to• Continue with the Respect developmentprogramme for new staff and the 15Steps Challenge to support the deliveryof improved experiences• Continue to review service user experiencesthrough local surveys• Complete the review of the range ofinformation we provide to service usersand agree improvements• Focus on supporting service users to access ourservices quickly. To support this we will confirmimprovement targets in respect of our IAPTservices (assessed within 4 weeks of referral) andour Community Mental Health teams (assessedwithin 2 weeks of referral) and establish targetsfor our Memory services (see Quality Objective 5).Nil155 staffExtra 209364 in total95 out of 100 9.5 out of 10 n/a see noteStanage WardQuality objective 5: To improveaccess to the right care for peoplewith a dementiaWe chose this priority becauseImproving dementia care is a priority for theTrust, governors, the City Council, SheffieldClinical Commissioning Group, and Healthwatch.The incidence of dementia is predicted to rise withSheffield’s aging population. We know that earlyidentification and rapid access to services can delaythe impact of dementia and lead to a better qualityof care and better support for carers.Overall Sheffield performs well in comparisonwith other areas in the identification of peoplewith dementia, enabling them to access careand treatment. This is measured by people witha diagnosis on the Quality Outcomes Frameworkby their GP in primary care. In 2012 in Sheffield63.6% of the expected number of people witha dementia have been registered, compared tothe national average of 44.2%. Sheffield is the2nd best performing area in England and Wales.We wanted to build on the delivery of theNICE Quality Standard for Dementia and positivedevelopment work already underway over the lastfew years to improve access to our services andreduce waiting times. Within our learning disabilityservices a specific dementia care pathway has beendeveloped because of the increased risk of earlydementia in people with Downs syndrome.We have worked successfully in partnershipwith Sheffield Teaching Hospitals NHS FoundationTrust and Sheffield Clinical Commissioning Groupto improve access to dementia support and carefor people who require access to general hospital.We said we would• Continue the development of our Memorymanagement services so we could providemore assessments and reduce waiting times• Implement and evaluate the dementia pathwayfor adults with a learning disability• Develop and implement a plan to improveaccess to services by people from Black andMinority Ethnic Groups• Survey service users and carers of dementiaservices about their experience of care andrespond to any issues raised.The outcome we wanted to achieve was• Support over 900 people with memoryassessments, and reduce service waitingtimes from 14.7 weeks• To establish a reliable baseline for the numberof people with learning disability receivingmemory assessments• To evaluate experience through service userand carer experience surveys for peoplereceiving dementia services from the MemoryManagement Service• To establish reliable baseline figures for peoplefrom different black and minority ethnic groupsuse of dementia services.Art therapy session on Ward G19798

How did we do?We have made good progress in improving access, though we have further work to do to continue toreduce waiting times. While we have managed, through a range of service improvements to see morepeople, waiting times have got worse over the year.Areas of experience 2010/11 2011/12 2012/13Number of people who received an assessmentand diagnosis749 876 918Average waiting times to access memory services 21.9 weeks 14.5 weeks 16.3 weeksNumber of people with a learning disabilitywho were assessed for dementiaNot available 40 approx 29We have completed an exciting project to gather the views and experiences of people with dementia.The ‘Involving People with Dementia Project’ aims to extend the good practice around service userinvolvement that already exists in SHSC by exploring how people with dementia could be better involvedin service feedback, evaluation and planning. The project has resulted in a film being produced. The filmaims to demonstrate that, given the opportunity, people with dementia have important things to contributeto services and society through their experience of dementia. The film powerfully shows how people withdementia have a voice and they want their voice to be heard. We are using this film to help raise awarenessacross Sheffield, both for our own staff and staff from other areas of health and social care.Our Memory Services benefited from a review with the Royal College of Psychiatrist’s Memory ServiceNational Accreditation Programme, which involved surveying independently the views of service usersand their carers. The feedback from the accreditation is very positive and encouraging about thestandard and quality of the care we provide, awarding our services an ‘Excellent’ rating.We successfully implemented and evaluated a dementia pathway for adults with a learning disability.We developed and introduced a programme of ‘awareness raising’ for BME Community groups aboutdementia and local services.During the year we also worked in partnership with Sheffield Teaching Hospitals NHS FoundationTrust to support them to provide better care and treatment for people with dementia in their hospitals.The aim of this pilot was to increase access to specialist dementia trained staff to inform the decisionsmade about people’s care and support needs. It has been successful so far, although the evaluation stillcontinues into the next year.We have continued to work closely during the year with Sheffield CCG and Sheffield City Council.Through these partnerships and commissioning relationships we have been able to make progressin improving access to community focused care and support.Sheffield CCG has identified the need to support primary care services to better be able to monitorpeople at lower risk of developing dementia. They have developed proposals with us to providespecialist support to GP’s to help with this. The expectation is that this will reduce some of the workof the existing memory services, freeing up time to see people who are newly referred quicker.With the City Council we continue to implement city wide plans for the development and improvementof social care support for people with dementia. These plans are focussed on increasing our resources toprovide more individually focussed support packages within local community areas, and reducing the levelof resource allocated for residential based respite care and support. Over the last few years people have beenusing our ‘resource centres’ less and less for residential respite and so we are planning to use the resource toprovide a different service in the future. This is expanded upon in our fuller Annual Report for 2012/13.Next year we intend to• We recognise the clear disparity in waiting times for people needing to access our memory servicescompared to other routine services we provide. We want to address this. We will review the optionsto deliver real improvements in waiting times for our memory services and will confirm the targetswe wish to deliver upon. We will then report on this in next year’s Quality Account, along with theprogress we have made• We will work with GP practices in Sheffield, and the Clinical Commissioning Group to supportmore people who have been assessed for memory problems to receive their on-going monitoringwith their GP, rather than needing to attend a specialist service• Evaluate the effectiveness of the pilot liaison services into the local general hospital and agreefuture needs• Build on the ‘Involving People with Dementia Project’ and introduce more ways to gain regularfeedback from people with dementia• Use the ‘Voice of Dementia’ film to support awareness raising and training for members of thepublic and staff across Sheffield working in relevant sectors.99100

101How do our structures help ensure we are able to develop our qualityimprovement capacity and capability to deliver these improvements?Our governance arrangements and structures support us to focus our efforts on improving the qualityand effectiveness of what we do, and deliver on the objectives we have setEngage and listenEnsuring we understand the experience andviews of those who use our services so wecan make the right improvements.Our Governors and membership share their experiencesand views and inform our plans for the future.We have a range of forums where service users cometogether to help us develop our services.We use a range of approaches to seek the views ofindividuals who use our services such as surveys.We have prioritised the development of service users tosurvey other service users about their experiences as thiswill give us much more reliable feedback.Monitor and assessEnsuring we evaluate how we are doing.We have a team governance programme that supportseach service to reflect on how they perform and agreeplans for development.We have prioritised the provision of information toteams so they can understand how they are doing,and we continue to improve our ability to providethem with the information they need.We periodically self-assess our services against nationalcare standards with service users, members, governorsand our non-executive directors providing their viewsthrough visits and inspections.• Service user Safety Group• Health and Safety Committee• Infection Prevention andControl Committee• Safeguarding ChildrenSteering Group• Audit committee• Mental Health Act GroupQuality and Assurance CommitteeEvaluates and makes sense of the information from the above systems,and directs actions and decision making for future actionBoard of DirectorsCouncil ofGovernorsDeliver best practiceEnsuring the care and support we provideis guided by what we know works.We have a NICE Implementation programme toensure we appraise our services against the availablebest practice and develop improvement plans.We have developed a range of care pathwaysacross services so we are clear about what weexpect to be provided.We have an established Audit programme that evaluateshow we deliver care against agreed standards.Regular Quality Improvement Group forum bringsclinicians and managers together to share best practice.Workforce developmentand leadershipSupporting and developing our staff todeliver the best care.We have an established workforce training programmethat aims to equip our staff with the skills, knowledgeand values to deliver high quality care.We have a well established culture and programme ofdeveloping our clinical and managerial leadership teamsto support them to deliver improvements in care.We use a range of service improvement and systemimprovement models to help us deliver the changes wewish to see, we continue to increase our ability to do this.• Safeguarding AdultsSteering Group• Psychological TherapiesGovernance Committee• Medicines ManagementCommittee• NICE Steering Group• Information Governance GpPart 2B: Mandatorystatements of assurancefrom the board relatingto the quality of servicesprovided2.1.Statements from the Care QualityCommission (CQC)Sheffield Health and Social Care NHS FoundationTrust is required to register with the Care QualityCommission and our current registration statusis registered without conditions and thereforelicenced to provide services.The Care Quality Commission has not takenenforcement action against the Trust during 2012/13.The Trust has not participated in any special reviews orinvestigation by the CQC during the reporting period.The CQC registers, and therefore licenses the Trustas a provider of care services as long as we meetessential standards of quality and safety. The CQCmonitors us to make sure we continue to meetthese standards.During 2012/13 we assumed the CQC registrationof Woodland View Nursing Home, which waspreviously registered by Guinness NorthernCounties Housing Association.Planned/unplanned reviewsDuring 2012/13 the CQC visited the followinglocations as part of their review of our compliancewith essential standards of quality and safety:• Residential homes for people with a learning disabilityBuckwood View, Handsworth, Mansfield View,East Bank Road, Beighton Road• Respite Care services for people witha learning disabilityLongley Meadows136a Warminster Road• Respite Care services for adultsBolehill View, Hurlfield ViewWainwright Crescent• Inpatient ServicesGrenoside Grange.All services inspected were fully compliant withthe exception of Bolehill View, where complianceactions were received for:• Consent to care and treatment and• Care records.Following the feedback received from the CQCwe took immediate improvement action over thefollowing month and the Commission confirmedfollowing a repeat inspection that we were fullycompliant with the required standards.The reports from the planned reviews of complianceare all available via the Care Quality Commissionwebsite at http://www.cqc.org.uk.At the publication date of the Trust Quality Accountall improvement and compliance actions have beenaddressed and the Trust was fully compliant withthe requirements of registration.Mental Health Act reviewsDuring 2012/13 the CQC has undertaken 9 visits toservices to inspect how we deliver care and treatmentfor inpatients detained under the Mental Health Act.They review our processes for care, the environmentin which we deliver our care and meet privately withinpatients. They have visited the following services:• Michael Carlisle CentreStanage, Burbage, Daleside,Maple, Pinecroft• Longley CentreHawthorne, Intensive Treatment Service• Forest LodgeAssessment & Rehabilitation wardsThe feedback from these visits is helpful and allowsus to ensure, and be assured, that we provide carein accordance with legislation and best practiceguidelines. These reviews and inspections confirmthat we continue to meet all essential standards.2.2 Monitors’ compliance frameworkThe Trust submits quarterly declarations to Monitor inrelation to governance and finance. Monitor reviewsthe Trust’s declaration and publishes a quarterly riskrating for each element. This information is availableat http://www.monitor-nhsft.gov.uk.The governance assessment (rated as either red,amber/red, amber/green or green) is based on theTrust’s self-declaration by the Board of Directorsagainst the following areas:• Compliance with its constitution• Growing a representative membership102

• Maintaining appropriate structures• Co-operating with other bodies• Risk management• Service performance and improvementin service quality.The tables below feature our ratings for the fourquarters of the last two years compared with theTrust’s expectation at the beginning of the yearas stated in our Annual Plans.2011/12The Trust was rated as Amber/ Red risk undergovernance following a review of its InpatientServices by the Care Quality Commission in theprevious year 2010/11. The CQC identified somemoderate/ minor areas of concern that the Trustneeded to address.The Trust implemented a development plan that wasagreed with the CQC, and the Amber/ Red assessmentremained until the action plan was completed.2011/12 Risk ratings compared to annual planAt the beginning of the year the Trust planned tohave completed the required actions by September2011, which it did so successfully.The progress made by the Trust was reviewed andacknowledged by the CQC and the Trust continuedwith a Green risk rating for Governance for the restof the year.During the 2011/12 year the Trust achieved ineach quarter all the quality standards requiredof a Mental Health NHS Foundation Trust.2012/13The Trust achieved all healthcare targets for eachQuarter with the exception of Quarter 2.During Quarter 2 the Trust failed to achieve therequirement to provide follow up care within 7days of discharge from inpatient care for peopleunder the Care Programme Approach. A rangeof improvement actions were implemented andthe Trust continued to achieve the target for therest of the year.2.3 Goals agreed with our NHS CommissionersA proportion of our income in 2012/13 was conditional on achieving quality improvementand innovation goals agreed between the Trust and any person or body they entered intoa contract, agreement or arrangement with for the provision of relevant health services,through the Commissioning for Quality and Innovation payment framework.For 2012/13 £1,639,911 of the Trust’s contracted income was conditional on the achievement of theseindicators. For the previous year, 2011/12, the associated monetary payment received by the Trust was£661,000. A summary of the indicators agreed with our main local health commissioner SheffieldClinical Commissioning Group for 2012/13 and 2013/14 is shown below.Incentivising improvements in the areas of Safety, Access,Effectiveness and User experiencesNHS Safety Thermometer Improve collection of dataWe wanted to improve collection of data in relation to pressure ulcers, falls, urinarytract infection in those with a catheter, and VTE. This was to ensure we were effectivelymonitoring safety. We were successful in implementing this programme during the year.Reducing variation in waiting times for patients referred to the IAPT servicesSome GP practices in Sheffield were experiencing longer waiting times than others.We wanted to reduce the waiting times in these practices by 10%. We were successfulwith this. Waiting times reduced from 7 weeks to 5.4 weeks.Goal during2012/13AchievedAchievedIs it acontinuedGoal for2013/14Annual plan2011/12Quarter 12011/12Quarter 22011/12Quarter 32011/12Quarter 42011/12Financial risk rating 4 4 4 4 4Governance risk rating Amber/ Red Amber/ Red Amber/ Red Green GreenReduced admissions to Acute Older Adult Wards through improvedcommunity are for people in a crisisWe had established new community services to provide alternatives to hospitaladmission. As a result of this we wanted to incrementally reduce the numbers ofpeople who needed hospital care over the year. We were partially successful inachieving this goal, with less people needing hospital care in 3 of the 4 quarterlyperiods during the year.Partiallyachieved2012/13 Risk ratings compared to annual planAnnual plan2012/13Quarter 12012/13Quarter 22012/13Quarter 32012/13Quarter 42012/13Financial risk rating 4 4 4 5 4Governance risk rating Green Green Amber/ Green Green GreenImproved recording of employment & vocational circumstances of peopleusing mental health servicesTo support our broader rehabilitation and recovery strategies we wanted to improvethe information we had about individuals circumstances to help us better understandtheir needs and the progress made in supporting their recovery. We were successfulin this, with 95.7% of service users in the target client group having the informationupdated in their care records.AchievedNoReduction in the number of falls causing harmThis goal supported our Quality Objective No 1. We successfully achieved our targetof reducing harm caused from falls by 5% this year (See Quality Objective 1 for details).Achieved103104

Improving the management of Violence and Aggression withininpatient servicesThis goal supported our Quality Objective No 2. The focus was to improve the serviceuser and staff experience in relation to violence and aggression. We successfully reducedincidents in relation to seclusion and restraint. (See Quality Objective 2 for details)..People using mental health services should have an agreed plan to helpreduce and manage the persons riskWe wanted to increase the numbers of service users who had risk reduction plansin place following their initial risk assessment. We did not make the progress weexpected to make this year, and will continue to deliver this objective next year.People who are referred for a routine assessment will be assessed within2 weeks of the referralFollowing changes to our community mental health team services we wanted todeliver quicker access to our services following referral from GPs. We set a goal tosee more people within 2 weeks of the referral being made. We were successful withthis. We have made significant progress on this and in the second half of the year(Oct-March) 175% more people were being assessed within 2 weeks.People using mental health services should have a care plan agreed with themand in place within 6 weeks of the assessmentIn line with the above service changes, we wanted to ensure that following anassessment, those who needed on-going support and treatment then had a planof care in place quickly. We did not make the progress we wanted to make. Overthe year 57% of people had a care plan agreed within 6 weeks. We will continueto deliver on this objective next year.Patients receiving acute inpatient care should benefit from care and treatmentfrom clinical psychologistsWe wanted to recruit and introduce clinical psychologist to work directly on ourinpatient wards. During the year we undertook a range of development work withthe ward teams to support the successful introduction of the new posts. We hadwanted the new staff to start working on the wards during the year, however thisdid not happen as planned. The staff have been recruited and we will fully implementthis goal from April 2013 onwards.People with long term neurological conditions needs at level 2 or 3 shouldhave agreed care plans in placeWe wanted to increase the proportion of people who had a care plan to co-ordinatetheir care with other services from 40% to 80% by the end of the year. We werepartially successful and overall made good progress on this objective, achieving a77% rate by the end of the year.People with long term neurological conditions with a care plan (see above)should benefit from a holistic screening of need and client action planWe wanted to ensure service users benefited from a holistic plan of care. We agreed atarget to achieve this for 90% of service users, and we achieved 100% through the year.Improved use of electronic discharge communications between inpatientservices and GP’sThis is a new goal for next year.Improved and standardised approaches to surveying service user experiencesacross all service areasThis is a new goal for next year.AchievedDid notachievedAchievedDid notachievedDid notachievedPartiallyachievedAchievedNoNoNoNoNo2.4 Review of servicesDuring 2012/13 SHSC provided and/or subcontracted54 services. These can be summarisedas 36 NHS services, 7 integrated health and socialcare services and 11 social care services. The incomegenerated by the relevant health services reviewedin 2012/13 represents 100% of the total incomegenerated from the provision of the relevant healthservices by the Trust for 2012/13.The Trust has reviewed all the data available on thequality of care in these services. The Trust reviews dataon the quality of care with Sheffield CCG, other CCGs,Sheffield City Council and other NHS commissioners.The Trust has agreed quality and performanceschedules with the main commissioners of its services.With Sheffield CCG and Sheffield City Council theseschedules are reviewed on an annual basis andconfirmed as part of the review and renewal of ourservice contracts. We have formal and establishedgovernance structures in place with our commissionersto ensure we report to them on how we areperforming against the agreed quality standards.Our governance systems ensure we review qualityacross all our services.2.5 Health and Safety Executive/South Yorkshire Fire and Rescue visitsHealth and Safety ExecutiveThere were no Health and Safety Executive visitsto the Trust during 2012/13.South Yorkshire Fire and RescueDuring 2012/13 the South Yorkshire Fire and Rescueservice visited and audited 9 of the Trust’s premises.No notices regarding improvement actions were issuedby the Fire service. The sites audited where as follows;Hurlfield View, Grenoside Grange, Bolehill View,Longley Centre, Wardsend Road, Woodhouse Clinic,St Georges, Wainwright Crescent, Ivy Lodge.2.6 Compliance with NHSLitigation Authority (NHSLA)risk management standardsThe NHSLA handles negligence claims made againstthe NHS and works to improve risk management.Their risk management standards cover organisational,clinical, non-clinical and health and safety risks.The Trust is compliant at Level 1 with the standardshaving last been assessed in March 2013. This meansour processes for managing risks have been properlydescribed and written down. We will be assessedagain in March 2015.2.7 Participation in clinical researchThe number of patients receiving relevant healthservices provided or sub-contracted by SheffieldHealth and Social Care NHS Foundation Trust in2012/13 that were recruited during that periodto participate in research approved by a researchethics committee was 555.We adopt a range of approaches to recruit peopleto participate in research. Usually we will focus onindividuals appropriate to the area being researched,staff involved in their care will make them aware of theopportunity to participate and they will be providedwith a range of information to allow then to takeinformed decisions about if they wish to participate.The Trust was involved in conducting 36 clinicalresearch projects which aimed to improve qualityof services, increase service user safety and delivereffective outcomes.Areas of research in which the Trust has been activeover the last 12 months include:• Improving the quality and effectiveness oftherapies and self-management in depression• Understanding and improving the safety ofpsychological therapies• Developing interventions to improve the physicalhealth of those with severe mental illness• New treatments for service users with schizophrenia• New treatments for service users with dementia(including Alzheimer’s disease).Research is a priority for the Trust and is one of thekey ways by which the Trust seeks to improve qualityand initiate innovation. Over the last year the Trusthas worked closely with the East Midland and SouthYorkshire Mental health Research Network to increaseopportunities for our service users to participatein commercial clinical trials of new treatments andwith academic partners, including the Clinical TrialsResearch Unit at the University of Sheffield, to initiateresearch projects sponsored by the Trust.105106

SHSC has been actively involved in the establishment of the Yorkshire and Humber Academic HealthSciences Network and will seek to maximise opportunities arising from this towards the goals of improvingpopulation health, transforming healthcare and wealth creation for the region.2.8 Participation in clinical auditsNational clinical audits and National confidential enquiriesDuring 2012/13 14 national clinical audits and 3 national confidential inquiries covered relevant healthservices that Sheffield Health and Social Care NHS Foundation Trust provides.During 2012/13 the Trust participated in 100% national clinical audits and 100% national confidentialinquiries which it was eligible to participate in.The table below lists the national clinical audits and national confidential inquiries the Trust participated in,along with the numbers of cases submitted by the Trust in total and as a percentage of those required bythe audit or inquiry.Other audit programmesNHS LA – Records audit 579 N/ADiabetes audit – Clover Group 1026 100%Suicide audit 5 N/AFood and nutrition 134 N/ASafeguarding children – Baseline audit of knowledge 252 N/ANational confidential inquiriesInquiry into suicide and homicide by people withmental illness16 30%*Inquiry into suicide and homicide by people withmental illness Out of District Deaths0 0%Name of national audit SHSC participated inGuideline auditsNational Audit of Schizophrenia (registered forre-audit) - To measure the Trusts performanceagainst national NICE guidelinesNational Audit of Psychological Treatments- To measure the Trusts performance againstnational NAPT guidelinesNumberof casessubmittedNumber of casessubmitted as a percentageof those asked for150 100%4009 100%Inquiry into suicide and homicide by people withmental illness Homicide data4 33%**Note: the percentage figure represents the numbers of people who we reported as having prior involvement with as percentage of all Inquiriesmade to us under the National Confidential Inquiry programme. i.e. in 70% of all inquiries, we had not record of having had prior involvementwith the individual concerned.The reports of 14 national clinical audits were reviewed by the Trust in 2012/13 and Sheffield Health andSocial Care NHS Foundation Trust intends to take the following actions to improve the quality of healthcare provided:National Parkinsons Audit - To measure theTrusts performance against National standards53 100%National auditNational audit of SchizophreniaResults and actionsResults – We did well on polypharmacy (top10%) but below average on user experience,monitoring of physical health and our prescribingof clozapine for treatment resistant patients.The actions we have taken are:POMH UKPrescribing high dose and combined antipsychoticson adult acute and psychiatric intensive care wards(Topic 1) – To ensure prescribing is appropriatewithin BNF limitsLithium Monitoring (Topic 7c) – To ensure Lithiumis prescribed in accordance with NICE guidelines144 100%108 100%Additional staff training has been providedon how to screen and intervene with patientsphysical health.Prescribing antipsychotics for people withDementia (Topic 11b)279 100%Metabolic side effects of antipsychotic (Topic 2f) 261 100%Prescribing for people with a personalitydisorder (Topic 12a)65 100%107108

National audit of psychological treatmentsNational Parkinsons auditPrescribing high dose and combinedantipsychotics on adult acute and psychiatricintensive care wardsLithium monitoring – To ensure Lithium isprescribed in accordance with NICE guidelinesPrescribing antipsychotics for people with DementiaResults – We did well on waiting times, skills andtraining of staff and our monitoring of outcomesof the treatment we provided, but below averageon satisfaction and the outcomesof the treatment provided.The actions we have taken are:Reviewed the way we organise our services,improved our shared care with gp’s and reducedthe bureaucracy in our referral processes. Sincethen we have seen a 10% improvement in dnarates, 5% improvement in recovery rates andsignificant improvement in client outcomes.Data was submitted in december for 53 patients.A report will be available in june 2013.Results – We have made improvements on theprevious year’s audit (2010) regarding the numberof people who were prescribed higher dosages ofdrugs than the recommended limits, however thiswas not consistent across all of our services.The actions we have taken are:We have made it easier for staff to access toinformation regarding the effect of combiningantipsychotics on the percentage maximumdose prescribed.Results – Our monitoring of lithium side effectsis at 60%, which compared well in the audit,however we need to improve how we monitorlithium toxicity.The actions we have taken are:Services continue to monitor how we are doing.We will improve how we monitor risks relatingto toxicity, and undertake a repeat audit toevaluate progress.Results – Most people were benefiting from areview and had evidence of having a plan in placeregarding what works best if they experience acrisis. We need to improve how we communicatewhy we have prescribed the medication we haveand when different treatment plans started.The actions we have taken are:We will improve the documentation of theclinical reason for proscribing the most recentantipsychotic and the duration of prescriptionof benzodiazepine.Metabolic side effects of antipsychoticNHS Litigation Authority – Records auditDiabetes auditSuicide auditResults – We did well on monitoring peoplesblood pressure, but need to improve how wemonitor peoples weight and encourage peopleto stop smoking.The actions we have taken are:We will improve practice and the documentationof smoking cessation, obesity and BMI. We haveapproved a Trust wide plan about improvingpeoples overall physical health.Results – Compared to the previous years auditwe have made significant improvement in thequality of the information we have about peoplescircumstances, such as HoNOS assessments,sexual vulnerability, child/ adult protection issues.However we still need to improve key areas suchas advance directives, risk prevention planningand communicating plans with gp’s.The actions we have taken are:All services are developing plans to address theunderperforming standards. We are alreadyimplementing a roll out of improved electronicpatient records focussing on areas of risk andassessment, which will support improvements.Results – We are doing well in how we monitor arange of risk issues for people who have diabetes(such as weight) and the treatment they are on(such as statins and ACE-inhibitors). We weren’tdoing as well in the supporting people to accesswell-structured education programmes.The actions we have taken are:To re-launch a patient education programme.Results – We were compliant with the majorityof standards for the care plans that we audited.We need to improve how we communicate withfamilies and carers after such tragic events, makingsure they have information about what happened.The actions we have taken are:We have put plans in place to ensure informationis shared with families and carers in an appropriateand supportive way.109110

Safeguarding childrenFood and nutritionLocal audit activityLocal clinical audits are conducted by staff and teamsevaluating aspects of the care they themselves haveselected as being important to their teams. Our maincommissioner, Sheffield CCG, also asks the Trust tocomplete a number of local clinical audits each year, toreview local quality and safety priorities. On a quarterlybasis the Board review the progress of other local audits.2.9 Data qualityGood quality information underpins the effectivedelivery of care and is essential if improvements inquality care are to be made. Adherence to gooddata quality principles (complete, accurate, relevant,accessible, timely) allows us to support teams and theBoard of Directors in understanding how we are doingand identifying areas that require support and attention.External Auditors have tested the accuracy ofthe data and our systems used to monitor thefollowing indicators:• 7 day follow up – everyone dischargedfrom hospital should receive support in thecommunity within 7 days of being dischargedResults – The audit identified that the majority ofstaff have ‘some’ understanding of the kinds ofchild abuse (particularly type of abuse). Most staffknow who to contact if a child has been abused(this includes line manager, safeguard lead)The actions we have taken are:We will continue with our training programmeto maintain and improve awareness.Results – The audit has revealed that nutritionalassessments are being done on admission for96% of patients on the older adult wards. Weneed to extend this practice to our other wards.The actions we have taken are:We will extend the practice of undertakingnutritional assessments to our adult wards.• ‘Gate keeping’ – everyone admitted tohospital should be assessed and consideredfor home treatmentAs with previous years, the audit has confirmedthe validity and accuracy of the data used within theTrust to monitor, assess and report our performance.The Trust submitted records during 2012/13 to theSecondary uses service (SUS) for inclusion in theHospital episodes Statistics which are included in thelatest published data. The percentage of records inthe published data which included the patient’s validNHS number was 99.9% for admitted care. Thepercentage of records in the published data whichincluded the patients valid General PractitionerRegistration Code was 95.7% for admitted care.No other information was submitted.The latest published data from the SUS regardingdata quality under the mental health minimum dataset is for April 2012- December 2013. The Trust’sperformance on data quality compares well tonational averages and is summarised as follows:Percentage of valid records Data quality 2012/13 National averageNHS Number 99.9% 99.4%Date of birth 100% 99.7%Gender 100% 99.4%Postcode 99.6% 99.0%Commissioner code 100% 99.3%GP Code 99.5% 98.3%Primary diagnosis 100% 98.5%HoNOS outcome 100% 88.9%The data and comparative data is from the published MHMDS Reports for the Q1 – Q3 periods inclusiveClinical coding error ratesSheffield Health and Social Care NHS FoundationTrust was not subject to the Payment by Resultsclinical coding audit during 2012/13 by theAudit Commission.2.10 Information governanceWe aim to deliver the best practice standardsin Information Governance by ensuring thatinformation is dealt with legally, securely andeffectively in order to deliver the best possiblecare to our service users.Concerns were highlighted in a number of areasduring 2011/12. The Trust undertook developmentand improvement actions in response to thefollowing issues:• Information governance management -Improving the provision of training aboutinformation governance• Clinical information assurance - Completionof staff training and audit for clinical coding• Corporate information assurance - Completinga review and audit of corporate records.During the year we completed our assessmentsthrough the NHS Connecting for Health InformationGovernance Toolkit. The Trust undertook andsubmitted a baseline assessment in October2012 anda final assessment and submission in March 2013.Following the improvement actions we hadundertaken, Sheffield Health and Social CareNHS Foundation Trust’s Information GovernanceAssessment Report overall score for 2012/13was 69% for the 45 standards and was gradedsatisfactory/green.AchievedCriteria 2011/12 2012/13 Current gradeInformation Governance Management 66% 73% SatisfactoryConfidentiality and Data Protection Assurance 74% 74% SatisfactoryInformation Security Assurance 64% 66% SatisfactoryClinical Information Assurance 73% 73% SatisfactorySecondary Use Assurance 41% 66% SatisfactoryCorporate Information Assurance 22% 66% SatisfactoryOverall 60% 69% Satisfactory111112

Part 3: Review of ourquality performance3.1 SafetyOverall number of incidents reportedThe Trust traditionally reports a high numberof incidents compared to other organisations.This is viewed as a positive reflection of the safetyculture within the Trust. It helps us to be able to reallyunderstand what the experience of care is like, spottrends and make better decisions about what wewant to address and prioritise for improvement. TheNational Patient Safety Agency consistently assessesour performance, using the data supplied through theNational Reporting Learning System (NRLS) as in thehighest (best performing) 25% of Trust’s for activelyencouraging the reporting of incidents. For the 6month period April - September 2012, SHSC was the10th highest performer of 56 mental health trusts.Nationally, based on learning from incidents anderrors across the NHS, the National patient SafetyAgency has identified a range of errors that shouldalways be prevented. These are often referred toas ‘never events’, because with the right systemsto support care and treatment in place they shouldnever need to happen again. None of the incidentsthat occurred within the Trust over the last yearwere of this category.Patient safety alertsThe NHS disseminates safety alerts through a CentralAlerting System. The Trust responded effectively toall alerts communicated through this system. During2012/13 the Trust received 70 non-emergency alertnotices, of which 100% were acknowledged within48 hours, 4 were applicable to the services provided bythe Trust and all were acted upon within the requiredtimescale. In addition a further 37 emergency alertswere received an acted upon straight away.Patient safety information on types of incidentsSelf-harm and suicide incidentsThe risk of self-harm or suicide is always a seriousconcern for mental health and substance misuseservices. The NPSA figures show 11.3% of allpatient safety incidents reported by the Trust wererelated to self harm, in comparison with 18.1% formental health trusts nationally. This is similar to theprevious year where the figures were 11.4% and18.7% respectively.During the last two years clinical risk trainingwas provided for SHSC staff and new clinical riskassessment and management tools have beenintroduced throughout the Trust. Last year 1,329staff from all professional groups received thetraining, which covers the principles and practice ofrisk assessment and management. We had plannedto train 2,000 members of staff. The main reasonleading to our under achievement of our target hasbeen capacity to support the release of staff fromfront line service delivery. We are reviewing ourapproaches to this for next year to ensure wecan deliver improvements.Violence, aggression and verbal abuseIn previous years the Trust has reported relativelylow incidents of disruptive and aggressive behaviourwithin our services compared to other mental healthorganisations. This has increased during 2012/13in line with the position reported in Section 2.20.6% of patient safety incidents reported by theTrust were for aggressive behaviour in comparisonwith a national average of 18.2%, based on NPSAbenchmarking data for first 6 months of the year.In the previous year, 2011/12 the figures were15.4% and 19% respectively.Medication errors and near missesStaff are encouraged to report near misses anderrors that do not result in harm to make surethat they are able to learn to make the use andprescribing of medication as safe and effective aspossible. 6.1% of patient safety incidents reportedby the Trust related to medication, compared with8.4% in mental health trusts nationally. There hasbeen little change in the number of medicationincidents reported by the Trust over the last 3 years.Cleanliness and infection controlThe Trust is committed to providing clean safe carefor all our service users and ensuring that harm isprevented from irreducible infections.To achieve this an annual programme is producedby the Infection Prevention and Control Team thatdetails the methods and actions required to achievethese ends.The programme includes:• Processes to maintain and improve environments• The provision of extensive training and education• Systems for the surveillance of infections• Audit of both practice and environment and• The provision of expert guidance and informationto manage infection risks identified.The efficacy of this programme is monitored bothinternally and externally by the provision of quarterlyand annual reports detailing the trusts progressagainst the programme. These reports are publiclyavailable via the internet.Single sex accommodationThe Trust is fully compliant with guidelines relatingto providing for appropriate facilities for menand women in residential and inpatient settings.During 2012/13 we have reported no breachesof these guidelines.SafeguardingThe Trust fully complies with its responsibilitiesand duties in respect of Safeguarding VulnerableAdults, and Safeguarding Children. We have aduty to safeguard those we come into contactwith through the delivery of our services. Wefulfil our obligations through ensuring we have:• Robust systems and policies in place thatare followed• The right training and supervision in placeto enable staff to recognise vulnerabilityand take action• Expert advice available to reduce the risksto vulnerable people.Reviews and investigationsWe aim to ensure that we review all our seriousincidents in a timely manner and share conclusions andlearning with those effected, and our commissioners.We monitor our performance in respect ofcompleting investigations within 12 weeks andundertaking investigations that are assessed asbeing of an ‘excellent/ good’ standard. Historicallywe have experienced challenges in this area andwe continue to prioritise our efforts to improveour review processes.Improvements and lessons learntAll incidents are reviewed to ensure we are able toidentify how we can make improvements and takecorrective action to maintain and improve safety.We formally review all serious incidents and theTrust’s Quality Assurance Committee and Board ofDirectors reviews the findings and lessons learnt fromthe incidents. We review and share all findings withour Commissioners and review our improvementplans with them.Examples of the types of improvement actions wehave been able to take following reviews of seriousincidents are• Involving service user families/carers in theircare/decision making• Comprehensive and timely record keeping,ensuring the rationale for decisions madeis recorded• Making sure that urgent referrals into theTrust are easily identified• Communication between NHS professionalsto be strengthened to ensure information isshared appropriately.Using incident data to prioritiseimprovement actionsFrom the incident data on the next page, and ourreview of the types of incidents that occur acrossour services, we prioritised falls and violent incidentsfor attention. Our plans, and progress against thoseplans is reported in detail in Quality Objectives 1 and2 in this report.Overview of incidents by typeThe table on the next page reports on the fullnumber of incidents reported within the Trust. It thenreports on the numbers of those incidents that werereported to result in harm for service users and staff.113114

Incident type 2010/11 2011/12 2012/13All incidents 5981 6408 (a) 6260All incidents resulting in harm 1627 1689 1508Serious incidents (investigation carried out) 38 45 34Patient safety incidents reported to NRLS (d) 3359 3598 3340Patient safety incidents reported as ‘severe’ or ‘death’ 28 41 42Expressed as a percentage of all patient safety incidentsreported to NRLS0.8% 1.1% 1.3%Slips, Trips and Falls incidents 1449 1652 1180Slips, Trips and Falls incidents resulting in harm 554 558 420Self-harm incidents 365 (a) 369 (a) 425Suicide incidents (in-patient or within 7 days of discharge) 1 2 (b) 0 (c)Suicide incidents (community) 24 13 5 (c)Violence, aggression, threatening behaviour and verbal abuse incidents 1485 1644 1930Violence, aggression and verbal abuse incidents resulting in harm 267 276 240Medication Errors 354 (a) 360 (a) 321Medication Errors resulting in harm 0 0 1Infection ControlInfection incidentsMRSA Bacteraemia 0 0 1Clostridium difficile Infections 0 0 0Periods of Increased infection/Outbreak• Norovirus• Rotavirus• InfluenzaShowing number of incidents, then people affected in bracketsPreventative measuresMRSA Screening – based on randomised sampling to identifyexpected range to target7 (52)1 (5)07 (60)003 (28)01 (3)n/a 2% 39%Staff Influenza Vaccinations 20% 37.6% 56%(a) The incident numbers have increased from those reported in the 2011/12 Quality Account report due to additional incidents being enteredonto the information system after the completion of the report.(b) The figure has decreased from that reported in last year’s Quality Account report due to an HM Coroner’s inquest which has not yet beenheld. It is likely that this figure will increase in next year’s report(c) Figures are likely to increase pending the conclusion of future HM Coroner’s inquests. This will be reported in next year’s report.(d) The NRLS is the National Reporting Learning System, a comprehensive database set up by the former National Patient Safety Agencythat captures patient safety information.3.2 EffectivenessThe following information summarises ourperformance against a range of measures ofservice effectiveness.Primary Care Services – Clover GroupGP PracticesThe Quality Outcomes Framework (QoF) providesa range of good practice standards for the deliveryof GP services. Traditionally the 4 practices thathave formed the Clover Group have been belowthe Sheffield averages in their performance againstthese standards have previously been in the lowestquartile in the city. The practice serves a majoritymulti-ethnic migrant population in areas of socialdeprivation within Sheffield. This brings a numberof acknowledged challenges for the service todeliver the range of standards.Over the last 2 years, significant progress andachievements have been made. In 2011/12 theClover Group of practices improved to be in thePrimary Care – Clover Gp’sFlu vaccinationshighest quartile in Sheffield and their challenge thisyear was to sustain this improvement. They haveachieved this, which is an excellent achievementand demonstrates that real improvements arebeing implemented for the longer term benefitof the communities the practices serve.In 2011/12 the service achieved a total of 98.7% ofall the QoF standards, with a Sheffield-wide averageof 97%. This year in 2012/13 the service achieved98.2% of the standards.The following table summarises performanceagainst national standards for GP services. Healthscreening for the practice population is challengingand influenced by the high proportion of the patientgroup being from BME communities. The servicehas been working closely with its community groupsto increase awareness and access arrangementsfor health screening programmes to supportimprovements. Uptake in the programmesgradually increases over the years.This yearstargetHow did wedo in year2011 – 12How did wedo this yearVaccinate registered population aged 65 and over 75% 75% 78%Vaccinate registered population aged 6 monthsto 64 years in an at risk populationVaccinate registered population who arecurrently pregnantChildhood immunisations70% 50%* 56%70% 45%* 51%Two year old immunisations 70-90% 90% 90%Five year old immunisations 70-90% 81% 85%Cervical cytology 60-80% 66.7% 66.4%*Note: The target for 2011/12 was 50% & 45% respectivelyInformation source: System One and Immform115116

Drug and alcohol servicesThe service continues to prioritise ensuring timely access to primary and secondary care treatment.The service aims to ensure all of Sheffield’s population that would benefit from the range of servicesprovided in drug and alcohol treatment are able to access support. The service adopts a range ofapproaches to engage with people from this vulnerable service user group.Priorities for next year including further expansion of the universal screening tool to increase the numberof people accessing primary care services for alcohol problems and maximising the numbers of peoplesupported and ready to finish treatment drug and/or alcohol free.Learning disability servicesA key area of focus has been ensuring that people with complex and challenging behaviours are supported throughcommunity focused support packages within Sheffield and the individual’s local community as far as possible.During the last year the service has made good progress in supporting people to return to Sheffield fromout of town placements. Within our local inpatient services we have ensured that individual clients do notexperienced prolonged periods in hospital beyond what the client needs. We have delivered care that iswell co-ordinated and focus on the needs of individuals, and delivered in a personalised and dignifiedway (as evidenced by visit reports from the CQC).Drug and alcohol servicesDrugsNo client to wait longer than 3 weeks from referralto medical appointmentNo drug intervention client to wait longer than5 days from referral to medical appointmentNo Premium client should wait longer than 48ours from referral to medical appointmentNo prison release client should wait longer than24 hours from referral to medical treatment% Problematic drug users retained in treatmentfor 12 weeks or moreAlcohol single entry and accessNo client to wait longer than 1 week from referralto assessmentNo client to wait longer than 3 weeks from Single Entryand Access Point assessment to start of treatmentOutcomes, self careThis yearstargetHow did wedo in year2011 – 12How did wedo this year100% 100% 100%100% 100% 100%100% 100% 100%100% 100% 100%90% 94% 95%100% 100% 100%100% 100% 100%Learning disability servicesNo-one should experience prolonged hospital care(‘Campus beds’)All clients receiving hospital care should have fullhealth assessmentsAssessments and supporting plans for theircommunication needsInformation source: Insight & Trust internal clinical information systemThis yearstargetNilHow did wedo in year2011 – 12NilHow did wedo this yearNil todate100% 100% 100%100% 100% 100%Dementia servicesOur specialist inpatient service for people with dementia and complex needs has prioritised its focus onimproving the care pathway to ensure discharge in a timely manner either home or as close to a person’shome as possible. This results in much better outcomes for the individual concerned. This has enabledmore throughput into the ward but recognises the increasing complexity of the service users admitted.We continue to explore ways to build on the excellent success of the memory service in improved accessand improved diagnosis rates within Sheffield. Making further improvements in this area is a priority forus next year.Initial Treatment Outcome Profile (TOP) completed 100% 96% 98%Review TOP completed 100% 80% 71%Discharge TOP completed 100% 100% 100%All clients new to treatment receive physical healthcheck as part of comprehensive assessmentNumber of service users and carers trained in overdoseprevention and harm reduction% Successful completions for the provision of treatmentfor injecting-related wounds and infections100% 100% 100%240 292 27275% 85% 94%Dementia servicesThis yearstargetHow did wedo in year2011 – 12How did wedo this yearDischarges from acute care (G1) 30 34 53Number of assessments for memory problemsby memory management services900 876 918Rapid response and access to home treatment 350 338 339Waiting times for memory assessment N/A 14.5 weeks16.3 weeksprojectedInformation source: National Drug Treatment SystemInformation source: Insight & Trust internal clinical information system117118

Independent living and choiceIndependent living and choiceThis yearstargetHow did wedo in year2011 – 12How did wedo this yearMental health servicesThis yearstargetHow did wedo in year2011 – 12How did wedo this yearAccess to equipment• Community equipment to be delivered within7 days of assessment95% ofitems to bedeliveredwithin 7 days95.3%95.2%projectImproving access to psychological therapies• Number of people accessing services• Numbers of people returning to work5,36489 people10,661396 (18.6%)10,735344 (31%) (a)Choice and control• People accessing direct payments to purchasetheir own social care packagesN/A263 peoplewith budgetsagreedFurther 203activelyexploring454 peoplewith budgetsagreedFurther 312activelyexploring• Number of people achieving recoveryEarly intervention• People should have access to earlyintervention services when experiencinga first episode of psychosis50%90 new casesper year49.5%136 newclientsaccessedservices46%107 newclientsaccessedservicesInformation source: Insight & Trust internal monitoring systemsMental health servicesServices continue to perform well across a range ofmeasures used to monitor access and co-ordination ofcare, achieving all national targets expected of mentalhealth services. A range of key service changes havebeen introduced during the last year (for informationabout them see our Annual Report), and the Trust hasensured that performance levels have been maintainedduring times of extensive change.7 day follow up standards. This is influenced mainlyby failures to achieve the standard in the secondquarter of the year. Following review at the time ourdischarge arrangements were strengthened further.Sheffield Health and Social Care NHS Trust hastaken the following actions to improve this.• Improved information sharing and monitoringof client circumstances to ensure the follow uphappened as plannedAccess to home treatment• People should have access to home treatmentwhen in a crisis as an alternative to hospital care‘Gate keeping’• Everyone admitted to hospital is assessedand considered for home treatmentDelayed transfers of care• Delays in moving on from hospital careshould be kept to a minimum1,202episodes to beprovided90% ofadmissions tobe gate-keptNo morethan 7.5%1,443episodesprovided99.4%Nationalaverage97.4% (b)1,418episodesprovided99.5%Nationalaverage98.2% (b)4.2% 4.7%The table below highlights our comparativeperformance on 7 Day follow up and Gatekeepingindicators. Sheffield Health and Social Care NHSFoundation Trust believes that its above averageperformance on gatekeeping is due to its robustcare pathway arrangements across communitymental health team, home treatment and inpatientservices. The Trust is below average in respect of• Combined with all service users who aredischarged receiving additional telephone basedsupport immediately after their discharge, inaddition to the planned follow up visit.These measures will support improvements in thequality of our services over the next year.7 day follow up• Everyone discharged from hospital on CPAshould receive support at home within 7days of being dischargedAnnual care reviews• Everyone on CPA should have an annualreview with their care coordinator95% ofpatients to befollowed up in7 days95%96.8%Nationalaverage97.3% (b)98.7%95%Nationalaverage98.2% (b)98%• Everyone on CPA should have a formalreview of their care plan90%89.5%86.3%Information source: Insight & Trust internal clinical information systemNote(a) 31% represents the % of those who were not in work at the beginning of treatment, who had returned to work at the end of treatment.During 2012/13 1,099 of the 10,735 people seen where not in work at the beginning of treatment. 344 of them (31%) returned to workby the time treatment had been completed.(b) Comparative information from Health and Social Care Information Centre. 2012/13 national average figure based on data published for theApr 12-Dec12 period.119120

3.3 Service user experienceComplaints and complimentsA full picture of the complaints and complimentsreceived by the Trust over the year is availableon our website in the Annual Complaints andCompliments Report. This includes feedback fromthe complainants (the people who have made thecomplaint) about their experience of the complaintsprocess and if they felt their concerns wereappropriately addressed and taken seriously.All complaints are investigated and if we agree withthe concern being raised we will put in place anaction plan to address the problem. The followingsummarises the numbers of complaints and positivefeedback we have received:We do use complaints as an opportunity to improvehow we deliver and provide our services. Examples ofsome of the changes we have made from reviewingconcerns that people have raised with us are:• Sheffield Aspergers Service to produce a writteninformation pack for service users with ADHD• Improved the information we provide toservice users about how to reduce sideeffects from medication• Development of peer support networks forservice users with personality disorders• Introduced improvements within inpatient wardsto provide a reasonable variety and quantity ofdiet to meet service user needs, eg halal andvegan meals.Intensive Treatment Service – secure carefor people who are acutely mentally illand in need of intensive care and supportOur current ward facility is too small and it does notprovide access for the service users to outside space.This significantly impacts on the experience of carefor the individuals on the ward, as well as the staffdelivering care.Recognising this, we have approved an investmentof £2.8 million to design and build a new Wardon our Longley Centre site. This will result in realimprovements to the design and feel of the Ward,much better facilities and access to dedicatedgardens and outdoor space. The work on thecommissioning of the new ward has startedduring this year, and we look forward to itopening towards the end of 2013/14.We have invested £3.2 million over two years ina new purpose built community facility to provideresidential based care and treatment for peoplewith challenging behaviour as part of the IntensiveSupport Service. The new facility has been built thisyear and will open in May 2013. We see this as atremendous move forward for us, and are excitedabout the significant improvements in care andsupport that we will be able to provide, and the realimprovements in the experience for the individualswe support with the opening of this new facility.General environmentDuring 2012/13 no external reviews of our facilitiestook place. The previous PEAT assessment tookplace in 2010/11. The conclusion of the reviewis summarised as follows:Number of 2010/11 2011/12 2012/13 (*)Formal complaints 86 97 143Informal complaints 286 215 260Compliments 1,559 1,401 1,368Data is for Apr – Dec: 3 QuartersSite Location Environment Score Food Score Privacy andDignity ScoreLongley Centre 4 Good 5 Excellent 4 GoodMichael Carlisle Centre 4 Good 5 Excellent 4 GoodForest Close 4 Good 5 Excellent 4 GoodDuring the last year 12 people referred theirconcerns to the Health Services Ombudsmanbecause they were dissatisfied either with the Trust’sresponse or the way we investigated their concerns.The Ombudsman did not feel there was a need toundertake any further investigations into the issueswithin these complaints.Over the last year we have implemented a range ofchanges to how our services are delivered. We havere-organised our community mental health teamsand closed some day centres and bed based servicesas we have provided more care in more appropriatecommunity based settings. All service changes canbring a feeling of uncertainty and disruption tocontinuity of care. We have placed great emphasison reducing the impact on the people who use ourservices while we introduce these changes. We arepleased that our service changes have not been anotable cause or reason for why people have raisedconcerns about their care through complaints orother means of feedback.Improving the experience through betterenvironments – investing in our facilitiesThe environment of the buildings in which wedeliver care has an important part to play and has adirect impact on the experience of our service users.The design, availability of space, access to naturallight, facilities and access to outside areas areall fundamental issues. Getting them right has adirect impact on how people feel about the careand treatment they are receiving. We have madesignificant progress this year in addressing key areaswhere our buildings haven’t been as good as wehave wanted them to be.Firshill Rise – services for people with alearning disability and challenging behaviourOur current facilities, the Assessment and TreatmentUnit, were inappropriate and very limiting. Despitethis the CQC recognised that we were providingexcellent care despite the poor facilities.Forest Lodge 4 Good 5 Excellent 4 GoodGrenoside Grange 5 Excellent 5 Excellent 5 ExcellentThe reviews are helpful in providing the Trust with external feedback about the environment in which weare providing our services. The review team involves people external to the Trust, including service usersand carers to gain their perspective and view about our facilities.121122

What do people tell us about their experiences?That national patient survey for mental health trusts suggests that the experience of our service userscompares well to other mental health trusts.Mental health surveyIssue – what did service users feeland experience regarding2010 Survey thatreported in 2011ScoreTop 10 of65 Trusts?2011 Survey thatreported in 2012Score outof 10Top 10 of60 Trusts?Their Health & Social Care workers 8.9 Yes 9 YesMedication 7.6 Yes 7.5 YesAccess to Talking Therapies 7.4 8.0 Yes – highestSupport from Care Co-ordinator 8.5 Yes 8.6Their Care Plan 7.0 7.3 YesCare Reviews 8.0 Yes 7.7Awareness about support options forCrisis Care6.5 5.9Day to day living 6.0 6.0 YesOverall view of care 7.2 Yes 7.2 YesOverall score 7.5Patient SurveyHow well did people who use our servicescomment on their experience of contactwith a health or social care worker?Lowest20%scoreYesJoint 2nd2010 Survey thatreported in 2011Top20%scoreOurscore7.5Lowestnationalscore8.2overallYesjoint 3rd2011 Survey thatreported in 2012Topnationalscore9.1overallOurscore9.0overallDid staff listen carefully to you? 8.6 8.9 9.3 8.2 9.3 9.1Did staff take your views into account? 8.3 8.7 8.9 7.9 9.0 8.9Did you have trust and confidence in them? 8.1 8.5 8.5 7.6 9.0 8.7Did they treat you with dignity and respect? 9.1 9.4 9.5 8.8 9.7 9.5Were you given enough time to discussyour condition?8.0 8.5 8.6 7.7 8.7 8.6The table opposite highlights our comparativeperformance on service user experience in respectof contact with our staff. Sheffield Health and SocialCare NHS FoundationTrust is proud of this positiveposition. We believe that this position is due to ourfocus on ensuring the individual client is the focus ofour care planning and review processes, supportedby clear information about their care, delivered bystaff with strong focus on service user engagementSheffield Health and Social Care NHS FT willcontinue to take actions to maintain this currentpositive position regarding the quality of ourservices. Our ongoing development programmes,such as the RESPECT programme, our QualityObjectives, and our focus on supporting individualteams to understand their own performance aresome of the key actions that will support this.Staff SurveyWhat percentage of staff would recommendthe trust as a provider of care to their familyor friendsThe above table highlights our comparativeperformance regarding the quality of our servicesfrom the perspective of our staff. Sheffield Healthand Social Care NHS Foundation Trust considers thispositive position is a result of our efforts to engagewith our staff and involve them in the plans anddecisions regarding how we move forward andfocus on improving the quality of our services.We place increasing emphasis on ensuring staff inteams are aware how we are performing, makingbest use of the information we have to support this.Sheffield Health and Social Care NHS FT intendsto continue with its programme of improving teamgovernance to improve further the involvement ofstaff in reviewing how we are doing and takingdecision locally about how to makefurther improvements.Working with the people who use our servicesto make the changes they want to seeWe engage with service users in a range of waysto understand their experiences and then use thatinformation to make improvements. The followingis provided to give an illustration of examples of this.Learning disabilities servicesConnections forum – Service users feedback theyfeel they belong more and are helping to improvetheir service. This involvement has given themgreater confidence in themselves.Autism – Through asking the client base what theyfelt was required in the brochure, the service wasable to create a brochure that clients feel wouldbe more useful to them.Lowest20%score2010 Survey thatreported in 2011Top20%scoreOurscoreLowestnationalscore2011 Survey thatreported in 2012TopnationalscoreOurscore3.30 3.56 3.6 3.36 3.68 3.63Average score 3.42 Average score 3.54Eating disordersSatisfaction has improved in four out the eightstandards since 2011. Survey feedback has led toservices looking at flexible appointments and howwe provide post discharge support.Mental health assertive outreach servicesSurvey feedback has highlighted we are gettingbetter at planning activities jointly with service users.Service users are feeling more involved.Community mental health teamsFeedback has led to improved access to informationregarding employment and vocational servicesaround Sheffield.123124

Memory servicesSurveys have led to steps to ensure that the cafes(support networks for carers and service users) offerwhat the service user and their carer/supporter wanteach week rather than what the service think theymight want.GP services – Clover GroupImproving access to health services has been a majorwork-stream for the Clover Group year on year.Despite major service developments to improveaccess and patient satisfaction, the Clover Grouphas not seen the desired impact of the servicere-designs in increasing patient satisfaction with thesystem. Surveys continue to highlight a high levelof dissatisfaction and frustration from the peoplewho use the practices. Nationally the satisfactionrates in the GP National Survey for all GP servicessuggest that respondents from black and ethniccommunities are on average up to 20% lesssatisfied in some indicators, than their whiteBritish counterparts, specifically from Asian orAsian British communities. This experience isreplicated locally in the Clover practices.The Clover Group have a constant programme ofservice developments to improve services to patientsand engage the community. All of the practiceshave implemented a system offering an open access/drop-in clinic which has resulted in a significantincrease in access to available appointments.EngagementWorse 5Previous year2011/12 2012/13This yearNationalaverages% Of staff receiving H&S Training 70% 50% 73%% Of staff receiving equality anddiversity trainingComparisonsWorse 20%Got worse32% 38% 59% Worse 20%Staff appraisals 78% 79% 87% Worse 20%% Staff suffering work related stress 34% 46% 41%Effective team working 3.73 out of 5 3.77 3.83Worse 20%Got worse3.4 Staff experienceNational NHS staff survey resultsEngagementPrevious year2011/12 2012/13Overall staff engagement 3.69 out of 5 3.73Able to contribute toimprovementsRecommend Trust as place towork or receive treatmentTop 5This yearNationalaverages70% 73% 71%3.59 out of 5 3.63 3.54% Of staff working extra hours 53% 64% 70%% Receiving job related trainingand learningComparisonsBetter thanaverageTop 20%getting worsen/a 85% 82% Top 20%Work pressures felt by staff 2.93 out of 5 3.02 Top 20%Job satisfaction 3.6 out of 5 3.72 3.66Good communications withsenior managementTop 20%Got better35% 30% Top 20%Overall the Trust is encouraged with the aboveresults. The positive feedback around engagementcontinues to support our ongoing work and focusin improving quality and delivering our plans forservice improvement.The full survey will be available via the CQC site.The survey provides a vast amount of detail aroundcomplex issues. The Trust looks to take a balancedview on the overall picture, recognising that someof the lines of enquiry may appear contradictory.For example, the survey indicates we are in the best20% of Trusts for staff not feeling pressures fromwork, and the worse 20% for staff suffering workrelated stress.The areas we have prioritised for ongoing andfurther development work are as follows:Stress within our workforceIt remains important for us to focus on thisissue, especially in light of the range of changeprogrammes we are pursuing. We have developedimproved access arrangements to occupationalhealth services. We have our own dedicated staffcounselling services and we are making better useof this service to support staff whose services areundergoing change.Staff appraisalsWe will continue to focus our efforts to improveboth the frequency and the quality of the appraisalsand development plans for our staff. To support thiswe are introducing more simpler arrangements andprocedures to ensure this can happen.TrainingWe have an extensive training programme inplace. During 2012/13 we reviewed all our trainingprovision alongside a needs analysis of what wasrequired to support our staff with the skills theyneeded to deliver high quality care. We introduceda new training prospectus that defines the trainingthat should be provided to staff working in ourdifferent service areas. Through the next year wewill continue to monitor how this is being delivered.125126

Annexe AStatements from local networks,overview and scrutiny committeesand Primary Care TrustsHealthwatchHealthwatch Sheffield is grateful for sight of theSheffield Health and Social Care NHS FoundationTrust’s Draft Quality Account for 2012-13 andwelcomes the opportunity to provide comments.These comments are based on the Draft 5 versionof the Quality Accounts for 2012-13 dated 5 April2013 and following a meeting with the Trust on26th April. Paragraph and page numbers citedbelow refer to this version.We felt that a regular dialogue throughout theQuality Account’s production would be beneficialto all parties, and it was unfortunate this hadnot happened this year. We look forward to aproductive relationship between SHSCFT andHealthwatch Sheffield in the forthcoming year.We were surprised not to see a mention of theimpact of the Francis Report (Mid Staffs) on thework and approach of the Trust. It was explained tous that the Trust felt this was not part of this QualityReport. However the Trust will include it in all theirwork and keep the service users up to date withchanges made due to the Francis Report.We were pleased to learn that two other versionsof the full report would be made: an “Easy Read”version for certain groups of service users, and amore accessible version for the general public.We felt that the review of priorities in 2012-13and goals for 2013-14 (pages 3 to 11) was veryclearly set out under a set of consistent subheadingswhich helped understanding andcommend the Trust on this.Objective 1 (page 4): We look forward tolearning how “assistive technologies” have helpedto reduce falls in next year’s report. Similarly we arepleased that the learning from the inpatient serviceimprovement programme is to be appliedto residential care services.Objective 2 (page 6): Violence to staff. Wherethe term “lower level” is used we think an examplewould be useful. It would also be helpful to havesome comparable data from other Trusts and withthe national average.Objective 3 (page 7-8): It is pleasing to see theprogress made in respect of physical health. Wewould like to see a work stream on physical health andmedication and suggest that the online screening toolcould perhaps be extended to include medication.Objective 4 (page 10): First contact with the Trust’sservices, It would be helpful to see the last 2 yearsdata for comparison, rather than just the last year.We welcome the new Crisis House service (page 9)and look forward to learning about it in next year’sQuality Account. We hope the use of this facilitywill be on an emergency basis only as its capacityis small; long term needs of patients being cateredfor elsewhere.Objective 5: We agree that it is regrettable thatwaiting times to access memory services haveincreased, We appreciate that those identified asemergencies must take priority for this service.Again it would be helpful to see 3 years dataand also comparative data with other Trustswhich would put the data into perspective.We note the information on working in partnershipwith Sheffield Teaching Hospitals which is verypositive for those patients with dementia. Wewould have liked to see mention of the Trust’swork in partnership with Sheffield City Council asthe Council has closed a dementia resource centreduring 2012-13 and is planning to close a secondleaving just one centre operational.We are happy to see references to web links forfurther information (as on page 15) but would alsolike to see how this information could be accessedin other ways.Page 17 section 2.7: Participation in ClinicalResearch. It is good to see that research is playingan important role in the Trust. We assume thatthe Trust follows the NICE guidance in recruitingpatients and staff to participate in research andfeel this would be worth mentioning.3.1 Safety (pages 22-24): We appreciate the spaceconstraints and would like to suggest more detailcould be offered via the website plus other meansfor those not connected to the web.Sheffield LINk always asked Trusts to includeinformation on Patient Safety Alerts (PSAs) inQuality Accounts. Therefore we are pleased to see(page 22) the action taken on the PSAs receivedduring 2012-13.We would also like to see reported in the QualityAccount information on any Coroners Rule 43Requests that were received by the Trust in 2012-13 such as the number of Requests received duringthe year, their subjects, the actions taken and statusof the Trust in respect of each.3.2 Effectiveness (pages 25-29): The tables arevery clear and we found the use of symbols toindicate performance helpful. Again the last 2 yearsdata would have been helpful. We are pleased tosee some primary care indicators from the CloverGroup of practices.Complaints and compliments (page 27). It wouldbe helpful to have information on the nature ofcomplaints and the learning from them andaction taken.Service User Experience (page 32). We commendthe Trust on its showing in the national patientsurvey for mental health trusts.We are pleased about the new buildings andgarden proposed for Longley Centre and howthese will provide considerable benefit to patientsas this has been an area of focus for the LINk/Healthwatch Sheffield.We would have liked to have seen included areport on the services at Woodland View CareHome as these are now run by the Trust.Finally we are pleased to say that the Trustand Healthwatch have agreed to work jointly toimprove awareness of each other’s roles and thatthe suggestion of an article in the Trust’s staffmagazine on Healthwatch has been welcomed.Mike Smith (Chair Sheffield LINk to March 2013)Pam Enderby (Chair Healthwatch Sheffield)9 May 2013Our responseWe welcome the helpful feedback from Healthwatch.As a result of the feedback we have been able tomake some changes to the report to make it clearer.We have provided information about previous yearsperformance when relevant and we have explainedbetter some of the statements we have made. Wehave reduced the reference to web based sourcesof information by expanding further on some of theinformation provided in the main Report.With regard to specific areas of feedback. It wasalways within our plans for physical health (QualityObjective 3) to recognise the important role ofmedication and the impact this can have on people’sphysical health. We have made clearer referenceto the focus on this area in our on-going plans.Comparative information is provided within thereport, for example where we report on rates ofaggressive behaviour. Unfortunately we do not havecomparable data for specific service waiting times,such as memory services. We have expanded on theareas of partnership work with the CCG and the CityCouncil in respect of the development of services forpeople with dementia.We have provided examples of the types of researchwe are mainly involved in, and examples of thelearning and changes we have made followingthe conclusions from complaints or incidentinvestigations. We have not had any CoronersRule 43 Requests during 2012/13.We welcome the opportunity to raise awareness of therole of Healthwatch during the next year. We will alsobe exploring with Healthwatch how we can maintainan on-going dialogue through the year to report onthe progress we make over the next 12 months.Sheffield City Council’s HealthierCommunities and Adult Social CareScrutiny CommitteeSheffield City Council’s Healthier Communitiesand Adult Social Care Scrutiny Committeewelcomes the opportunity to comment onthe Trust’s Quality Account.The Committee is pleased to see the progress madeagainst the quality priorities, although notes that atthe time of consideration full year information wasnot yet available. From the information presented,progress against reducing harm from falls, andimproving the identification and assessment ofphysical health problems in at risk client groupswas notable.We were reassured to hear that the significantincrease in staff reporting incidents of violenceand assault is due to improved staff awarenessas a result of the staff development work thathas been undertaken.127128

It was harder for the Committee to comment onthe performance information relating to QualityObjective 4 – improving the experience of firstcontact with the Trust’s services – due to figuresbeing unavailable at that time. We look forward toseeing progress in this area over the coming year.On Quality Objective 5 – improving access to theright care for people with dementia, the Committeehas concerns around the length of time people arewaiting to access the Memory Clinic. We share theTrust’s ambition of reducing waiting times, and willbe monitoring progress on this over the next year.We welcome the progress made on the ‘InvolvingPeople with Dementia’ Project, and suggest thatthe film produced as a result of the project isshared widely across the city. We offer ourassistance in doing this.The Committee is pleased to note the involvementof the Trust Governors and Service Users in thedevelopment of the Quality Account – and feelsthat this should be emphasised. We also feel thatfurther emphasis could be given to the Trust’sbuilt environment, and work going on aroundCapital developments and improvements inthe Quality Account.In terms of presentation, the Committee welcomesplans to develop an easy read version of the finaldocument. We would like to see where possible,trend information provided over a 3 year period.Including benchmarking and comparisons withother areas within the report would help to give aclearer picture of Trust performance. Considerationcould also be given to including information aboutinternal Trust structures and their contribution toquality development.We look forward to working with the Trust overthe coming year, and progressing the qualitypriorities further.26 April 2013Our responseWe welcome the feedback from the HealthierCommunities and Adult Social Care ScrutinyCommittee. We have made a range of amendmentsto our Quality Report to incorporate the feedbackprovided to give a broader view on our progress inimproving quality.We share the Committee’s concern regarding thelength of time people have to wait to access ourmemory services. We have made good progressin previous years, supported by our Commissionerfor the service Sheffield CCG. We will continue toprogress options to make further improvementsover the next year and will report on our progressduring the year.Sheffield Clinical Commissioning GroupNHS Sheffield Clinical Commissioning Group (CCG)has had the opportunity to review and commenton the information in this quality account prior topublication. Sheffield Health and Social Care NHSFoundation Trust has considered our commentsand made amendments where appropriate. Weare confident that to the best of our knowledgethe information supplied within this report isfactually accurate and a true record, reflectingthe trust’s performance over the period April2012 – March 2013.Sheffield Health and Social Care NHS FoundationTrust provides a range of general and specialisedmental health, learning disability, substance misuse,community rehabilitation and primary care servicesto the people of Sheffield, and it is right that all ofthese services should aspire to make year-on-yearimprovements in the standards of care theycan achieve.Our overarching view is that Sheffield Health andSocial Care NHS Foundation Trust continues toprovide high quality services, which are underpinnedby strong contractual performance. This qualityaccount evidences that the trust has achievedpositive results against its objectives for 2012-13and highlights where further improvement has beenidentified for 2013-14. The CCG is in agreementwith the trusts identified objectives for qualityimprovement (identified below) in 2013-14 andhas used the 2013-14 CQUIN scheme to supportthe trust to deliver these priorities.Quality Objective 1: To reduce the number of fallsthat cause harm to service users.Quality Objective 2: To reduce the incidence ofviolence and aggression and the subsequent useof restraint and seclusion.Quality Objective 3: To improve the identificationand assessment of physical health problems inat-risk client groups.Quality Objective 4: To improve the experienceof first contact with the Trust’s services.Quality Objective 5: To improve access to the rightcare for people with a dementia.Moving forward into 2013-14 the CCG will buildon existing good clinical and managerial workingrelationships to progress the development ofinitiatives that will drive for quality and deliverthe required levels of efficiency.9 May 2013Our responseWe welcome the feedback from Sheffield ClinicalCommissioning Group. We have made a range ofamendments to our Quality Report to incorporatethe feedback provided to give a broader view onour progress in improving quality.We are pleased that we have a broad agreementon the areas and priorities that need improving.The use of the CQUIN scheme to incentiviseprogress in the same areas is a positive reflectionof this.We look forward to delivering further benefits andimproved outcomes with the support of our mainhealth commissioner, alongside agreed efficiencyimprovement programmes.129130

Annexe BAnnexe C2012/13 Statement of directors’responsibilities in respect of thequality reportThe directors are required under the Health Act2009 and the National Health Service (QualityAccounts) Regulations 2010 to prepare QualityAccounts for each financial year. Monitor has issuedguidance to NHS Foundation Trust Boards on theform and content of annual Quality Reports (whichincorporate the above legal requirements) and onthe arrangements that Foundation Trust Boardsshould put in place to support the data qualityfor the preparation of the Quality Report.In preparing the Quality Report, directors arerequired to take steps to satisfy themselves that:• The content of the Quality Report meets therequirements set out in the NHS FoundationTrust Annual Reporting Manual• The content of the Quality Report is notinconsistent with internal and external sourcesof information including:• Board minutes and papers for the period April2012 to May 2013;• Papers relating to Quality reported to the Boardover the period April 2012 to May 2013;• Feedback from the commissioners dated3 May 2013;• Feedback from governors dated 25 April 2013;• Feedback from LINks/ Healthwatch dated9 May 2013;• The trust’s complaints report published underregulation 18 of the Local Authority SocialServices and NHS Complaints Regulations 2009,dated August 2012;• The [latest] national patient survey issued in 2012;• The national staff survey issued February 2013;• The Head of Internal Audit’s annual opinion overthe trust’s control environment dated 28 May2013; and• Care Quality Commission quality and riskprofiles issued monthly during 2012/13;• The Quality Report presents a balanced pictureof the NHS Foundation Trust’s performance overthe period covered;• The performance information reported in theQuality Report is reliable and accurate;• There are proper internal controls over thecollection and reporting of the measures ofperformance included in the Quality Report, andthese controls are subject to review to confirmthat they are working effectively in practice; and• The data underpinning the measures ofperformance reported in the Quality Report isrobust and reliable, conforms to specified dataquality standards and prescribed definitions,is subject to appropriate scrutiny and review;and the Quality Report has been prepared inaccordance with Monitor’s annual reportingguidance (which incorporates the QualityAccounts regulations) (published at www.monitor-nhsft.gov.uk/annualreportingmanual)as well as the standards to support data qualityfor the preparation of the Quality Report(available at www.monitor-nhsft.gov.uk/annualreportingmanual).The Directors confirm to the best of their knowledgeand belief they have complied with the aboverequirements in preparing the Quality Report.By order of the BoardChairman28th May 2013Chief Executive28th May 2013Independent Auditor’s Reportto the Council of Governors ofSheffield Health and Social CareNHS Foundation Trust on theQuality ReportWe have been engaged by the Council of Governorsof Sheffield Health and Social Care NHS FoundationTrust to perform an independent assuranceengagement in respect of Sheffield Health and SocialCare NHS Foundation Trust’s Quality Report for theyear ended 31 March 2013 (the ‘Quality Report’) andcertain performance indicators contained therein.Scope and subject matterThe indicators for the year ended 31 March 2013subject to limited assurance consist of the nationalpriority indicators as mandated by Monitor:• 100% enhanced Care Programme Approach(CPA) patients receive follow up contact withinseven days of discharge from hospital;• Admissions to inpatient services had access tocrisis resolution home treatment teams; and• Total number of safety incidents reportedincluding the number of incidents resultingin severe harm or death.We refer to these national priority indicatorscollectively as the ‘indicators’.Respective responsibilities of the Directorsand auditorsThe Directors are responsible for the content andthe preparation of the Quality Report in accordancewith the criteria set out in the NHS Foundation TrustAnnual Reporting Manual issued by Monitor.Our responsibility is to form a conclusion, basedon limited assurance procedures, on whetheranything has come to our attention that causesus to believe that:• The Quality Report is not prepared in all materialrespects in line with the criteria set out in theNHS Foundation Trust Annual Reporting Manual;• The Quality Report is not consistent in all materialrespects with the sources specified in section2.1 of Monitor’s 2012/13 Detailed Guidance forExternal Assurance on Quality Reports; and• The indicators in the Quality Report identified ashaving been the subject of limited assurance inthe Quality Report are not reasonably stated inall material respects in accordance with the NHSFoundation Trust Annual Reporting Manual andthe six dimensions of data quality set out in theDetailed Guidance for External Assurance onQuality Reports.We read the Quality Report and consider whetherit addresses the content requirements of the NHSFoundation Trust Annual Reporting Manual, andconsider the implications for our report if webecome aware of any material omissions.We read the other information contained in theQuality Report and consider whether it is materiallyinconsistent with:• Board minutes for the period April 2012to May 2013;• Papers relating to Quality reported to the Boardover the period April 2012 to May 2013;• Feedback from Sheffield City Councils HealthierCommunities and Adult Social Care ScrutinyCommittee dated 26 April 2013;• Feedback from the Commissioners dated3 May 2013;• Feedback from local Healthwatch organisationsdated 9 May 2013;• The Trust’s complaints report published underregulation 18 of the Local Authority SocialServices and NHS Complaints Regulations2009, dated August 2012;• The national patient survey issued in 2012;• The national staff survey dated February 2013• Care Quality Commission quality and riskprofiles issued monthly during 2012/13; and• The Head of Internal Audit’s annual opinion overthe Trust’s control environment dated 28 May 2013.We consider the implications for our report ifwe become aware of any apparent misstatementsor material inconsistencies with those documents(collectively, the ‘documents’). Our responsibilitiesdo not extend to any other information.We are in compliance with the applicableindependence and competency requirements ofthe Institute of Chartered Accountants in Englandand Wales (ICAEW) Code of Ethics. Our teamcomprised assurance practitioners and relevantsubject matter experts.131132

This report, including the conclusion, has beenprepared solely for the Council of Governors ofSheffield Health and Social Care NHS FoundationTrust as a body, to assist the Council of Governorsin reporting Sheffield Health and Social Care NHSFoundation Trust’s quality agenda, performanceand activities. We permit the disclosure of thisreport within the Annual Report for the yearended 31 March 2013, to enable the Council ofGovernors to demonstrate they have dischargedtheir governance responsibilities by commissioningan independent assurance report in connection withthe indicators. To the fullest extent permitted by law,we do not accept or assume responsibility to anyoneother than the Council of Governors as a body andSheffield Health and Social Care NHS FoundationTrust for our work or this report save where termsare expressly agreed and with ourprior consent in writing.Assurance work performedWe conducted this limited assuranceengagement in accordance with InternationalStandard on Assurance Engagements 3000(Revised) – ‘Assurance Engagements otherthan Audits or Reviews of Historical FinancialInformation’ issued by the International Auditingand Assurance Standards Board (‘ISAE 3000’).Our limited assurance procedures included:• Evaluating the design and implementation ofthe key processes and controls for managingand reporting the indicators• Making enquiries of management• Testing key management controls• Limited testing, on a selective basis, of thedata used to calculate the indicator back tosupporting documentation• Comparing the content requirements of theNHS Foundation Trust Annual Reporting Manualto the categories reported in the Quality Report• Reading the documents.A limited assurance engagement is smaller inscope than a reasonable assurance engagement.The nature, timing and extent of proceduresfor gathering sufficient appropriate evidenceare deliberately limited relative to a reasonableassurance engagement.LimitationsNon-financial performance information is subject tomore inherent limitations than financial information,given the characteristics of the subject matter andthe methods used for determining such information.The absence of a significant body of establishedpractice on which to draw allows for the selectionof different but acceptable measurementtechniques which can result in materially differentmeasurements and can impact comparability. Theprecision of different measurement techniques mayalso vary. Furthermore, the nature and methodsused to determine such information, as well as themeasurement criteria and the precision thereof, maychange over time. It is important to read the QualityReport in the context of the criteria set out in theNHS Foundation Trust Annual Reporting Manual.The scope of our assurance work has not includedgovernance over quality or non-mandated indicatorswhich have been determined locally by SheffieldHealth and Social Care NHS Foundation Trust.ConclusionBased on the results of our procedures, nothing hascome to our attention that causes us to believe that,for the year ended 31 March 2013:• The Quality Report is not prepared in all materialrespects in line with the criteria set out in theNHS Foundation Trust Annual Reporting Manual;• The Quality Report is not consistent in allmaterial respects with the sources specifiedin section 2.1 of Monitor’s 2012/13 DetailedGuidance for External Assurance on QualityReports; and• The indicators in the Quality Report subject tolimited assurance have not been reasonably statedin all material respects in accordance with the NHSFoundation Trust Annual Reporting Manual.KPMG LLP, Statutory AuditorLeeds29th May 2013SECTION 12.0Rivelin Boardroom at Fulwood HouseStatement of AccountingOfficer’s Responsibilities133134

12.0 Statement of AccountingOfficer’s ResponsibilitiesThe NHS Act, 2006 states that the ChiefExecutive is the Accounting Officer ofthe NHS Foundation Trust.The relevant responsibilities of accounting officers,including their responsibility for the propriety andregularity of public finances for which they areanswerable, and for the keeping of proper accounts,are set out in the NHS Foundation Trust AccountingOfficer Memorandum issued by Monitor.Under the NHS Act, 2006, Monitor has directedSheffield Health and Social Care NHS FoundationTrust to prepare, for each financial year, a statementof accounts in the form and on the basis set out inthe Accounts Direction. The accounts are preparedon an accruals basis and must give a true and fairview of the state of affairs of Sheffield Health andSocial Care NHS Foundation Trust and of its incomeand expenditure, total recognised gains and lossesand cash flows for the financial year.In preparing the accounts, the Accounting Officeris required to comply with the requirements of theNHS Foundation Trust Annual Reporting Manualand in particular to:• Observe the Accounts Direction issued byMonitor, including the relevant accountingand disclosure requirements and apply suitableaccounting policies on a consistent basis• Make judgements and estimates on areasonable basis• State whether applicable accounting standardsas set out in the NHS Foundation Trust AnnualReporting Manual have been followed, anddisclose and explain any material departuresin the financial statements; and• Prepare the financial statements on a goingconcern basis.The Accounting Officer is responsible for keepingproper accounting records which disclose, withreasonable accuracy, at any time, the financialposition of the NHS Foundation Trust and to enablehim/her to ensure that the accounts comply withrequirements outlined in the above-mentioned Act.The Accounting Officer is also responsible forsafeguarding the assets of the NHS FoundationTrust and hence for taking reasonable stepsfor the prevention and detection of fraudand other irregularities.To the best of my knowledge and belief, I haveproperly discharged the responsibilities set outin Monitor’s NHS Foundation Trust AccountingOfficer Memorandum.Kevan TaylorChief ExecutiveDate: 28th May 2013Staff Area, Burbage WardSECTION 13.0Annual GovernanceStatementCraft group at theLongley CentreService user postcards,SPACES SouthKevan Taylor, DaveMcCarthy, Dan Jarvis MPand Tony Russell, Arts &Wellbeing Conference 2012135136

13.0 Annual Governance Statement13.1 Scope of ResponsibilityAs Accounting Officer, I have responsibility formaintaining a sound system of internal control thatsupports the achievement of the NHS FoundationTrust’s policies, aims and objectives, whilstsafeguarding the public funds and departmentalassets for which I am personally responsible, inaccordance with the responsibilities assigned tome. I am also responsible for ensuring that theNHS Foundation Trust is administered prudentlyand economically and that resources are appliedefficiently and effectively. I also acknowledge myresponsibilities as set out in the NHS FoundationTrust Accounting Officer Memorandum.Sheffield Health and Social Care NHS FoundationTrust forms part of the Sheffield social andhealthcare communities. As the AccountingOfficer I work closely with NHS Sheffield, who isthe main commissioner of the Trust’s services. Weare also accountable to Sheffield City Council forthe social care it provides through the Section 75Agreement which is monitored on a monthly basisby the Joint Performance Group, and quarterly viaa Partnership Board. Part of the agreement includesan accountability framework. We also have aNon-Executive Director on our Board of Directorswho is an elected member of the Council. Positiverelationships with NHS North of England, (formedin October 2011 from three Strategic HealthAuthorities – Yorkshire and the Humber, NorthEast and North West), have been maintained.Art therapy atMoncrieffe RoadOT exercise session at theLongley Centre13.2 The Purpose of the Systemof Internal ControlThe system of internal control is designed to managerisk to a reasonable level, rather than to eliminate allrisk of failure to achieve policies, aims and objectives;it can therefore only provide reasonable and notabsolute assurance of effectiveness. The system ofinternal control is based on an on-going processdesigned to identify and prioritise the risks to theachievement of the policies, aims and objectives ofSheffield Health and Social Care NHS FoundationTrust, to evaluate the likelihood of those risks beingrealised and the impact should they be realised,and to manage them efficiently, effectively andeconomically. The system of internal control hasbeen in place in Sheffield Health and Social CareNHS Foundation Trust for the year ended 31 March2013 and up to the date of approval of the AnnualReport and Accounts.13.3 Capacity to Handle Risk13.3.1 Risk Management leadership and StructureCorporate leadership, support and advice for handlingrisk is provided through the Integrated GovernanceTeam (including risk management and clinicalgovernance functions). During the year leadershipfor risk management and governance has changedfrom the Executive Director of Nursing and IntegratedGovernance (current title Chief Operating Officer/Chief Nurse) to joint leadership between the DeputyDan Jarvis MP, Artsand WellbeingConference 2012Chief Executive and the Medical Director. Thisprovides assurance on the Trust’s capacity to handlerisk through the various reports that are providedto the Quality Assurance Committee, the Audit andAssurance Committee and the Board of Directors itself.Roles and responsibilities for risk management aredescribed in detail in the Trust’s Risk ManagementStrategy. Responsibilities include:• All directors are operationally responsible forsafety and the effective management of riskwithin their areas of responsibility• All managers including team managers/leadersand heads of departments are responsible forhealth and safety and the effective managementof risks within their teams, services or departments• All staff in the Trust, including those ontemporary contracts, placements or secondments,and contractors must keep themselves and otherssafe. All staff have a duty of care to provide safeservices and do no harm. All health and socialcare staff working directly with service users andcarers are responsible for ensuring that their workis safe and that they use systematic clinical riskassessment and management processes in thedelivery of care and treatment.13.3.2 Staff Training and DevelopmentStaff training and development needs with regardto risk management and safety are described in theTrust’s Mandatory Training Policy. This policy wasrevised and approved by the Executive Directors’Group (in accordance with the Trust’s Policy onPolicies) in January 2011.Development for the Board and senior managersin 2012/13 has included various workshops onannual planning, looking at the external andinternal environment, service and financial planning,financial challenges, optimising value in care and theimplications of the Health and Social Care Bill 2012.Training provided by the Trust for its staff includes:• Corporate Welcome – An introduction tothe organisation• Core Training – An intensive 4 day trainingpackage for all new starters, which includes riskmanagement, health and safety, equality andhuman rights, information governance, infectioncontrol etc. Training is tailored, dependent uponthe individual’s job role• Incident Reporting and Investigation (includingroot cause analysis);• Mental Health Act• Mental Capacity Act• Health, Safety and Security, including Fire Safety• Equality & Human Rights• Respect (Managing Violence and Aggression)• First Aid and Life Support (including Resuscitation)• Root Cause Analysis• Clinical Risk Assessment and Management• Medicines Management• Safeguarding Children and Vulnerable Adults• Infection Control• Care Programme Approach.The service directorates and the professional groupsalso provided a range of regular training up-datesfor their staff during the year.National Institute for Health and Clinical Excellence(NICE) guidance and evidence-based practicecontinue to be incorporated into clinical practice.NICE guideline implementation groups are establishedfor all mental health guidelines, progress is reportedthrough the Quality Improvement Group and quarterlyto the Quality Assurance Committee of the Boardof Directors. Performance on implementation ismonitored by the Medical Director and also by NHSSheffield. All relevant NICE Technical Appraisals havebeen implemented within timescales.The Trust employs a range of suitably qualifiedand experienced persons who are accessible to allstaff to advise on risk issues, such as clinical risk,infection control, risk assessment, health and safety,litigation, liability, fire and security, environmental,estate management, medicines management,psychological therapies governance, safeguardingchildren and vulnerable adults, human resourcesand finance among others.137138

13.3.3 Learning from Good PracticeThe Trust utilises a number of methods for ensuringthat good practice and lessons learned are sharedacross the services. These include:• Utilising clinical audit/clinicaleffectiveness reports• Quality Improvement Group• Staff and service user surveys and thedissemination of results• Reports of compliments received and thelearning from complaints, incidents and claims• Improving quality events• Quality check meetings;• Team and directorate governance reportsand events• Inpatient Forum (formerly Acute Care Forum)• Community Care Forum• Service User Safety Group• Sharing Good Practice events• Making contributions at conferences• Risk Register Leads meetings.A key learning point from incidents reported in theperiod is ensuring that service users’ families andcarers are involved in care planning and decisionmaking. The Trust is continuing to improve recordkeeping to ensure comprehensive and timelyrecords are made. Communication between NHSprofessionals also needs to be strengthened to ensureinformation is shared appropriately.Learning is also shared through the Service UserSafety Group, as well as through a variety ofcommunications, for example Risk ManagementUpdate and Litigation News. As Chief Executive, Isend out a monthly letter to all staff, which includesreferences to good practice and achievements thatthe Trust has identified.The Trust’s annual Quality Accounts provide abalanced view of the Trust’s performance onquality issues.13.4 The Risk and Control Framework13.4.1 Risk Management StrategyThe Trust recognises that positive and managedrisk taking is essential for growth, developmentand innovation. ‘Risks’ are not seen as barriersto change and improvement; instead they arerecognised, considered and managed effectivelyas part of improvements.The Trust’s Risk Management Strategy, which wasrenamed and revised during 2012/13 and ratified inMarch 2013, is shared with new staff at induction,handed out at training courses and is available onthe Trust’s intranet and internet sites, together withother policies and procedures to inform practice.The Risk Management Strategy describes:• The Trust’s vision, values, attitude and strategicapproach to safety and risk management;• The Trust’s structure and governancearrangements for safety and risk management;• Roles, responsibilities and accountabilities forsafety and risk management;• The risk assessment and management processes;• Key components of risk management, namely:– Board Assurance Framework– Risk Registers– Incident and Serious Incident Reporting– Identification and analysis, controland monitoring,– Learning and sharing learning from Incidents,Complaints and Claims;• Staff Learning and Development• Involving Service Users and Carers;• The Trust’s operational approach to riskmanagement;• Using evidence-based practice;• Using information effectively.Other policies related to the effective assessmentand management of risk are available to all staffvia the Trust intranet and internet sites and arereferenced in the Risk Management Strategy.A system is in place to prompt the review andrevision of policies as required.13.4.2 Risk Assessment and Monitoring SystemsIdentifying and managing risk is embedded in theactivity of the organisation through the governancestructure. This includes service governance withineach of the service directorates and agencies, andteam governance in all clinical teams. Each teamproduces a report at least annually, for directoratereview. All Directorates are reviewed through aregular performance review with the Executive Team.Risks to achieving the Trust’s corporate objectivesand risks to the viability of the Trust are recordedand monitored through the Board AssuranceFramework, which is linked to the broader Trust(Corporate) Risk Register. All risks are assessed usinga stepped approach which identifies and analysesthe risk, identifies the control measures in placeand how effective these are and the actions thatneed to be taken to reduce/mitigate/remove therisk. Risks are graded according to their severityand likelihood of recurrence, using a 5 x 5 riskgrading matrix based upon guidance produced bythe former National Patient Safety Agency. All risksthat are categorised as moderate or high (scoring12 or above) are entered onto the Corporate RiskRegister, together with all risks that are categorisedas cross-Trust risks, for example, information riskswhich affect more than one directorate. Risks arerecorded on the Ulysses Safeguard system which isan electronic database with sub sections for eachdirectorate. Within directorates, individual teamsor departments also have their own sub-sections.All recorded risks have an accountable individualand are reviewed and monitored by the appropriateoperational governance group.Directorate Risk Registers are reviewed as part ofthe service review process to ensure that they are‘live’ and being managed effectively and efficiently.Each directorate has a risk register lead who isresponsible for reviewing and maintaining their riskregister. The Corporate Risk Register is administeredby the Risk Register Co-ordinator, who also providesadvice, support and guidance for the directorate riskregister leads.All high level risks are reported to the ExecutiveDirectors Group and the Board of Directors monthlyusing a Board Risk Profile. The Corporate RiskRegister is reviewed and reported to the ExecutiveDirectors’ Group, the Quality Assurance Committeeand the Audit and Assurance Committee quarterly.Risks are also highlighted via feedback from incidents,including serious incidents, complaints, concerns,claims and other queries. The Executive Directors’Group, Clinical, Service and Support Directors receivea monthly overview of all on-going serious incidents.Directorates also receive monthly reports on theirown incidents..The Quality Assurance Committee of the Board ofDirectors and directorates receive quarterly reportson incidents and complaints which analyse thedata from these sources for any trends and issuesidentified. National benchmarking information fromthe National Patient Safety Agency (responsibilitiespassed to National Commissioning Board) is usedto understand and interpret the Trust’s incidentreporting patterns. The findings of external inquiriesand national reports are also shared and acted uponas described in the Trust’s National ConfidentialEnquiries Policy.13.4.3 Board Assurance FrameworkThe Board has an approved Board AssuranceFramework for the period 1st April 2012 to31st March 2013, which was last approved by theBoard in March 2013. The Assurance Frameworkis based on the Trust’s strategic aims, as describedin the Annual Business Plan, and the corporateobjectives derived from these strategic aims. TheBoard Assurance Framework was further developedthis year to take into account recommendationsfrom Internal Audit reports. Key high level andcorporate risks identified through risk registerswere incorporated during the development ofthe Framework.Implementation of the actions in the BoardAssurance Framework is monitored through theExecutive Directors’ Group. The Framework isup-dated and reviewed quarterly by the ExecutiveDirectors’ Group and the Audit and AssuranceCommittee and bi-annually by the Board.As at 1st April 2013, there are no high level risksrecorded on the Assurance Framework. There are,however, a number of risks graded as moderate orbelow. The Board Assurance Framework recordsrisks associated with the achievement of the Trust’sstrategic objectives and acknowledges and identifiesareas where improvements are required. However,none of the areas identified are deemed to besignificant or pose a serious risk to the effectiveness139140

of the systems of internal control. All residual risksand actions will carry forward into the 2013/2014Board Assurance Framework and the underlyingrisks will be entered onto the Trust’s CorporateRisk Register.Internal Audit has undertaken a review of theorganisation’s Assurance Framework and relatedassurance processes to ensure that they areembedded and effective and thus provide evidenceto support the Annual Governance Statement.The overall conclusion drawn from this review is thatthe Trust has maintained an Assurance Frameworkthroughout 2012/13 that is consistent withDepartment of Health guidance. The framework isconsidered to be fit for purpose and reflective of theprincipal risks that could impact on the achievementof the Trust’s strategic objectives, thereby acting asa key evidence source for the Trust in its preparationof the Annual Governance Statement.13.4.4 Public Stakeholder Involvementin Managing RisksService users and carers are members of the servicegovernance structures at Trust, directorate andteam level and contribute to planning and serviceimprovement groups such as the In-patient Forumand Service User Safety Group. Their contributionincludes addressing issues of service user safety andimproving the quality and effectiveness of care.Service user views are also actively sought throughsurveys and focus groups.During the past year, successful and well attendedimproving quality events for service users, carersand Governors have been held to review qualityin the Trust and build greater service user andcarer involvement in work to improve the qualityof services throughout the Trust. The Trust is alsoa partner to Sheffield Local Involvement Network(LINk) to be replaced by Healthwatch Sheffield fromApril 2013. Governors played a large role in thedevelopment of the Trust’s Quality Accounts andLINk members were also consulted.Service users and carers, who are part of thePartners in Improving Quality Group, haveundertaken various site visits across the Trust inrelation to checking compliance against the CQC’sEssential Standards of Quality and Safety, as well asbeing involved in the former Patient EnvironmentAction Team (PEAT) assessments (replaced withPLACE (Patient-Led Assessments of the CareEnvironment) from April 2013.As a Foundation Trust Sheffield Health andSocial Care has public members and a Councilof Governors. The overall role of the Council ofGovernors is to assist the Trust in the drive to raisestandards by providing services of the highestpossible quality that meet the needs of the peopleof Sheffield. The Council of Governors receives updateson the Trust’s compliance against regulationsand standards and helps plan and steer the Trustand assists in setting priorities for improvementsand changes. Governors are also members of keygovernance meetings where they can represent theinterests of the local community, service users andcarers and make sure that the Trust does what itsays it will do.13.4.5 Quality Governance ArrangementsThe Foundation Trust is fully compliant with theregistration requirements of the CQC.The CQC carried out a Review of Complianceat the following locations during the year:Hurlfield View (June 2012)Mansfield View (July 2012)Longley Meadows (July 2012)Bolehill View (January 2013 and March 2013)Wainwright Crescent (February 2013)136a Warminster Road (February 2013)Grenoside Grange (February 2013)From these inspections all locations with theexception of Bolehill View, were deemed to befully compliant against the Essential Standards ofQuality and Safety that were reviewed. Bolehill Viewreceived two compliance actions against outcome2 (consent to care and treatment) and outcome21 (records). However, during a further review inMarch 2013, both compliance actions were liftedand the location is fully compliant again.Ongoing compliance with the CQC’s EssentialStandards of Quality and Safety is assessedthroughout the year by individual teams withintheir internal governance processes. Any areasof concern are escalated through directorates andto the Head of Integrated Governance. The Trustalso holds Quality Check meetings throughout theyear, which includes stakeholders and membersof the Partners in Improving Quality Group,which provides assurance to the Trust on ongoingcompliance and shares the learning from anyinspection reviews. The Trust has devised a templatethat senior managers and volunteers use, to assesscompliance against the standards, when carryingout site visits at registered locations.The Trust assesses itself against Monitor’s QualityGovernance Framework on a quarterly basis andthis is reported to the Board of Directors.Sheffield Health and Social Care reports progresson the Trust’s Quality Objectives to the QualityAssurance Committee of the Board of Directorsquarterly and also regularly monitors progressagainst the quality indicators contained withinthe Quality Schedule that is agreed with ourcommissioners, NHS Sheffield.The Trust has maintained Level 1 of the NHSLitigation Authority’s Risk Management Standardsfor Mental Health and Learning Disability, beingassessed in March 2013 and is aiming to beassessed at Level 2 during 2014/15.13.4.6 Information Governance and Data SecurityThe Trust has an Information Governance Policy whichprovides a framework that incorporates a range ofpolicies relating to the creation, use, safe handlingand storage of all records and information. Policiesincluded within this framework are InformationSecurity Policy, Remote Working and Mobile DevicesPolicy, E-mail Policy, Internet Acceptable Use Policy,Information Quality Assurance Policy, RecordsManagement Policy, Confidentiality Code of Conduct(including Safe Haven Procedures), Starter andLeaver Procedures, Subject Access Procedures andIncident Reporting Procedures. The management andmonitoring of information risks is the responsibility ofthe Trust’s Senior Information Risk Owner (the DeputyChief Executive) and information risks and incidentsare reviewed and monitored through the InformationGovernance Steering Group, which is a sub-group ofthe Quality Assurance Committee. The InformationGovernance Steering Group has a sub-group, theCare Records Group, reporting to it.The Trust continues to adhere to the InformationGovernance Toolkit. The Trust submitted theInformation Governance Toolkit in March 2013and has met the required level on all items. A workprogramme is in place to ensure further progressover the following year.The IT department has ensured all laptops havebeen encrypted locally and has rolled out anationally procured encryption solution, ‘Safeboot’,for portable computers and storage devices.The Trust has implemented an encryption systemfor external e-mails.Information Governance training is included aspart of the core training for new starters and othertraining sessions have been provided for managers.Information Governance is also covered in the Trust’slocal induction checklist for all new staff. Remindersare presented to staff when accessing the Trust’smain patient information system. and all staff areexpected to complete annual online informationgovernance training.Information governance and data security incidentsand risks are recorded and reported through the Trust’srisk management processes, as described above. Therewere no serious incidents of severity 3 – 5 (as classifiedby the Department of Health Checklist for Reporting,Managing and Investigating Information GovernanceSerious Untoward Incidents, Gateway Ref. 13177)reported in the Trust between 1st April 2012 and31st March 2013.13.4.7 NHS Pensions Scheme RegulationsAs an employer with staff entitled to membershipof the NHS Pension Scheme, control measures are inplace to ensure all employer obligations containedwithin the Scheme regulations are compliedwith. This includes ensuring that deductions fromsalary, employer’s contributions and payments intothe Scheme are in accordance with the Schemerules, and that member Pension Scheme recordsare accurately up-dated in accordance with thetimescales detailed in the Regulations.13.4.8 Equality, Diversity and Human RightsControl measures are in place to ensure that allthe organisation’s obligations under Equality andHuman Rights legislation are complied with.The Trust is committed to eliminating discrimination,promoting equal opportunity and fostering goodrelations in relation to the diverse communities itserves and its staff, taking account of all protectedcharacteristics as defined within the EqualityAct 2010. Policy, procedure, systems and leadposts (for example safeguarding) are in place tooversee practice and ensure that Human Rightsare considered and maintained in Trust services.141142

The Trust has identified Equality Objectives andpublished these in April 2012. Progress on thePublic Sector Equality Duty is published in theTrust Annual Equality and Human Rights Reportalongside a report which contains detailed data andinformation relating to people who use Trusts servicesand people employed by the Trust. These are madepublicly available through the Trust’s website.The Trust has a lead Director responsible forEquality and Human Rights who reports to theTrust’s Executive Directors’ Group.An update on Equality and Diversity for 2012/13can be found in Section 2.16.2.13.4.9 Carbon Reduction PlansThe Foundation Trust has undertaken riskassessments and carbon reduction delivery plansare in place in accordance with emergencypreparedness and civil contingency requirementsas based on UKCIP2009 weather projects, toensure that this organisation’s obligations underthe Climate Change Act and the AdaptationReporting requirements are complied with.13.5 Review of Economy, Efficiency andEffectiveness of the Use of ResourcesThrough its infrastructure, the Committees of theBoard of Directors, namely the Audit and AssuranceCommittee, Finance and Investment Committeeand the Quality Assurance Committee, togetherwith various operational groups, ensure that theBoard of Directors’ is assured that the organisationis monitored. This is undertaken by a number ofreports received by the Board and its Committees,which are produced via the operational governancegroups and consider areas including workforce,quality, risk and business related matters on amonthly basis. The Executive Directors’ Groupprovides operational governance for all plans todevelop new or reconfigured services, supportedby the Business Planning Group.The Trust has continued to review a number ofoperational efficiency metrics throughout the year,including the results of benchmarking exercises.Alongside this, the roll out and implementation ofservice line reporting of income and expenditurehas been developed to further focus on areas ofoverspending or inefficiency. This has enabledthe Trust to focus on service elements that can beconsidered in terms of the delivery of the Trust’sCost Improvement Programme (CIP) targets. Inaddition, the Trust has put in place a MutuallyAgreed Resignation Scheme (MARS) that has beenutilised to facilitate enabling schemes and servicetransformations in order to deliver efficiency savingsand a more effective use of resources.The Trust has continued to take a Quality,Innovation, Prevention and Productivity (QIPP)approach to the delivery of Cost Improvementand Cash Releasing Efficiency (CIP/CRES) targets.Detailed plans have been presented to the Boardof Directors and regular reports are provided tothe Board regarding delivery against these targets.The organisation has strong leadership throughits operational Directors, where a Service andClinical Director have joint management of clinicaldirectorates and Support Directors have the sameresponsibility for Central or Corporate Directorates.Each of these Directors have had budget trainingand are responsible for ensuring that the resourcesthey manage are done so effectively and efficientlyand are economic. Budget managers are providedwith monthly budget reports and activity statementsfor their areas of responsibility to assist them inundertaking this role. A service review, includingfinancial matters, is undertaken on a six monthlybasis and a financial sign off for current yearbudgets is performance managed by therespective Executive Directors.During 2012/13 internal audit has, as part ofthe Trust’s annual internal audit plan, conductedoperational/value for money reviews, including areview of Clover Group Governance and; in humanresources, in respect of Performance DevelopmentReviews (PDRs). The areas reviewed by internalaudit link to the efficient and effective operationof the Trust.13.6 Annual Quality ReportThe Directors are required under the Health Act 2009and the National Health Service (Quality Accounts)Regulations 2010 (as amended) to prepare QualityAccounts for each financial year. Monitor has issuedguidance to NHS foundation trust Boards on theform and content of annual Quality Reports whichincorporate the above legal requirements in the NHSFoundation Trust Annual Reporting Manual.During the year the Board of Directors hascontinued to review performance against its qualityindicators and designated quality objectives. TheBoard does this through the reports and reviewsundertaken to the Quality Assurance Committee(a formal sub-Committee of the Board of Directors)and to the Directors directly. This has enabledthe Board to remain appraised of our currentperformance in respect of quality.Additionally, joint meetings of the Board ofDirectors’ and Council of Governors have reviewedareas of importance to be progressed in the future.In preparing the Quality Report, directors satisfiedthemselves that the report presents a balanced viewand that there are appropriate controls in placeto ensure the accuracy of the data taken from theTrust’s systems for patient records (Insight) andrisk management (Ulysses Safeguard) and publicwebsites, e.g. the CQC. Service user feedback andinformation collected through team governance hasalso been used in the production of the report.National reviews and guidance reports on QualityAccounts from Monitor, and the Audit Commissionwere reviewed as well as the Audit Commission’sassurance report on Sheffield Health and SocialCare NHS Foundation Trust’s Quality Accountsfrom last year.The Quality Report has been consulted upon withSheffield City Council’s Healthier Communities andAdult Social Care Scrutiny Committee, HealthwatchSheffield and NHS Sheffield Clinical CommissioningGroup. It has also been received and considered bythe Board of Directors’ Quality Assurance Committee,Audit and Assurance Committee and by the Board ofDirectors itself.In reviewing and confirming its Quality objectivesthe Trust supported the Governors to undertakeengagement with our Members on their opinionsand thoughts on our planned improvement areas.Over 150 members commented on our proposalsand their views and opinions have informed ourfinal plans as outlined in the Quality Account.Our Quality Report is contained in Section 11of this Annual Report.13.7 Review of EffectivenessAs Accounting Officer, I have responsibility forreviewing the effectiveness of the system ofinternal control. My review of the effectiveness ofthe system of internal control is informed by thework of the internal auditors, clinical audit and theexecutive managers and clinical leads within theNHS Foundation Trust who have responsibility forthe development and maintenance of the internalcontrol framework. I have drawn on the content ofthe quality report attached to this Annual Reportand other performance information available to me.My review is also informed by comments madeby the external auditors in their reports. I havebeen advised on the implications of the result ofmy review of the effectiveness of the system ofinternal control by the Board of Directors, the Auditand Assurance Committee, the Quality AssuranceCommittee, the Finance and Investment Committee,the Information Governance Steering Group, theHuman Resources and Workforce Group, theBusiness Planning Group, the Operational DeliveryGroup, the Strategic Leadership Group, the QualityImprovement Group and the Executive Directors’Group and a plan to address weaknesses and ensurecontinuous improvement of the system is in place.These Committees/groups and their accountabilityand reporting relationships are described more fullybelow and in the Trust’s Business Plan. I believethat they form an effective and robust system ofgovernance for the Trust.The Head of Internal Audit provides me with anopinion based on an assessment of the designand operation of the underpinning AssuranceFramework and supporting processes and anassessment of the individual opinions arising fromrisk-based audit assignments contained withinthe internal audit risk based plan that have beenreported throughout the year. This assessmenthas taken into account of the relative materialityof these areas and management’s progress inrespect of addressing control weaknesses. Theoverall opinion of the Head of Internal Audit is thatsignificant assurance can be given that there is agenerally sound system of internal control, designedto meet the organisation’s objectives and thatcontrols are generally being applied consistently.Executive managers within the organisation, who haveresponsibility for the development and maintenanceof the system of internal control, provide me withassurance. The Assurance Framework itself providesme with evidence that the effectiveness of controlsthat manage the risks to the organisation achievingits principal objectives have been reviewed.My review is also informed by:• Reports from the Board of Directors and theBoard Committees;143144

• Reports from External Audit;• Reports from Internal Audit;• External assessments by the National HealthService Litigation Authority;• External assessments by the CQC, includingMental Health Act Commissioners;• Full registration with the CQC acrossall locations;• The bi-annual Performance Review held withall Service Directorates to review their progressand performance against targets;• The similar 6 monthly Performance Review heldwith all support/corporate directorates;• Clinical Audit Programme;• Patient Environment Action Team (PEAT)assessment (replaced in April 2013 with PLACE);• Service User Surveys;• Information Governance Toolkit assessment.13.7.1 Board of DirectorsThe Board of Directors is responsible for ensuringthat the organisation has robust clinical, corporate andfinancial governance systems in place. This includes thedevelopment of systems and processes for financialcontrol, organisational control and risk management.13.7.2 Audit and Assurance CommitteeThe Audit and Assurance Committee providesassurance to the Board through objectivereview and monitoring of the Trust’s internalcontrol mechanisms, such as financial systems,financial information, compliance with the law,governance processes, among others. It monitorsthe effectiveness of the systems in place for themanagement of risk and governance, and deliveryof the Board Assurance Framework.13.7.3 Quality Assurance CommitteeThe Quality Assurance Committee provides assuranceto the Board on the quality of care and treatmentprovided across the Trust by ensuring there areefficient and effective systems for quality assessment,improvement and assurance and that service userand carer perspectives are at the centre of theTrust’s quality assurance framework. A number ofcommittees/groups report to the Quality AssuranceCommittee such as the Medicines ManagementCommittee, Infection Control Committee,Safeguarding Adults and Children and PsychologicalTherapies Governance Committee, among others.These groups regularly meet to discuss risks in theirspecific areas. The Service User Safety Group hasa particular role in reviewing risks to the safety ofservice users, staff and the public.13.7.4 Finance and Investment CommitteeThe Finance and Investment Committee providesassurance on the management of the Trust’s financesand financial risks.13.7.5 Remuneration and Nominations CommitteeThe Remuneration and Nominations Committeemakes recommendations to the Board on thecomposition, balance, skill mix and successionplanning of the Board, as well as advising onappropriate remuneration and terms and conditionsof service of the Chief Executive, Executive andAssociate Directors.13.7.6 Executive Directors’ GroupThe role of the Executive Directors’ Group is to ensurethe operational and performance delivery of servicesin line with Trust strategic and business objectives.The Executive Directors’ Group is the key team whichmanages strategic and operational risk issues, andreceives frequent reports on risk and governance. TheDeputy Chief Executive and the Medical Director havejoint executive responsibility for risk and governance.13.7.7 Operational Governance Groups12 operational governance groups report tothe Executive Directors’ Group:• Business Planning Group• Quality Improvement Group• HR and Workforce Group• Operational Delivery Group• Strategic Development Forum• Health and Safety Committee• Service User Safety Group• BME Strategy Group• Mental Health Act Group• Policy Governance Group• Information Governance Steering Group• Research and Development Group.In addition, a series of professional advisory groupsand Committees are established whose role is toprovide clinical and professional advice.The HR and Workforce Group, Business PlanningGroup, Health and Safety Committee, ServiceUser Safety Group, Operational Delivery Groupand the Information Governance Steering Groupcover relevant aspects of risk. For example, the HRand Workforce Group considers staff-related riskssuch as the Trust’s response to staff sickness rates;information security risks are monitored throughthe Information Governance Steering Group.The new integrated governance and performancestructure, incorporating risk, is fit for purpose forthe Trust’s future as a Foundation Trust, as assessedby due diligence and the Monitor review process.From the reports and information provided acrossthe organisation to the various governance groups,I am satisfied that the system of internal control iseffective and supports the achievement of the Trust’spolicies, aims and objectives, whilst safeguardingthe public funds and departmental assets.13.8 ConclusionIn my opinion, no significant control issues havebeen identified for the period 1st April 2012 to31st March 2013.Kevan TaylorChief Executive28th May 2013145146

Service user artwork at Moncrieffe Road14.0 Auditor’s ReportSECTION 14.0Auditor’s ReportIndependent auditor’s reportto the council of governors ofsheffield health and social carenhs foundation trustWe have audited the financial statementsof Sheffield Health and Social Care NHSFoundation Trust for the year ended 31March 2013. The financial statementscomprise the Statement of ComprehensiveIncome, the Statement of Financial Position,the Statement of Changes in Taxpayers’Equity, the Statement of Cash Flows and therelated notes. These financial statementshave been prepared under applicable lawand the NHS Foundation Trust AnnualReporting Manual 2012/13.This report is made solely to the Council ofGovernors of Sheffield Health and Social Care NHSFoundation Trust in accordance with Schedule 10of the National Health Service Act 2006. Our auditwork has been undertaken so that we might stateto the Council of Governors of the Trust, as a body,those matters we are required to state to them inan auditor’s report and for no other purpose. To thefullest extent permitted by law, we do not acceptor assume responsibility to anyone other than theCouncil of Governors of the Trust, as a body, forour audit work, for this report or for the opinionswe have formed.Respective responsibilities of the accountingofficer and the auditorAs described more fully in the Statement ofAccounting Officer’s Responsibilities the accountingofficer is responsible for the preparation of financialstatements which give a true and fair view. Ourresponsibility is to audit, and express an opinionon, the financial statements in accordance withapplicable law and International Standards onAuditing (UK and Ireland). Those standards requireus to comply with the Auditing Practice’s Board’sEthical Standards for Auditors.Scope of the audit of the financial statementsAn audit involves obtaining evidence about theamounts and disclosures in the financial statementssufficient to give reasonable assurance thatthe financial statements are free from materialmisstatement, whether caused by fraud or error.This includes an assessment of whether theaccounting policies are appropriate to the Trust’scircumstances and have been consistently appliedand adequately disclosed, the reasonablenessof significant accounting estimates made by theaccounting officer and the overall presentation ofthe financial statements. In addition we read allthe financial and non-financial information in theannual report to identify material inconsistencieswith the audited financial statements. If we becomeaware of any apparent material misstatements orinconsistencies we consider the implications forour report.Opinion on financial statementsIn our opinion the financial statements:• Give a true and fair view of the state of SheffieldHealth and Social Care NHS Foundation Trust’saffairs as at 31 March 2013 and of its incomeand expenditure for the year then ended; and• Have been prepared in accordance withthe NHS Foundation Trust Annual ReportingManual 2012/13.Opinion on other matters prescribed by theAudit Code for NHS Foundation TrustsIn our opinion the information given in theDirectors’ Report for the financial year for whichthe financial statements are prepared is consistentwith the financial statements.Matters on which we are required to reportby exceptionWe have nothing to report where under theAudit Code for NHS Foundation Trusts we arerequired to report to you if, in our opinion, theAnnual Governance Statement does not reflectthe disclosure requirements set out in the NHSFoundation Trust Annual Reporting Manual, ismisleading or is not consistent with our knowledgeof the Trust and other information of which we areaware from our audit of the financial statements.147148

We are not required to assess, nor have we assessed,whether all risks and controls have been addressedby the Annual Governance Statement or that risksare satisfactorily addressed by internal controls.CertificateWe certify that we have completed the auditof the accounts of Sheffield Health and SocialCare NHS Foundation Trust in accordance withthe requirements of Chapter 5 of Part 2 of theNational Health Service Act 2006 and the AuditCode for NHS Foundation Trusts issued by Monitor.Damian Murray CPFAFor, and on behalf of, KPMG LLPStatutory AuditorChartered Accountants1 The EmbankmentLeedsLS1 4DW29th May 2013Service user postcards for SheffieldWellbeing Festival 2012SECTION 15.0Annual Accounts149150

15.0 Annual AccountsDirector of finance’s introductionto the accountsThe Financial Plan for 2012/2013 submitted toand agreed by Monitor (the Independent Regulator),has been successfully delivered to the target surplus,however, the significant cost improvements requiredby the Government has only been achieved bynon-recurrent measures.The effort and work undertaken by Directorsand staff alike has been excellent, although thecontinued request for financial efficiency savings isnow becoming more difficult to achieve recurrently.For the second year running there is an increasingamount of non-recurrent cost improvements ofaround £3m to carry forward into next year.The NHS, along with all other public services, will befacing even more financial challenges over the nextfew years. It is, therefore, pleasing to see we haveachieved and exceeded our targets in the last 4½years as a Foundation Trust.The main elements of the Trust’s financialperformance are as follows:• Achievement of surplus of £3,512k• Delivery of EBITDA (Earnings Before Interest,Tax, Depreciation and Amortisation)• Delivery of planned financial risk rating of4 with the Independent Regulator, Monitor• An expectation that the Trust will pay itsnon-NHS creditors within 30 days. We achieved84.85% by value and 85.34% by numberaveraged over the year, however improvementsto payment processes saw the Trust achieve90.42% by value and 88.83% by number inMarch 2013. It is incumbent upon public bodieslike the Trust to support the general economyand ensure this target is increased wherepossible, especially in the economic downturnwhich will be facing the broader economy overthe next few years.A major benefit of Foundation Trust status isthat the organisation can retain any income andexpenditure surplus. This has resulted in a healthycash balance. This cash will enable the Trust tospend on its buildings to ensure we have a qualityenvironment, fit for the population we serve.We have already committed funds for:• Intensive Support Service Unit (new build) forour Learning Disability client group (circa £3m)• Psychiatric Intensive Care Unit to replace existingcramped environment (circa £3m)• Vehicle replacement; various IT schemes andequipment replacement (circa £600k)The major project will be to upgrade ourin-patient facilities and this will be anothersignificant challenge as we need approximately£25m to complete this scheme.During the financial year the Trust’s external auditors,the Audit Commission, who are appointed by theTrust’s Governors, were disbanded and followingagreement with Governors, their contract wastransferred to KPMG, which is a globally recognisedcompany of accountants and financial advisors.We have seen a number of financial challenges overthe years and we have been successful in deliveringfinancial performance and care quality standards, bytargeting inefficient areas of high cost. The financialchallenges facing the Trust over the coming years isunprecedented, combined with significant cuts inother public services, including the Local Authority,will make the delivery of financial savings targetseven more difficult at the same time as deliveringsafe, quality services to the population we serve.Paul RobinsonExecutive Director of FinanceForeword to the accountsSheffield Health and Social Care NHS Foundation TrustThese accounts for the year ended 31st March 2013have been prepared by Sheffield Health and SocialCare NHS Foundation Trust in accordance withparagraphs 24 and 25 of Schedule 7 of the NationalHealth Service Act 2006 in the form which Monitor,the Independent Regulator of NHS Foundation Trusts,has, with the approval of HM Treasury, directed.Kevan TaylorChief Executive (as Accounting Officer)28th May 2013151152

The Accounts of Sheffield Health and Social Care NHS Foundation Trust for the period ending 31st March2013 follow. The four primary statements; the Statement of Comprehensive Income (SOCI), the Statementof Financial Position (SOFP), the Statement of Changes in Taxpayers’ Equity (SOCITE), and the Statementof Cashflows (SCF) are presented first. These are followed by the supporting notes to the accounts.Note 1 outlines the Foundation Trust’s accounting policies. Subsequent notes provide further detailon lines in the four primary statements and are cross referenced accordingly.The financial statements (Accounts) were approved by the Board on 28th May 2013 and signed on itsbehalf by:Signed: (Chief Executive) Date: 28th May 2013Statement of comprehensive income for the year ended and this year endNote 2012/13£0002011/12£000Operating income 2, 3 128,382 122,547Operating expenses 2, 4 (122,994) (118,466)Operating surplus 5,388 4,081Finance costs:Finance income 6 234 189Finance expense – financial liabilities 7 (87) (88)Unwinding of discount on provisions 18 (17) 0Public dividend capital dividends payable (1,986) (2,191)Net finance costs (1,856) (2,090)Movement in fair value of investment property 10 (20) 0Surplus for the year 3,512 1,991Other comprehensive incomeImpairments (losses) (1,587) (19)Revaluation gains/(losses) 416 258Actuarial gains on defined benefit pension schemes 987 778Actuarial losses on defined benefit pension schemes (1,122) (819)Total comprehensive income for the year 2,206 2,189Statement of financial position as at and this year endNote31 March2013£00031 March2012£000Non-current assetsIntangible assets 8 16 15Property, plant and equipment 9 54,528 55,342Investment property 10 180 200Trade and other receivables 12 3,751 2,921Total non-current assets 58,475 58,478Current assetsInventories 11 106 163Trade and other receivables 12 3,465 3,798Cash and cash equivalents 13 22,731 17,028Total current assets 26,301 20,989Total assets 84,777 79,467Current liabilitiesTrade and other payables 15 (5,776) (4,910)Taxes payable 15 (1,868) (2,013)Provisions 18 (1,131) (201)Other liabilities 16 (216) (204)Total current liabilities (8,991) (7,328)Non-current assets plus net current assets 75,786 72,139Non-current liabilitiesProvisions 18 (680) (392)Other liabilities 16 (3,867) (2,714)Total non-current liabilities (4,547) (3,106)Assets less liabilities 71,239 69,033Financed by taxpayers' equity:Public dividend capital 33,572 33,572Revaluation reserve 17,191 18,523Income and expenditure reserve 20,476 16,938Total taxpayers' equity 71,239 69,033153154

Statement of changes in taxpayers’ equityStatement of cash flows for the year ended and this year endPublicdividendcapital£000Revaluationreserve£000Income &ExpenditureReserve£000Total£000Taxpayers' equity at 1 April 2012 33,572 18,523 16,938 69,033Surplus for the year - - 3,512 3,512Impairments on property, plantand equipment- (1,587) - (1,587)Revaluations on property, plantand equipment- 416 - 416Actuarial loss on defined benefitspension scheme- - (135) (135)Other reserve movements - (161) 161 -Taxpayers' equity 31 March 2013 33,572 17,191 20,476 71,239Changes in taxpayers’ equity for 2011 – 12Taxpayers' equity at 1 April 2011 33,572 18,600 14,672 66,844Surplus for the period - - 1,991 1,991Impairments on property, plantand equipment- (19) - (19)Revaluations on property, plantand equipment- 258 - 258Actuarial loss on defined benefitspension scheme- - (41) (41)Other reserve movements - (316) 316 -Taxpayers' equity at 31 March 2012 33,572 18,523 16,938 69,033The amounts included within the revaluation reserve relate to property, plant and equipment.Note 2012/13£0002011/12£000Cash flows from operating activitiesOperating surplus SOCI 5,388 4,081Depreciation and amortisation 9 2,049 2,075Impairments and reversals 9 172 -(Gain) on disposal 3 (318) (73)(Increase) in trade and other receivables SOFP (496) (1,479)Decrease in other assets SOFP - 174Decrease in inventories SOFP 57 36Increase/(decrease) in trade and other payables SOFP 721 (170)Increase in other liabilities SOFP 1,165 657Increase/(decrease) in provisions SOFP 1,218 (211)Other movements in operating cash flows SOFP (245) (93)Net cash generated from operations 9,711 4,997Cash flows from investing activitiesInterest received 6 149 94Payments for intangible assets 8 (4) (15)Purchase of property, plant and equipment 9 (2,741) (678)Receipts from disposal of property, plant and equipment 9 644 73Net cash generated used in investing activities (1,952) (526)Cash flows from financing activitiesPDC dividends paid (2,056) (2,132)Net cash generated (used in) financing activities (2,056) (2,132)Net increase in cash and cash equivalents 5,703 2,339Cash & cash equivalents at 1st April 17,028 14,689Cash & cash equivalents at 31st March 13 22,731 17,028155156

SUPPORTING NOTESTO THE ACCOUNTSNote 1. Accounting policies1. Accounting policies andother informationMonitor has directed that the financial statementsof NHS foundation trusts shall meet the accountingrequirements of the NHS Foundation Trust AnnualReporting Manual which shall be agreed withHM Treasury. Consequently, the following financialstatements have been prepared in accordance withthe 2012/13 NHS Foundation Trust Annual ReportingManual issued by Monitor. The accounting policiescontained in that manual follow InternationalFinancial Reporting Standards (IFRS) and HMTreasury’s Financial Reporting Manual to the extentthat they are meaningful and appropriate to NHSfoundation trusts. The accounting policies have beenapplied consistently in dealing with items consideredmaterial in relation to the accounts.Sheffield Health and Social Care NHS FoundationTrust (‘the Trust’) achieved foundation trust statuson 1 July 2008.Accounting conventionThese accounts have been prepared under thehistorical cost convention modified to account forthe revaluation of property, plant and equipment,intangible assets, inventories and certain financialassets and financial liabilities.1.1 IncomeIncome in respect of services provided is recognisedwhen, and to the extent that, performance occursand is measured at the fair value of the considerationreceivable. The main source of income for the Trust iscontracts with commissioners in respect of health andsocial care services.Where income is received for a specific activity whichis to be delivered in the following financial year,that income is deferred.Income from the sale of non-current assets isrecognised only when all material conditions of salehave been met, and is measured as the sums dueunder the sale contract.1.2 Expenditure on employee benefitsShort-term employee benefitsSalaries, wages and employment-related paymentsare recognised in the period in which the service isreceived from employees. The cost of annual leaveentitlement earned but not taken by employees atthe end of the period is recognised in the financialstatements to the extent that employees arepermitted to carry-forward leave into thefollowing period.Pension costsNHS pension schemePast and present employees are covered by theprovisions of the NHS Pensions Scheme. Details ofthe benefits payable under these provisions canbe found on the NHS Pensions website at www.nhsba.nhs.uk/pensions. The scheme is an unfunded,defined benefit scheme that covers NHS employers,general practices and other bodies, allowed underthe direction of Secretary of State, in England andWales. The scheme is not designed to be run in away that would enable NHS bodies to identify theirshare of the underlying scheme assets and liabilities.Therefore, the scheme is accounted for as if it werea defined contribution scheme: the cost to the NHSBody of participating in the scheme is taken as equalto the contributions payable to the scheme for theaccounting period.Employer’s pension cost contributions are charged tooperating expenses as and when they become due.Additional pension liabilities arising from earlyretirements are not funded by the scheme exceptwhere the retirement is due to ill health. The fullamount of the liability for the additional costs ischarged to the operating expenses at the time theTrust commits itself to the retirement, regardless ofthe method of payment.In order that the defined benefit obligationsrecognised in the financial statements do not differmaterially from those that would be determinedat the reporting date by a formal actuarial valuation,the FReM requires that “the period betweenformal valuations shall be four years, withapproximate assessments in intervening years”.An outline of these follows:a) Accounting valuationA valuation of the scheme liability is carried outannually by the scheme actuary as at the end ofthe reporting period. Actuarial assessments areundertaken in intervening years between formalvaluations using updated membership data andare accepted as providing suitably robust figuresfor financial reporting purposes. The valuation ofthe scheme liability as at 31 March 2013, is basedon the valuation data as 31 March 2012, updatedto 31 March 2013 with summary global memberand accounting data. In undertaking this actuarialassessment, the methodology prescribed in IAS 19,relevant FReM interpretations, and the discount rateprescribed by HM Treasury have also been used.The latest assessment of the liabilities of the schemeis contained in the scheme actuary report, whichforms part of the annual NHS Pension Scheme(England and Wales) Pension Accounts, publishedannually. These accounts can be viewed on theNHS Pensions website. Copies can also be obtainedfrom The Stationery Office.b) Full actuarial (funding) valuationThe purpose of this valuation is to assess the levelof liability in respect of the benefits due underthe scheme (taking into account its recentdemographic experience), and to recommendthe contribution ratesThe last published actuarial valuation undertakenfor the NHS Pension Scheme was completed forthe year ending 31 March 2004. Consequently, aformal actuarial valuation would have been due forthe year ending 31 March 2008. However, formalactuarial valuations for unfunded public serviceschemes were suspended by HM Treasury on valuefor money grounds while consideration is givento recent changes to public service pensions, andwhile future scheme terms are developed as partof the reforms to public service pension provisiondue in 2015.The Scheme Regulations were changed to allowcontribution rates to be set by the Secretary ofState for Health, with the consent of HM Treasury,and consideration of the advice of the SchemeActuary and appropriate employee and employerrepresentatives as deemed appropriate.The next formal valuation to be used for fundingpurposes will be carried out at as at March 2012and will be used to inform the contribution ratesto be used from 1 April 2015.c) Scheme provisionsThe NHS Pension Scheme provided definedbenefits, which are summarised below. This list isan illustrative guide only, and is not intended todetail all the benefits provided by the Scheme orthe specific conditions that must be met beforethese benefits can be obtained:The Scheme is a “final salary” scheme. Annualpensions are normally based on 1/80th for the1995 section and of the best of the last three yearspensionable pay for each year of service, and 1/60thfor the 2008 section of reckonable pay per yearof membership. Members who are practitionersas defined by the Scheme Regulations have theirannual pensions based upon total pensionableearnings over the relevant pensionable service.With effect from 1 April 2008 members can chooseto give up some of their annual pension for anadditional tax free lump sum, up to a maximumamount permitted under HMRC rules. This newprovision is known as “pension commutation”.Annual increases are applied to pension paymentsat rates defined by the Pensions (Increase) Act 1971,and are based on changes in retail prices in thetwelve months ending 30 September in the previouscalendar year. From 2011 – 12 the Consumer PriceIndex (CPI) will be used to replace the Retail PricesIndex (RPI).Early payment of a pension, with enhancement,is available to members of the scheme who arepermanently incapable of fulfilling their dutieseffectively through illness or infirmity. A deathgratuity of twice final year’s pensionable pay fordeath in service, and five times their annualpension for death after retirement is payableFor early retirements other than those due to illhealth the additional pension liabilities are notfunded by the scheme. The full amount of theliability for the additional costs is charged tothe employer.Members can purchase additional service in the NHSScheme and contribute to money purchase AVC’srun by the Scheme’s approved providers or by otherFree Standing Additional Voluntary Contributions(FSAVC) providers.157158

Local government pension schemeSome employees are members of the LocalGovernment Pension Scheme, administered bythe South Yorkshire Pensions Authority, which isa defined benefit pension scheme. The schemeassets and liabilities attributable to these employeescan be identified and are recognised in the Trust’saccounts. The assets are measured at fair value,and the liabilities at the present value of futureobligations.The increase in the liability arising from pensionableservice earned during the year is recognised withinoperating expenses. The expected gain duringthe year from scheme assets is recognised withinfinance income. The interest cost during the yeararising from the unwinding of the discount onthe scheme liabilities is recognised within financecosts. Actuarial gains and losses during the year arerecognised in the income and expenditure reserveand reported in the Statement of ComprehensiveIncome as an item of ‘other comprehensive income’.These postings are mostly countered by the terms ofthe current partnership agreement.The terms of the current partnership agreementwith Sheffield City Council (‘the Council’) providethat any long term pension liability arising from thescheme will be funded by the Council, with theexception of any pension changes which relate tosalary increases in excess of any local governmentgrading agreements. The impact on current andprior year Statement of Comprehensive Income andStatement of Changes in Taxpayers’ Equity relatingto the application of IAS 19 – ‘Employee Benefits’within the accounts of the Trust is mostly negatedby the inclusion of a corresponding non-currentreceivable with the Council. As at 31 March 2013,the deficit on the scheme was £3,867,000(31 March 2012 – £2,714,000), which is offsetby a non-current receivable of £3,402,960 (31 March2012 – £2,388,000). For further informationsee note 26.Expenditure on other goods and servicesExpenditure on goods and services is recognisedwhen, and to the extent that they have beenreceived, and is measured at the fair value of thosegoods and services. Expenditure is recognised inoperating expenses except where it results in thecreation of a non-current asset such as property,plant and equipment.Property, plant and equipmentRecognitionProperty, Plant and Equipment is capitalised where:• it is held for use in delivering services or foradministrative purposes;• it is probable that future economic benefitswill flow to, or service potential be provided to,the Trust;• it is expected to be used for more than onefinancial year;• the cost of the item can be measured reliably;and• the item has a cost of at least £5,000; or• collectively, a number of items have a cost ofat least £5,000 and individually have a costof more than £250, where the assets arefunctionally interdependent, they had broadlysimultaneous purchase dates, are anticipated tohave simultaneous disposal dates and are undersingle managerial control (a “grouped asset”); or• items form part of the initial equipping andsetting-up cost of a new building, ward or unit,(treated as a “grouped asset”) .Where a large asset, for example a building, includesa number of components with significantly differentasset lives e.g. plant and equipment, then thesecomponents are treated as separate assets anddepreciated over their own useful economic lives.MeasurementValuationAll property, plant and equipment assets aremeasured initially at cost, representing the costsdirectly attributable to acquiring or constructing theasset and bringing it to the location and conditionnecessary for it to be capable of operating in themanner intended by management. All assets aremeasured subsequently at fair value.Land and buildings used for the Trust’s services or foradministrative purposes are stated in the Statementof Financial Position at their revalued amounts,being the fair value at the date of revaluation lessany subsequent accumulated depreciation andimpairment losses. Revaluations are performedwith sufficient regularity to ensure that carryingamounts are not materially different from those thatwould be determined at the end of the reportingperiod. The current revaluation policy of the Trust isto perform a full valuation every five years with aninterim valuation in the third year. These valuationsare carried out by professionally qualified valuersin accordance with Royal Institution of CharteredSurveyors (RICS) Appraisal and Valuation Manual.Fair values are determined as follows:• Land and non-specialised buildings – marketvalue taking into account existing use• Specialised buildings – depreciatedreplacement costHM Treasury has adopted a standard approach todepreciated replacement cost valuations based onmodern equivalent assets and, where a service couldbe provided in any part of the City, the Trust hasused the alternative site valuation method.An interim valuation exercise was undertaken by theTrust’s valuers, GVA Grimleys, during 2012/13. Thevaluation methodology detailed above was utilisedwithin this revaluation, which was performed asat 1 April 2012.Properties in the course of construction for serviceor administration purposes are carried at cost, lessany impairment loss. Cost includes professionalfees but not borrowing costs, which are recognisedas expenses immediately, as allowed by IAS 23 forassets held at fair value. Assets are revalued anddepreciation commences when they are broughtinto use.The carrying value of plant and equipment is writtenoff over their remaining useful lives and new plantand equipment is carried at depreciated historic costas this is not considered to be materially differentfrom fair value.Subsequent expenditureSubsequent expenditure relating to an item ofproperty, plant and equipment is recognised as anincrease in the carrying amount of the asset when itis probable that additional future economic benefitsor service potential deriving from the cost incurredto replace a component of such item will flowto the enterprise and the cost of the item can bedetermined reliably.Where a component of an asset is replaced, thecost of the replacement is capitalised if it meetsthe criteria for recognition above. The carryingamount of the part replaced is de-recognised. Otherexpenditure that does not generate additionalfuture economic benefits or service potential, suchas repairs and maintenance, is charged to theStatement of Comprehensive Income in the periodin which it is incurred.DepreciationItems of property, plant and equipment aredepreciated over their remaining useful economiclives in a manner consistent with the consumptionof economic or service delivery benefits. Freeholdland is considered to have an infinite life and isnot depreciated.The estimated useful economic lives are as follows:Minimum life years Maximum life yearsBuildings – Freehold 15 50Plant and Machinery 5 15Transport Equipment 3 7Information Technology 5 10Furniture and Fittings 7 10Property, plant and equipment which has been reclassified as ‘Held for Sale’ ceases to be depreciated upon thereclassification. Assets in the course of construction are not depreciated until the asset is brought into use.159160

Revaluation gains and lossesIncreases in asset values arising from revaluationgains are recognised in the revaluation reserve,except where, and to the extent that, they reversea revaluation decrease that has previously beenrecognised in operating expenses, in which casethey are recognised in operating income.Revaluation losses are charged to the revaluationreserve to the extent that there is an availablebalance for the asset concerned, and thereafterare charged to operating expenses.Gains and losses recognised in the revaluationreserve are reported in the Statement ofComprehensive Income.ImpairmentsIn accordance with the FT Annual Reporting Manual,impairments that are due to a loss of economicbenefits or service potential in the assets are chargedto operating expenses. A compensating transfer ismade from the revaluation reserve to the income andexpenditure reserve of an amount equal to the lowerof (i) the impairment charged to operating expenses;and (ii) the balance in the revaluation reserveattributable to that asset before the impairment.As the Trust has no current or prior year impairmentsof this type, no adjustment is required.An impairment arising from a loss of economicbenefit or service potential is reversed when andto the extent that, the circumstances that gave riseto the loss is reversed. Reversals are recognisedin operating income to the extent that the assetis restored to the carrying amount it would havehad if the impairment had never been recognised.Any remaining reversal is recognised in therevaluation reserve. Where, at the time of theoriginal impairment, a transfer was made from therevaluation reserve to the income and expenditurereserve, an amount is transferred back to revaluationreserve when the impairment reversal is recognised.Other impairments are treated as revaluation losses.Reversals of ‘other impairments’ are treated asrevaluation gains.De-recognitionAssets intended for disposal are reclassified as ‘Heldfor Sale’ once all of the following criteria are met:The asset is available for immediate sale in itspresent condition subject only to terms which areusual and customary for such sales;The sale must be highly probable i.e:• management are committed to a plan tosell the asset;• an active programme has begun to find a buyerand complete the sale;• the asset is being actively marketed at areasonable price;• the sale is expected to be completed within12 months of the date of classification as‘Held for Sale’; and• the actions needed to complete the plan indicateit is unlikely that the plan will be dropped orsignificant changes made to it.Following reclassification, the assets are measured atthe lower of their existing carrying amount and their‘fair value less costs to sell’. Depreciation ceases to becharged. Assets are de-recognised when all materialsale contract conditions have been met.Property, plant and equipment which is to bescrapped or demolished does not qualify forrecognition as ‘Held for Sale’ and instead is retainedas an operational asset and the asset’s economiclife is adjusted. The asset is de-recognised whenscrapping or demolition occurs.Donated, government grant and other grantfunded assetsDonated and grant funded property, plant andequipment assets are capitalised at their fair valueon receipt. The donation/grant is credited to incomeat the same time, unless the donor has imposeda condition that the future economic benefitsembodied in the grant are to be consumed in amanner specified by the donor, in which case, thedonation/grant is deferred within liabilities and iscarried forward to future financial years to the extentthat the condition has not yet been met. The donatedand grant funded assets are subsequently accountedfor in the same manner as other items of property,plant and equipment.1.5 Intangible assetsRecognitionIntangible assets are non-monetary assets withoutphysical substance which are capable of being soldseparately from the rest of the Trust’s business orwhich arise from contractual or other legal rights.They are recognised only where it is probable thatfuture economic benefits will flow to, or servicepotential be provided to, the Trust and where thecost of the asset can be measured reliably.Internally generated intangible assetsInternally generated goodwill, brands, mastheads,publishing titles, customer lists and similar items arenot capitalised as intangible assets.Expenditure on research is not capitalised.Expenditure on development is capitalisedonly where all of the following can bedemonstrated:• the project is technically feasible to the point ofcompletion and will result in an intangible assetfor sale or use;• the Trust intends to complete the asset andsell or use it;• the Trust has the ability to sell or use theasset;• how the intangible asset will generate probablefuture economic or service delivery benefitse.g. the presence of a market for it or itsoutput, or where it is to be used for internaluse, the usefulness of the asset;• adequate financial, technical and otherresources are available to the Trust to completethe development and sell or use the asset;and• the Trust can measure reliably theexpenses attributable to the asset duringdevelopment.SoftwareSoftware which is integral to the operation ofhardware e.g. an operating system, is capitalisedas part of the relevant item of property, plant andequipment. Software which is not integral to theoperation of hardware e.g. application software,is capitalised as an intangible asset.MeasurementIntangible assets are recognised initially at cost,comprising all directly attributable costs neededto create, produce and prepare the asset to thepoint that it is capable of operating in the mannerintended by management.Subsequently intangible assets are measured at fairvalue. Revaluation gains and losses and impairmentsare treated in the same manner as for property,plant and equipment.Intangible assets held for sale are measured at thelower of their carrying amount or ‘fair value lesscosts to sell’.AmortisationIntangible assets are amortised over their expecteduseful economic lives in a manner consistent with theconsumption of economic or service delivery benefits.1.6 Investment propertyInvestment property comprises properties thatare held to earn rentals or for capital appreciationor both. It is not depreciated but is stated at fairvalue based on regular valuations performed byprofessionally qualified valuers. Fair value is basedon current prices for similar properties in the samelocation and condition. Any gain or loss arisingfrom the change in fair value is recognised in theStatement of Comprehensive Income. Rental incomefrom investment property is recognised on a straightline basis over the term of the lease.1.7 Government and other grantsGovernment grants are grants from Governmentbodies other than income from primary care trustsor NHS trusts for the provision of services. Where aGovernment grant is used to fund expenditure it istaken to the Statement of Comprehensive Incometo match that expenditure.During 2012/13 no government grants or othergrants were received.1.8 InventoriesInventories are valued at the lower of cost and netrealisable value. The cost of inventories is measuredusing the First in First Out (FIFO) method.161162

1.9 Financial instruments, financial assetsand financial liabilitiesRecognitionFinancial assets and financial liabilities which arisefrom contracts for the purchase or sale of nonfinancialitems (such as goods or services), whichare entered into in accordance with the Trust’snormal purchase, sale or usage requirements,are recognised when, and to the extent which,performance occurs i.e. when receipt or deliveryof the goods or services is made.All other financial assets and financial liabilities arerecognised when the Trust becomes a party to thecontractual provisions of the instrument.De-recognitionAll financial assets are de-recognised when therights to receive cashflows from the assets haveexpired or the Trust has transferred substantially allof the risks and rewards of ownership.Financial liabilities are de-recognised when theobligation is discharged, cancelled or expires.Classification and measurementFinancial assets are categorised as ‘Loans andreceivables’.Financial liabilities are classified as ‘OtherFinancial liabilities’.Loans and receivablesLoans and receivables are non-derivative financialassets with fixed or determinable payments whichare not quoted in an active market. They areincluded in current assets.The Trust’s loans and receivables comprise: cash andcash equivalents, NHS receivables, accrued incomeand ‘other receivables’.Loans and receivables are recognised initially at fairvalue, net of transaction costs, and are measuredsubsequently at amortised cost, using the effectiveinterest method. The effective interest rate is therate that discounts exactly estimated future cashreceipts through the expected life of the financialasset or, when appropriate, a shorter period, to thenext carrying amount of the financial asset.Other financial liabilitiesAll ‘other’ financial liabilities are recognised initiallyat fair value, net of transaction costs incurred, andmeasured subsequently at amortised cost using theeffective interest method. The effective interest rate isthe rate that discounts exactly estimated future cashpayments through the expected life of the financialliability or, when appropriate, a shorter period, to thenet carrying amount of the financial liability.They are included in current liabilities except foramounts payable more than 12 months after theStatement of Financial Position date, which areclassified as long-term liabilities.Interest on financial liabilities carried at amortised costis calculated using the effective interest method andcharged to Finance Costs. Interest on financial liabilitiestaken out to finance property, plant and equipmentor intangible assets is not capitalised as part of thecost of those assets.Impairment of financial assetsAt the Statement of Financial Position date, theTrust assesses whether any financial assets, otherthan those held at ‘fair value through income andexpenditure’ are impaired. Financial assets areimpaired and impairment losses are recognised if, andonly if, there is objective evidence of impairment asa result of one or more events which occurred afterthe initial recognition of the asset and which has animpact on the estimated future cashflowsof the asset.For financial assets carried at amortised cost, theamount of the impairment loss is measured as thedifference between the asset’s carrying amount andthe present value of the revised future cash flowsdiscounted at the asset’s original effective interestrate. The loss is recognised in the Statement ofComprehensive Income and the carrying amountof the asset is reduced through the use of a baddebt provision.1.10 LeasesFinance leasesThe Trust has no finance leases.Operating leasesOther leases are regarded as operating leases andthe rentals are charged to operating expenses ona straight-line basis over the term of the lease.Operating lease incentives received are added tothe lease rentals and charged to operating expensesover the life of the lease.Leases of land and buildingsWhere a lease is for land and buildings, theland component is separated from the buildingcomponent and the classification for each isassessed separately. Leased land is treated asan operating lease.1.11 ProvisionsThe Trust recognises a provision where it has apresent legal or constructive obligation of uncertaintiming or amount; for which it is probable that therewill be a future outflow of cash or other resources;and a reliable estimate can be made of theamount. The amount recognised in the Statementof Financial Position is the best estimate of theresources required to settle the obligation. Wherethe effect of the time value of money is significant,the estimated cashflows are discounted using theshort- (-1.8%); medium- (-1.0%); and/or long-term(+2.2%) real discount rates published by the HMTreasury, except for early retirement provision andinjury benefit provisions which both use the HMTreasury’s pensions discount rate of 2.35% (2.8%2011/12) in real terms.Clinical negligence costsThe NHS Litigation Authority (NHSLA) operates arisk pooling scheme under which the Trust pays anannual contribution to the NHSLA, which, in return,settles all clinical negligence claims. Although theNHSLA is administratively responsible for all clinicalnegligence cases, the legal liability remains withthe Trust. The total value of clinical negligenceprovisions carried by the NHSLA on behalf of theTrust is disclosed at note 18 but is not recognised inthe Trust’s accounts.Non-clinical risk poolingThe Trust participates in the Property ExpensesScheme and the Liabilities to Third Parties Scheme.Both are risk pooling schemes under which the Trustpays an annual contribution to the NHS LitigationAuthority and in return receives assistance withthe costs of claims arising. The annual membershipcontributions, and any ‘excesses’ payable in respectof particular claims are charged to operatingexpenses when the liability arises.1.12 ContingenciesContingent assets (that is, assets arising from pastevents whose existence will only be confirmed byone or more future events not wholly within theTrust’s control) are not recognised as assets, but aredisclosed in note 19 where an inflow of economicbenefits is probable. As at 31st March 2013 theTrust has no contingent assets.Contingent liabilities are not recognised, but aredisclosed in note 19, unless the probability of atransfer of economic benefits is remote. Contingentliabilities are defined as:* possible obligations arising from past eventswhose existence will be confirmed only by theoccurrence of one or more uncertain future eventsnot wholly within the Trust’s control; or* present obligations arising from past eventsbut for which it is not probable that a transferof economic benefits will arise or for which theamount of the obligation cannot be measured withsufficient reliability.1.13 Public dividend capitalPublic dividend capital (PDC) is a type of publicsector equity finance based on the excess of assetsover liabilities at the time of establishment of thepredecessor NHS Trust, being Sheffield Care Trust.HM Treasury has determined that PDC is not afinancial instrument within the meaning of IAS 32.A charge, reflecting the cost of capital utilisedby the Trust, is payable as public dividend capitaldividend. The charge is calculated at the rate setby HM Treasury (currently 3.5%) on the averagerelevant net assets of the Trust during the financialyear. Relevant net assets are calculated as the value163164

of all assets less the value of all liabilities, except for(i) donated assets (including lottery funded assets),(ii) net cash balances held with the GovernmentBanking Services (GBS) excluding cash balancesheld in GBS accounts that relate to a short-termworking capital facility and (iii) any PDC dividendbalance receivable or payable. In accordance withthe requirements laid down by the Department ofHealth (as the issuer of the PDC), the dividend forthe year is calculated on the average relevant netassets as set out in the ‘pre-audit’ version of theannual accounts. The dividend thus calculated is notrevised should any adjustment to net assets occur asa result of the audit of the annual accounts.1.14 Value added taxMost of the activities of the Trust are outside thescope of VAT and, in general, output tax does notapply and input tax on purchases is not recoverable.Irrecoverable VAT is charged to the relevantexpenditure category or included in the capitalisedpurchase cost of property, plant and equipmentassets. Where output tax is charged or input VAT isrecoverable, the amounts are stated net of VAT.1.15 Corporation taxThe Trust has carried out a review of corporation taxliability of its non-healthcare activities. At present allactivities are either ancillary to patient care activityor below the de-minimis £50,000 profit level atwhich corporation tax is due.1.16 Foreign exchangeThe functional and presentational currenciesof the Trust are sterling.1.17 Third party assetsAssets belonging to third parties (such as moneyheld on behalf of patients) are not recognised in theaccounts since the Trust has no beneficial interest inthem. However, they are disclosed in note 21 to theaccounts in accordance with the requirements ofHM Treasury’s Financial Reporting Manual.1.18 Losses and special paymentsLosses and special payments are items thatParliament would not have contemplated whenit agreed funds for the health service or passedlegislation. By their nature they are items thatideally should not arise. They are therefore subjectto special control procedures compared with thegenerality of payments. They are divided in todifferent categories, which govern the way thatindividual cases are handled. Losses and specialpayments are charged to the relevant functionalheadings in expenditure on an accruals basis,including losses which would have been made goodthrough insurance cover had NHS trusts not beenbearing their own risks.However the losses and special payments note iscompiled directly from the losses and compensationsregister which reports on an accruals basis with theexception of provisions for future losses.1.19 Accounting standards that have beenissued but have not yet been adoptedA number of standards, amendments andinterpretations have been issued by the IASB buthave not yet been adopted by the EU and aretherefore not reflected in the Foundation TrustAnnual reporting Manual. We have consideredthese changes and have concluded that nonewill have a material impact on the Trust.1.20 Critical Judgements and key sourcesof estimation uncertaintyIn the application of the Trust’s accounting policies,management is required to make judgements,estimates and assumptions about the carryingamounts of assets and liabilities that are not readilyapparent from other sources. The Trust confirmsthat it has not used any key assumptions concerningthe future or had any key sources of estimationuncertainty at the end of the reporting period,that have a significant risk of causing a materialadjustment to the carrying amounts of assets andliabilities within the next financial year that needto be disclosed under IAS1.The main area of estimation uncertainty withinthe Trust is the carrying value of the propertyportfolio and the assumptions used in thedetermination of fair value at the Statement ofFinancial Position date. In accordance with Trustpolicy, a property valuation is commissioned everyfive years with interim valuations every third year.The revaluations are undertaken by professionalvaluers and significantly reduce the risk of materialmisstatement. The last interim revaluation tookplace on 1 April 2012.Provisions have been calculated having recognisedan obligating event during the year and includeestimates and assumptions relating to the carryingamounts and timing of the anticipated payments.The litigation provisions are based on estimatesfrom the NHS Litigation Authority and the injurybenefit provisions on figures from NHS Pensions.A further area where estimation is required relatesto the net liability to pay pensions in respect of thestaff who transferred to the Trust from Sheffield CityCouncil. This estimation depends on a number ofcomplex judgements relating to the discount rateused, the rate at which salaries are projected toincrease, changes in the retirement ages, mortalityrates and expected returns on pension fund assets.A firm of consulting actuaries is engaged by theSouth Yorkshire Pensions Authority to provide theTrust with expert advice about the assumptions tobe applied. See note 26.1.21 Merger accounting and transformingcommunity servicesFor functions that have been transferred to the trustfrom another NHS or local government body, theassets and liabilities are recognised in the accountsas at the date of transfer. The assets and liabilitiesare not adjusted to fair value prior to recognition.The net gain or loss corresponding to the net assetsor liabilities transferred is recognised within incomeor expenses, but not within operating activities.For property plant and equipment assets andintangible assets, the cost and accumulateddepreciation/amortisation balances from thetransferring entity’s accounts are preserved onrecognition in the trust’s accounts. Where thetransferring body recognised revaluation reservebalances attributable to the assets, the trust makesa transfer from its income and expenditure reserveto its revaluation reserve to maintain transparencywithin public sector accounts.For functions that the trust has transferred toanother NHS or local government body, the assetsand liabilities transferred are de-recognised fromthe accounts as at the date of transfer. The net lossor gain corresponding to the net assets or liabilitiestransferred is recognised within expenses/income,but not within operating activities. Any revaluationreserve balances attributable to assets de-recognisedare transferred to the income and expenditurereserve. Adjustments to align the acquired functionto the foundation trust’s accounting policies areapplied after initial recognition and are adjusteddirectly in taxpayers’ equity.No assets or liabilities were transferred to, or from,Sheffield Health and Social Care NHS FoundationTrust in 2012 – 13. However, we expect to take on£583,330 worth of assets, mostly buildings and ITequipment from NHS Sheffield on the closure of thePrimary Care Trust. These assets will transfer on the1st April 2013. For more information see note 23.2. Operating segmentsThe Trust considers that it has one operatingsegment, that being the provision of healthand social care. All revenues are derived fromwithin the UK.Details of operating income by classification andoperating income by type are given in Note 3.165166

3. Operating income3.1 Operating income by classification comprises3.2 Private patient incomeThe Trust has no private patient income.3.3 Operating lease income2012/13£0002011/12£000Rental income from operating leasesIncome from patient care activitiesCost & Volume income 3,046 2,986Block contract income 83,242 76,026Clinical partnerships providing mandatory services (including Section 31 agreements) 4,446 5,520Clinical income for the secondary commissioning of mandatory services - 11Other clinical income from mandatory services 2,542 2,41893,276 86,961Other operating incomeResearch and development 570 540Education and training 6,587 6,216Non-patient care services to other bodies 22,760 27,149Other income 712 559Profit on disposal of land and buildings 313 -Profit on disposal of other tangible fixed assets 5 2Gain on disposal of assets held for sale - 71Reversal of impairments of property, plant and equipment 23 -Rental revenue from operating leases – minimum lease receipts 34 33Income in respect of staff costs where accounted for on a gross basis 4,102 1,01635,106 35,5862012/13£0002011/12£000Rents recognised as income in period 34 33Future minimum lease payments due2012/13£0002011/12£000Receivable on leases of buildings expiringNot later than one year 14 13Later than one year and not later than five years 42 50Later than five years - -56 63Total operating income* 128,382 122,547*Income is almost totally from the supply of services. Income from the sale of goods is immaterial.167168

3.4 Operating income by type comprises2012/13£0002011/12£000Income from patient care activitiesNHS foundation trusts 16 47NHS trusts - 1Primary care trusts 87,459 80,500Local authorities 4,446 5,520Non-NHS: Other 1,355 89393,276 86,961Other operating incomeResearch and development 570 540Education and training 6,587 6,216Charitable and other contributions to expenditure - -Non-patient care services to other bodies 22,760 27,149Income in respect of staff costs (gross basis) 4,102 1,016Rental revenue from operating leases 34 33Other income 712 55934,765 35,513Total operating income 128,041 122,474Profit on disposal of plant and equipment 5 2Profit on disposal of land and buildings 313 -Reversal of impairments of property, plant and equipment 23 -Gain on disposal of assets held for sale - 71Total income 128,382 122,5474. Operating expenses4.1 Operating expenses comprise:Note 2012/13£0002011/12£000Services from NHS Foundation trusts 1,286 1,216Services from NHS Trusts 68 -Services from PCT's 1,288 864Purchase of healthcare from non-NHS bodies 3,307 98Employee expenses – Executive Directors 5.1 805 796Employee expenses – Non-executive Directors 97 99Employee expenses – Staff 5.1 98,709 99,444Drug costs 1,200 1,390Supplies and services – clinical (excluding drug costs) 1,390 1,357Supplies and services – general 1,176 1,090Establishment 2,435 2,344Research and development 64 66Transport 576 405Premises 4,933 4,176Increase/(decrease) in provision for impairmentof receivables- (1)Inventories written down (net, including inventory drugs) 5 -Rentals under operating leases – minimum lease receipts 4.2 774 707Depreciation on property, plant and equipment 2,046 2,075Amortisation on intangible assets 3 -Impairments of property, plant and equipment 195 -Audit fees: statutory audit* 69 65Other auditors remuneration: other services 1 -Clinical negligence 233 261Legal fees 238 121Consultancy costs 374 286Training, courses and conferences 468 507Patient travel 108 106Car parking and security 92 71Redundancy 5.1 320 -Publishing 6 -Insurance 167 121Losses and ex gratia payments 17 47Other 544 755122,994 118,466169* There is a £1,000,000 limit on Auditors liability.170

4.2 Operating leases4.2.1 Payments recognised as an expense5. Employee expenses and numbers5.1 Employee expenses2012/13£0002011/12£0002012/13£0002011/12£000Minimum lease payments 774 7074.2.2 Future minimum lease payments2012/13£0002011/12£000Payable:Not later than one year 646 597Later than one year and not later than five years 1,261 1,348Later than five years 9,078 8,43210,985 10,3774.2.3 Significant leasing arrangementThe term of the operating lease for properties on the Northern General Hospital site is 125 years from1 April 1991. The rent payable to Sheffield Teaching Hospitals NHS FT (STH) is based on the capital chargesfor the buildings.There is no option to renew when the lease finishes on 31 March 2116. At the end of the lease period orfollowing a termination by the tenant, if the landlord sells the property or any part of it, the net proceedsof the sale will be divided between the landlord and the tenant in accordance with a table contained inthe lease ranging from 50% / 50% within 1 year of reversion to 100% / nil in favour of the landlord after10 years from the reversion date.Under the terms of the lease the following restrictions are imposed; not to assign, sub let, mortgage,charge or part with possession of the whole or part of the property and to only use the property, or anypart of it, for the housing and treatment of learning disabilities service users.Salaries and wages 79,503 81,340Social security costs 5,854 6,081Employer contributions to NHS pension scheme 8,903 9,279Employer contributions to Local Authority scheme 389 385Termination benefits 1,603 446Agency/contract staff 3,589 2,7465.2 Directors remuneration99,841 100,277Less costs capitalised as part of assets (7) (37)Total 99,834 100,2402012/13£0002011/12£000Fees to non-executive directors 91 92Executive Directors – Salaries* 643 635Executive Directors – Benefits (NHS Pension scheme) 85 83* Salaries stated are all emoluments paid to Executive Directors, including payments for clinical responsibility within the Trust andexcluding national insurance contributions.Further information about the remuneration of individual directors and details of their pension arrangements is provided in theRemuneration Report and Note 5.3819 810171172

The aggregate of remuneration received by executive directors is £643,000. There are 5 executive directors who benefit from the NHS definedbenefit pension scheme. The total employer contributions paid to the NHS pension scheme in respect of these directors is £85,000.The employer contributions shown above relate to the NHS Pensions Scheme. There were no share option or long term incentive schemes.No advances, credits or guarantees of any kind were entered into by the Trust on behalf of the directors.E Lightbown, Chief OperatingOfficer/Chief Nurse100-105 12 14 100 - 105 - 12 14Dr T Kendall, Executive Medical Director 60-65 125-130 23 21 60 - 65 125 - 130 23 21P Robinson, Executive Director of Finance 15-20 2 3 - - - -M Rodgers, Deputy Chief Executive/Executive Director of Finance95-100 12 14 105 - 110 - 13 15C Clarke, Deputy Chief Executive and SocialCare Care Lead100-105 12 14 100 - 105 - 12 14K Taylor, Chief Executive 135-140 16 19 135-140 - 17 19S Rogers - Non-Executive Director 10 - 15 1 10 - 15 - 1 -M Thomas - Non Executive Director 10 - 15 1 10 - 15 - 1 -A Clayton Non-Executive Director 10 - 15 1 10 - 15 - 1 -M Rosling, Non-Executive Director 10 - 15 1 10 - 15 - 1 -Cllr. M Rooney, Non-Executive Director 10 - 15 1 10 - 15 - 1 -Prof. A Walker, Chairman 25 - 30 3 25 - 30 - 3 -Name and title Salary(bands of£5000)£000OtherRemuneration(bands of£5000)£000Employer Employer Salary Other Employer EmployerNational Superannuation (bands of Remuneration National SuperannuationInsurance Contributions £5000) (bands of Insurance ContributionsContributions (rounded to the £000 £5000) Contributions (rounded to the(rounded to the nearest £000)£000 (rounded to the nearest £000)nearest £000)nearest £000)Period 1.4.12 to 31.3.13 Period 1.4.11 to 31.3.125.3 Directors’ remuneration5.4 Average number of people employed2012/13Number2011/12NumberrestatedMedical and dental 152 151Administration and estates 526 542Healthcare assistants and other support staff 166 176Nursing, midwifery and health visiting staff 1,202 1,296Scientific, therapeutic and technical staff 365 377Social care staff 117 134Bank and agency staff 133 642,661 2,740*2011/12 restated to exclude non-executive directors5.5 Early retirements due to ill healthDuring 2012/13 there were 4 (2011/2012 – 1 case) early retirements from the Trust agreed on the groundsof ill-health. The estimated additional pension liabilities of these ill-health retirements will be £168,478(2011/2012 – £33,000). The cost of these ill-health retirements will be borne by the NHS Business ServicesAuthority – Pensions Division.The employer contributions shown above relate to the NHS Pensions Scheme. There were no share optionor long term incentive schemes. No advances, credits or guarantees of any kind were entered into by theTrust on behalf of the directors.5.6 Exit packagesThe table below summarises the total number of exit packages agreed during 2012/13. Included withinthese are compulsary redundacies and other schemes including MARS (Mutually Agreed ResignationScheme) applications.Exit package cost bandNumber ofcompulsoryredundanciesNumberof otherdeparturesagreedTotal numberof exitpackages bycost band

6. Finance income7. Finance costs2012/13£0002011/12£000Interest incomeBank accounts 153 101Finance income associated with the Local Authority pension scheme* 81 88Other loans and receivables - -Total 234 1892012/13£0002011/12£000Finance costs associated with the Local Authority pension scheme* 87 88No payments were made during 2012/13 under The Late Payment of Commercial Debts (Interest) Act 1998(year ended 31 March 2012 – £nil).*2011/12 finance income and costs associated with the local Authority pension scheme presented gross for comparison purposes8. Intangible assetsComputer software2012/13£0002011/12£000Gross cost at 1 April 23 8Additions 4 15Disposals - -Gross cost at 31 March 27 23Amortisation at 1 April 8 8Provided during the year 3 -Disposals - -Amortisation at 31 March 11 8Net book value – closingAt 31 March 16 159. Property, plant and equipmentTotalFurnitureand fittingsInformationtechnologyTransportequipmentPlant andmachineryLand Buildings Assets underconstruction2012/13: £000 £000 £000 £000 £000 £000 £000 £000Cost or valuation at 1 April 2012 9,034 49,583 378 966 482 2,056 149 62,648Additions purchased - - 2,714 103 40 44 - 2,901Impairments charged to revaluation reserve (265) (1,322) - - - - - (1,587)Reclassifications - - (124) 59 - 65 - 0Revaluation surpluses - (4,518) - - - - - (4,518)Reclassified as held for sale (100) (230) - - - - - (330)Disposals - - - - (33) - (3) (36)At 31 March 2013 8,669 43,513 2,968 1,128 489 2,165 146 59,078Depreciation at 1 April 2012 - 5,036 - 551 281 1,315 123 7,306Provided during year - 1,667 - 98 63 208 10 2,046Reversal of Impairments - (23) - - - - - (23)Reclassifications - - - - - - - -Impairments charged to revaluation reserve - 195 - - - - - 195Revaluation surpluses - (4,934) - - - - - (4,934)Reclassified as held for sale - (4) - - - - - (4)Disposals - - - - (33) - (3) (36)Depreciation at 31 March 2013 - 1,937 - 649 311 1,523 130 4,550Net book valuePurchased 9,034 43,964 378 415 201 741 26 54,759Donated - 583 - - - - - 583Total at 1 April 2012 9,034 44,547 378 415 201 741 26 55,342Net book valuePurchased 8,669 41,012 2,968 479 178 641 16 53,963Donated - 564 - 0 - 1 - 565Total at 31 March 2013 8,669 41,576 2,968 479 178 642 16 54,528Analysis of property, plant and equipment - net book valueProtected 4,510 31,416 - - - - - 35,926Unprotected 4,159 10,160 2,968 479 178 642 16 18,602Total at 31 March 2013 8,669 41,576 2,968 479 178 642 16 54,528No assets were held under finance leases or hire purchase contracts as at 31 March 2013175176

No assets were held under finance leases or hire purchase contracts as at 31 March 2012Total at 31 March 2012 9,034 44,547 378 415 201 741 26 55,342Unprotected 4,509 11,212 378 415 201 741 26 17,482Protected 4,525 33,335 - - - - - 37,860Analysis of property, plant and equipment - net book valueTotal at 31 March 2012 9,034 44,547 378 415 201 741 26 55,342Donated - 583 - - - - - 583Purchased 9,034 43,964 378 415 201 741 26 54,759Net book valueTotal at 1st April 2011 9,034 45,681 531 501 198 525 30 56,500Donated - 604 - - - - - 604Purchased 9,034 45,077 531 501 198 525 30 55,896Net book valueDepreciation at 31 March 2013 - 5,036 - 551 281 1,315 123 7,306Disposals - - - - (28) (183) - (211)Reclassified as held for sale - - - - - - - -Revaluation surpluses - (36) - - - - - (36)Reclassifications - - - - - - - -Impairments charged to SOCI - - - - - - - -Provided during period - 1,708 - 103 60 191 13 2,075Depreciation at 1 April 2011 - 3,364 - 448 249 1,307 110 5,478At 31 March 2012 9,034 49,583 378 966 482 2,056 149 62,648Disposals - - - - (28) (183) - (211)Reclassified as held for sale - - - - - - - -Revaluation loss - 222 - - - - - 222Reclassifications - 335 (742) - - 407 - -Impairments charged to revaluation reserve - (19) - - - - - (19)Additions purchased - - 589 17 63 - 9 678Cost or valuation at 1 April 2011 9,034 49,045 531 949 447 1,832 140 61,9782011/12: £000 £000 £000 £000 £000 £000 £000 £000Prior year Land Buildings Assets underconstructionPlant andmachineryTransportequipmentInformationtechnologyFurnitureand fittingsTotal10. Investment property10.1 Investment property – carrying value10.2 Investment property expenses10.3 Investment property income11. Inventories11.1 Inventories31 March2013£00031 March2012£000As at 1 April 200 200Acquisitions in year - -Impairments recognised in expenses (20) -As at 31 March 180 2002012/13£00031 March2013£0002011/12£000Direct operating expense arising from investment property generatingrental income in the year 10 132012/13£0002011/12£000Investment property income 34 3331 March2012£000Consumables 106 163177178

11.2. Inventories recognised in expenses2012/13£0002011/12£000Inventories recognised as an expense in the period* 1,862 1,794Write-down of inventories (including losses) 5 71,867 1,80112.2 Ageing of impaired receivables31 March2013£00031 March2012£000Up to three months 2 -In three to six months 3 -Over six months 13 1818 18*Inventories recognised as an expense in the period (consumed) are recorded against additions in the period.12. Trade and other receivables12.1 Trade and other receivables31 March2013£000Current31 March2012£00031 March2013£000Non-current31 March2012£000NHS receivables 1,645 1,362 - 281Receivables due from NHS charities 3 - - -Other receivables with related parties 878 248 3,403 2,388Provision for impaired receivables (18) (18) - -Prepayments 431 468 348 252Accrued income 24 1,357 - -Interest Receivable 8 11PDC receivable 66 - - -VAT receivable 144 65 - -Other receivables 284 305 - -3,465 3,798 3,751 2,921The majority of trading is with primary care trusts, as commissioners for NHS patient care services.As primary care trusts are funded by government to buy NHS patient care services, no credit scoring ofthem is considered necessary. In addition, commissioning of social care is through public sector fundedbodies, such as councils and housing associations. Again, no credit scoring is considered necessary.12.3 Receivables past their due date but not impaired12.4 Provision for impairment of receivables31 March2013£00031 March2013£00031 March2012£000By 0 – 30 days 359 174By 30 – 60 days 223 82By 60 – 90 days 51 58By 90 – 180 days 53 20Over 180 days 186 50Total 872 38431 March2012£000Balance at 1 April 18 19Increase in provision - -Unused amounts reversed - (1)Balance at 31 March 18 18179180

13. Cash and cash equivalents15. Trade and other payables31 March2013£00031 March2012£000Balance at 1 April 17,028 14,689Net change in year 5,703 2,339Balance at 31 March 22,731 17,028Made up ofCash at commercial banks and in hand 181 106Cash with the Government Banking Service 22,447 4,285Other current investments 103 12,637Cash and cash equivalents as in statement of financial position 22,731 17,02814. Non-current assets held for saleCurrent year: 2012/13Property,plant andequipment£000Other assets£000Total£000As at 1 April 2012 - - -Assets classified as available for sale in the year 226 100 326Assets sold in year (226) (100) (326)Impairment of assets held for sale - - -As at 31 March 2013 - - -Prior year: 2011/12Property,plant andequipment£000Other assets£000Total£000As at 1 April 2012 174 - 174Assets classified as available for sale in the year - - -Assets sold in year (174) - (174)Impairment of assets held for sale - - -As at 31 March 2012 - - -At 31 March 2013 there were no properties declared surplus to operational requirements.16. Other liabilities17. Prudential borrowing limitThe Trust is required to comply and remain within a prudential borrowing limit. This is made up of two elements:• the maximum cumulative amount of long-term borrowing. This is set by reference to the five ratiotests set out in Monitor’s Prudential Borrowing Code. The financial risk rating set under Monitor’sCompliance Framework determines one of the ratios and therefore can impact on the long termborrowing limit• the amount of any working capital facility approved by Monitor.31 March2013£000Current31 March2012£000NHS payables 33 135Amounts due to other related parties 1,160 1,250Trade payables – capital 212 52Other trade payables 931 778Other payables - -Accruals 3,440 2,691PDC dividend payable - 4Total excluding taxes 5,776 4,910Taxes payable 1,868 2,013Total 7,644 6,92331 March2013£000Current31 March2012£00031 March2013£000Non-current31 March2012£000Deferred iIncome 216 204 - -Net pension scheme liability - - 3,867 2,714216 204 3,867 2,714Further information on the NHS Foundation Trust Prudential Borrowing Code and Compliance Frameworkcan be found on the website of Monitor, the independent Regulator of Foundation Trusts.181182

The Trust’s prudential borrowing limit is:31 March2013£00031 March2012£000Total long term borrowing limit set by Monitor 24,900 23,500Working capital facility approved by Monitor 8,100 8,100Total prudential borrowing limit 33,000 31,600Legalclaims£000Redundancy£000Injurybenefits£000At 1 April 2012 95 - 438Arising during the year 65 926 339Used during the year (46) - (48)Reversed unused (33) - -At 31 March 2013 81 926 729Neither of the above facilities were utilised by the Trust in 2012/13 or in the year to 31 March 2012.The financial ratios for 2012/13 and 2011/12 as published in the Prudential Borrowing Code are shownbelow, together with the actual level of achievement by the Trust.Financial ratioActualratios2012/1331 March2013£000CurrentApprovedPBL ratios2012/1331 March2012£000Actualratios2011/1231 March2013£000Non-currentApprovedPBL ratios2011/12Minimum Dividend Cover 4.5 >1x 3 >1xMinimum Interest Cover 1.5 >3x - >3xMinimum Debt Service Cover - >2x - >2xMaximum Debt Service to Revenue -

A provision of £729,000 relates to Injury Benefits. These are payable to current and former members of staffwho have suffered injury at work. These cases have been adjudicated by the NHS Pensions Authority. Thevalue shown is the value of payments due to the individuals for the term indicated by Government Actuary lifeexpectancy tables, and the actual value of this figure represents the main uncertainty in the amounts shown. (31March 2012 – £438,000).Previously £314,000 of provisions in 2011/12 were covered by ‘back-to-back’ income arrangements withSheffield Primary Care Trust. Due to the demise of Primary Care Trusts as at 31st March 2013, Sheffield PrimaryCare Trust cleared their outstanding liability with the FT during 2012/13. Therefore, there areno back to back arrangements with effect from1st April 2013.£3,585,000 is included in the provisions of the NHS Litigation Authority at 31 March 2013 in respect of clinicalnegligence liabilities of Sheffield Health and Social Care NHS Foundation Trust (31 March 2012 – £1,743,000).19. Contingent liabilities31 March2013£00031 March2012£000Legal claims (66) (58)Redundancy (412)(478) (58)Legal claims contingent liabilities represent the consequences of losing all current third party legal claimcases. Redundancy contingent liabilities represent potential redundancies where there may be an outflowof resources embodying future economic benefits in settlement of: a) a present obligation; or b) a possibleobligation whose existence will be confirmed only by the occurrence or non-occurrence of one or moreuncertain future events not wholly within the control of the Trust.20. Financial instrumentsIFRS 7, ‘Financial Instruments: Disclosures’, requiresdisclosure of the role that financial instrumentshave had during the period in creating or changingthe risks a body faces in undertaking its activities.Because of the continuing service providerrelationship that the Trust has with primary caretrusts and the way those primary care trusts arefinanced, the Trust is not exposed to the degreeof financial risk faced by business entities. Alsofinancial instruments play a much more limited rolein creating or changing risk than would be typicalof listed companies, to which the internationalfinancial reporting standards mainly apply. The Trusthas limited powers to borrow or invest surplus fundsand financial assets and liabilities are generatedby day-to-day operational activities rather thanbeing held to change the risks facing the Trust inundertaking its activities.The Trust’s treasury management operations arecarried out by the finance department within theparameters defined formally within the Trust’sStanding Financial Instructions and policiesagreed by the Board of Directors. Trust treasuryactivity is subject to review by the Trust’s internalauditors.Currency riskThe Trust is principally a domestic organisationwith the great majority of transactions, assets andliabilities being in the UK and sterling based. TheTrust has no overseas operations. The Trust thereforehas low exposure to currency rate fluctuations.Interest rate riskThe Trust has low exposure to interest rate fluctuationsas it has no borrowings and any excess funds areinvested on a short term basis with low risk institutions.Credit riskAs the majority of the Trust’s income comes fromcontracts with public sector bodies, the Trust haslow exposure to credit risk. The maximum exposureas at 31 March 2013 are in receivables fromcustomers, as disclosed in the receivables note.20.1 Financial assets31 March2013£00031 March2012£000Denominated in £ Sterling – Floating interest rate* 22,664 16,963*This excludes cash in hand of £67,000 (2011/12 £65,000)Liquidity riskThe Trust’s net operating costs are incurred underannual service agreements with local Primary CareTrusts and Local Authorities, which are financedfrom resources voted annually by Parliament. TheTrust finance its capital expenditure from fundsobtained within its prudential borrowing limit.The Trust is therefore not exposed to significantliquidity risks.The financial assets which have a floating rate of interest are cash held at the Government BankingService and cash held with commercial banks. This cash is held on short term deposit. All other financialassets, including non-current assets, are non interest bearing. The Trust has no financial assets with fixedinterest rates.20.2 Financial liabilitiesThe Trust has no financial liabilities with floating or fixed rates of interest. They are all non interest bearing.20.3 Financial assets by category31 March2013£00031 March2012£000Loans and receivablesNHS receivables 1,666 1,643Other receivables with related parties 4,284 2,604Provision for irrecoverable debts (18) (18)Accrued income 11 1,368Other receivables 247 305Cash at bank and in hand 22,731 17,02828,921 22,930185186

20.4 Financial assets by category31 March2013£00031 March2012£000Other financial liabilitiesNHS payables 533 135Other payables with related parties 1,161 1,250Trade payables – capital 212 52Other trade payables 931 778Accruals 3,439 2,691Provisions under contract - 60Total at 31 March 5,776 4,96625. Related party transactionsSheffield Health and Social Care NHS Foundation Trust is a body corporate established by order of theSecretary of State for Health.During the year the Trust has had transactions with a number of organisations with which key employees/directors of the Trust have some form of relationship. These are detailed below:Paymentsto RelatedParty£000Receiptsto RelatedParty£000Amountsowed toRelatedParty£000Amountsdue fromRelatedParty£000Sheffield Teaching Hospitals NHS FT 1,564 3,247 166 459University of Sheffield 528 152 83 14Royal College of Psychiatrists 23 97 - -Turning point 36 5 - 420.5 Fair valuesThe fair value of the Trust’s financial assets and financial liabilities at 31 March 2013 equates to thebook value.21. Third party assetsThe Trust held cash of £4,342,736 at bank and in hand at 31 March 2013 (31 March 2012 – £3,960,418)which relates to monies held by the Trust on behalf of patients. This has been excluded from the cash atbank and in hand amount reported in the accounts.22. Losses and special paymentsThere were 97 cases (the year ended 31 March 2012 – 72 cases) of losses and special payments totalling£50,417 (the year ended 31 March 2012 – £216,000) approved during the year ended 31 March 2013.23. Events after the reporting periodThe Trust expects to take on £583,330 worth of assets, mostly buildings and IT equipment, from NHSSheffield on the closure of the Primary Care Trust. These assets will transfer on the 1st April 2013 and relateto the transfer of Highgate Clinic and Albert Terrace Road.24. Capital commitmentsContracted capital commitments at 31 March not otherwise included in these financial statements are:31 March2013£00031 March2012£000Property, plant and equipment* 477 34*These relate to the Trust’s Intensive Support Service development and capital developments at the Longley CentreThe relationships are:• The wife of one of the Trust’s non executivedirectors is a non executive director at SheffieldTeaching Hospitals NHS Foundation Trust• The Executive Medical Director isDeputy Director of the Royal College ofPsychiatrists.• The Chair is Professor of Social Policy at theUniversity of Sheffield.• One of the non executive directors receives apension from Turning Point.• One of the non executive directors serves as acouncillor at Sheffield City Council.The Trust is required, under International AccountingStandard 24 ‘Related Party Disclosures’, to discloseany related party transactions. The objective of IASIncome£00024 is to draw attention to the possibility that thereported financial position and results may havebeen affected by the existence of related partiesand by material transactions with them. In the casesabove, all payments shown have been made by theTrust to the organisations concerned and not to theindividual officers.Amounts owed to related parties are unsecured,interest-free and have no fixed terms of repayment.The balances will be settled in cash. No guaranteeshave been given or received. No provisions fordoubtful debts have been raised against amountsoutstanding and no expense has been recognisedduring the period in respect of bad or doubtfuldebts due from related parties.The value of the Trust’s transactions with relatedparties during the year is given below:2012/13 2011/12Expenditure£000Income£000Expenditure£000Department of Health 123 - 106 -Other NHS bodies 105,010 3,664 97,252 3,227Charitable funds - - - -Other bodies (including WGA) 12,028 16,662 12,452 17,682117,161 20,326 109,810 20,909*2011/12 figures include minor reclassification for comparable data187188

The value of transactions with board members and key staff members in 2012/13 is £nil (2011/12 – £nil).Details of Directors’ remuneration and pensions can be found at note 1.2 of the accounts. Disclosuresrelating to salaries of board members are given in Note 5.5 and details of exit packages in note 5.4. Furtherdetails of executive and non executive directors’ salaries and pensions can be found in the RemunerationReport in the Annual Report.The value of receivables and payables balances held with related parties as at the date of the statement offinancial position is given below:Receivables£00031 March 2013 31 March 2012Payables£000Receivables£000Payables£000Department of Health 66 - - 18Other NHS bodies 1,666 644 2,743 840Charitable funds - - - -Other bodies (including WGA) 4,456 3,285 3,201 3,5576,188 3,929 5,944 4,415Value of balances (other than salary) with boardmembers and key staff members at 31 March 2013is £nil (31 March 2012 – £nil).The value of balances (other than salary) withrelated parties in relation to the provision forimpairment of receivables as at 31 March 2013 is£9,223 (31 March 2012 – £nil). In addition, thevalue of balances (other than salary) with relatedparties in relation to the writing off of receivablesduring 2012/13 is £nil (2011/12 – £nil).The Department of Health is the Trust’s parent bodyand is regarded as a related party. During the year,the Trust has had a significant number of materialtransactions with the Department, and with otherentities for which the Department is regardedas the parent Department. These entities arelisted below:• Yorkshire and the Humber Strategic HealthAuthority• Sheffield Primary Care Trust (NHSSheffield)• Barnsley Primary Care Trust• Derbyshire County Primary Care Trust• Rotherham Primary Care Trust• Derbyshire Healthcare NHS Foundation Trust• Nottinghamshire Healthcare NHS Trust• Rotherham Doncaster and South Humber NHSFoundation Trust• Sheffield Children’s Hospital NHS FoundationTrust• Sheffield Teaching Hospitals NHS FoundationTrust• Leeds Partnership NHS FT• NHS Litigation Authority• NHS Business Services AuthorityIn addition, the Trust has had a number of materialtransactions with other Government departmentsand other central and local government bodies.Most of these transactions have been with HMRevenue and Customs, the NHS Pension Scheme aswell as with Sheffield City Council in respect of jointenterprises and the South Yorkshire Pension Scheme.26. South Yorkshire pensions fund –Retirement benefit obligationsThe total defined benefit pension loss for 2012/13 inrespect of the local government scheme administeredby South Yorkshire Pensions Authority was £420,000(the year ended 31 March 2012 a loss of £369,000).A pension deficit of £3,867,000 is included in thestatement of financial position as at 31 March 2013(31 March 2012 – £2,714,000 deficit).The terms of the current partnership agreementwith Sheffield City Council provide that any longterm pension liability arising from the scheme willbe funded by the Council, with the exception ofany pension changes which relate to an increasein salary in excess of any local government gradingagreements. The impact on the current and prior yearstatement of consolidated income andtaxpayers equity relating to the application of IAS19 – ‘Employee Benefits’ within the accounts of theTrust is negated by the inclusion of a correspondingnon-current receivable with the Council. As at31 March 2013, the deficit on the scheme was£3,867,000 (31 March 2012 – £2,714,000 deficit),the majority of which is offset by a non-currentreceivable of £3,402,960 (31 March 2012 –£2,388,000).Estimation of the net liability to pay pensionsdepends on a number of complex judgements. A firmof consulting actuaries is engaged by South YorkshirePensions Authority to provide expert advice aboutthe assumptions made, such as mortality rates andexpected returns on pension fund assets.With effect from 2011, the UK Governmentannounced that pension increases or revaluationsfor public sector schemes should be based on theConsumer Prices Index (“CPI”) measure of priceinflation, rather than the Retail Prices Index (“RPI”)measure of price inflation.The main actuarial assumptions used at the date ofthe statement of financial position in measuring thepresent value of defined benefit scheme liabilities are:31 March2013%31 March2012%Rate of inflation 2.4 2.5Rate of increase in salaries 4.15 4.25Rate of increase in pensions and deferred pensions 2.4 2.5Discount rate 4.2 4.9Expected rate of return on assets 0.5 - 7.0 0.5 - 7.0The current life expectancies at age 65 underlying the accrued liabilities for the scheme are:31 March2013Years31 March2012YearsNon retired member – Male (aged 65 in 20 years time) 23.7 22.8Non retired member – Female (aged 65 in 20 years time) 26.6 25.8Retired member – Male 21.8 21.5Retired member – Female 24.7 24.2189190

The fair value of the scheme’s assets and liabilities recognised in the balance sheet were as follows:Movements in the fair value of the scheme’s assets were:Schemeassets%31 March2013£000Schemeassets%31 March2012£000Equities 61.4 8,405 62.3 7,547Government Bonds 11.1 1,520 17.0 2,059Other bonds 10.2 1,396 7.7 933Property 9.3 1,273 9.9 1,199Cash/liquidity/other 8.0 1,096 3.1 376Total fair value of assets 100.0 13,690 100.0 12,114Present value of defined benefit obligation (17,557) (14,828)Net retirement benefit deficit (3,867) (2,714)2012/2013£0002011/2012£000At 1 April (12,114) (11,332)Expected return on plan assets (675) (744)Actuarial gains/(losses) on assets – current year (1,024) 246Employer contributions (389) (385)Member contributions (126) (144)Benefits paid 638 245At 31 March (13,690) (12,114)The net pension expense recognised in operating expenses in respect of the scheme is:Movements in the present value of the defined benefit obligations are:2012/2013£0002011/2012£000At 1 April 14,828 13,243Current service cost 372 357Interest on pension liabilities 723 735Member contributions 126 144Actuarial (losses)/gains on liabilities 2,146 573Benefits paid (638) (245)Past service gain - -Curtailments - 21At 31 March 17,557 14,828Year ended31 March 2013£000Year ended31 March 2012£000Current service cost (372) (357)Past service costs - -Pension expense gain/(charge) to operating surplus (372) (357)Expected return on plan assets 675 744Interest on pension liabilities (723) (735)Effect of curtailments - (21)Pension expense credited (48) (12)Net pension gain/(charge) (420) (369)The reconciliation of the opening and closing statement of financial position is as follows:2012/2013£0002011/2012£000At 1 April (2,714) (1,911)Expenses recognised (420) (369)Actuarial losses recognised (1,122) (819)Contributions paid 389 385At 31 March (3,867) (2,714)191192

Actuarial gains and losses are recognised directly in the Income and Expenditure reserve. However themajority of the gains and losses are covered by the back to back agreement with Sheffield City Council(further information is provided at note 1.2). At 31 March 2013, a cumulative amount of £463,000, wasrecorded in the Income and Expenditure Reserve (31 March 2012 £328,000).The history of the scheme for the current and prior year is:Year ended31 March 2013£000Year ended31 March 2012£000Present value of defined benefit obligation 17,557 14,828Fair value of scheme assets (13,690) (12,114)Net retirement obligation 3,867 2,714Experience gains on scheme liabilities for 2012/13 are £nil (the year ended 31 March 2012 – £nil) andexperience gains on scheme assets are £1,699 (year ended 31 March 2012 – £498).SECTION 16.0Glossary193194

16.0 GlossaryAnnual AccountsDocuments prepared by the Trust to show itsfinancial position.Accounts Payable (Creditor)A supplier who has delivered goods or services inthe accounting period and has invoiced the Trust,but has not yet been paid.Accounts Receivable (Debtor)An organisation which has received a service fromthe Trust in the accounting period and has beeninvoiced by the Trust, but has not yet paid.Annual Governance StatementA statement about the controls the FT has in placeto manage risk.AssetSomething which is owned by the Trust. Forexample, a building or a piece of equipment, somecash or an amount of money owed to the Trust.BudgetRepresents the amount of money available fora service in a period of time and is compared toactual spend for the same period.Capital ExpenditureMoney spent on buildings and valuable pieces ofequipment such as major computer purchases.Cash Equivalent Transfer Value (Pensions)This is the total value of the pension schemebenefits accrued (i.e. saved up) which are thecontributions paid by a member of staff and theTrust over the period of employment. These fundsare invested and valued at a point in time by anactuary. The cash equivalent transfer value is theamount which would be transferred, if a staffmember moved to work for a different organisation.Current AssetsThese are assets, which are normally used ordisposed of within the financial year.Current LiabilitiesRepresents monies owed by the Trust that are dueto be paid in less than one year.Deferred IncomeFunding received from another organisation inadvance of when we will spend it.DepreciationAn accounting charge which represents the use,or wearing out, of an asset. The cost of an assetis spread over its useful life.Donated Asset ReserveThis represents the value of property, plant andequipment which has been, either donated to theTrust, or purchased from donated funds.EBITDAEarnings Before Interest, Tax Depreciation andAmortisation – this is a key indicator of financialperformance and profitability and indicates theability to pay the dividends due to the Governmentin respect of the 3.5% return on assets the Trust isexpected to achieve. The EBITDA is used to calculatesome of Monitor’s risk ratings.Going concernThe accounts are prepared on a going concern basiswhich means that the Trust expects to continue tooperate for at least the next 12 months.IFRS (International Financial Reporting Standards)The professional standards Trusts must use fromApril 2009 when preparing the annual accounts.ImpairmentA decrease in the value of an asset.Income and Expenditure ReserveThis is an accumulation of transfers to / from theRevaluation Reserve as well as the cumulative surplusesand deficits reported by the Trust, including amountsbrought forward from when it was an NHS Trust.Intangible assetAn asset which is without substance, for example,computer software.InventoriesStocks such as clinical supplies.LiabilitySomething which the Trust owes, for example, a billwhich has not been paid.MEA (Modern Equivalent Asset)MonitorMonitor was established in January 2004 toauthorise and regulate NHS Foundation Trusts.Net Book ValueThe net book value is the lower of the cost to thebusiness to replace a fixed asset or the recoverableamount if the asset was sold (net of expenses).Non-current assets held for saleBuildings that are no longer used by the Trust anddeclared surplus by the Board, which are availablefor sale.Non-current asset or liabilityAn asset or liability which the Trust expects to holdfor longer than one year.Non-Executive DirectorThese are members of the Trust’s Board of Directors,however they do not have any involvement in theday-to-day management of the Trust. Their role isto provide the Board with independent challengeand scrutiny.Payment by ResultsA national tariff of fixed prices that reflect nationalaverage prices for hospital procedures. Already inuse in acute trusts and currently being developedfor mental health and learning disabilities services.Provisions for Liabilities and ChargesThese are amounts set aside for potential paymentsto third parties, which are uncertain in amount ortiming, for example, claims arising from litigation.Public Dividend CapitalThis is a type of public sector equity finance basedon the excess of assets over liabilities at the timeof the establishment of the predecessor NHS Trust.It is similar to a company’s share capital.Public Dividend Capital PayableThis is an amount paid to the Government forfunds made available to the Trust.Prudential Borrowing LimitAn NHS Foundation Trust is required to complyand remain within a prudential borrowing limit.This means that the total of borrowings by an NHSFoundation Trust from all sources must be containedwithin the borrowing limit set for it by Monitor inthe Terms of Authorisation.Reference CostThe costs of the Trust’s services are produced forthe Department of Health for comparison withother similar trusts.Revaluation ReserveThis represents the increase or decrease in thevalue of property, plant and equipment over itshistoric cost.Service Line ReportingA system which identifies income and expenditureand then produces gross profit across defined‘business units’, with the aim of improving qualityand productivity.Statement of Cash FlowsShows the cash Flows in and out of the Trust duringthe period.Statement of Changes in Taxpayers’ EquityThis statement shows the changes in reserves andpublic dividend capital during the period.Statement of Comprehensive IncomeThis statement was previously called ‘Incomeand Expenditure Account’. It summarises theexpenditure on pay and non-pay running costs lessincome received, which results in a surplus or deficit.Statement of Financial PositionA year-end statement which provides a snapshotof the Trust’s financial position at a point in time.The top half shows the Trust’s total net assets(assets minus liabilities). The bottom half showsthe Taxpayers Equity or investment in the Trust.UK GAAP(Generally Accepted Accounting Practice)This was the standard basis of accounting in theUK before the international financial reportingstandards were adopted.This is an instant build approach, using alternativesite valuation in some circumstances.195196

17.0 ContactsSheffield Health and Social CareNHS Foundation Trust HeadquartersHeadquartersFulwood HouseOld Fulwood RoadSheffieldS10 3THTel: 0114 271 6310 (24 hour switch board)www.shsc.nhs.ukHuman ResourcesIf you are interested in a career with SheffieldHealth and Social Care NHS Foundation Trust,visit the Trust’s website (www.shsc.nhs.uk) andclick on the ‘Working for the Trust’ tab.CommunicationsIf you have a media enquiry, require furtherinformation about our Trust or would like torequest copies of this report please contact theCommunications Manager.Email: communications.shsc@shsc.nhs.ukTel: 0114 2263302MembershipIf you want to become a member of the Trustor want to find out more about the services itprovides, please contact the MembershipManager on 0114 271 8825.Contacting members of the Councilof GovernorsSECTION 17.0The Governors can be contacted byemailing governors@shsc.nhs.uk orby phoning 0114 2718825.Contacts197198