Annual General Meeting - Salisbury · Patient-Centred & Safe Professional Responsive Friendly 2013-14 Analysis of Group Revenue 90,859 18,648 14,393 5,307 39,363 1,139 5,260 4,120

Patient-Centred & Safe Friendly Professional Responsive 1

Annual General Meeting

22 September 2014

Patient-Centred & Safe Friendly Professional Responsive

Annual General Meeting

Nick Marsden

Chairman


Agenda

1. Introduction and Welcome Nick Marsden, Chairman

2. Annual Accounts and Audit Opinion 2013/14

Malcolm Cassells, Director of Finance & Procurement

3. Annual Report 2013/14 Peter Hill, Chief Executive

4. 21 years of care and treatment at Salisbury District Hospital

Dr Shaun McGee, Consultant Radiologist Maria Ford, Nurse Consultant in Critical Care

5. Questions and Answers Nick Marsden, Chairman


Financial Performance 1 April 2013 to 31 March 2014

Malcolm Cassells Director of Finance and Procurement


Summary Facts for 2013-14

For the first time the SFT accounts for 2013-14 required the consolidation of Salisbury District Hospital Charitable Fund. In addition the accounts of Odstock Medical Ltd, and Salisbury Trading Ltd were also consolidated.

We planned (excl charitable funds) a surplus of £1,856k and we achieved £1,869k.

We struggled to achieve our savings target of £9.2m and achieved £6.9m. The shortfall was offset by revenue from activities which grew by £15m overall.

Each day on average the Hospital spends over £0.5m

Non-Current Assets rose in value by £10.3m to £146.0m reflecting the revaluation of assets.

Net Current Assets increased by £3.4m to £14.6m

Operating Surplus increased to £8.2m (2012-13 £6.4m), EBITDA was £15.4m with a margin of 7.7% of turnover

Slight reduction in in-patients treated but big increase in day case work and out-patient attendances

Positive External Audit Report


Group Statement of Comprehensive Income 2013-14

2013-14 2012-13£000 £000

Income:From clinical activities 178,954 166,734Other operating income 20,539 17,783

Total Operating Income 199,493 184,517Operating Expenses -191,321 -178,114OPERATING SURPLUS 8,172 6,403Finance income 193 327Public Dividend Capital payable -3,510 -3,254Other finance costs -1,930 -1,853RETAINED SURPLUS FOR THE YEAR 2,925 1,623Revaluation gains/losses (-) 10,166 -1,811Fair value gains on investments 262 658TOTAL 13,353 470RETAINED SURPLUS FOR THE YEAR - SFT ONLY 1,970 1,648


2013-14 Group Revenue

• Total Revenue £199.5m including charitable (£184.5m in 2012-13)

• Revenue in respect of SFT only was £194.3m

• Revenue from Patient Care grew by £12.3m to £179.0m

• Revenue from other activities grew by £2.8m to £20.5m

• National Tariff declined by 4%

• Final settlements with CCGs in accordance with Plan

• Sales of ‘My Trusty Little Sunflower Cream’ £130k


2013-14 Analysis of Group Revenue

90,859

18,648

14,393

5,307

39,363

1,139

5,260

4,120

789

4,963

3,191

2,906

8,555

0 20,000 40,000 60,000 80,000 100,000

Wilts CCG

Dorset CCG

W. Hants CCG

Other CCGs

NHS England

Local Auths

Educ & Training

FTs and NHSTs

Research

Non-NHS

STL - laundry

Charitable

Other Income

£000


2013-14 Analysis of Group Revenue

Non-clinical, 20,539

Other clin, 42,286

Out-pati

ents, 2

9,701

Private, 1,865Elec

tive,

36,

972

Non-elective, 63,215ED

, 4,9

15


2013-14 Group Expenditure

• Total Expenditure £196.8m (of which SFT is £192.3m)

• Operating Expenditure £191.3m

• £120.3m (62.6%) spent on paying staff

• £36.7m spent on clinical supplies & healthcare

• £37.2m spent on buildings, departments and non-clinical supplies etc

• Good Efficiency - SFT costs are 8% less than National Average for England [source national reference costs]

• Working Capital Facility has been discontinued

• Management and administrative costs less than 4% of turnover


Operating Expenditure - Pay (total £120.3m – SFT only)

34,333

32,989

18,797

14,006

12,711

6,111

1,393

31,812

30,868

18,107

14,048

12,198

6,120

1,412

05,000

10,000

15,000

20,000

25,000

30,000

35,000

Nursing & Midwifery

Medical & Dental

Scientific & Therapy

Healthcare Assts

Admin & Clerical

Board & Sen Managers

Other

£000

2012-132013-14


Operating Expenditure - Non-Pay (total £66.5m – SFT only)

14,841

19,221

6,184

7,101

9,171

576

3,926

2,020

3,175

13,098

17,552

5,690

6,387

8,496

579

3,272

2,167

2,370

05,0

0010

,000

15,00

020

,000

25,00

0

Drugs

Clinical Supplies

General Supplies

Premises incl IT

Depreciation

Use of Non-NHS

Insurance

Other NHS Orgs

Other

£000

2012/132013/14


Group Statement of Financial Position

at 31.3.14 at 31.3.13£000 £000

Non-current Assets - Property, plant & equip 146,004 135,737Current Assets 34,119 30,291Current Liabilities -19,546 -19,175Total Assets less current liabilities 160,577 146,853Less Non-current Liabilities -20,300 -21,714TOTAL ASSETS EMPLOYED 140,277 125,139

FINANCED BY:Public Dividend Capital 53,339 51,554Revaluation Reserve 58,452 49,106Income & Expenditure Reserve 15,965 13,428Charitable Funds reserve 12,465 10,989Minority Interest 56 62

TOTAL CAPITAL & RESERVES 140,277 125,139


2013-14 Capital Expenditure - £8.288m

Key schemes include: £m

Medical equipment 1.281

Dementia friendly wards 737

Maternity improvements 446

Building works 2.363

Information technology 1.997

Energy efficiency 306


Financial Ratings

Using earlier FRR assessment: 2013/14 2012/13 RATING EBITDA Margin 8.1% 8.0% 3 EBITDA % Achieved 103.3% 105.7% 5 Return on Assets Employed 0.8% 1.0% 3 I&E Surplus Margin 1.0% 1.3% 3 Liquidity 24.8 days 21.0 days 4

Overall FRR is 3

Monitor Risk Assessment Framework: RATING Capital Service Capacity

Revenue available for debt service divided by capital service costs

3

Liquidity Cash divided by expenditure per day 4 Overall rating 4


Key Messages

A successful financial year – however: • Exceedingly challenging financially - need to work closely with the

new Clinical Commissioning Groups to ensure continuity of local service provision

• Further reductions in the national tariff of 4% likely • Some reductions in activity in 2013/14 and more activity likely to be

restricted by CCGs • Level of tariff deflator is not sustainable • Concern about how to improve and renew assets if we do not

generate surpluses at a higher level • Proving very difficult to achieve recurring cost savings especially

given the Trust is one of the more efficient in the country


Charitable Receipts 2013-14

Donations, Legacies & Grants of £2,269k together with other net Charitable Income of £548k

Enabled

New Equipment & Facilities £774k

Patients Welfare & Amenities £420k Staff Education & Welfare £375k

Research £180k

And (arriving in 2014)

TWO NEW CT SCANNERS!!!

Thank you!!!


Annual Report 2013/14

Peter Hill Chief Executive


Some light reading:

February Francis Report – Public inquiry into Mid Staffs Hospital

April Health and Social Care Act

July Keogh Review – Review of 14 hospitals with persistently high mortality rates Neuberger Review of Liverpool Care Pathway Cavendish Report – Independent review of training for healthcare assistants

August Berwick Review – Improving patient safety

October Clwd–Hart Report – Review of hospital complaint systems

November Jane Cummings’ Report – Nursing & Midwifery staffing capacity and capability


District General Hospital Services

Orthopaedics

Facilities

Surgery

Maternity

Children’s Services

Diagnostics

Medicine

Emergency Department


Regional Specialist Services

Wessex Laser Centre

Wessex Rehabilitation

Genetics

Cleft Lip & Palate

Plastic Surgery Burns


Supra-Regional Spinal Services


Facts & Figures for 2013/14

Elective Admissions 6,700

Day Cases 21,400

Regular Day Attendees 6,400

Emergency Admissions 27,700

A&E Attendances 43,200

Number of Births 2,500

Number of Diagnostic scans (CT, MRI) and X-Ray 165,000


Review of Performance for 2013/14

90.3% Inpatient or day cases treated within 18 weeks - National Target: 90%

98% Patients who did not need to be admitted were treated within 18 weeks – National Target: 95%

98.5% Cancer patients treated within 31 days of decision to treat - National Target: 96%

96.3% A&E attendees admitted, treated or discharged within 4 hours – National Target: 95%


98.7% Patients risk assessed for VTE – (National Average: 90%)

0 MRSA bacteraemia notifications – (target: 0 ) Two reported cases were contaminates

21 Trust apportioned Clostridium Difficile cases - (National Target: 21)

91.6% Patients who had a CT scan within 24 hours of admission with a stroke– (National Target: 90%)


What our patients say:

98.3%

1.7% REAL-TIME FEEDBACK April 2013 - March 2014 Overall, how would you rate the quality of care

you received?

Good -Excellent

n = 1825

98.5%

1.5% REAL-TIME FEEDBACK April 2013 - March

2014 Do you feel cared for?

YesNo

n = 1740

330 Complaints

Dignity & Respect

Quality of Care Recommend Hospital


What our staff say:

3.10

3.20

3.30

3.40

3.50

3.60

3.70

3.80

3.90

4.00

4.10

Salisbury NHSFoundation Trust

SouthamptonUniversity Hospital

Poole Hospital The RoyalBournemouth

Hospital

Royal UnitedHospital Bath

Great WesternHospital Swindon

GloucestershireRoyal Hospital

Staff recommendation of the Trust as a place to work or receive treatment


Achievements

Expansion of palliative care service

CT Scanner campaign New Health and wellbeing programme for cancer patients

social stimulation for older patients


Achievements cont…

29

Spinal nurse wins national award Patient and Public

involvement award

Major refurbishment of general wards


Contribution of Patients, Public, Volunteers and Governors

Patients and Public Involvement: •Patients Involved in over 30 projects – using patient stories, focus groups and Real Time Feedback

Volunteers: •Over 670 volunteers give up around 1,900 hours a week of extra support, helping on wards and departments, acting as guides and supporting one off projects •Other volunteers: cover all types of work and includes, Stars Appeal, ArtCare, League of Friends, WRVS and Pets as Therapy

Governors: •25 Governors (Public, Staff and Nominated) representing over 17,300 members •Link with membership, statutory duties, support services and sample patient experience


Our Focus for 2014/15

Challenges:

Areas for improvement:

•Changes to commissioning and the impact on smaller general hospitals •National and local initiatives to keep people out of hospital •Finance – around 9 – 10 million pound annual year-on-year savings

•Infection prevention •Care of older people in hospital •Patients with long term conditions – preventative care •End of Life Care


Diagnosis and Care 1993-2014

Dr Shaun McGee FRCP FRCR Consultant Radiologist


The challenge of leadership

Regional Scientific Officer for Wessex circa 1986

“There will never be a CT scanner in Salisbury” Why ?

“Places like Salisbury have no need for a CT scanner”

“In fact one CT scanner will adequately serve the needs of the entire region”

and where will it be?

“ of course it will have to be in Southampton ”


Wide range of diagnostic and therapeutic imaging modalities

• Ultrasound • Computed Tomography ( CT, CAT scanning) • Magnetic Resonance Imaging • Nuclear Medicine • Positron Emission Tomography (PET scanning) • Interventional radiology – image guided biopsy/therapy


How does this help Salisbury Patients?

Ultrasound

Gall Bladder Kidney Pregnancy



Magnetic Resonance Imaging

Back Knee Hearing Cancer



Computed Tomography (CT)

Head/Neck Pelvis Coronary Arteries


Progress in computer processing/display

• Faster acquisition and display of images • Improved resolution and clarity of images • Picture Archiving and Communications Systems

(PACS) for reporting • Filmless and paperless departments of Clinical

Radiology


Progress in computer processing/display

Ward

A & E

Operating Theatre

GP surgery

Consultant Radiologist Home

↑

→ ←

→ ←


CT Colonography or Virtual Colonoscopy


Virtual Colonoscopy or CT Colonography


Endoluminal repair of Abdominal Aortic Aneurysm


SDH 1967 to 2013

Consultant Radiologists

Radiographer WTE

Admin Exams pa (K)

£

1967

2

8

4

30

40K

2013

13

45

18

130

5.8M


Thank you

In 2014 diagnostics is at the heart of the patient journey in virtually every field of medicine


Commitment to Care – a personal perspective

Maria Ford Consultant Nurse in Critical Care RGN, MA, PGDHE, BSc(Hons), DPSN


Through the decades…

1930’s 1940’s

1950’s

1960’s Radnor Ward

1980’s


Changing the Shape of Nursing

Influencing factors

Public health issues

Government policy

Technology Nurse and

medical education

Professional accountability


Professional Accountability

In my estimation obedience is the first law and the very corner stone of good nursing. And here is the first stumbling block for the beginner. No matter how gifted she may be, she will never become a reliable nurse until she can obey without question. The first and most helpful criticism I ever received from a doctor was when he told me that I was supposed to be simply an intelligent machine for the purpose of carrying out his orders. (Matron Dock 1917)


External Influences

Role Expansion

Ventilator in 1980 and 2000

ED 1993 and 2014

Patient transfer to spinal unit (circa 1980)


What has not changed?

Commitment

Communication

Compassion Courage

Competence Amy Johnson Senior Sister

Abi Rigby Senior Sister

Steve Nobbs Diabetic

Specialist Nurse

Emma Crockett Sister



Stars Appeal

52


Questions and answers

Documents

Annual General Meeting - Salisbury · Patient-Centred & Safe Professional Responsive Friendly 2013-14 Analysis of Group Revenue 90,859 18,648 14,393 5,307 39,363 1,139 5,260 4,120