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Annual Report 2013-14

Welcome

Wirral Community NHS Trust has a duty to produce detailed annual reports for the whole organisation providing information about our progress and performance over the last financial year.


You can access the report in this section of the website, alternatively you can download a PDF version of the full document and accounts.


A summary annual report is also available.


The report will be formally presented at our Annual General Meeting (AGM) on the 11 September 2014.


Welcome to our Annual Report and Accounts 2013/14. We have achieved a great deal over the last 12 months and after three years of operation have established ourselves as a strong and credible community NHS trust in Wirral and to the communities we serve.

Our vision continues to underpin all our work and is now refreshed to reflect our ambitions to provide excellent community care where there is the opportunity to do so. So too are our values, which have evolved through engagement with staff and highlight the position of the patient at the heart of everything we do.


We have delivered against our objectives and worked hard to both meet and exceed the standards and expectations of our patients, our commissioners and our partners. Quality is top of our agenda, and this report alongside our Quality Account for 2013/14, provide the evidence of actions and achievements in providing high quality community health services that are safe, effective, caring, responsive and well led.


Our Foundation Trust journey moves forward and we remain in a strong position in terms of our board and quality assurance arrangements and will continue to apply the rigour we have in place in readiness for the next stages of the assessment process when announced.


We are delighted to have met all our Care Quality Commission(CQC) standards following a number of routine inspections of our services in a number of areas including our Community Dental Service and two of our Walk in Centres. As part of the inspection process the CQC inspectors spoke with patients and the report particularly highlighted the extremely positive patient feedback that the inspectors received.


In addition the NHS Trust Development Authority (TDA) Winter Report, which sets out how Trusts have performed between August 2013 and January 2014, recorded the Trust as one of only 14 trusts to be reported as no identifiable concerns.


Our Leadership and Patient Safety Walk Rounds have gained momentum and helped ensure frontline staff have the opportunity to engage on a frequent basis with the Trust Board and Executive Team, to discuss patient safety in clinical practice at the point of care delivery. Our patient stories have also played an increasingly pivotal role in shaping and improving service delivery.


We have performed well against our financial targets. The delivery of our cost improvement plan (CIP) has been a challenge, but right across the organisation staff have recognised the need to do things differently to meet our financial targets whilst continuing to deliver high quality care. The next financial year will see another significant challenge with further savings of over £3.3m to be realised. Plans are in place to deliver these savings.


We have worked hard to develop a clear link between what our staff do, our organisational plan and what our commissioners expect from us. We are motivated to deliver on our key strategic service developments for the next two years and believe we have laid strong foundations for lasting organisational sustainability.


Locally, we are proud to be a lead organisation in the partnership with Wirral CCG, Wirral Borough Council, Wirral University Teaching Hospital and Cheshire & Wirral Partnership in the development of a health and social care strategy called 'Vision 2018'. Collectively we recognise the need to identify ways of working together that will provide better services and outcomes for our patients, empower them to manage their health and wellbeing, reduce inefficiencies and tackle the expected financial shortfall the NHS and social care faces in Wirral.


The value of community services is becoming increasingly apparent nationally, and although progress has been made, further change is needed to realise the ambition of moving more care out of hospital and closer to people's homes.


Wirral Community NHS Trust is firmly committed to remaining at the heart of making this happen. We will continue to do this thanks to the dedication, energy and passion for quality care that our staff and volunteers deliver every day.


Best wishes

 

FrancesStreet                                        SimonGilby6

Frances Street                                                                    Simon Gilby

Chairman                                                                          Chief Executive

 


Wirral Community NHS Trust is a high performing organisation with an excellent clinical reputation providing high quality primary, community, therapy and lifestyle services to the population of Wirral and its surrounding areas. Our focus is on achieving the best outcomes for the communities we serve.


The Trust has a growing track record of innovation and flexibility, responding to our commissioners' requirements and needs of the local population. Demand for our services is strong (from both patients and commissioners) and we have plans in place to ensure the key business opportunities and risks* facing the organisation are managed. With patients at the heart of our organisation, we aim to become known for excellent care by meeting and exceeding expectations.


Our vision is clear - To be the outstanding provider of high quality, integrated care to the communities we serve.


We have the capability to deliver this vision over the next five years. Our services are delivered by dedicated and innovative health professionals and supported by equally committed staff behind the scenes who strive to continue to develop and improve our services by working with and listening to our patients, partners and commissioners.

Our values

We are committed to engagement across all levels of the organisation and we held a series of 18 'Listening Events' whose purpose was to provide our staff with the opportunity to share their ideas, thoughts and feedback on what we do, the way we do it and be part of shaping and leading the organisation.

As a result of the feedback and further staff engagement activity, we were able to refresh our values in order for them to more effectively guide how we will achieve our vision and face up to the challenges that lie ahead.

These refreshed values link to our visual identity and put an increased focus on how we all provide care to patients. They underpin what we do as a Trust and how we do it. They are supported by a list of behaviours:

  • Provide compassionate care with empathy, kindness, respect and dignity
  • Act with honesty and integrity
  • Communicate openly with patients and colleagues
  • Act with courage when things are not right
  • Build effective partnerships


Together with the values, they define how we treat each other and our patients.


*Details of risks and uncertainties are shown in the Annual Governance Statement

 


By providing community based healthcare services at home and closer to home, we give people greater personal control and choice, helping them to stay independent longer. As the importance of community healthcare grows against the backdrop of a changing NHS environment, the benefits of treating patients in their homes and in the communities where they are comfortable are evident and help us provide a more patient-focused service.

We are one of a small number of community NHS trusts in the UK without any inpatient beds. Our services are local and community-based and serve approximately 319,800 people across Wirral and our local boundaries resulting in around 1.1million patient contacts. From our community nursing, health visiting and sexual health services to our walk-in centres, Livewell programme and therapy services our priority is to care for everyone as an individual, taking a holistic approach to care and working in partnership to bring about a patient journey that is where possible, seamless.

With around 1,430* members of staff** we deliver over 40 health services from approximately 50 community locations, and provide care within a variety of settings.

We have organised our operational business around a divisional structure. A summary of our structure in 2013/14 is set out below.

DivisionsandServices 

In addition to this are our clinical support services, which include: Infection Prevention and Control, Quality and Governance and Safeguarding.


Also included are Communications and Marketing, Estates Management, Finance, Human Resources, Business Intelligence and Information Technology.


*The number of staff differs from that disclosed in the financial statements, as the NHS Manual for Accounts requires that 'the average number of employees is calculated as the whole time equivalent number of employees under contract of service in each week in the financial year, divided by the number of weeks in the financial year'. Whereas the number of staff disclosed in the annual report is based on headcount.


**Gender distribution is shown in the Directors Report.



We are the primary community health provider in Wirral and provide services across our boundaries into the wider Cheshire and the Merseyside area.


The profile of Wirral is diverse and our services aim to be as flexible as possible to ensure that they can be accessed in the right way, in the right place and at the right time.

Wirral Profile*


Part of a wider sub-region centred around Liverpool, Wirral is bordered to the south by the district of Cheshire West and Chester and is home to approximately 319,800 people, including 190,000 people of working age. The population grew by 2.4 % and by 7,500 households between 2001 and 2011.


The 2011 census reported a small, but increasing, ethnic minority population in the borough. Just over 5% (16,101) of Wirral's population classify themselves as being from a from a Black and Minority Ethnic population group


The older population in Wirral as a whole (aged 65 years and above) is expected to increase at the fastest rate (than any other age group) over the next decade. The population of over 85s is also projected to increase by a possible 29.9%.


Other Key Issues**

  • There are about 38,000 carers in Wirral representing about 12% of the population
  • Dementia is a current concern and is forecast to become a greater problem for Wirral, with an estimated 4,443 people over 65 living with dementia in 2011. This is projected to rise to almost 5,300 within the next eight years
  • Lifestyle behaviours such as smoking and obesity, contribute to health inequalities and these behaviours are all more prevalent in Wirral's most deprived areas.


*Wirral Health and Wellbeing Strategy 2013/14


**Wirral Clinical Commissioning Group Prospectus 2013/14



The business environment


The environment in which the Trust operates has seen significant change in recent years. We have seen changes to how and by whom services are commissioned, our regulators, the quality regime we operate in, as well as increasing competition in the sector. Quality of care requirements alongside financial constraints is also a significant factor.

We continue to build on already strong and productive relationships with those who commission our services; Wirral Clinical Commissioning Group (CCG), Wirral Council, Liverpool Clinical Commissioning Group, West Cheshire Commissioning Group and NHS England.

Patient expectations for the quality and accessibility of healthcare services are rising, the population we serve is changing with an increasing number of elderly patients and those with long term conditions. All while financial pressures continue to grow. There is significant pressure for service change and greater integration between health and social care.

As an aspirant Foundation Trust our quality, performance and sustainability is regulated by the Care Quality Commission and Trust Development Authority (TDA) as well as the commissioners for whom we deliver services.


In 2013/14 we received five inspections from CQC and passed all without conditions.


The NHS Trust Development Authority Winter Report, which sets out how trusts have performed between August 2013 and January 2014, recorded WCT as one of only 14 trusts to be reported as no identifiable concerns.

'Securing Sustainability – Planning Guidance for NHS Trust Boards 2014/15 – 2018/19' issued by the TDA has provided us with the opportunity this year to refresh our five year strategic objectives and two year business goals. This framework and alignment to commissioner intentions has provided us with a platform to develop a robust business plan that will enable us to continue to deliver high quality patient care within a financially sustainable organisation.

A draft of our two year plan was submitted to the TDA in March 2014 within the required timescales.

Our strategy


Our strategy is built on four strategic themes which are supported by strategic objectives or actions.


For the period 2013/14 these were:

Patient, community and commissioner

  • Improve quality outcomes and patient satisfaction
  • Increase service provision in Wirral, Merseyside and Cheshire
  • Promote integration and joint working


Clinical delivery

  • Meet commissioned contracts
  • Improve patient safety and risk management
  • Improve efficiency and effectiveness of care services


People and resources

  • Improve human resource development and engagement
  • Maintain financial stability
  • Provide value for money services


Supporting functions

  • Improve utilisation of informatics and technology
  • Ensure we are well run with high quality support services
  • Improve utilisation and efficiency of estates and facilities


As part of our business planning for 2014/15 we reviewed these themes and our business objectives to better align them with our service needs and to respond more effectively to the changing NHS environment. Our new five year strategic themes and objectives are detailed below.

Strategy


This renewed framework also includes the development of our two year goals and strategic service developments for 2014/15 and 2015/16.

Further details are given in the Our Future section.

In reviewing our performance within this report, we will use the 2013/14 strategic theme headings as these align to our stated business priorities.

 

Performance Review

 


Our services continued to deliver high quality responsive care to Wirral residents from numerous clinical sites and in many cases in the patient's own home.

We have achieved a high level of performance against the community indicators that we are measured against. These are consolidated in our overall comprehensive performance management framework which provides a consistent process to measure and monitor performance across all levels within the organisation.

In 2013/14 we had around 1.1 million patient contacts across our core service divisions.

And for a third year:

  • performed above, or within defined tolerance thresholds of 92% of our contractual targets
  • treated all patients within the 18 week target
  • delivered a range of urgent care services, such as Walk-in Centres and GP out of hours. In all cases we achieve the prevailing national indicators which are key to supporting the delivery of system wide urgent care.

We are working with the Foundation Trust Network to support the development of Community Outcome Indicators and have worked closely with our commissioners in 2013/14 to improve the salience of our key measures of service performance.

Patient Contacts


We have seen consistency in the number of patient contacts with an increase of over 30,000 within our Nursing Division.


Contacts

* In addition to community services contacts the Primary Care Division also provides Dental Services and runs two GP practices
 

Here are just a few of our highlights for 2013/14:

  • Over 315,000 Community Nursing appointments / visits
  • 244,000 patient blood samples taken by our Phlebotomy Service
  • Over 115,000 Health Visitors Healthy Child team appointments
  • Nearly 84,000 patients treated at Walk in Centres at Eastham, Wallasey and Arrowe Park
  • Over 68,500 consultations through the MSK/Community Therapy Service
  • Over 46,500 pieces of equipment delivered by our Community Equipment Service
  • 12,800 appointments and gym attendances with our Heart and Cardiac Services
  • Almost 30,000 people attended walk in and pre-booked appointments with Sexual Health Wirral


Public Health / Livewell Programme


Offering a range of free health and wellbeing activities, our public health teams had approximately 22,500 contacts working with people of all ages across the Wirral. Supporting individuals to make positive lifestyle changes through their stop smoking, weight management and healthy eating programmes.


The Awards...


We are proud of our achievements and aim to celebrate and recognise those teams and individuals who go above and beyond what is expected and are innovative in how they approach patient care.\

 

'For You Thank You' staff awards 2014 - Our second annual staff awards recognised and celebrated the excellent work of staff in all areas of the trust. This year we received over 75 nominations from a broad section of clinical and non clinical teams and the winners were selected by panels of trust staff and public members. The awards highlight the passion and commitment to patient care not just on the front line, but also from those people behind the scenes that support the work of the Trust.

National Awards


In addition, our services have received national recognition:


Nursing Times - The Continence Service were shortlisted in the Nursing Times Awards category for 'Continence Promotion and Care' for their innovative approach to working with patients who have a catheter. The new way of working that has been developed helps to ensure that Wirral residents do not have to visit hospital unless necessary and instead can receive their treatment at home or in community clinics.


Health Service Journal (HSJ) - The Speech and Language Service were Highly Commended in the 'Improved Partnerships between Health and Local Government' category of the Health Service Journal Awards for their work to improve the awareness and knowledge of language and communication development in young children and to strengthen the links between organisations.

 


Our business priorities for 2013/14 included:

  • Improve quality outcomes and patient satisfaction
  • Increase service provision in Wirral, Merseyside and Cheshire
  • Promote integration and joint working


Below are examples of some of the service developments implemented to achieve them and other highlights.

Patient satisfaction


During 2013/14 we have worked hard to better understand and learn from our patients' experience of accessing our services for the first time, and improved the way we collect and manage feedback from both patients and staff to maximise patient safety and experience.

Feedback from our patient experience questionnaires indicates that 95% of patients said that they would recommend our service to their family and friends.

Patient experience


During 2013/14 we have worked hard to better understand and learn from patients as they access our services from first impressions through to improving the way we collect and manage feedback from both patients and staff to maximise patient safety and experience. Throughout the year we have:

  • increased the amount of patient experience feedback received
  • used our patient shadow programme to identify a number of improvements to our services
  • reviewed our process for managing any complaints and concerns received by the Trust


For further details of our patient experience achievements and our other quality themes, please refer to our Quality Account 2013/14.

Telehealth systems


The Trust introduced Telehealth systems with attendees of the Cardiac Rehabilitation Service. A monitoring system for heart failure patients, Telehealth allows patients to take charge of their condition and understand their readings and allows the service to use it as an early warning system to intervene and prevent hospital admissions. It is also used when titrating medications so the service can monitor response.

Since 2012 46 patients have been recruited with ten patients currently on the system being monitored.

We have also actively supported the introduction of telehealth programmes to underpin the development of robust Integrated Care Pathways in the Integrated Care Programme.

Livewell Programme


In 2013/14 WCT redesigned its offer in Public Health and established the Livewell programme which has a focus on enhancing and developing public health and wellbeing promotion across communities. The service has now moved into flexible delivery teams which allow it to provide a more responsive service to local communities.

The Livewell teams are specialists in a range of lifestyle themes and provide support to local people, schools, organisations and workplaces. Working across Wirral we're helping people to: get more active, eat healthier, quit smoking, lose weight, relax and unwind. GPs and health professionals can now use one simple referral through a single point of access. The team then make contact with individuals within two days to make their appointment and following the assessment work with them to set and achieve their Livewell goals.

Dementia Care Screening


Over 90% of community nursing patients in the last year were successfully screened for potential signs of early dementia and referred to their GP. This early screening has helped patients get the right treatment and to find the best sources of support, as well as to make decisions about the future.

In addition, a new pain scoring chart has been introduced especially designed for patients who have been diagnosed with dementia to provide timely pain relief when required, improving quality of care.

The Trust is also working in partnership with the Achieving Quality Alliance (AQuA), which aims to improve the quality of healthcare, to spread best practice across services to improve care delivered to patients with dementia and support for their carers.

'ACCLAIM' Programme


The 'ACCLAIM' Programme has been developed by the Trust in response to the Francis Report (2013). It is a patient safety and experience programme that supports our aim to achieve high quality compassionate care. The programme uses learning from patient and staff feedback and all data captured is recorded centrally using the Trust's web based reporting system which facilitates active data comparison of complaints, concerns, compliments and incidents. This dynamic process enables areas of clinical concern to be identified promptly, ensuring appropriate response and monitoring to improve and maximise patient safety and experience.

In addition, the programme invites patients, families and carers to participate in telling their personal experience of receiving care from the Trust by recording a patient story. Stories enable people who use services to reflect and talk about how they felt about their care experience and the impact it had on decisions about their care. This process offers the opportunity to learn from the experiences of patients, families and carers, shaping services which meet the needs and preferences of the people who use them.

Equality & Diversity Strategy


The new Equality and Diversity Strategy was launched and as part of the strategy, the Trust has established a community panel with specific experience and understanding of different people's needs (including disability, race, sexual orientation, age and beliefs). The panel provides expert insight into barriers that might prevent people from using healthcare services.

Representatives from Wirral's Mencap, LGBT network, Healthwatch and Cultural Diversity Network all kindly contributed to the launch.

 


Our business priorities for 2013/14 included:

Clinical delivery

  • Meet commissioned contracts
  • Improve patient safety and risk management
  • Improve efficiency and effectiveness of care services


There is nothing more important to us than ensuring that our patients receive the highest standard of clinical care. In line with the national Quality, Innovation, Productivity and Prevention (QIPP) agenda, we continue to develop and implement robust plans to improve the quality of care we provide while releasing resources, where possible, that can be invested in future service improvements.

We continue to report separately on the quality of the care our patients receive through the Quality Account 2013/14.

Below are some examples of how we have delivered against this strategic theme.

Integrated care and Vision 2018

In 2013/14 the Trust became a lead partner and participator in the newly established Vision 2018 – a collaborative approach across the health and social care community leadership to deliver sustainable and effective services through transformation, led by Wirral Clinical Commissioning Group. As a lead for integration within the community, we have progressed integration developments across a number of areas including:

  • establishment of a fully integrated discharge team operating across 3 organisations, our local acute provider, our local authority and ourselves
  • establishment of a new discharge hierarchy
  • development of a shared leadership post across integrated discharge funded by all organisations
  • discharge team availability across Saturday and Sundays
  • reduction in the number of acute bed days
  • improved pathway development

Urgent Care


In 2013/14 the Trust were active members of the Urgent Care Board, actively engaging with all key stakeholder to ensure effective pathways of care provided appropriate interventions following initial assessment.


The Trust has led on a number of key initiatives:

  • Development of Integrated Care Coordination Teams to ensure patients in the community or in hospital receive the right care in the community and spend as little time in hospital as required
  • Ambulance pathfinder development meaning people with trauma injuries are transfered, when clinically appropriate, to our Minor Injuries unit and not to hospital
  • Introduction of the Community Care Plan in partnership with North West Ambulance Service (NWAS) with the aim of reducing transfers to hospital underpinned by better clinical information
  • Streaming patients from the A&E department to a more appropriate setting such as their own GP or one of our Walk-in centres
  • Expanded the scope of the Single Point of Access to support whole system decision making in urgent care
  • Engagement with Monitor and NHS England on the post Keogh development of the urgent care model and funding structures
  • In depth review of safe staffing levels within walk in centres
  • DVT team increasing the scope of their service to support early discharge of in-patients who need support with their coagulation requirements

GP Visiting Scheme


The GP Visiting Scheme is an initiative that has been taken on in collaboration with the Wirral Community Trust and the North West Ambulance Service. Its remit is to enhance the integrated working of these services for the benefit of our patients. The aim of the service is to ensure that the patient is seen by the most appropriate medical professional for their presenting medical complaint.

Operationally the scheme runs by following a predetermined pathway. The patient will ring 999 and the Paramedic will attend the patient's home. The Paramedic will determine, using their clinical pathways, whether the patient needs conveyance to A&E or alternatively if the patient is deemed clinically stable would the patient be safe to stay at home and be seen by a visiting GP.

The GP then contacts the Single Point of Access using one telephone number were they will speak to a Nurse Clinician. The SPA clinician will determine, depending upon the time of day, as to whether the call can be transferred to the patient's own GP or the Out of Hours Service. Once all of the details have been taken by SPA the call is transferred through the most appropriate route. The receiving GP will then determine whether the patient can be visited at home or should be admitted.

The scheme commenced on the 20th January 2014 and since its start there have been 139 referrals through SPA from Paramedics. As the weeks continue the activity is increasing and this has been recognised with an agreement by commissioners that the service should continue with a review date at the end of April 2014.

Safety & Quality


We are committed to providing the highest possible standards of clinical quality, and listening to our patients, staff and partners, and working with them to deliver services that meet the needs and expectations of the people who use them.

During 2013/14 we can point to many examples of where we are providing excellent clinical care including the achievement of our CQUIN schemes and quality objectives in areas such as Dementia Care, Long term Conditions, End of Life Care and Infection Prevention and Control.

We have further developed our patient experience model and, over the last year have expanded our programme of Safety and Patient Experience walk rounds by our leadership team. In April 2013 the Care Quality Commission again registered all services provided by Wirral Community NHS Trust without conditions.

We are determined to achieve a sustainable, financially stable and efficient organisation. Quality is the foundation of everything we do in delivering safe and effective services and we recognise that quality is both a clinical and business priority for a successful healthcare organisation.


Our business priorities for 2013/14 included:

People and resources

  • Improve human resource development and engagement
  • Maintain financial stability
  • Provide value for money services


Below are examples of some of the service developments implemented to achieve them and other highlights.

Staff Survey


The results of the national NHS staff survey for 2013 show levels of staff engagement, job satisfaction and motivation. They also reflect on working conditions, communication, training and management practice.


The results for our trust are a great reflection on what we all try hard to achieve every day – making this a good place to work and provide care. In 23 out of 28 result areas, we scored average or better in comparison to other community trusts nationally, and in 19 of these areas we score better than average.


For a second year, the overall indicator of staff engagement for the Trust is 3.75 and was above (better than) average when compared with trusts of a similar type.


The best scores for our Trust:

 

Staffsurvey


* Where a number is not a percentage, it is an aggregated score derived from several questions, expressed as a number from 1(poor) to 5 (excellent).


Following the implementation of an action from last year, the areas of most improvement were:


Staffsurveytraining


We have agreed themes to address some of the main areas of feedback from the workforce and as well as taking these forward, the HR Business Partners will look at the results within individual services, and support them to agree local actions to further improve their results.

Health and safety training


The staff survey response reflects the number of staff who has received health and safety training within a 12 month period. This result is in line with target which was set by the Trust Board as a strategic goal that 95% of staff attends health and safety training on a two year cycle. As can be seen from the results there has been an increase in the 2013/2014 figures compared to 2012/13 and we are exceeding projected targets.**

Staff sickness


Staff sickness remains one of our priorities. We have had a strategy in place to improve attendance and support staff who take leave as a result of ill health. We recognise that there is still work to do to ensure we manage all forms of absence consistently and robustly. In 2013/14 the sickness rate for the organisation was 4.7%. This was higher than we aimed for and we are putting in place incremental targets for 2014/15 and 2015 /16 to provide a realistic but stretching target.

Public and staff engagement


2013/14 has seen the development of visible Board leadership through a dedicated programme of Leadership and Patient Safety Walk Rounds, and the establishment of Listening Events.

Other areas of engagement include: further development and embedding of the staff intranet (Staff Zone), weekly all staff e-bulletins, monthly cascade team briefings, quarterly staff and member magazines and the annual staff awards. Director blogs and Staff Council meetings ensure that two way communication is maintained and improved.

In 2013/14 we have continued to provide direct health messages via a Health Matters page in the local paper and greater use of press releases, our website and social media.

We have developed our relationships with our community through the development of our volunteer and work experience programmes and the introduction of a highly successful careers event for 14-16 year olds.

7 day working


7 day working in 2013/14 has been enhanced in accordance with the urgent care agenda priorities and in support of service developments delivered with our partners. The links between community, residential and hospital services will be improved, with care delivered through integrated services 7 days a week that are joined up around the needs of patients.

This integrated care will be provided into community settings near patients' homes, to enable the right care to be provided at the right time and the right place, with patients supported to self-care as appropriate.

As such our service has additionally extended its hours in 2013/14 to include 7 day working in the following services - Community nursing, Central Call Centre, Phlebotomy services, Sexual Health services and Livewell services.

Workforce planning


This was achieved through enhancing the role of the HR Business Partner both in efficiency plan development and Divisional business planning. As a result local change programmes to deliver service priorities are fully linked to the central workforce plan, and HR Business Partners are able to prioritise their input in order to support these programmes.

Management development


We have introduced a core management programme for all our employees who have management responsibilities. This mandatory course equips all our managers and team leaders with the core skills they need to lead, manage and develop their teams effectively.

Rapid improvement events

A programme of Rapid Improvement events took place where internal facilitators worked with individual teams to make radical changes to current processes and activities within very short timescales.

Teams were encouraged to take ownership of their processes and make changes that had a positive impact and improve efficiency and effectiveness. Each solution was assessed against risks and impacts to:

  • patient safety
  • patient experience
  • and the quality of the service delivered.


So far the rapid improvement facilitators have worked with 15 teams from a range of corporate and clinical services during the period of September 2013 – February 2014. Final approval for any rapid changes proposed is provided by the Trust's Director of Quality and Nursing.

Financial performance


The Trust received a total of £69m of income for delivering Healthcare services to the public and patients of Wirral and surrounding areas in 2013/14. The majority of this was received from NHS Wirral CCG (£47.8m), however following the reforms to NHS Commissioning implemented on 1st April 2013 we also receive income from NHS England directly for Primary Care and Health Visiting services and from the Local Authority, Wirral Council for Public Health and Sexual Health services.

  • The Trust achieved the statutory duties required, by Parliament, of all NHS Trusts.


  • Whilst the 2013/14 annual accounts show an overall deficit of £8,370,000 this includes the impact of a one off impairment of our asset values of £9,293k. Our residual financial position which is used to assess our financial performance for the year is a surplus of £923,000. This is in line with our plans at the start of the year and represents a surplus of 1.3%. (See page 33 'Impairment of Trust's Estate' for further detail).


  • All of our operating surplus remains with the Trust and will be re-invested in developing services for the population of Wirral and the communities we serve.


  • The majority of Trust expenditure incurred (excluding impairments) relates to staffing costs. These represent £45.9m or 67% of total expenditure.


  • We have invested £1,059k in capital infrastructure, this includes the implementation of our new IT system for Community Nursing and the roll out of mobile working across services.


  • We performed well against the financial risk ratings applied to NHS providers by the independent regulator Monitor. The continuity of service risk rating measures the liquidity and capital service cover of NHS Foundation Trusts and in the future all providers of NHS care. Had the Trust been subject to this regime in 2013/14, we would have received an overall risk rating of 4 out of 4, the highest level of financial performance.


  • The Trust has received the transfer of PCT assets under the Transforming Community Services regime. This equated to a total of £31,540,000 of assets, however in line with best practice these assets have been revalued on receipt and have been assessed to have reduced in value by £10,811,000 leaving a total of 20,729,000.

 

**Health, Safety and Security is reported on within the Directors' Report (p.50) 

 


Our business priorities for 2013/14 included:

Supporting functions

  • Improve utilisation of informatics and technology
  • Ensure we are well run with high quality support services
  • Improve utilisation and efficiency of estates and facilities


Below are examples of some of the service developments implemented to achieve them and other highlights.


SystmOne


In February 2014 the Trust rolled out SystmOne to its community nurses, specialist nursing teams and health visitors providing staff with the ability to collect all key data around the patient and in future develop an electronic patient record.

Around 640 staff across community nursing, specialist nursing and health visiting are now using the system on a daily basis, instead of the previous paper systems. The Trust's Nursing Strategy calls for all patient records to be in a hand-held digital format so staff can access them whilst out visiting patients. This supports a truly agile workforce, freeing up staff time through more modern and efficient ways of working.

Having successfully implemented phase one, plans are in place to roll SystmOne out across all services with the aim being to become paper free by the end of the year.

Systems Improvements

The data warehouse implementation has commenced and now holds data from our two main clinical systems expanding to include data from the new community nursing system. The trust has achieved level 2 Information Governance (IG) compliance in its March 2014 submission.

In 2013/14 the Trust implemented a performance dashboard framework in support of robust performance management, and assurance.

In addition the Trust has engaged in the Workforce and Culture Domain group for the programme of integration being developed across Wirral.

Organisational development

During 2013/14 the approach to organisational development has become embedded within the annual planning cycle for the Trust. Activities which have supported this have included:

  • undertaking an organisational capacity survey with the Board and Senior Leadership team
  • developing a monthly Extended Senior Management Team meeting to underpin the development of our leaders
  • opportunity pipeline development
  • individual divisional planning events
  • improvements in procurement


Maximising our estate portfolio


Estates reviews have been undertaken during 2013/14 and identified a number of changes to our utilisation of the Trusts estate.

As a result in 2013/14 WCT has developed a comprehensive Estates Strategy which will ensure our estate is fit for purpose – from utilisation, to disposal and income maximisation.

Caring for the environment


Since the creation of Wirral Community NHS Trust in April 2011 we have implemented a bespoke sustainability approach for our organisation. We have:

  • Set up an Environmental Management System
  • Reduced our carbon emissions to 2,054 tonnes CO2 equivalent;
  • Recovered or recycled 67% of our waste – equivalent to 357 tonnes
  • Engaged with local suppliers to monitor and reduce the amount of energy used and waste produced to help meet our sustainability objectives
  • Continued to assess the viability of using renewable energy sources to generate energy at our properties and reduce carbon emissions and costs
  • Assessed our St. Catherine's redevelopment against the BREEAM standards (Building Research Establishment Environmental Assessment Methodology) and achieved an 'Excellent' rating at Post Construction assessment stage

The estate continues to perform well in terms of energy efficiency. Areas in need of further improvement have been assessed alongside the development of premises and Estates space utilisation work as part of the Estates Strategy. Further improvements in general environmental management will continue to make improvements across the Wirral Community NHS Trust estate.

The Trust is committed to conducting all aspects of its activities with due consideration to sustainability, whilst providing high quality patient care in line with the NHS Carbon Reduction Strategy and Sustainable Development Strategy for the Health and Care System. View the Sustainability Report.


The Trust has achieved a high level of performance against the indicators that we are currently measured against. There are a number of sources of performance measures that are both internally and externally imposed.

Patient, Community and Commissioners


The first of our four strategic themes focuses on Patients, the Community we serve and the needs of Commissioners. The table below illustrates the Key Performance Indicators (KPIs) identified for this theme in 2013/14. The KPIs range from national targets requiring us to see patients in our walk in centres and minor injuries units within 4 hours of arrival, through to nationally defined "never" incidents. "LNE" refers to additionally defined local "never incidents" which set even higher standards than those required nationally.

PatientCommunityandCommissioners

 

Care Delivery


The second strategic theme area focuses on delivering the care commissioners have appointed us to deliver, and as such, the second area of the Trust's Balanced Scorecard contains all the contractual indicators. These are monitored on a monthly and on a cumulative basis to ensure areas of challenging performance are highlighted to responsible managers and action plans are put in place to address any issues.

At the end of 2013/14 the Trust was monitored against 122 separate KPIs, of which the majority (89%) were rated as either "Green" or "Amber" based on thresholds set by the commissioners. Whilst performance of 89% is below the trust's ambition to have at least 90% of KPIs rated as Green or Amber, 2013/14 saw the introduction of a significant number of "Did Not Attend" (DNA) indicators for our services. This indicator monitors the % of booked appointments where patients fail to attend and do not cancel their appointment. 8 of the 13 indicators rated "Red" are the result of more than 7% of appointments lost to DNAs in individual services.

 

CareDelivery

 

Enabling Functions


The third strategic theme of the Trust's Balanced Scorecard details the enabling functions of the trust which work to assist the delivery of frontline services. The roll out of SystmOne to the trust's nursing services and health visitors in February 2014 has resulted in the trust being able to collect a community information dataset across all of its applicable services, in addition to the considerable clinical and operational advantages the new system offers the trust.

A red rating on the Corporate Induction indicator below means less than 95% of staff have attended corporate induction within 6 weeks of starting, not that they have not subsequently attended the course.

 

Enablingfunctions

 
People and Resources


The final strategic theme of the Balanced Scorecard combines both the staff dimension and the organisation's financial performance. The current workforce of our Trust consists of c. 1400 members of staff, 85% of whom are patient-facing and 90% of whom are women. The largest staff groups are nursing, physiotherapists and clinical support.

We had an annual budget of £70m with a cost improvement plan to target £3.3m of savings in 2013/14.


PeopleResources

 

Financial review

 


Wirral Community NHS Trust is pleased to say it has met all of its statutory financial duties for 2013/2014, our third successful year of operations as a standalone NHS Trust.

Our financial performance is in line with the plans approved by the Trust board in March 2013 and is evidence of the continued financial strength of the Trust as well as the effectiveness of the financial planning, monitoring, forecasting and control within the organisation. The Trust's accounts are presented in summary form at the end of this document.

The Trust performance against its statutory duties is summarised below:

 

statduty

 

Whilst the trust has recorded an technical deficit of £8,370k in its accounts for 2013/14, this includes the one off impact of an impairment of the trust's estate of £9,293k which is stripped out of the deficit for the Department of Health and Trust Development Authority to measures our financial performance. We have therefore delivered an operating surplus of £923,000 as our recorded financial performance for the year which was in line with plans and represents around 1.3% of our overall turnover.

All other financial duties have been achieved, including a significant over-achievement against the Trust's external financing limit which reflects the efficient management of cash and working capital by the Trust. As well as delivering the statutory requirements of an NHS Trust, we have also performed well against the financial risk ratings applied to NHS Foundation Trusts by the independent regulator monitor.

The new monitor risk assessment framework introduced during 2013/14 sets out a continuity of service risk rating which replaces the previous financial risk rating (FRR). The continuity of service risk rating assesses providers of NHS care against two indicators, liquidity, or how strong the organisations cashflow is, and capital servicing capacity, or how well the trust can meet its capital payment obligations. Each measure is scores out of 4 and Wirral Community NHS Trust has scored the maximum 4 in each category.


Analysis of Income


The Trust received a total of £70m income for delivering Healthcare services to commissioners and others in 2013/14. This is an increase of 5% on the total income received in 2012/13. Following the NHS commissioning reforms which came into effect on 1st April 2013, the majority of this income is now received from NHS Clinical Commissioning Groups (CCGs). However the Trust now also receives a significant level of income from other bodies including NHS England and Wirral Council. Services delivered to CCGs represented 71% of the Trust's total income at £48,972k, NHS England represented 14% with £9,457k and Local Authorities made up 11% of income at £7,658k.

The full breakdown of income for 2013/14 is shown below:

Analysis of Income Received 2013/2014

Analysisofincome

 


Analysis of Expenditure


If we strip out the one off impact of the impairment of the Trust's estate, the Trust expended 98.7% of the income it earned on pay, non-pay and other expenditure items. The majority of expenditure incurred (£45.9m) relates to staffing costs. The overall expenditure of the Trust in 2013/14, including the £9,293k impairment was £78,130k. A breakdown of expenditure is shown below.


Analysis of Expenditure 2013/2014

Analysisofexpenditure

 

Impairment of Trust's Estate


On 1st April 2013 the Trust, under the national transforming community services capital transfer process, received land, buildings and capital equipment opreviously held on the books of NHS Wirral. The value of the assets transferred was £31,540k. In line with best accounting practice the Trust undertook a comprehensive exercise to revalue the estate following this transfer. This was done to ensure the value stated in the Trust's accounts reflected an accurate and up to date value of the assets. The net impact of the revaluation was to reduce the book value of the trust's land and buildings by £10,811k. The Trust was able to offset £1,518k of this reduction in value against the revaluation reserve previously held in the PCT's accounts and transferred to the Trust, however the remaining £9,293k could not be offset and therefore appears in the Trust's accounts as an impairment and a charge to the income and expenditure account.

 

It is important to note however, that this impairment is not considered part of the analysis of the trust's financial performance for the year and does not count against the statutory duty to break even.

Capital Expenditure


The Trust spent £1,059,000 on capital items in 2013/2014. Capital expenditure is expenditure on items that cost more than £5,000 and last for more than one year. The Trust's expenditure related to planned investment in IT infrastructure and investment in medical equipment and was in line with both financial and IMT investment strategies. As an NHS Trust we also have to maintain capital expenditure within an agreed limit set by the Department of Health. This limit was set for 2013/14 at £1,059,000 so the Trust has complied with this duty.


The majority of the trust's capital expenditure was funded through internally generated resources, however we were also successful with a bid to the Department of Health's Safer Hospital, Safer Wards technology fund and received £346k of public dividend capital to fund the roll out of mobile technology across the trusts services.


Public Sector Payment Policy


The Trust is required to pay its suppliers promptly in line with the Better Payment Practice Code, aiming to pay all undisputed invoices within 30 days. The performance is shown below:

 

billspaid 

Performance was below the level expected of an NHS Trust which is 95%. Whilst the trust's overall performance has improved in 2013/14 work is still required in 2014/15 to address this underperformance.

Non-Current Assets


As noted above the Trust received a transfer of non current assets from NHS Wirral PCT of £31,493k as identified above plus a further £47k of IT assets transferred from the PCT on 1st April 2013. The trust had previously held non current assets of £945k. Following the revaluation the opening value of non-current assets held by the trust was £21,674k. This value was increased by the £1,059k of capital additions outlined above and reduced by £921k of depreciation, amortisation and disposals. This gives a closing balance of £21,812k of non current assets.

Liquidity and Working Capital Management

At 31st March 2014 the Trust held working capital balances of £1,788k. This was made up of £3,417k of cash at bank and equivalent, £6,827k of money owed to us in the form of accounts receivable and £8,726k owed to other bodies and individuals as accounts payable and £291k of stock and inventories.


The Trust is committed to managing its working capital balances in an effective and efficient manner including the maintenance of a strong liquidity position in line with Monitor's requirements. Our investment actions are in line with treasury rules and ensure that the security and safety of public funds is paramount. In 2013/2014 all our cash balances were held in government banking service accounts.

External Auditors


The Trust's External Auditors for 2013/14 are Grant Thornton. They charged the Trust a total of £52k for their work in this financial year.

Counter Fraud


The Trust is committed to the prevention, detection and remedy of any fraud committed against ourselves or our partners. We have a dedicated counter fraud service which helps develop an anti-fraud culture as well as supporting the trust's management in identifying and investigating individual incidents of fraud.

Cost Improvement Plans and Efficiencies

As with the vast majority of public sector service providers, the Trust faces significant financial challenges as part of the difficult economic circumstances. In 2013/14 our commissioners imposed a 4% efficiency requirement as part of the contract settlement for the year. This has required the Trust to deliver £3.3m of cost releasing savings. These savings targets have been delivered in full by individual services and departments.

Long Term Financial Plans


This report sets out the Community Trust's vision, values and strategic objectives for the next 5 years. In addition to this work we have developed a comprehensive financial model covering the same time period. Effective financial planning will form a key part of the Trust submission to become a Foundation Trust with the three tests for foundation trust status being that the Trust can show it is:

  • Legally constituted
  • Well governed, and
  • Financial stable.


The Trust's plans show that whilst it will remain financially stable with good levels of performance against Monitor's financial risk ratings throughout the planning period, the required level of cost improvements will remain between 4% and 5% annually, equating to the release of some 23% of total costs by 2018/2019. This will present a significant challenge and the Trust has put in place a process to support this delivery and also to ensure that whilst the Trust does all that is necessary to deliver on this financial position, quality is not impaired by the need to deliver efficiencies. To this end all savings proposals will have to be signed off by the Trusts Director of Quality and Governance following a full quality impact assessment.

Statutory Basis


The legislation under which we were established was the National Health Service Act 2006 and according to the establishment order, Wirral Community National Health Service Trust came into force on 1st April 2011.

We have since had a revised version of our Establishment Order passed by Parliament in July 2013 which is referred to in the Trust's Annual Governance Statement.

The accounts for the year ended 31 March 2014 have been prepared by Wirral Community NHS Trust under section 232 (15) of the National Health Service Act 2006 in the form which the Secretary of State has, with the approval of Treasury, directed.

Going Concern


The Trust Board has reviewed the financial performance in 2013/14 and the Trust's long term financial plans and considers the Trust meets the requirements to be considered a going concern.

 


Senior Managers' Remuneration Report

The tables shown on the following pages provide information on the remuneration and pension benefits for senior managers for the year ended 31 March 2014. These tables are subject to external audit review.


What this report covers


This report to stakeholders:

  • Sets out the Trust's remuneration policy
  • Explains the policy under which the Chairman, Executive Directors, and Non-executive Directors were remunerated for the year ended 31 March 2014
  • Sets out tables of information showing details of the salary and pension interests of all directors for the year ended 31 March 2014; and
  • Details of the pay multiples from the Trust's highest paid director to the median paid member of staff within the Trust.

Role of the Remuneration Committee


The Remuneration Committee is a committee of the Trust Board. An effective committee is key to ensuring that Executive Directors' remuneration is aligned with stakeholders' interests and that directors are motivated to enhance the performance of the Trust.


Membership of the Remuneration Committee


The members of the committee are the Chairman and all Non-Executive Directors. Committee meetings are considered to be quorate when the Chairman and two Non-Executive Directors are present.


The Chief Executive and Director of Human Resources and Corporate Affairs also attend in an advisory role but are not members of the committee and do not participate in any discussion or decision making in respect of their own remuneration or other terms of service.


Service Contracts


All Executive Directors have service contracts, which are usually awarded on a permanent basis, unless the post is for a fixed term. Directors have a three month notice period within their contracts of employment. Termination payments are made in accordance with contractual agreements.


Remuneration policy for Executive Directors


Directors' posts (with the exception of the Chief Executive and Medical Director) are currently evaluated using the national Agenda for Change Job Evaluation Framework. The Chief Executive and Medical Director posts are evaluated using the North West Strategic Health Authority Job Evaluation Panel. All executive posts are subject to approval by the Remuneration Committee. Any pay awards are agreed by the committee.


Directors participate in an annual appraisal process which identifies and agrees objectives to be met. This is supported by a personal development plan.


The Trust does not operate a performance related pay scheme.


Remuneration policy for the Chairman and Non-executive Directors


Increases in the remuneration of the Chairman and Non-executive Directors are agreed nationally by the Department of Health and implemented locally by the Trust.


Download Directors' information.

Pension Benefits


Download pension benefits information.
 

 

Cash Equivalent Transfer Values


A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member's accrued benefits and any contingent spouse's pension payable from the scheme. CETVs are calculated in accordance with the Occupational Pension Schemes (Transfer Values) Regulations 2008.


Real Increase in CETV


This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period.

Pay Multiples


Reporting bodies are required to disclose the relationship between the remuneration of the highest-paid director in their organisation and the median remuneration of the organisation's workforce.

The banded remuneration of the highest paid director in Wirral Community NHS Trust in the financial year 2013-14 was £112,500 (2012-13: £107,500). This was 5.6 times (2012-13: 5.2 times) the median remuneration of the workforce, which was £19,950 (2012-13: £20,513).

The pay multiple of the highest paid director compared to the median remuneration of the Trust as a whole has increased from 2012-13. This is due to service redesign and skill mix changes within the Trust.

In 2013-14, 1 employee received remuneration in excess of the highest-paid director (2012-13: 1). Remuneration ranged from £462 to £120,949 (2012-13: £457 to £120,000).

Total remuneration includes salary, but excludes non-consolidated performance-related pay, benefits in kind, employer pension contributions, and the cash equivalent transfer value of pensions. This is a departure from the guidance with the Department of Health Manual for Accounts; however the Trust does not consider that this has a material impact on the figures reported.



 

 

Our future

 


As the NHS continues to change, we have taken the opportunity to refresh our five year strategy objectives and ensure that they continue to be linked to our commissioners' plan based around patient needs.


Our key priorities continue to be:

  • our patients and community,
  • our services,
  • our people and
  • our sustainability

... all the things that will make us the organisation we want to be.

Each of our five year strategic objectives are aligned to organisational goals in our two year business plan. These then link through to divisional and team plans and ultimately to our staff's personal objectives. It is these links that help to ensure that we continue to deliver our vision and ensure that each member of staff can identify and value their contribution to our achievements.

Behind each of our goals are a series of measures so that we can keep track of our progress.

PatientsCommunity2

Services

 

People

 

Sustainability


Our strategic service developments 2014/15 and 2015/16


We have identified a number of key service developments that will help us to achieve our strategic objectives and goals for the next two years. They are also aligned to the priorities identifed by our commissioners and the wider healthcare economy. In addition to these service developments we will continue to build our long term organsational sustainability by developing our apporach to new business opportuniies and retaining existing services.

 

Download strategic service developments 2014/15 and 2015/16.

 


During 2013/14 the Trust has continued to work closely with colleagues from the NHS Trust Development Authority (TDA) to demonstrate its readiness to become an NHS Foundation Trust (FT).

Becoming an FT will allow the trust greater freedom and flexibility in the way we provides and invests in services. The FT model will also give staff, public and stakeholders more say in how the trust is run.

This process is on-going because recent, high-profile reports into failings at a number of NHS trusts have led sector regulators, the Care Quality Commission (CQC) and Monitor, to adapt their approaches to the authorisation of new FTs.

In 2013, it was announced that all aspirant FTs must undergo a new inspection by the CQC's Chief Inspector of Hospitals before they may be granted FT status by Monitor. Our trust anticipates an inspection in the second half of 2014.

In the meantime, we continue to focus on the provision of high quality, accessible health services to the communities we serve and actively engage with our membership community.


We aim to engage people in the life of our trust to benefit our patients and wider community. We have over 4500 public members and regularly involve them in events and surveys. We also benefit from having many volunteers who enhance patient care and we are investing in the future by providing work placements for young people in Wirral.

We want membership to be useful, interesting and personal. Members can specify how they want to be involved with our trust when they join.

Through online surveys we gain member feedback on a range of topics. Members also took part in the judging panels for our staff awards.

We held regular member events and in 2014/15 we will be focusing on providing opportunities for members help us improve the quality of our services. This will involve:

  • holding four member events that include an interactive session to discuss improving some aspect of trust services
  • inviting members to participate in 6 online surveys
  • giving members the opportunity to take part in 'Welcome Visits' to assess the quality of our care settings

 

 

Governance

 


Sustainable Development Management Plan


Since the creation of the Trust in April 2011 we have been realigned and recalculated our activity to the new organisational structure and are in the process of updating our Sustainable Development Management Plan. The NHS Wirral Carbon Reduction Strategy (effectively the SDMP) was published in 2009, and reviewed by the Community Trust in 2013 with a planned publication in 2014.

In 2013/14 the Trust has continued with the implementation of an Environmental Management System, enabling us to monitor the Trust's sustainability performance against key performance indicators such as carbon emissions, utility consumption and waste.

The plan has Board level accountability through the Director of Operations & Performance and ensures that sustainability issues have visibility and ownership at the highest level of the organisation.

Adaptation to climate change will pose a challenge to both service delivery and infrastructure in the future. It is therefore appropriate that we consider it when planning how we will best serve patients in the future. As such sustainability issues form an integral part of our Estates Strategy and our approach to managing risk.

In addition to our focus on carbon, we are also committed to reducing the wider environmental and social impacts associated with the procurement of goods and services. This is set out within our policies on sustainable procurement.

The NHS places a burden on the transport infrastructure, whether through patient, clinical or other business activity. This generates an impact on air quality and greenhouse gas emissions. It is therefore important that we consider what steps are appropriate to reduce or change travel patterns and are included in our Sustainable Transport Plan. The STP produced for NHS Wirral was adopted by WCT.

Carbon Emissions


The NHS aims to reduce its carbon footprint by 10% between 2009 and 2015. In 2013/14 The Trust's measured Greenhouse Gas emissions from energy use were 2,054 tCO2e (tonnes of CO2 equivalent); a reduction of 561 tCO2e on the previous year. This shows a gradual reduction in carbon emissions associated with gas and electricity consumption.

 

Energyuse

 

As an organisation our main impact areas are associated with our premises (gas and electricity) and business travel as a result of the community based nature of our services.

Carbon emissions have reduced overall over the last three years as a result of the implementation of the NHS Wirral Carbon Reduction Strategy (produced in 2009) and an investment in energy efficiency of the Community Trust Estate properties (e.g. replacement of old building stock, improved thermal insulation in existing properties, building controls and installation of Solar PV). A 4kWhp Solar PV system was installed at Fender Way Health Centre in January 2011 that continues to generate renewable energy and reduce carbon emissions associated with our premises.


energyconsumption 

A reduction in energy consumption, in addition to a partnership with a specialist energy procurement partner (Government Procurement Service), have resulted in an overall reduction in energy costs of 10.1% over the last 12 months.

 

We do not currently purchase renewable energy for energy use but the Trust generates 0.046% of our energy on site from the 4kWhp Solar PV system installed at Fender Way Health Centre in January 2011.

Waste


Waste recycling initiatives have been implemented across the estate, with all locations encouraged to recycle paper, cardboard, bottles, cans and mixed recyclable waste.

We recover or recycle 357.1 tonnes of waste, which is approximately 67% of the total waste we produce.


wastebreakdown

 

 

The Board of Directors


The Board of Directors has overall responsibility for ensuring that we are delivering high quality services that are efficient and effective. They oversee the running of the Trust, make the decisions that shape future direction, monitor performance, ensure accountability and look for opportunities to improve.


The Board is made up of the Chairman, Non-executive Directors, Chief Executive and other Executive Directors. The Chief Executive and Executive Directors are full time members of staff who bring skills and expertise from their positions in key areas of the Trust. The Chairman and Non-executive Directors work part-time. They each bring insight and experience from a range of professional backgrounds. They are not involved in the day-to-day running of the organisation but offer an independent view which both constructively challenges and contributes to the performance and management of the Trust.


Non-executive Directors


Frances Street, Chairman - Frances was appointed Chairman of Wirral Community NHS Trust by the NHS Appointments Commission in January 2011. She has extensive experience in NHS leadership, having served as Chairman of NHS Wirral, Birkenhead and Wallasey Primary Care Trust (PCT), and a Non-executive Director of Wirral Hospital Trust and Wirral Health Authority. Frances is also a Governor of Birkenhead Sixth Form College.

Brian Simmons, Chair of Audit Committee - Brian was formerly the Assistant Chief Officer and Finance Director for the Cheshire Constabulary. Brian joined the Civil Service in 1972 working in accounts and audit for the Property Service Agency. He has also worked as Business Services Director for a Ministry of Agriculture Science Laboratory. Brian is a fellow of the Chartered Institute of Management Accountants.

Alan Wilson - has extensive banking, business advisory and business development experience from a career working in the banking industry and subsequent work with corporate finance and accountancy practices. He currently assists a Wirral based leasing company as well as running his own consultancy business. Alan has worked previously in the public sector in a Non-Executive capacity at Wirral University Teaching Hospital NHS Foundation Trust (WUTH) where he was chair of the Audit Committee.

Chris Allen - Chris is currently Chief Executive of Forum Housing Association. She was Vice Chair of Wirral Community Health Council (WCHC) when it was in existence representing the Voluntary, Community and Faith sector. This included working in partnership with health professionals during the early transitions between Primary Care Groups (PCG) and PCTs. Chris holds a number of other public roles in education and criminal justice. Chris was awarded the British Empire Medal in January 2013 for services to the community across Merseyside.

Murray Freeman - Murray has been a GP in Rock Ferry for nearly 30 years and has a particular interest in palliative care and end of life care. Over the years he has held a number of additional posts including GP Trainer, Cancer Lead for NHS Wirral, Chairman of Wirral Local Medical Committee, Medical Director of Wirral Community Healthcare NHS Trust and most recently GP Executive Member of Wirral Health Commissioning Consortium.

Executive Directors

Simon Gilby, Chief Executive - Simon joined the Trust in April 2012 and has a wealth of experience in the NHS at local, regional and national levels. Immediately prior to joining, he spent a short period with NHS South Yorkshire supporting the implementation of national policy. For the five years before that he was the Managing Director of Sheffield Primary Care Trust Community Services. Previous roles include Chief Executive of Sheffield West Primary Care Trust and Chief Executive of Southern Derbyshire Health Authority.

Steve Wilson, Director of Finance and Development - Steve joined the Trust in May 2011 and has worked in NHS finance for over 16 years. Following graduation from the University of Leeds he entered the National Financial Management Training Scheme in 1996. Based in the North West his first role on the training scheme was at Salford Community NHS Trust and he has since had a varied career across a range of NHS organisations including community, acute and specialist providers. He has also gained significant experience in commissioning through roles at Sefton Primary Care Trust and most recently as Deputy Director of Finance and latterly Acting Director of Finance at NHS Manchester.

John Lancaster, Director of Operations* - John has worked for the NHS for over 30 years and in Wirral since 2007. After several years working as a clinician in Orthopaedics and Trauma services, John's management career has been diverse and has included IT Project Management and senior management roles in both Acute Trusts and Primary Care organisations. More recently John was Programme Manager in the Emergency Services Action Team, which led Urgent Care redesign across Cheshire and Merseyside. Prior to obtaining his current post he has held the roles of Head of Unplanned Care and Head of Provider Services in NHS Wirral. John is a registered Nurse and has an MBA.

Dr Ewen Sim, Medical Director - Since leaving Edinburgh Medical School in 1990, Ewen has had a varied career in healthcare holding a range of Junior Doctor posts including Histopathology and A&E. He has also worked at the North West Deanery and at the Department of Health regulating working conditions of doctors in training. He came to Wirral in 2001 to train as a GP and is now a GP partner in Fender Way Health Centre. Prior to joining Wirral Community NHS Trust in June 2011 as a Medical Director he was a Clinical Director in Liverpool. Ewen was a union leader for doctors in the British Medical Association in charge of education and training, working with the General Medical Council, the British National Formulary and the Royal College of General Practitioners. He is also a founder member of the Postgraduate Medical and Education Training Board (now part of the GMC).

Sandra Christie - Director of Quality and Nursing - Sandra is a nurse and health visitor by background and has had a varied career in the NHS covering operational and strategic management, service improvement and quality development. Sandra has worked for the NHS for over 30 years and joined the board in 2013. Prior to this post Sandra was the Head of Quality and Governance in the Trust. Sandra is passionate about quality and improving care for patients and is a Florence Nightingale Leadership scholar.

Jo Harvey, Director of Human Resources and Organisational Development*- Jo has over 15 years' experience as a Human Resources professional and has worked in the NHS since 2002. Prior to the role of Director of Human Resources at Wirral Community NHS Trust, Jo was Human Resources Director for NHS Wirral and before that the Assistant Director of Human Resources at United Lincolnshire Hospitals NHS Trust. Previously Jo worked for ten years in both managerial and HR roles in the Civil Service, at the Lord Chancellor's Department and OFSTED. She is a member of the Chartered Institute of Personnel and Development.

* Non-voting members of the Board


Board Committees


The Board is supported by the following committees:

  • Audit Committee
  • Remuneration Committee
  • Quality & Governance Committee
  • Finance & Performance Committee
  • Education & Workforce Committee

Audit Committee


The Audit Committee has a key role to play in the production of the Trust's annual report and annual accounts. The Audit Committee is chaired by one of the Non-Executive Directors, Brian Simmons, and comprises of two other Non-Executive Directors (Alan Wilson and Dr Murray Freeman).

The Audit Committee works closely with both internal and external auditors and supports the Trust Board in ensuring that effective controls are in place to deliver value for money, transparency and probity in financial matters. The committee has delegated authority to approve the Trust's annual financial statements and advises the Board on the adequacy and effectiveness of internal controls, as well as the arrangements for managing risk and wider control and governance processes.

So far as the chair and directors of the committee are aware, there is no relevant audit information of which the Trust's auditor is unaware, and they have taken all the steps that ought to have taken in order to make themselves aware of any relevant audit information and to establish that the Trust's auditor is aware of that information.

External Auditors

The Trust's External Auditors for 2013/14 are Grant Thornton. They charged the Trust a total of £52 for their work in this financial year.

Counter Fraud


The Trust is committed to the prevention, detection and remedy of any fraud committed against ourselves or our partners. We have a dedicated counter fraud service which helps develop an anti-fraud culture as well as supporting the trust's management in identifying and investigating individual incidents of fraud.

Employee consultation


We have a strong partnership agreement with our trades' union representatives, and information is provided on the progress and performance of the Trust at regular bi-monthly Joint Forum meetings. There is an established Organisational Change Policy which ensures that information regarding the development of services is shared with affected staff and their representatives at the earliest opportunity.

Staff Council has met on a monthly basis since its launch in 2011 and has been able to raise issues directly to directors resulting in a number of actions including; set up of an IT user group, staff retirements letter of appreciation, salary sacrifice car scheme and the annual staff awards.

The Trust has a briefing process cascaded through Heads of Service and Divisional Managers which delivers key information from the Board to all employees. We also have a staff bulletin, produced weekly, to provide access to a range of information to staff.

The policy in relation to disabled employees

The Trust is a 'Positive about Disabled People' employer and is therefore entitled to display the Jobcentre Plus 'Two Ticks' symbol for advertising , corporate material and publications. The Trust has a set of equality objectives which include equal opportunities training for all staff to eliminate discrimination against disabled employees.

All relevant policies are assessed for their impact on disabled staff, and adjustments are made to support disabled employees to gain and continue employment with the Trust. The Trust has recently revised its Equality and Diversity Strategy which includes a revised Equality Analysis process and the introduction of a Disabled Staff Network to support staff to share concerns and issues with the Trust to improve their working lives.

The policy on equal opportunities


Wirral Community NHS Trust aims to be a leading organisation for promoting Equality and Diversity in Wirral. We believe that any modern organisation has to reflect all the communities and people it serves, in both service delivery and employment, and tackle all forms of discrimination. We need to remove inequality and ensure there are no barriers to health and wellbeing.

We aim to implement this by:

  • becoming a leading organisation for the promotion of Human Rights Equality and Diversity, for challenging discrimination, and for promoting equalities in service delivery and employment;
  • creating an organisation which recognises the contribution of all staff, and which is supportive, fair and free from discrimination; and
  • ensuring that Wirral Community NHS Trust is regarded as an exemplary employer.

The Trust has made a commitment to valuing diversity and achieving equality; the Trust's vision is that NHS care in Wirral will have a culture of fairness, equality, and respect for diversity that is evident to everyone.

The following principles underpin our work:

  • support and respect for everyone's Human Rights as a fundamental basis for our work with people;
  • identifying and removing barriers that prevent people we serve from being treated equally;
  • treating all people as individuals respecting and valuing with their own experiences and needs;
  • finding creative, sustainable ways of supporting Human Rights, improving equality and increasing diversity;
  • working with the people who use our services and staff towards achieving equality;
  • learning from what we do – both from what we do well and from where we can improve;
  • using everyday language in our work; and
  • working together to tackle barriers to equality across our organisation.

Employee gender distribution


The figures reflecting the breakdown of gender distribution of employees within the Trust are:

 

genderbreakdown2

 

Sickness absence data


The information for staff sickness is provided by the Department of Health for all NHS bodies. Information from the Electronic Staff Record (ESR) system shows that the annual sickness rate for the year April 2013/March 2014 was 4.7%. This figure remains above the North West average figure and the Trust's target figure of 3.4%.

The average number of days lost per employee in 2013/14 was 10.4. (2012/13 - 10.7)

Health, Safety and Security

RIDDOR Reportable Incidents

 

riddor

 

*Please note there was a change in the criteria for RIDDOR


During 2012/13 there was a reduction in the number of RIDDOR reportable incidents. Due to the change in RIDDOR reporting requirements it is difficult to make a direct comparison with the previous years data. However implementation of the community homeworker risk assessment process which highlights the hazards to domiciliary workers and a significant focus on slip, trip and fall prevention (STF) and manual handling within mandatory training is believed to have contributed to the reduction.

Security


There have been two incidents of physical abuse towards staff during the past year in both cases the incidents were attributable to the medical condition of the patients. A new programme of conflict resolution has been implemented across the trust to ensure staff have the necessary skills to prevent and manage conflict.

Emergency preparedness


Wirral Community NHS Trust contingency arrangements are concerned with the Trust's ability to continue to operate its business processes to deliver its services and to mitigate the effects of disruption, whatever the cause.

Under the Civil Contingencies Act 2004 the Trust as a Category 1 responder must work with other responders to assess risks, develop and maintain plans, share information and co-operate on civil contingency response, and can manage incidents events while maintaining services to patients.

The Major Incident Plan outlines how as a Trust we will plan for, respond to and recover in the event of an emergency, meet our responsibilities as an operational responder and comply with relevant guidance and legislation.

The major incident plan is built on the principles of risk assessment, cooperation with other partners, emergency planning, communication and information sharing. To assist in a response to a major incident the Trust has access to a fully resourced major incident room including satellite phone, laptops, internet access etc at its headquarters and a backup room at an alternative location.

The Trust operates a well tried and tested 'on call' senior management rota to manage and support business continuity. The on call duty manager also provides advice in relation to out of hours incidents/medical emergencies. The rota is updated regularly and supported by an on call duty manager's Standard Operating Procedure which provides details of the specific incident pathways to follow.

The Trust has business continuity plans in place at a divisional and service level which are aligned to national plans and reviewed annually. These plans support coordinated and clinically safe responses to unplanned/unprecedented increases in demand. The Trust ensures that the plans reflect the requirements of the EPRR ( Emergency Planning Resilience and Response) agenda through membership of the Cheshire Local Health Resilience Forum and the Merseyside Local Health Resilience Forum.

Over the last 12 months, The Trust has sought to develop further its Emergency Preparedness arrangements including the following developments exercises and training:

  • Exercise Echo – a joint live exercise with Wirral University Teaching Hospital
  • A Cheshire and Merseyside Multi Agency Outbreak of Infectious Diseases Plan Exercise
  • Exercise High Tide
  • Board development on EPRR – NHS England Structures
  • Emergency Preparedness Awareness Session for Divisional Managers and Service leads.

Principles of Remedy


The Trust follows the six principles set down by the Parliamentary and Health Service Ombudsman in 'Principles for Remedy' (revised February 2009). The aim is to provide redress for any instances of injustice or hardship as a result of maladministration or poor service.

The principles involve:

  • Getting it right
  • Being customer focused
  • Being open and accountable
  • Acting fairly and proportionately
  • Putting things right
  • Seeking continuous improvement.

The Trust has met these principles by:

  • incorporating the NHS complaints procedures into our own policy;
  • the Chief Executive takes a personal interest in all complaints and the quality of investigation and response;
  • having a Patient Experience Service which aims to resolve many problems or concerns without the need for a formal complaint;
  • having in place a 'losses and compensations' procedure; and
  • regular reporting to the Quality and Governance Committee of complaints received as part of the Trust's performance monitoring.

Cost allocation and charges for information

The Trust will generally not charge for information that it has chosen to publish in its Publication Scheme. Charges may be levied for hard copies, multiple copies or copying onto media such as a CD-ROM. Information that is available from the Trust's website will be free of charge, although any charges for internet service provider and personal printing costs would have to be met by the individual. For those without internet access, a single print out of the information available on the website will be available by post or personal application. The Trust will not provide print outs of other organisation's websites.

The duty to comply with a request for information does not arise if the Trust judges that the cost of compliance with the request would exceed the appropriate limit that will be established in national Fees Regulations. The Trust will provide advice and assistance to applicants to investigate ways of bringing costs within appropriate limits.

If the Trust estimates that the cost of compliance with the request for information exceeds the appropriate limit set by the Fees Regulations the applicant will be notified in writing of the estimated cost. The Trust will follow the national Fees Regulations for general rights of access under the FOI Act.

Better payments practice code

The Better Payment Practice Code requires the Trust to pay its suppliers within 30 days of receipt of goods or a valid invoice whichever is later. In 2013-14 the Trust paid 92.1% (2012-13: 87.7%) of invoices within 30 days.

Prompt payment code


The Trust is a signatory to the Prompt Payment Code.

Exit packages and severance payments

In 2013-14 the Trust had one (2012-13: nil) compulsory redundancy costing £14k. There were no other exit packages agreed or paid.

Off payroll engagements


There were no off payroll engagements in 2013-14.


Responsibility for preparing the Accounts


The Chief Executive is our designated Accounting Officer with the duty to prepare the accounts in accordance with statutory requirements.



Name of Organisation: Wirral Community NHS Trust

Organisation Code: RY7

Scope of Responsibility


As the Accountable Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the trust's policies, aims and objectives, whilst safeguarding the public funds and departmental assets for which I am personally responsible, in accordance with the responsibilities assigned to me. I am also responsible for ensuring that the trust is administered prudently and economically and that resources are applied efficiently and effectively.

I acknowledge my responsibilities as set out in the Accountable Officer Memorandum.

The Governance Framework


The trust board functions as a corporate decision-making body considering the key strategic issues facing the trust in carrying out its statutory and other functions.

During 2013-14 the board met in public on 8 occasions. Before each of the public meetings of the board members convene in a private session to specifically focus on any matters considered commercial in confidence. The annual schedule of board business allows for 4 additional private only board meetings.

The board comprises Non-Executive and Executive Directors who share equal responsibility for the board's decisions and for the direction and control of the organisation.

The Trust's Establishment Order was updated and passed by Parliament in July 2013 to reflect its current composition:

  • Non-Executive Chairman
  • 4 Non-Executive Directors (including one Associate Non-Executive Director)
  • 4 Executive Directors
  • Chief Executive
  • Director of Finance & Development
  • Medical Director
  • Director of Quality & Nursing

The Director of Operations and the Director of Human Resources and Organisational Development, attend trust board meetings as non-voting members.

Representatives from stakeholder groups are also invited to attend public board meetings in a
non-voting capacity.

One of the Non-Executive Directors acts as the SID for the trust following approval in 2012.

The roles and responsibilities across the executive team were reviewed during 2013-14 resulting in a revised executive management structure. The key changes were to;

  • Establish the Director of Quality & Nursing post, which also discharges the Executive Nurse role
  • Extend the current role of the Director of Finance to encompass responsibility for development and business planning
  • Refocus the role of the Director of Human Resources to formally include Organisational Development
  • Remove the Director of Quality & Governance post as responsibilities were re-aligned to other roles

Additional governance roles are also undertaken by members of the executive team including Director of Infection Prevention and Control (DIPC), Caldicott Guardian, Senior Information Risk Owner (SIRO) and Responsible Officer (RO).

The names of board members, who served during the year, and their biographical details, are included in the directors report.

There were 8 public board meetings held during 2013/14 and 4 meetings held in private session. Before each of the public meetings of the board, members convene in a private session to specifically focus on any matters considered commercial in confidence. According to the standing orders of the trust, the chairman may call a meeting of the board at any time and one-third or more members of the board may request a meeting in writing to the chairman. These provisions have not been enacted during 2013-14

The table below shows the attendance record for each Board member compared to the maximum number of meetings they could have attended in 2013-14. It also reflects that members of the non-executive and executive team, who are not formal members of committees, will on occasion attend to contribute to discussions on specific topics. The table on the next page provides detail on committee chairmanship and membership.

 

boardmeetings

 

*11 meetings of the Education & Workforce committee were held in 2013-14

**Alan Wilson, Associate Non-Executive Director from April 2013-August 2013; recruited substantively in August 2013.

***Attend by Invitation only

^ Non-voting board members

 

The board committee structures reporting through to board have been clearly defined following a comprehensive review of terms of reference and reporting arrangements, led by the committees. The board has formally delegated specific responsibilities to the committees listed below, full minutes of which are reported to board.

  • Quality & Governance Committee (Monthly)
  • Finance & Performance Committee (Monthly)
  • Education & Workforce Committee (Monthly)
  • Remuneration & Terms of Service Committee (at least once per annum)
  • Audit Committee (up to 5 meetings per annum)

 

Sub-Committees of the Board - Chairmanship and Membership

 

Committeedirectors  

 

As part of the trust's governance arrangements, the chair of each committee presents a report on the matters considered and any decisions taken at its meetings at the next meeting of the trust board, with full minutes also provided to the trust board, once approved.

The table below provides an overview of the duties of each committee of the board. The primary role of each is to provide assurance to the board on the areas of responsibility.

 

Committeefunctions

 

It can be confirmed that the Board has received assurance from the Quality and Governance Committee that the arrangements for the discharge of its statutory functions have been checked for irregularities and are legally compliant.

As an aspirant FT, the trust continues to embrace the Board Governance Assurance Framework (BGAF) as a tool to support on-going assessment of current capacity and capability. The framework underpins the trust's assessment in the Board Governance Memorandum (BGM), initially completed in June 2012, and subsequently externally reviewed in June 2013. During 2013-14 the board received a quarterly report on progress against each of the recommendations highlighted in the BGM. Additionally, the board met regularly to consider board composition and capacity, board effectiveness and performance and board behaviours; and, with effect from January 2013, has considered a quarterly report on board composition in the context of any changes to the environment or skill gaps.

In April 2013 each committee of the board completed an annual review of performance and effectiveness against objectives, as set out in the terms of reference. The consolidated results were formally presented to board in September 2013.

During 2013-14 the trust has continued to report monthly to the Trust Development Authority on progress against a set of board statements and a subset of Monitor's provider licence conditions, and has declared full compliance against all indicators and relevant conditions.

Corporate Governance


The NHS Act 2006, Health and Social Care Act 2012 and subsequent regulations set out the legal framework within which the Trust operates. The trust recognises that effective corporate governance, along with clinical governance, is essential to achieve its clinical, quality and financial objectives. Fundamental to effective corporate governance is having the means to verify the effectiveness of this direction and control, achieved through independent review and assurance.

The work of the trust board in 2013-14 has complied with the core principles of theHM Treasury/Cabinet Office Corporate Governance Code:

Leadership

 

The trust has an effective board which is collectively responsible for the long-term success of the organisation.

Effectiveness

 

The board and committees of the board have an appropriate balance between members skills, experience, independence and knowledge which is reviewed on a quarterly basis.

Accountability

 

The board presents a fair, balanced and understandable assessment of the organisation through sound risk management and internal control systems.

Remuneration

 

The trust has a transparent procedure for developing policy on executive remuneration, delegated to the remuneration & terms of service committee.

Sustainability

 

The trust board takes a long-term view about what the trust is aiming to achieve through the development and scrutiny of strategic plans.

 

Quality Governance


The board recognises that quality is an integral part of its business strategy and to be most effective, quality should be the driving force of the organisation's culture. The board recognises that quality is not a programme or a project within the organisation and it is not the responsibility of any one individual to implement the quality agenda. As such, the board is committed to ensuring that quality forms an integral part of its philosophy, practices and business plans with responsibility for driving this being accepted at all levels of the organisation.

The trust's definition of quality is:

"Excellence in the services we deliver that satisfies our patient and service user expectations and those of external agencies and professional bodies".

The quality strategy for 2013-14 clearly defined roles and responsibilities for quality within the trust to support the production of the annual quality account and the on-going assessment of the quality governance assurance framework (QGAF).

During 2013-14 the trust has continually monitored progress against the QGAF, thereby providing the board with assurance over the effective and sustainable management of quality through the organisation. The trust's self-assessment in January 2014 resulted in a score of 2.0 with a clear ambition (with supporting action plans) to achieve a score of 1.0 by April 2014.

The quality account 2013-14 provides evidence of progress against quality goals set for the year and highlights aspirational goals for the forthcoming year. It reflects the trust's commitment to providing the highest possible standards of clinical quality, and demonstrates how the trust listens to patients, staff and partners, working with them to deliver services that meet the needs and expectations of the people who use them. The quality account 2013-14 is reviewed by external partners including the overview and scrutiny committee and CCGs who provide supporting statements and it will be formally approved by the audit committee prior to publication in June 2014. The Quality Account is developed in consultation with the Quality & Governance Committee and the content is based on the information regularly shared and scrutinised by the committee on a monthly basis through quality reports.

The trust has a robust programme of clinical audit in place and during 2013-14, 36 clinical audits were planned and completed. The key quality outcomes from the audits are reported in the quality account. Other methods of internal quality assurance include frontline focus visits, infection prevention and control audits, safeguarding audits, all complemented by an internal audit programme of work led by Mersey Internal Audit Agency (MIAA).

The Trust is compliant with the Care Quality Commission 'Essential Standards of Quality and Safety' and this is monitored via the compliance group which reports to the quality and governance committee.

The information governance group monitors performance of action plans designed to meet the requirements of the information governance toolkit and reports to the quality and governance committee. The Trust achieved level 2 of the Information Governance Toolkit (version 10.0) with 96% of all staff completing and passing the Information Governance e-learning training during 2013-14.

Risk Assessment


The Trust's corporate strategy for risk management is preventative, aimed at influencing behaviour and developing a culture within which risks are recognised and addressed. This process is aligned to both controlling clinical and non-clinical risks and supporting a persuasive safety culture.

The Trust operates within a clear risk management framework which sets out how risk is identified, assimilated into the risk register, reported, monitored and escalated throughout the corporate governance structure. This framework is set out in the risk management strategy. Risks are recorded at service, divisional and organisational level forming the trust's risk register.

The risk management strategy sets out the responsibility and role of the chief executive and directors in relation to risk management with overall responsibility for the management of risk lying with the chief executive, as accounting officer.

The process of risk management has been embedded within the organisation and cascaded to service areas to assist with the development of an organisation-wide risk awareness culture. In addition to the risk management strategy, the Trust has developed a number of policies and systems which encourage staff at all levels to be involved in raising concerns about any risks. These include, but are not limited to; raising concerns policy, on-line incident reporting via the Datix system, regular quality forums, information governance policies and processes, and leadership and patient safety walkrounds.

Risk management training is also mandatory for all staff and is a key part of the organisation's corporate and local induction and essential learning programmes.

The trust has identified key strategic risks as part of the overall development of its organisational and financial strategy which formed the basis for the development of the Integrated Business Plan (IBP). These strategic risks are reflected in both the IBP and the Board Assurance Framework. In 2013-14 the key strategic risks related to the following:

Clinical Delivery 

 

The ability to continue to deliver high quality services in a demanding environment of change, taking into account the unavoidable risk of human and external factors.

Finance

 

Loss of a service and the impact this would have on the Trust's financial stability, together with a challenging Cost Improvement Programme.

Technology

 

The ability to provide robust data for further development of KPI reporting due to lack of fit for purpose IT systems.

People and Culture

 

The on-going challenge to staff to respond to the requirements of FT and competition, and the resistance to change and new ways of working.

FT Process

 

The increasing and challenging demands of the FT process and organisational capacity to respond.

 

No new strategic risks have been identified during 2013-14.

As the Trust moves forward, these risks are being reviewed and refined as part of the development of the trust's 2-year operational plan and 5-year strategic business plan.

The risk and control framework


During 2013-14, the board has continued formally to review the Board Assurance Framework (BAF) on a quarterly basis and has participated in regular development sessions to scrutinise and strengthen the controls in place to mitigate the risks to the trust's strategic objectives. The work during the year has informed the assurance framework review completed by internal audit (MIAA) which concluded that "an assurance framework has been established which is designed and operating to meet the requirements of the AGS and provides reasonable assurance that there is an effective system of internal control to manage the principle risks identified by the organisation"

The BAF is recognised as a key tool to drive the board agenda by ensuring the board focuses attention on those areas which present the most challenge to the organisation's success.

The risk management framework in place across the trust allows for the board to review risks and associated action plans that have been escalated through the quality and governance committee, the principal committee that monitors areas of risk across the organisation. This committee provides an opportunity for close scrutiny of risk registers and if required, will escalate risks to board.

The board receives a monthly risk report, detailing defined high-level organisational risks that require board review and action as appropriate. Any areas of risk identified through the trust's risk management framework or audit are the responsibility of the relevant executive director to address and ensure mitigation where appropriate.

The quality, patient experience and risk group (QPER) discuss and monitor responses to all reported risks, incidents, concerns and complaints. This group ensures that lessons learned from incidents, complaints, audits, research and other sources are shared across the organisation and enable views from patients and the public to be considered. The group provides assurance to the quality and governance committee which advises the board of all significant risks, areas for development and exceptional good practice ensuring lessons are learnt and shared from incidents, concerns and complaints.

During 2013-14 the Trust reported 11 SUIs (Serious Untoward Incidents) to NHS England via the national reporting and learning system (NRLS) in accordance with Department of Health protocols. All SUIs are fully investigated and themes are reviewed and learning is shared across the Trust to prevent them from reoccurring. There were zero IG SIRIs (Serious Incident Requiring Investigation) that required reporting to the ICO (Information Commissioners Office). The trust acknowledged however that from June 2013 the IG Toolkit Incident Reporting Tool should be used to report level 2 IG SIRIs to the DH, ICO and other regulators.

All risk registers and incident reports are centralised on an electronic database, Datix, and scrutinised monthly by the quality, patient experience and risk group (QPER) which reports directly to the quality & governance committee. The Datix system allows greater data interrogation through the development of dashboards to monitor trends and provides greater assurance to board members.

The Trust commissions the services of Wirral Fraud & Probity Service to provide a bespoke anti-fraud agenda. There is an annual risk-based work plan in place. The Trust utilises the services of two fully accredited counter fraud specialists both of whom are fully accredited and experienced.

All reports of fraud are dealt with professionally, diligently and in line with all current legislation and the requirements of NHS Protect. The Director of Finance & Development is briefed on a monthly basis and the audit committee are updated at each meeting. Trust staff have access to a 24/7 fraud advice and reporting line and are regularly reminded of the need to be vigilant. The trust has developed a fraud & corruption policy and a bribery policy which are accessible to all staff via Staff Zone.

There were no reportable incidents of fraud within the trust during 2013-14.

The effectiveness of risk management and internal control


In accordance with NHS Internal Audit Standards, the Director of Internal Audit has provided an annual opinion, based upon and limited to the work performed, on the overall adequacy and effectiveness of the organisation's risk management, control and governance processes (i.e. the organisation's system of internal control) during 2013-14.This is achieved through a risk-based plan of work, agreed with the Senior Management Team and approved by the Audit Committee.

The purpose of the Director of Internal Audit Opinion is to contribute to the assurances available to the Accountable Officer and the board which underpin the board's own assessment of the effectiveness of the organisation's system of internal control.

The overall opinion for 2013-14 provides Significant Assurance.

There is a generally sound system of internal control designed to meet the organisation's objectives, and that controls are generally being applied consistently. However, some weaknesses in the design or inconsistent application of controls put the achievement of particular objective at risk.

Internal audit conducted 13 reviews during 2013-14 of which 6 received significant assurance and 7 received limited assurance. The Trust provided a full response to each of the reviews and action plans are in place to deliver on the recommendations. In addition, internal audit work included 3 specific projects which contributed to the control environment where advice and guidance were provided to support the trust to strengthen risk management, internal control & governance.

Significant Issues


As Accountable Officer I confirm that there are no significant issues to report.

 

SimonGilby6

 

Simon Gilby                                                                     June 2014
Chief Executive
Wirral Community NHS Trust

 


Independant Auditor's Report to the Directors of Wirral Community NHS Trust


We have audited the financial statements of Wirral Community NHS Trust for the year ended 31 March 2014 under the Audit Commission Act 1998. The financial statements comprise the Statement of Comprehensive Income, the Statement of Financial Position, the Statement of Changes in Taxpayers' Equity, the Statement of Cash Flows and the related notes. The financial reporting framework that has been applied in their preparation is applicable law and the accounting policies directed by the Secretary of State with the consent of the Treasury as relevant to the National Health Service in England.

We have also audited the information in the Remuneration Report that is subject to audit, being:

  • the table of salaries and allowances of senior managers
  • the table of pension benefits of senior managers
  • the pay multiples narrative notes

This report is made solely to the Board of Directors of Wirral Community NHS Trust in accordance with Part II of the Audit Commission Act 1998 and for no other purpose, as set out in paragraph 44 of the Statement of Responsibilities of Auditors and Audited Bodies published by the Audit Commission in March 2014. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Trust's directors and the Trust as a body, for our audit work, for this report, or for opinions we have formed.

Respective responsibilities of Directors and auditor


As explained more fully in the Statement of Directors' Responsibilities in respect of the accounts, the Directors are responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view. Our responsibility is to audit and express an opinion on the financial statements in accordance with applicable law and International Standards on Auditing (UK and Ireland). Those standards also require us to comply with the Auditing Practices Board's Ethical Standards for Auditors.

Scope of the audit of the financial statements


An audit involves obtaining evidence about the amounts and disclosures in the financial statements sufficient to give reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud or error. This includes an assessment of: whether the accounting policies are appropriate to the Trust's circumstances and have been consistently applied and adequately disclosed; the reasonableness of significant accounting estimates made by the Trust; and the overall presentation of the financial statements. In addition, we read all the financial and non-financial information in the annual report which comprises to identify material inconsistencies with the audited financial statements and to identify any information that is apparently materially incorrect based on, or materially inconsistent with, the knowledge acquired by us in the course of performing the audit. If we become aware of any apparent material misstatements or inconsistencies we consider the implications for our report.

Opinion on financial statements

In our opinion the financial statements:

  • give a true and fair view of the financial position of Wirral Community NHS Trust as at 31 March 2014 and of its expenditure and income for the year then ended; and
  • have been prepared properly in accordance with the accounting policies directed by the Secretary of State with the consent of the Treasury as relevant to the National Health Service in England.

Opinion on other matters


In our opinion:

  • the part of the Remuneration Report subject to audit has been prepared properly in accordance with the requirements directed by the Secretary of State with the consent of the Treasury as relevant to the National Health Service in England; and
  • the information given in the annual report for the financial year for which the financial statements are prepared is consistent with the financial statements.

Matters on which we report by exception


We report to you if:

  • in our opinion the governance statement does not reflect compliance with the Trust Development Authority's Guidance
  • we refer the matter to the Secretary of State under section 19 of the Audit Commission Act 1998 because we have reason to believe that the Trust, or an officer of the Trust, is about to make, or has made, a decision involving unlawful expenditure, or is about to take, or has taken, unlawful action likely to cause a loss or deficiency; or
  • we issue a report in the public interest under section 8 of the Audit Commission Act 1998.

We have nothing to report in these respects.

Conclusion on the Trust's arrangements for securing economy, efficiency and effectiveness in the use of resources


Respective responsibilities of the Trust and auditor

 

The Trust is responsible for putting in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources, to ensure proper stewardship and governance, and to review regularly the adequacy and effectiveness of these arrangements.

We are required under Section 5 of the Audit Commission Act 1998 to satisfy ourselves that the Trust has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources. The Code of Audit Practice issued by the Audit Commission requires us to report to you our conclusion relating to proper arrangements, having regard to relevant criteria specified by the Audit Commission.

We report if significant matters have come to our attention which prevent us from concluding that the Trust has put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources. We are not required to consider, nor have we considered, whether all aspects of the Trust's arrangements for securing economy, efficiency and effectiveness in its use of resources are operating effectively.

Scope of the review of arrangements for securing economy, efficiency and effectiveness in the use of resources

We have undertaken our audit in accordance with the Code of Audit Practice, having regard to the guidance on the specified criteria, published by the Audit Commission in October 2013, as to whether the Trust has proper arrangements for:

  • securing financial resilience
  • challenging how it secures economy, efficiency and effectiveness.

The Audit Commission has determined these two criteria as those necessary for us to consider under the Code of Audit Practice in satisfying ourselves whether the Trust put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2014.

We planned our work in accordance with the Code of Audit Practice. Based on our risk assessment, we undertook such work as we considered necessary to form a view on whether, in all significant respects, the Trust had put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources.

Conclusion


On the basis of our work, having regard to the guidance on the specified criteria published by the Audit Commission in October 2013, we are satisfied that in all significant respects Wirral Community NHS Trust put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources for the year ending 31 March 2014.

 

Certificate

 

We certify that we have completed the audit of the accounts of Wirral Community NHS Trust in accordance with the requirements of the Audit Commission Act 1998 and the Code of Audit Practice issued by the Audit Commission.

Mark R Heap
for and on behalf of Grant Thornton UK LLP, Appointed Auditor


4 Hardman Square
Spinningfields
Manchester
M3 3EB


7 June 2014


AnnualaccountsAnnualaccountsstatement

 

Last Updated: Wednesday, 02 November 2016 15:05

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