1. family and parenting
2. children

Annual Report & Accounts 2013-14
Birmingham Children’s Hospital NHS Foundation Trust
Annual Report & Accounts 2013-14
Presented to Parliament pursuant to Schedule 7, paragraph
25(4) of the National Health Service Act 2006
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Chief Executive’s Foreword
As another significant year in the history of Birmingham Children's Hospital comes to an end, it is
important to reflect on the journey the hospital has been on over the last few years and look
towards the future.
On taking up the role of Chief Executive five years ago, the most common concerns I heard from
staff was our lack of capacity to treat all of the children and young people who needed our care. I
heard this message loud and clear, and alongside a huge service transformation programme, we
have increased our hospital by 80 beds, 11 paediatric intensive care beds, five theatres and 700
staff.
We are achieving the best clinical care for our children and young people, our patient experience
and engagement work is recognised at a national level and we are also increasing our research and
fundraising profile. However, there is still a long way to go to resolve the issues our hospital has
faced for 150 years - too many operations are cancelled and too many children needing beds are
waiting too long.
This year we have seen another rise in the number of patients we have seen, many of which are
coming to us with increasingly complex conditions – something that we know will continue to rise.
Based on population growth alone, we are expecting to see over 17,000 more patients every year by
2022. On top of that, our Victorian hospital is no longer fit for purpose. We have outgrown it and
need a new hospital which is fit for the 21st century.
Throughout the year we have continued to develop a number of options for how best to do this,
either on our current Steelhouse Lane site in the city centre or in Edgbaston. We are working closely
with our partners at Birmingham Women’s Hospital, University of Birmingham and University
Hospitals Birmingham, to explore the potential for our hospitals to be co-located on the university
campus, delivering an integrated approach to family care. There is still a long way to go in our
planning, but we are determined to make sure we get this important decision right.
In the meantime, to ensure we are able to cope with our current capacity pressures between now
and 2022, we have committed £35m to develop and expand our Steelhouse Lane site, in addition to
the £9m already committed to developing our Parkview mental health unit. This is called our Next
Generation project which will ensure we have the hospital that we need now and that we can build
the hospital we need in the future too. This is much more than bricks and mortar though. The issues
we are facing with increasing demand for our services means we have to continue to grow our
capacity at a rapid pace, not just by building new facilities, but by investing in technology to enable
change and redesigning our workforce to use our skilled professionals in new ways.
We've come a long way in 2013/14 and have some exciting times ahead. I look forward to working
together as 'Team BCH' to be the very best hospital and secure our future for children, young people
and families today, and for the next generation too.
………………………………………………………
Sarah-Jane Marsh, Chief Executive
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Chairman’s Foreword
The last 12 months has seen an exciting and challenging year, both for the NHS and Birmingham
Children’s Hospital. The reports around Mid Staffordshire Hospitals NHS Foundation Trust reminded
us all just how important compassion and quality of care is to everything we do. Our Board spent
significant time examining how we continue to ensure that we provide high quality services that
meet the needs of the children and young people that we see. Building strong high performing
teams is central to meeting this challenge and the work we have done around 'Building Team BCH' is
paying real dividends.
The Trust has never been busier, demand for our services continues to increase whether that is
referrals for specialist care or demand for emergency or intensive care. Our staff across the Trust
have continued to provide high quality services but also ensured that we can do this in a sustainable
way, within an ever tighter financial envelope.
Our financial position provides a strong basis for the development of services and I am pleased to
say that Monitor, our regulator, has confirmed this with its assessment of our financial standing. This
means we have a strong foundation as we look forward and develop our plans for the next five
years.
It is important to note that every penny we generate as a surplus is reinvested back into the hospital.
The role of the Board is to ensure that this is balanced between what is required today, but also
making sure that we do not neglect our future plans.
Finally, I would like to thank our staff for their great effort over the last 12 months and I am
confident that we have the ambition and skills to meet the future challenges facing the NHS.
…………………………………………
Keith Lester, Interim Chair
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Section 1
Who we are and what we do
Mission, Vision & Values
Our Journey through the Year
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Who we are and what we do
Birmingham Children’s Hospital NHS Foundation Trust provides the widest range of children’s health
services for young patients from Birmingham the West Midlands and beyond, with over 257,000
patient visits every year.
We are a nationally designated specialist centre for epilepsy surgery, a trauma centre for the West
Midlands, a national liver and small bowel transplant centre, a centre of excellence for complex
heart conditions, the treatment of burns, cancer and liver and kidney disease and we have one of
the largest Child and Adolescent Mental Health Services in the country with a dedicated Eating
Disorder Unit and Acute Assessment Unit for regional referrals of children and young people with
the most serious problems (Tier 4).
Our hospital has:
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257,173 patient visits a year
360 beds
34 specialties (including liver transplant surgery, cardiac surgery, burns, major trauma,
craniofacial surgery, blood and marrow transplantation, specialised respiratory and
dermatology, neurology, cystic fibrosis, Child and Adolescent Mental Health Services)
11 Nationally Commissioned Services
14 theatres (including our Hybrid and Laparoscopic theatres)
3T MRI scanner which supports pioneering research into brain tumours in children
164,370 outpatient visits a year
50,296 Emergency Department patients a year
42,507 inpatient admissions to hospital each year
61 room parent and family accommodation
KIDS regional emergency transport service
Wellcome Clinical Research Facility
31 bedded PICU – the largest in the UK
£246m annual income
3,500 staff
Education
As one of the UK’s leading paediatric teaching centres we go to great lengths to identify, teach,
nurture and develop the skills of our present and future workforce, to enable access to training and
education and to foster life-long learning. Our aim is that all staff are appropriately equipped and
qualified for the work they do and continue to learn and develop during their time with us. We
continually examine our practise and look at ways to innovate and improve the service we all deliver
so that our children, young people and families receive a first-class service.
Research
Research is a fundamental part of what we do at the hospital and we are leading the way with
pioneering international research into:
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Childhood cancer
Rare diseases
Liver disease
Infection, inflammation and immunity
Nutrition, growth and metabolism in childhood
Drug use in children
Relapsed and refractory acute lymphoblastic leukaemia
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Infant neuroblastoma
Infant brain tumours
Our Mission
To provide outstanding care and treatment to all children and young people who choose and need
to use our services, and to share and spread new knowledge and practice, so we are always at the
forefront of what is possible.
Our Vision
To be the leading provider of healthcare for children and young people, giving them care and
support – whatever treatment they need – in a hospital without walls.
To help us do this, we have six strategic objectives which focus us on where we are now and what
we want to achieve in the future:
Our Journey through the Year section details how we’ve been delivering against each of these
strategic objectives.
Our Values
We know that organisations which have strong values and behaviours do
well and that employees are engaged, happy and motivated in their
work.
We’ve worked closely with staff to develop and embed our values in all
that we do at Birmingham Children’s Hospital and we will continue to ensure that they underpin the
way we care for our patients and each other.
Trust
Our patients and families will trust us to have the skills, knowledge and ability to look after them
properly and deliver the very highest quality of care.
Commitment
We will show commitment to achieving the very best possible outcomes for our patients and
families.
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Compassion
We will always be friendly, approachable and alert to what our patients and families need, no matter
what time of day.
Courage
We will always have the courage to stand up for what is right, raise concerns, challenge the status
quo and improve care at all times.
Respect
Whatever the needs or beliefs of our children, young people and their families, we will always do all
we can to tailor their care and make their experience a good one.
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Our Journey through the Year
Delivering excellent care today
Every child and young person requiring access to care at Birmingham Children’s Hospital will be
admitted in a timely way, with no unnecessary waiting along their pathway.
We know that our children, young people and families want to get better and get home as soon as
they can, and we work hard to make that happen. The paths they take to get to us, the way they are
looked after while they're here and how this continues when they've gone home, is what makes
their experience of care a good one.
We have seen significant improvements in our emergency care pathway this year and, through the
creation of our Paediatric Assessment Unit and Hospital at Home team, we have been able to better
manage the flow of patients into hospital beds, allowing us to care for those most in need, more
quickly.
An £800k refurbishment and expansion of our Emergency Department has been the icing on the
cake this year. We have significantly improved the décor, created a new walk-in entrance, bigger
waiting area and three new cubicles to treat more patients in a more comfortable environment. Top
Gear presenter, Richard Hammond, was the guest of honour at the opening in January, who lent his
support as a personal thank you for the care his godson, Jobe Taylor-Davies, received at Birmingham
Children’s Hospital in 2012. Jobe came to us with significant head injuries after being kicked in the
head by a horse on his family farm at just 16 months old. He spent three weeks in a coma but is now
on the road to a full recovery.
Speaking at the event, Richard said: “The work of the staff at Birmingham Children’s Hospital and in
this Emergency Department is astonishing. Anything that can be done to comfort the patients and
make their stay here better, is essential. The environment is fantastic but aside from that, the staff
here do some amazing work that you would be hard-pushed to find elsewhere.”
We’ve also achieved success through our ‘What are we waiting for?’ project. By looking at what was
preventing our longer stay patients from getting home as quickly as they could, a new multidisciplinary team has been established to take ownership of these patient journeys. The group has
developed a number of solutions based on individual patient and family needs and works closely
with community healthcare colleagues to make sure that the family home is ready, and community
support is in place, as soon as the child is well enough to leave us. Within our gastroenterology
pathway this has already reduced the average length of stay by 1.5 days. It has saved bed days,
which other children and young people have been able to use.
In 2014/15 we will build on this to focus on our current ‘hot spot’ pathways – outpatients and
surgical flow, as part of our Next Generation project. Next Generation was launched in April and has
two phases - 2014 until 2022 and from 2022 onwards, when we hope to have our new hospital. We
have committed £35m to phase one and our challenge for 2014/15 will be to find the best ways to
improve our patient pathways, expand our services and remodel our existing buildings. Working
with frontline staff, who struggle daily to get patients in and treated, we will determine what
improvements can be made to be more efficient, so that we can see patients more quickly, with
fewer delays.
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Our new Respiratory and Cystic Fibrosis Unit is another development that is speeding up access and
improving care. Opened in December 2013, the modern unit is big and bright and brings together all
of the hospital’s respiratory services for outpatients in one purpose-built location.
The unit can now see over 1,600 patients per year thanks to a second lung function testing area, new
counselling room and three purpose built sleep study bedrooms. The lung function area is at the
heart of the unit and plays a critical role in assessing how a patient’s lungs are working. Previously,
only one patient could be seen at a time, but families now have more privacy and appointments are
more flexible so that children can be seen more quickly in tandem.
Our Child and Adolescent Mental Health Service (CAMHS) Emergency Response and Assessment
(ERA) team has also gone from strength to strength this year. This is a small but specialist team of
experienced clinicians who respond to emergency psychiatric referrals from the Emergency
Department and paediatric wards, assessing young people for mental illness who are in crisis. This is
often due to a presentation of self-harm or following an overdose.
The ERA team provides prompt psychiatric assessment and intervention for the young person, whilst
also supporting the paediatric teams in meeting the emotional needs of these vulnerable young
people. They work closely with each young person and their family, to provide short term
intervention whilst in hospital, follow up in the community and linking them quickly to the
appropriate services for ongoing support.
Currently the ERA team covers Birmingham Children’s Hospital, Good Hope, Heartlands, City and
Sandwell Hospitals, and since January 2014 supports young people seven days a week, which has
delivered huge improvements to patient care, has reduced waits for assessments and the amount of
time they have to stay in hospital.
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Delivering excellent care today
Every child and young person cared for by Birmingham Children’s Hospital will be provided with
safe, high quality care, and a fantastic patient and family experience.
Safe, high quality care is at the heart of what we do at Birmingham Children's Hospital. We have a
responsibility to the vulnerable children, young people and families who come to us in their time of
need to deliver treatment in a safe environment.
We hosted the Paediatric Patient Safety Day in May 2013 - part of the Patient Safety Congress 2013 where over 60 delegates came together from around the world. Several expert speakers joined us
from across the UK and USA to share their good safety practice and one significant outcome of this
has been the creation of a new working group, called MIST – Making it Safer Together. MIST is a
collaboration between staff from children’s hospitals across the country whose aim is to share safety
data and best practice.
We are also helping to lead the way on the national development of the first tool which measures
harm specifically in children’s hospitals. The National Safety Thermometer, which measures things
like pain management, deteriorating patients and skin integrity, is not sensitive to the harms in
children and young people and our tool, called SCAN (Safer Children Audit No Harm) has been
endorsed by NHS England which will be developing the concept and rolling it out nationally.
We are also one of four sites in the UK to support the Health Foundation’s Safer Clinical Systems
programme. We have been focussing on clinical handover between day staff and the Hospital at
Night team to improve the consistency and quality of information exchanged about a patient’s
condition. As part of this we have launched a unified electronic handover system, which not only
standardises the information handed over, but also provides a toolkit about communication and
behaviours, a handover checklist and an electronic training programme for all staff.
All this activity was backed up by the glowing report we received from the Care Quality Commission
(CQC) who visited us in November 2013 as part of a routine inspection. Its inspectors observed how
we care for children and young people and spoke to staff, patients and families who told inspectors
that they “cannot fault the care” we provide. They saw that effective systems were in place to assess
and monitor the quality and safety of care and safeguard patients from abuse, concluding that we
had met all five essential CQC standards.
We were also pleased to get involved with NHS Change Day for a second year in March 2014, which
focussed our hearts and minds on the smaller things that make a big difference. Led by Chief
Executive Sarah-Jane Marsh, who read stories to children by their bedsides, 300 staff pledged to
make one single change as part of the national campaign. Examples include donating blood platelets
to help cancer patients, giving books to children, developing training and employment opportunities
for young people with learning disabilities, encouraging smokers to quit and offering tea and cakes
for visitors to wards.
Making the hospital experience for patients and families as good as it can be is also what drives
everything we do at Birmingham Children’s Hospital. We take time to develop and invest in new
ways to gather feedback and listen to what people tell us.
Our Patient Feedback App has gone from strength to strength. The first of its type in the NHS, the
app allows patients and families to send anonymous feedback directly to the manager in charge of a
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particular area or department so it can be addressed in real time with no delays. The messages are
also published openly on our hospital website for patients and families to view.
Since the app was launched in 2013 we have received over 1,200 messages for 55 different areas
from children, young people and parents. The vast majority have been positive and many have led to
changes and improvements. It has also been recognised nationally with a Guardian Public Service
Award for Digital Excellence, a PR Week Public Sector Communications Award and Birmingham
Chamber of Commerce Excellence in Innovation Award.
The app is just one of many ways that we gather feedback. We know that a one size fits all approach
does not work for our patients and families so we continue to talk to people face to face, use
feedback cards and engage in conversation with our patients, families and supporters through social
media too. We have a strong presence on Facebook with 26,000 followers, one of the largest social
media profiles of all children's hospitals.
‘KIDS’, our Kids Intensive Care and Decision Support team, has been working hard to engage with
parents, who may only be with them for a few hours, to find out what their experience was like and
what improvements could be made. Listening to parents tell their story, by chatting to them in the
ambulance and visiting them on PICU the next day, has really helped the team to get a fresh
understanding of what they are going through at such a worrying time. They found that it was simple
things that would make a big difference when they were going through a very worrying time, such as
providing phone chargers on-board the ambulance so they can keep in touch with their loved ones,
and giving them a ‘snack pack’ to keep hunger at bay while they are travelling with us.
KIDS has also undertaken a large-scale publicity programme to make sure all local hospital teams
know that parents are welcome to travel in the KIDS ambulance with their child, so they can
reassure parents that they will not be separated from their child. The team also loans sat-navs to
families who are travelling by car to help them find their child’s hospital quickly, with a freepost
envelope to post it back to once they get home. It’s made a huge difference, with feedback from
families saying:I hadn’t eaten for hours and hours, and I am 33
weeks pregnant…the snack pack was most
appreciated.
Using the phone charger in the ambulance was
great - my phone battery was flat and I was really
worried how I would find my husband when we
got to the other hospital.
We ask a children’s and young person’s version of the national 'Friends and Family Test' question on
discharge to find out how likely they would be to recommend the hospital to friends or family, and
this year introduced this in our Emergency Department too. We have seen an improved response
rate and overall score from last year - in 2013/14 we asked 21% (13% in 2012/13) of parents and
19% of children and young people over the age of 8 years whether they would recommend our
hospital. Our overall score was an impressive and improved 82% - an increase from 73% in the
previous year, and out of 2,930 parents, 2,895 said they were either ‘likely’ or ‘extremely likely’ to
recommend Birmingham Children’s Hospital to their friends and family.
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Most importantly though is the action that we take in response to this valuable feedback. In
partnership with parents, we launched our ‘Listening to You’ guide to empower parents to speak to
staff about a worry or concern. Parents know their child better than anyone and we truly value the
important role that they play in their child’s care. Through a Health Foundation grant we have
developed the guide to capture their worries, clearly explaining who is who on their ward, clearly
explaining the escalation process to reassure them that we will listen and act on their concerns. This
is the first time that this has been done in the NHS and the feedback from parents and staff has been
overwhelmingly positive.
In response to feedback from our children and young people we gave our main outpatients area a
modern and colourful makeover this year, with a new main reception desk, better flooring, more
seating, and an adolescent 'pod' with Wi-Fi and gadget charging docks. We have also opened our
new ‘Wish You Well’ Outpatients café, named by one of our patients, which is now open longer and
offers a greater range of drinks and snacks while families wait for their appointments.
Young people needing operations also told us they didn’t want to see white, clinical-looking walls
and ‘scary’ equipment like needles and cannulas when they came to our theatres, so we invested in
a new welcoming reception area, brightly coloured walls, drawers and cupboards, and flat screen
TVs to distract patients before and during their anaesthetic.
This year we also celebrated our 1,000th laparoscopic operation - called keyhole surgery - in our £2m
state-of-the-art theatre. This revolutionary technique uses very small incisions of up to just 1cm,
which means that patients have far less noticeable scars, a speedier recovery and less time in
hospital.
Josh's story
Josh Downing is one of many patients to benefit from this pioneering 'key-hole' surgery. Josh had a
form of anaemia called Spherocytosis, which made him sleepy and turned his skin yellow. His
symptoms had to be managed by regular blood transfusions, until his spleen was removed in a
laparoscopic procedure. This means that he no longer needs transfusions and his energy levels are
high. The scar that Josh has from the operation is minimal, which surprised his parents Kirsty and
Richard. Kirsty said:The laparoscopic theatre was better than any we've seen and the
equipment is really modern, clean and new, which really filled us with
confidence.
Josh’s surgeon said:-
We're delighted with the new theatre. The lighting, pressure flows and
positioning of the operating table and screens is preset specifically for
each surgeon, giving greater comfort and improving accuracy and
performance. Set up time is now much shorter, which means we can
carry out operations in less time.
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Another project to improve the hospital experience has been our new Sensory Garden. We know
that coming into hospital can be daunting for young patients, particularly those with a learning
disability who are sensitive to noise, changes in routine and can become anxious around lots of
people and in a loud environment. Our Sensory Garden gives children a colourful, relaxing and
stimulating play area, with scented flowers, calming music and multiple textures, while they wait for
their appointment.
A dedicated unit for patients with complex care needs was also opened this year, for those who
often need to stay in hospital for weeks or months at a time. It has six beds, a large dedicated
playroom and more space for parents and families to sit comfortably by their bedsides.
Ten-month-old Jack Mead is one of many to benefit from the new unit. Jack has a respiratory
problem called bronchomalacia and was born with his heart on the opposite side of the body, which
means he needs special equipment to help him to breathe. Jack and his family spent nine months in
hospital and experienced both the old and new complex care unit. His mum Katie said:-
The bed spaces are much bigger, which is better for patients like Jack who
need a lot of equipment. Patients and families have more privacy and it’s
great that the unit has its own playroom. It’s made our stay much more
comfortable.
Parents and young people have also been instrumental in developing our new, Lots on Your Mind
website for children and young people with mental health issues or those who may be feeling angry,
worried or bullied. The website is a one-stop-shop for children and young people to access advice on
managing their emotional wellbeing and to find out about the hospital’s Child and Adolescent
Mental Health Service (CAMHS). Parents can also benefit from information to support them in
understanding their child’s condition.
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Lots on Your Mind
Fifteen year-old CAMHS outpatient, Daniel Horton, and his mum Denise helped design the Lots on
Your Mind website. Denise said:Daniel has had lots of support from Birmingham Children’s Hospital and the
amazing care that he has received from the CAMHS team inspired him to
get involved in developing the new website. I felt it was important to
become involved as a parent representative because many parents find
themselves not knowing where to turn when their child becomes ill. The
new website offers information and advice to support parents at a
worrying and upsetting time in their lives.
Daniel said:-
When you are worried or upset, you
have lots on your mind. So I suggested
Lots on Your Mind for the name. I am
really pleased that it was chosen and I
think that the website looks great.
Elaine Kirwan, CAMHS Service Director, said:-
We were really pleased to have so many children, young people and
parents involved in helping us design our new website. The feedback
we've had has been great and we hope that it will be a valuable source
of information and support for anyone who needs it.
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Striving to Make it Even Better
Every member of staff working for Birmingham Children’s Hospital will be looking for and
delivering better ways of providing outstanding care, at better value.
At the heart of our innovation and achievements are our staff who strive to find ways to make what
they do even better.
Keen to improve their service, the nutritional care and gastroenterology teams have worked
together to find new ways of delivering special nutrition feeds to our young patients. Sometimes
children are unable to eat any or enough food because of illness. This is because their stomach or
bowel may not be working normally, or they may have had surgery to remove part or all of these
organs. Nutrition then needs to be supplied to their body through a vein – referred to as parenteral
nutrition – which is complex and must be delivered by experienced staff.
The team has developed a case for a dedicated Nutritional Support Team (NST), which will be up and
running by August 2014, to help staff deliver this both in hospital and at a patient’s home. This will
improve the quality of care, reduce clinical risk, improve the patient and family experience and
ensure that prescriptions are being ordered appropriately.
Technology has been a priority this year as we find better and more innovative ways of using it to
help us to improve what we do. Our £7m IT strategy was launched this year which sets out our
investment in technology to enhance the quality of our care and improve the way we work. Our goal
is to be paperless by 2016 with the introduction of our Paediatric Electronic Patient Record system
which will bring together clinic lists, ward lists, operation lists, inpatient lists, and activity data with
patient demographic details, tests, scans, medicines and correspondence.
This is a huge project which will also help us to communicate better with children and families by
providing direct access to information about their care. It will also help us link up with general
practitioners and other professionals more effectively to share and seek advice. The first foundation
project has been moving staff onto a digital dictation system which is already transforming what we
do.
Staff in our Kids Intensive Care and Decision Support service (KIDS) - which provides urgent
assistance to hospitals who are treating critically ill children and young people - have developed a
new system for call handling. The team relies on its 24/7 call centre systems to manage the
assessment and triage of patients between KIDS consultants and other specialists, so to make the
handling of referrals and unplanned emergency conference calls more efficient and speed up
decision-making, the team has launched its teleconferencing and call handling system – Xpert. It is
the first of its type in the NHS, and although it's early days we are confident it will really improve the
service we provide.
Research is important in finding new ways to provide outstanding care and at Birmingham Children’s
Hospital there are many expert researchers who strive to find out what treatments work and how
they can improve them. Evidence also shows that patients do better in hospitals that carry out
research – even if they don’t actually take part in a study themselves - and we are pleased to be one
of several Trusts in Birmingham that are helping spearhead a rise in clinical research.
We currently have 200 research studies underway, more than ever before, and over the last year we
have recruited roughly 2,000 children and young people to our trials. Our campaign in May, ‘It’s OK
to ask’, helped with this, empowering patients and families to speak to their doctor or nurse about
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being involved in research. This included a huge 14ft tall piece of wall art in our main hospital
corridor to promote research and the ways to get involved.
One of our cancer consultants, Frank Mussai, made a key scientific breakthrough in the fight against
leukaemia this year. His research led to the discovery that Acute Myeloid Leukaemia cells are able to
turn off the immune system and escape detection. Frank's team is now investigating how the
nutrient Arginine, which can be found in meat and milk, affects the behaviour of Acute Myeloid
Leukaemia in the blood cells. This will help doctors learn how to treat the cancer by targeting these
cells in the future.
Case Study - Ali's story
Fourteen year old Ali Zaidi has been part of a clinical trial of a new enzyme replacement drug for
five years. Ali has Morquio Syndrome, a rare inherited metabolic disorder which causes an
abnormal storage of large and complex sugar molecules within the cells of the body. This leads to
an abnormal function of several systems in the body and predominantly affects the skeletal system.
People with morquio syndrome have a severely short stature, abnormal bone structure,
progressive breathing difficulties and reduced mobility.
Ali said:-
I would definitely encourage other patients or parents to
ask their child’s doctor or nurse about being part of a
clinical trial. I can already feel the difference and the
improvements that are happening within me.
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Striving to Make it Even Better
Every member of staff working for Birmingham Children’s Hospital will be a champion for children
and young people.
As one of the UK’s leading specialist paediatric centres, we go to great lengths to target, teach,
nurture and develop the skills of our current and future workforce, to enable access to training and
education and to foster a culture of life-long learning. Our aim is to ensure that we have enough
staff who are appropriately equipped and qualified for the work they do and that they receive the
support to enable them to be true champions for children and young people day in, day out.
We continually examine our practice and look at ways to innovate and improve our services so that
our children, young people and families receive a first-class service. This was most recently
demonstrated by becoming the number one 'flu fighting' hospital in the country, proving our
commitment to protecting vulnerable patients from the virus. Our campaign featured former world
champion heavyweight boxer Evander Holyfield and was a huge success with 86% of our 2,817
frontline staff getting vaccinated. The campaign was centred around breaking flu myths with weekly
stories of brave staff who overcame their fears.
Supporting staff to do their jobs well is vital in any organisation. This year, we focussed our staff
engagement week - InTent - around 'Building Team BCH'. To develop our week of activities, we held
a number of listening events to gather the views from staff across the Trust about what’s important
to them and how the Trust can support them in their roles. We heard how important good team
work and feeling valued is to them - which became the focus for the InTent week.
During the week, our most successful yet, more than 600 staff took part in 11 workshops and four
leader’s masterclasses on teamwork with special guest speaker, Professor Michael West – an expert
in organisational psychology on a national and international health arena. We were also joined by
NHS Employers Policy Manager Steven Weeks who said that InTent was the best staff engagement
event he had ever been to.
Following this, we have launched our successful Team Maker Programme, and other team working
initiatives, based around what staff say makes a great team and a great manager. This supports our
leaders to work together with their colleagues to create better team working and find ways to
improve their working lives. Three cohorts of staff are already underway, with a further 15 groups
lined up for 2014/15. We have also delivered a number of refreshed leadership development
programmes aimed at helping both new and established managers to create the best environments
for their staff. Recruiting the best staff is critical to delivering great patient care and we attracted
over 20,000 applicants over the year, demonstrating that our hospital is a place people really want
to work.
We had the best ever response to our annual staff survey this year too. This showed, amongst many
other things, that staff feel more engaged but also feel under increased pressure since last year. We
are committed to addressing this and have already responded to support our teams in a number of
ways.
One of these is our Big White Wall health and wellbeing initiative. This is a completely anonymous
and free online mental health and emotional support service, offering self-help courses on issues
ranging from smoking cessation to managing anxiety and depression. It is also being used to access
peer and professional support, helpful information and tests. Staff relaxation classes have been
18
introduced, which have been really popular, and a number of health and wellbeing sessions took
place throughout the year to help staff to take time out.
But like many hospitals around the country, we face challenges around a national shortage of
specialist doctors, nurses and other healthcare professionals. We have continued to look at how we
can work differently and ensure we have the right skills, at the right level, to create new models of
care for our next generation.
One example has been our junior doctor workforce. Working with junior doctors we have improved
their experience through improved access to training, redesigned shift patterns, developed new
roles such as Physician Associates and increased numbers of Clinical Site Practitioners, Advanced
Clinical Practitioners and Advance Nurse Practitioners which has made us work smarter and in a
much safer way. It has been a real success, backed up by a very positive Deanery review by Health
Education West Midlands in March 2014 and we are replicating this approach in other areas.
Our staff show they are advocates for children and young people by living by our Trust values every
day - showing courage, trust, respect, compassion and commitment in all that they do. It is really
important that our staff feel valued and we recognise their achievements in a number of ways.
Hundreds of staff gathered for our annual staff recognition ceremony with over 100 doctors, nurses,
volunteers and support staff being recognised for their tireless commitment to children, young
people and families at our annual Midsummer Night of Stars ceremony in June. A record-breaking
400 staff were nominated for one of 11 awards and Professor Anita Macdonald, the UK’s first
Consultant Metabolic Dietician, received the prestigious Lifetime Achievement Award. Anita has
dedicated the last 25 years to her patients and their families, has been instrumental in practical
research and shows inspirational commitment to education and training which is improving
outcomes for children and young people with Inherited Metabolic Disorders.
We’ve seen over 400 nominations for colleagues to become Star of the Month and for another year
running, many individuals and teams have picked up national and regional awards too. Twelve new
Stars of the Month have been crowned throughout the year, including teams of nurses, doctors,
domestics and business support staff.
19
Star of the Month Winners
April
The Health Promotions Team - Jane Powell, Harriet Giles and Marzana Begum : The team was
commended for promoting health and wellbeing to staff within the Trust. They are really positive,
friendly and inspiring and their outlook shows that they really care about helping staff look at
different ways to be healthier, either by diet or exercise.
May
Lorraine Cumberlidge, Order Processor, Procurement: Always available at the end of the phone or an
email, Lorraine deals with a constant stream of enquiries calmly and patiently. She is committed to
helping with the smooth running of procurement within the Trust and she has earned the respect of
her colleagues and business associates alike with her dedication to providing an outstanding service.
June
Paul Saunders, Ward Clerk, Neonatal Surgical Ward: Paul has worked in the team for seven years in a
very demanding role, and continually proves himself to be invaluable, demonstrating all of the
Trust's values at all times. Nothing is ever too much trouble for Paul, he is well respected,
trustworthy and professional and his communication skills and compassion supports families who
are often in distressing situations.
July
Katie Owen, PICU Staff Nurse: Katie was nominated by a family who wanted to recognise her for the
way she not only cared for their son, but also showed compassion and empathy to the family and
their friends during their stay on the unit. She patiently explained every part of his treatment to
them and supported them through what was a very stressful time.
20
August
Lisa Walton, Clinical Psychologist, and Sonia Cummings, Lead Nurse, Community CAMHS: The 'Choice
and Partnership Approach' (CAPA) transformation model introduced within CAMHS has radically
reduced waiting times for the children and young people needing our CAMHS services. Without the
strong leadership, commitment, teamwork and dedication of Lisa and Sonia, the implementation of
this model would not have been as successful.
September
Peter Hodgkinson, Ocean Ward Manager, CAMHS: With 20 years under his belt with the Trust, Peter
has shown compassionate leadership and provided guidance and support to every member of his
team. Throughout the years, Peter has also demonstrated great dedication and commitment to the
children, young people and their families within his care on the ward.
October
John Sheridan, Food Service Assistant: John is very popular with staff and families and on days when
he is not at work, John's absence is noticeable. He is always professional, pleasant and helpful,
especially when parents and staff go to the conservatory to have a break during stressful and busy
times.
November
Denise Richards, Contracts Manager: Denise demonstrated extraordinary commitment to the
hospital and to her team during a very busy and difficult time. Denise’s professionalism, attitude and
approach have succeeded in building positive relationships with our Commissioners who trust her
not only to be fair but also remain patient-focussed. She shows great compassion and support to her
colleagues at all times.
December
Hollie Hastings, Facilities Manager: Hollie shows compassion to colleagues, commitment and
boundless energy and patience - from organising car park passes, to holding her colleagues hands
when they get their flu jab. Hollie has worked hard to raise the profile of the facilities team and is an
inspiration to everyone.
January
Emergency Department Team: The Emergency Department Team has undergone quite a lot of
changes to improve their working area. They have rallied round and worked hard to support each
other during some exceptionally busy and challenging times, whilst still ensuring that the children,
young people and families using our services receive safe, high quality care.
February
Muhammed Farooqi, Registrar, Oncology / Hospital at Night: Muhammed always gives 110% and has
played a leading role in the launch and roll-out of the new E-Handover system. Not only did he take
the time to fully understand the system, he encourages and helps his colleagues to use it too,
demonstrating compassion and respect towards patients and colleagues.
March
Clare Thomas, Lead Nurse, Burns Unit: Clare is caring and compassionate with everyone and is
always smiling. She is passionate about her job and provides an excellent standard of care to her
patients, sharing her best practice with colleagues across the Trust.
21
On a national level, Professor of Hepatology, Deirdre Kelly was recognised as one of the Health
Service Journal’s Top 50 Inspirational Women. The Liver Unit at Birmingham Children’s Hospital is
the leading paediatric liver unit in the world and busiest liver and small bowel transplant unit in
Europe. Professor Kelly set up the unit in 1989 and has transformed outcomes for children with liver
disease, raising the survival rate in children with liver transplants from 40% to 90%.
Our Chief Nurse, Michelle McLoughlin, also won a prestigious NHS Leadership Patient Inclusivity of
the Year Award for her commitment to improving the patient experience at the hospital, particularly
following the success of our Feedback App and new Dignity Giving Suit.
22
Shaping excellent care for tomorrow
We will strengthen Birmingham Children’s Hospital as a provider of Specialised and Highly
Specialised Services, so that we become the leading provider of children’s healthcare in the UK.
At Birmingham Children’s Hospital we have a number of specialties and nationally commissioned
services through which we see and treat young patients from across the UK.
As a specialist Burns Centre we care for lots of children and young people from across the Midlands
and UK every year. A burn injury is complex and can be particularly devastating for young people. To
find new treatments we have been working with our partners at University Hospitals Birmingham
and the University of Birmingham to launch a new £6m Centre for Burns Research, based at the
Queen Elizabeth Hospital. Reducing the impact of burn scarring is a big part of our work and this
significant development will help us to investigate how the body responds to burns injuries whilst
developing new treatments for repair in both children and adults.
We’re also the regional centre for trauma care and this year we were delighted to receive a glowing
report from an expert Peer Review panel. They reported that we have the best trauma outcomes of
all children’s hospitals in the UK, and took away lots of ideas to share with other centres.
As one of the main leading providers of rare diseases, which affect less than one in 2,000 people,
and the lead National Institute of Health Research (NIHR) site for children’s research collaboration,
we have continued to support lots of patients who need specialist care. Rare diseases are complex
and can affect children in many different ways. Because of our expertise and experience we
understand how best to care for a child or young person living with a rare disease and our clinicians
work closely to follow a whole person approach that takes into account clinical, environmental,
social and personal elements.
We have big ambitions to create a dedicated rare diseases facility at Birmingham Children's Hospital
that meet and exceed our requirements, and those of the national commissioning strategy. Our
teams of expert clinicians and researchers have been working together over the year to focus our
strategy, which will develop in 2014/15 as part of our £35m Next Generation project.
Through Birmingham Health Partners - our partnership with the University of Birmingham and
University Hospitals Birmingham - we have also been helping to develop plans for Birmingham's
Institute of Translational Medicine (ITM). The ITM will help progress the very latest scientific
research findings from the University of Birmingham into enhanced treatments for children, young
people and adults, across a range of major health conditions, such as cancer and liver disease. This
will be particularly important for our rare disease patients as they transition into adult services.
Specialist mental health care for children and young people is also a priority for us in the West
Midlands and this year we were pleased to announce a £9m redevelopment project which will vastly
improve our inpatient facility.
Parkview, our Child and Adolescent Mental Health Service (CAMHS) unit in Moseley, is one of the
largest NHS inpatient facilities in the country for children and young people. Our exciting
redevelopment work, due to start in 2014, will rejuvenate and extend the current unit, bringing
together all four inpatient wards under one roof. Staff, patients and families helped develop the
design, which will offer huge benefits to children and young people. Each will have their own bright
and airy single en-suite bedroom and there will be more communal areas and modern facilities.
23
Shaping excellent care for tomorrow
We will continue to develop Birmingham Children’s Hospital as a provider of outstanding local
services - ‘a hospital without walls’ - working in close partnership with other organisations.
Birmingham Children's Hospital has a long history in the city and is a treasured institution for many.
Our current Victorian site on Steelhouse Lane however, is no longer fit for purpose. We are growing
so fast that it cannot keep up, and although we know we need a new hospital, we must also invest in
our hospital now to see us through the next eight to 10 years. This is a key strand of our Next
Generation project which will see us develop an exciting new clinical space on our existing site, as
well as strengthening how we work with other organisations across the city.
We know that the children and young people that we look after are so much more than their illness.
We understand that the care they receive from other health professionals, the quality of their local
community, their education and their home all make a big difference to their opportunity of having
the best possible health and wellbeing. That's why we're working closely with health partners and
other colleagues across the city to support them outside of our hospital walls.
We are one of the hospitals in the successful West Midlands Collaboration for Leadership and
Applied Health Research and Care (CLAHRC), working alongside other hospitals and the universities
of Birmingham and Warwick to conduct research on the best ways to structure and deliver
healthcare. Our early research is looking at how we deliver health promotion in a hospital setting,
and how planning care can improve the experience of very sick children.
Our Hospital at Home service has continued to grow over the year. The team has been co-located on
our Paediatric Assessment Unit and works closely with all wards within the hospital helping patients
from a variety of specialties get home earlier and spend less time in our hospital. The team has
gained clinical leadership from one of the consultant general paediatricians and several new
members of nursing staff, allowing the team to go from strength to strength. The team is now
developing its next expansion plan and has several ideas for ways of helping even more children
receive care closer to home.
Children and young people with diabetes from South and Central Birmingham are continuing to
benefit from home care through our Diabetes Home Care Unit, which has just celebrated its first
year in a dedicated unit. The team works closely with nurseries and schools, providing expert advice
to regional paediatric diabetes teams and contributes to regional and national networks. It offers a
nurse-led 24/7 phone support service and weekend drop-in clinics to the 335 children and young
people with Type 1 and Type 2 diabetes, Cystic Fibrosis related diabetes and secondary diabetes
from conditions such as cancer or organ transplants, Bardet-Biedl, Alstrom and Wolfram Syndrome.
In the last year, the team has initiated three new education programmes for children of all ages with
diabetes and their families – to educate them about their condition, to support them with selfmanagement and teach them how to use insulin pumps. The training has been really well received
and is continuing to rise. The team is now looking at new ways to deliver the training in an even
more effective and innovative way.
Following a two year pilot, our Child and Adolescent Mental Health Service’s (CAMHS) Home
Treatment Team was commissioned in June 2013 to provide a lifeline to around 100 young people
who need support with anxiety, depression, healthy eating, medication management and much
more, giving the option of being treated at home instead of an inpatient psychiatric ward.
24
The Home Treatment Team is a 24-hour service, offering telephone advice and contact outside of
office hours with a trained mental health nurse. They can be visited as many as three times a day,
seven days a week if needed, to prevent them having to go into hospital. We work closely with
families to ensure that the young person’s risk is appropriately managed and that they are safe, and
as some of these young people are too unwell to attend school, we work with their school and
families to help them integrate back into their own school or facilitate a referral to our hospital
school, James Brindley, if needed.
Our networks have also strengthened throughout the year. The paediatric surgical network came
together during our staff InTent week to develop a joint vision for a surgical model for the region as
well as developments in creating a model for the future of children’s health across Birmingham.
We have appointed our first Consultant in Public Health, Dr Christopher Chiswell. As part of his role,
Chris will be helping us to increase our contribution within the local public health agenda, ensuring
that the issues facing our children and young people are prioritised. He is also supporting a number
of initiatives, including our Making Every Contact Count health promotion scheme, so that any
member of staff can point you in the right direction if today is the day you want to make a healthy
change for the better.
Chris is also working with teams across the hospital to develop our health and wellbeing strategy,
and make sure that we are a healthy place to be, for staff, patients and their families. We've also
joined the obesity steering group in Birmingham, which is looking at how we reverse a trend that
sees one in four children becoming obese by the age of 11.
We’ve worked with Birmingham Community Healthcare NHS Trust to coordinate a conference to
raise awareness of vitamin D deficiency amongst community healthcare professionals. Vitamin D is
essential for good bone development and if a child doesn't get enough, it can result in deformities
such as bowed legs, rickets, or hypocalcaemic seizures.
Birmingham is home to the country’s only free vitamin scheme for expectant and new mothers and
children under the age of four. Where the vitamin is being taken up, the scheme has proven to be
successful, but we are keen that all mothers and children take advantage of the scheme. As part of
the conference, two films have been produced for the public and health professionals, available here
[https://www.youtube.com/watch?v=8DbK1l8aZcY] and further awareness raising work will
continue into 2014/15.
25
Case Study - Increasing Vitamin D Uptake in Birmingham
Nyeisha Charlton is backing the call for greater awareness of vitamin D after her three-year-old
daughter Azaliyah suffered from rickets. She said:
By the time Azaliyah was one I
could tell she was a little bit
different. She was smaller than
other children, she wasn’t stable
on her feet and was struggling to
walk. Finding out this was caused
by a lack of vitamin D was a real
surprise as I’ve had six other
children who haven’t had any
problems at all.
Thankfully the treatment was really easy.
We gave Azaliyah vitamin D drops every
day, and after only three months she was
standing more strongly, was so much more
active and a totally different child. The
good news is we no longer have to go for
check-ups at the hospital now as she’s
developed so well. I just wish I had known
how important vitamin D was for babies
and mums and urge everyone to make the
most of this scheme and access these free
vitamins.
Nick Shaw, Consultant Endocrinologist at Birmingham Children's Hospital, said:-
It's startling to see a disease of the past making a resurgence in this day
and age. This is a wholly preventable disease, which is why it's critical
that we do all we can to raise awareness of the Universal Healthy Start
Vitamin scheme amongst mothers and health professionals so that
people in Birmingham, and across the UK, can heed this important
health advice.
26
The Impact of Fundraising
Over the past year the fundraising team has helped push boundaries and improve standards of
excellence in research, treatment and care thanks to the £5.64m it has raised - a 27% increase on
2012/13.
Every patient and family in our care will have been touched by fundraising in some way. Whether it
be a newly refurbished ward or playroom, toys donated at Christmas, or visiting our newly extended
Emergency Department. The impact of fundraising on patient experience is much more than purely
financial.
As we look to the future, we know that our supporters will become more important than ever if we
are to deliver more projects that go above and beyond.
Our highlights for the year:
•
•
•
•
Reaching the £3.5m mark in our £4m Children’ Cancer Centre Appeal. This target was
boosted by a £1m donation from Children with Cancer UK – which is the single largest
donation of the year.
Our Emergency Department underwent a £800,000 revamp and now boasts three new
cubicles, a dedicated walk in entrance, an extended waiting area and colourful new décor
and was officially opened by Top Gear presenter Richard Hammond. Almost £500,000 of this
was met by listeners of local radio station Free Radio who took part in a Walkathon.
£71,000 was raised to fund our new Sensory Garden outside the main Outpatient
department. The garden provides a calm oasis for some of our patients with learning
disabilities who find our waiting rooms noisy and uncomfortable.
General fundraising activities enabled the charity to award 25 grants this year throughout
the hospital, from £600 for a range of resources for our Autism Patients, to £5,000 to set up
a ‘Pill School’ to help teach patients to take their long term medicines.
Key facts for the year:
•
•
•
•
•
Our fundraising hub has welcomed 29,000 visitors through its doors and received over
£785,000 in donations.
Our Facebook following has grown from 4,000 to an incredible 26,000 and our ‘Princess
Poppy’ post went viral receiving 26,000 likes.
Wesleyan Assurance Society has contributed £90,000 over the last 12 months from a
combination of employee fundraising, sponsorship and activities.
One family of supporters raised a record £200,000 for our Paediatric Intensive Care Unit in
the last 12 months after their son survived major trauma.
Our Winter Ball achieved over £100,000 in pledged income in one evening.
What does the future hold for 2014/15?
•
•
•
We will continue to use our supporters’ donations to help the hospital deliver world class
treatment and improve the patient experience for children and families in our care.
The fundraising team is looking to increase our impact further with a £5.8m target in
2014/15.
Our Children’s Cancer Centre Appeal will conclude as we reach our £4m target. We hope to
see work start on the new centre in early 2015.
27
•
Over the next three years our ambition is to reach annual income of at least £10m to invest
in the latest technologies, facilities and research, which will prepare us for our largest capital
appeal to date, a new state-of-the-art children’s hospital.
We are constantly amazed and inspired by the lengths many of our supporters go to - some climb
mountains or run marathons, bake cakes or wash cars, and some give time, talent and creativity to
help us reach our goals.
So a huge thank you to all our supporters - each and every one makes a real difference to the life of
our hospital.
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Section 2
The Governance of our Organisation
29
Group Strategic Report
The Birmingham and Midland Free Hospital was founded in 1862 and moved to Steelhouse Lane in
Birmingham in 1998. The hospital Trust was granted Foundation Trust status on 1 February 2007
under the Health and Social Care (Community Health and Standards) Act 2003. The Trust also owns a
second site located at Parkview in Moseley which hosts the Child and Adolescent Mental Health
Service (CAMHS). The Trust provides services from a range of accommodation in the community and
in several partner acute organisations.
Birmingham Children’s Hospital NHS Foundation Trust provides the widest range of children’s health
services for young patients from Birmingham, the West Midlands and beyond, with over 257,000
patient visits every year. We are one of the UK’s four standalone children’s hospitals, one of 33
providers of specialised children’s services, and one of the UK’s 246 trusts providing hospital
paediatric services to the local population. We provide 11 national services, 34 services to children
and young people in the West Midlands, and general and emergency services to the south and
central population of Birmingham.
We are characterised by a unique collocation of all the services, specialist expertise and diagnostic
and treatment resources that a sick child needs. The population is characterised by diseases which
have one or more of the following characteristics: rarity, complexity, co-morbidity, unresponsiveness
to conventional therapy, age or acuity.
The Trust’s Executive Directors and Non Executive Directors in 2013/14
Ms Sarah-Jane Marsh
Chief Executive Officer (returned from maternity leave June 2013)
Mrs Michelle McLoughlin
Chief Nursing Officer
Dr Vinod Diwaker
Chief Medical Officer (sick leave from April to September 2013)
Dr Fiona Reynolds
Interim Chief Medical Officer (from April to September 2013)
Mr David Melbourne
Mr Philip Foster
Interim Chief Executive (until June 2013)
Chief Finance Officer / Deputy Chief Executive
Interim Chief Finance Officer (until June 2013)
Mr Tim Atack
Chief Operating Officer
Mrs Theresa Nelson
Chief Officer for Workforce Development
Mr Keith Lester
Professor Jon Glasby
Non Executive Director
Interim Chairman
Non Executive Director
Deputy Chairman, Engagement and Participation (until February
2014)
Senior Independent Director
Non Executive Director
Deputy Chairman, Strategy and Partnerships
Non Executive Director
Mrs Elaine Simpson
Non Executive Director
Mr Roger Peace
Non Executive Director
Mrs Judith Green
Mr Colin Horwath
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We are facing increasingly high demand for our services which means we have to continue to grow
our capacity at a rapid pace, not just by building new facilities, but also by organising ourselves
differently to improve our patient pathways. We need to redesign our workforce to use our skilled
professionals in new ways and invest in technology to enable change. If we look ahead to the next
five years, our local population is expected to grow significantly, and we will see thousands more
children every year, with even more complex conditions. Our analysis tells us our current hospital
will simply not be able to cope with this demand, so we have been developing options for a new
hospital, either at our current Steelhouse Lane site or at Edgbaston within the City.
The development of Birmingham’s first purpose-built children’s hospital is an exciting and important
step in our future strategy, but we fully recognise that 2022, the very earliest it could be built by, is
too long to wait, and it is essential that we invest in our future now, to be able to cope with our
current demand projections. For that reason, we are launching our Next Generation project in April
2014 and this will form a key element of both our operational and strategic plan for the next ten
years up until 2024.
As part of the business planning process in 2013 the Trust agreed a set of three year operational
priorities covering the period 2013-2016 and these are outlined below:
We will strengthen Birmingham Children’s Hospital’s position as a provider of Specialised and
Highly Specialised services, so that we become the leading provider of healthcare in the UK
•
•
To develop and promote our strategy for rare diseases
To be more ambitious in our delivery of specialised mental health services, ensuring children
and young people receive the best care in the best environment
Every member of staff working at Birmingham Children’s Hospital will be a champion for children
and young people
•
•
•
•
To further develop our position as an advocate and provider of public health advice, improve
the lives of our patients, and all children and young people across Birmingham
To further strengthen the voice of children and young people in how our services are run
and how we promote healthy lifestyles
To improve the quality of end of life care
To improve the life chances for young people with a learning disability by developing a range
of employment opportunities
We will continue to develop Birmingham Children’s Hospital as a provider of outstanding local
services: ‘a hospital without walls’, working in close partnership with other organisations
•
•
•
To continue to develop, with our partners, a Birmingham Children’s Network, that enables
high quality, high value health care for children and young people across Birmingham
To work with primary care partners to examine how we might come together to best
provide first line care for children and young people
To examine, with partners, how we best provide community mental health services for
children and young people, given the budget reductions expected from commissioners
31
Every child and young person requiring access to care at Birmingham Children’s Hospital will be
admitted in a timely way, with no unnecessary waiting along their pathway
•
•
To ensure that no child or young person has their appointment or operation cancelled,
unless there is unforeseen urgent clinical priority
To provide high quality consistent emergency medical and surgical care by improving the
patient journey and removing all unnecessary delays
Every child and young person cared for by Birmingham Children’s Hospital will be provided with
safe, high quality care and a fantastic patient experience
•
•
•
•
To further develop our approaches to gaining feedback from staff, children, young people
and families to ensure that their voice is heard at every level of the organisation
To further innovate our systems to promote and enhance patient safety and reduce
avoidable harm
To introduce technology to improve the service safety, quality and experience
To build an organisation of high performing teams, focussing on quality
Every member of staff working at Birmingham Children’s Hospital will be looking for, and
delivering better ways of providing care, at better value
•
•
•
To review whether we have the right people, with the right skills, undertaking key roles to
ensure we can provide high quality services within the resources available
To support and develop innovation in the delivery of care by redesigning a range of clinical
pathways
To explore how we can work with partners, to improve our commercial offer in order to
further support NHS services
Our Short-Term Strategic Analysis
Over the past year the Trust has undertaken a detailed strategic analysis to support the
development of our organisational strategy which has considered:
•
The specialist nature of the hospital and responding to the increasing centralisation of
complex services into a few national centres as part of the emerging NHS England strategy
•
Developing the local Birmingham and West Midlands acute paediatric service offer, working
closely with other local paediatric providers such as Heart of England NHS Foundation Trust
and Sandwell & West Birmingham Hospitals NHS Trust in partnership with the local
commissioners to identify how local paediatric services are best delivered
•
Extending clinical networks into the community and secondary care across the West
Midlands
•
Providing a complete service for children and young people with mental health problems
from specialist community to complex inpatient care
•
Developing and promoting our strategy for research and rare diseases in line with the UK
National Strategy
•
Improving the quality of our end of life care
32
•
Championing the health and well-being of children and young people in Birmingham, across
the West Midlands and nationally
•
The need to address capacity issues in our estate in both the short and long term
Some of the key challenges that we are facing and that have influenced the development of our
strategy in both the short and medium term are around:Demographics
National Designation
Changing Face of Secondary Care
Workforce
Policy and Finance
Clinical Service Evolution and Technology
Patient and Family Expectations
With regards to patient and family expectations, we appreciate that for children and young people
coming into hospital can be a frightening and disorientating experience. Currently much of the
hospital is based on old-fashioned Nightingale wards that offer poor privacy and space for our
patients. Upgrading to more single rooms will offer greater dignity and privacy and also allow
parents to sleep next to their children.
In terms of our workforce, healthcare is primarily a service-based industry, delivered by people. The
aim of the trust is to attract and retain the best and brightest people in what is becoming an
increasingly competitive labour market. The number of available senior doctors and nurses is
gradually decreasing and we will be competing for a diminishing pool of healthcare workers with
other children’s healthcare providers both within the UK and internationally.
Our current estate, due to ad-hoc expansion, does not provide ideal clinical adjacencies, leading to
inefficiencies for staff. In addition, the core of the estate is based in Victorian buildings and does not
have the capacity to accommodate large-scale cutting edge technology such as inter-operative MRI.
Many of the Trust’s national and international competitors are investing heavily in new
infrastructure and in order to achieve our service ambitions BCH will need to respond.
In order to develop our plan for 2014-2016 we needed to fully understand our future demand and
capacity requirements. As part of our planning we have therefore modelled the expected demand
for the next two years based on a range of indicators as outlined below:1. Demographic & Population Changes
The birth rate in the West Midlands is currently rising, and combined with the effect of migration,
urban centres including Birmingham are experiencing very rapid rises in the number of children and
young people living within them. This has a direct impact on the number of children and young
people requiring treatment, and using our services. Birmingham Children’s Hospital serves a local,
regional and national population. We recognise the differential impact of local population changes
on secondary care services, and national changes on the specialist paediatric care market.
33
Our model shows a 7.1% increase in total hospital activity by 2021 from 2013 baseline, rising to a
total increase of 8.5% by 2025. The most significant rise in volume is in the 0-4 age group, although
the largest proportional rise is in 5-9 year olds. The model also predicts a shift in length of stay, with
increasing number of admissions in ages that historically have shorter lengths of stay.
Outside of London, the West Midlands is also the most ethnically diverse region in England and
Wales. The ethnic diversity of the population has a significant impact on activity profiles due to rises
in case-mix complexity and birth rates, leading to an increase in demand and rising complications
from consanguineous relationships. Understanding the age profile and demographic of the West
Midlands population and the expected shifts over the next few years is critical for ensuring that we
predict demand.
Overall we see that demographic change alone will increase activity by an additional 1,500 bed days
by 2015, with the largest growth in paediatrics, paediatric surgery and clinical haematology and
blood/marrow transplantation.
2. Market Assessment
In addition to understanding demographic changes it is important to also consider changes linked to
market share and competition from other providers. A full market analysis of key competitors for
Birmingham Children’s Hospital has been undertaken as part of the strategic planning process.
Over the last few years Birmingham Children’s Hospital has continued to increase its overall market
share within the West Midlands region for the provision of paediatric care. Secondary care provision
of paediatrics is reducing amongst some providers, with activity shifting to specialist centres, such as
BCH, potentially as a result of the difficulty of maintaining expertise and clinically viable rotas.
We are well placed in terms of the maximising the potential opportunities that may arise from the
emerging NHS England strategy for specialised services. The strategy proposes that specialised
services are provided in centres of excellence and that the number of nationally commissioned
providers reduces significantly from the current number. This aligns well with the strategy that we
have developed and the expansion of our estate, as part of the Next Generation project, gives us the
flexibility to expand our market share as a result as the model is implemented.
3. National and Local Commissioning Priorities
It is critical that our plans are congruent with both national and local commissioning priorities and
seek to address some of the challenges that will be faced across our Local Health Economy (LHE)
during the next two years. Having an affordable and realistic financial offer from local, regional and
national commissioning bodies continues to be important for maintaining and growing market share.
We have therefore engaged through the local Joint Clinical Commissioning Group and have
presented both the long term strategic challenges and shorter term activity projections to our
commissioning partners to ensure that they are supportive of our operational planning assumptions.
4. Service Reviews and Reconfigurations
In addition to the changing commissioning architecture across the NHS outlined above there are also
a range of commissioner led initiatives that have also been considered as part of our operational
planning.
34
Next Generation Project
The issues we are facing with increasing high demand for our services means we have to continue to
grow our capacity at a rapid pace, not just by building new facilities, but also by organising ourselves
differently to improve our patient pathways. We need to redesign our workforce to use our skilled
professionals in new ways and invest in technology to enable change. For that reason, we are
launching our Next Generation project in April 2014. This project has two phases:•
Phase 1- today until 2022
•
Phase 2- our new hospital from 2022 and beyond
Planning for these will overlap, but they are part of the same ambition for children and young
people. Next Generation must not be seen as purely a buildings project as both of these phases are
about more than just bricks and mortar, and have four key components:
Patient Pathways
Better patient pathways improve patient care and help us maximise our capacity
The paths that our patients take to get to us, the way they are looked after while they're here, and
how this continues when they've gone home, is what makes their experience of care what it is. We
know that in general, our children, young people and families want to get better and get home as
soon as they can, and we work hard to make that happen.
One of our most recent improvement projects has been to our emergency care pathway. By creating
our Paediatric Assessment Unit, and Hospital at Home team, we have been able to better manage
the flow of patients into hospital beds, allowing us to care for those most in need, more quickly.
Building on this we will now focus on our current ‘hot spot’ pathways – outpatients and surgical
flows. Working with frontline staff that struggle on a daily basis to get patients in and treated, we
will determine what improvements can be made to be more efficient, and through this we know we
will be able to see patients more quickly, with fewer delays. This programme of work will form the
basis of our EQUIP work stream (Enabling Quality Improvement).
People
The best teams deliver the best results
Like many hospitals around the country we continue to face staffing challenges due to national
shortages of specialist doctors, nurses and other healthcare professionals. This is why it is more
important than ever to look at how we can work differently and ensure we have the right skills, at
the right level, rather than be fixated on old fashioned workforce models that we could never recruit
to anyway.
Training also plays a critical role in the success of our people, and amongst our ongoing training
programmes, a key area of focus will be equipping managers with the skills and knowledge to
support staff to deliver better services. Our Team Maker Programme is the cornerstone of this.
We also need to be realistic given the fact that we, and the NHS as a whole, face the biggest financial
challenge in our history and as a result it has never been more important to make every penny work
hard for us. Sometimes this is about getting the basics right and we hear about great common sense
35
ideas all the time that just need to happen. Through a Trust wide campaign we will support people
to make better use of our funding, so we can reinvest more into patient care.
We have a People Strategy that sets out our commitment and plans for developing and supporting
every member of staff to be the best they can be.
Technology
Taking the hassle out of healthcare
Technology will play a critical role in delivering our Next Generation project. We have a clear vision
and strategy for how we will use technology to enhance the quality of care we provide for children
and their families, and at the same time improve our working lives. Our goal is to go paperless, and
to do this in the next few years through Paediatric Electronic Patient Record (PEPR) programme.
PEPR will be a place which will:
•
•
•
•
Bring together integrated information to support clinicians in running their services - for
example clinic lists, ward lists, operation lists, inpatient lists, activity data
Bring together information to improve decision making and clinical care – for example
demographic details, tests, scans, medicines, correspondence within a single electronic
patient record
Help us communicate better with children and families by providing direct access to
information about care, and let them provide feedback directly to clinicians.
Help us communicate better with other healthcare professionals – general practitioners and
also other professionals who ask our advice, and from whom we ask advice.
Facilities
Great buildings support great care
Our hospital is old, cramped and restrictive, and we must look at how our existing buildings can be
remodelled and where new buildings could be built on site, to keep us going through to 2022. Our
Board has committed £35 million to developing our site, on top of the £9 million already allocated to
Parkview. The project team will develop our business case for approval by the end of 2014, with
building work due to be completed by 2016.
In December 2012 the Board reviewed the initial Strategic Outline Case (SOC) for the development
of a new children’s hospital facility in Birmingham. This was based on analysis that indicated in order
to meet demand over the medium and longer term and maintain and improve market share new
facilities would be required. In approving the case the Board recognised: •
Whilst there were two options that were feasible – develop at the back of the current city
centre site or move to Edgbaston co-located with University Hospitals Birmingham NHS
Foundation Trust, with a new joint facility with Birmingham Women’s NHS Foundation Trust,
the latter was the favoured option. This would require service reconfiguration and close
working between Birmingham Women’s Hospital NHS Foundation Trust and University
Hospitals Birmingham NHS Foundation Trust.
•
Assuming the development of a new hospital in 2022 investment was required over the
medium term to meet demand requirements. Our modelling has indicated that the Trust
would require four new theatres, additional beds and associated patient and carer facilities
(e.g. Parent accommodation).
36
We have worked with our partners since January 2013 to develop a solution in the City Centre that
will provide a legacy facility if the main hospital site is to move. Up until 2022 this will be mainly
utilised by BCH, post 2022 it will be shared by BCH and UHB providing a specialist facility and
addressing some of the access issues that were raised by commissioners during the development of
the SOC. The Trust has appointed a range of professional advisors to support the development of
this legacy solution and we would expect a business case to be submitted to the Trust Board in the
winter of 2014 with a value of £35million. We would expect a start on site in 2015 with capital
expenditure associated with the demolition of the on-site multi-storey car park where the new
clinical block is likely to be located.
We are currently exploring the funding options for this new facility – starting with a strong cash
position and £4million collected via fundraising for the children’s oncology element of the new
facility. We would expect the majority of the capital to come from these internally generated
resources but may consider a loan from the Independent Trust Financing Facility for a small element.
The Better Care Fund
In addition to the Next Generation project we are also actively engaged within our local health
economy with the Better Care Fund (BCF), which presents us with a unique opportunity to
strengthen integrated working across the region. The BCF plan requires local areas to formulate a
joint plan for integrated health and social care and to set out how their single pooled BCF budget will
be implemented to facilitate closer working between health and social care services. Work
undertaken through the development of the BCF plan for Birmingham has resulted in a shared
commitment to develop a viable health and social care system which more appropriately responds
to the needs of individuals who are vulnerable.
The programme focuses upon an aspiration to maximise the opportunities for providing quality care
including mental health in a variety of community based settings, with a focus on preventative and
proactive care, only admitting to a hospital bed when it is the right thing to do so. This means
avoiding non-qualified admissions and discharging people from acute care at the optimum time into
more appropriate alternatives.
Our Staff
As one of the UK’s leading paediatric centres we go to great lengths to target, teach, nurture and
develop the skills of our present and future workforce, to enable access to training and education
and to foster life-long learning. Our aim is to ensure that all staff are appropriately equipped and
qualified for the work they do and continue to learn and develop in their time with us. We
continually examine our practice and look at ways to innovate and improve the service we all deliver
so that our children, young people and families receive a first-class service.
The Trust's strategy is based on our mission, which is “to provide outstanding care and treatment to
all children and young people who choose and need to use our services, and to share and spread
new knowledge and practice, so we are always at the forefront of what is possible.” This is
supported by a clear set of strategic goals and our vision of being the leading provider of healthcare
to children and young people in the UK, whatever their condition and wherever they need our
expertise.
The People Strategy has been refreshed and the revised priorities are set out below:
37
Caring for our people
1. Leadership Culture & Development
• Enabling our leaders to develop compassionate leadership styles, to improve staff
engagement, wellbeing, and organisational culture, including how we manage our
‘talent’ and ensure staff are valued for their contribution
2. Wellbeing
• Development of support and self-care packages for staff health and wellbeing to reduce
stress and build resilience and further investment in wellbeing, including on-line and elearning
Managing our people
3. People systems
• Improving our people management systems & processes through better use of IT and
further enhance the workforce planning process
• Improved managers induction and tools to support them in their roles
4. Reward & recognition
• Ensuring that individual performance is clearly aligned to reward and there are
opportunities for staff to develop through clear career frameworks
• Development of clear individual and team objectives linked to Trust priorities
Developing our people
5. Workforce redesign
• Development of the clinical workforce for the future, growing new and innovative roles,
to support excellence in clinical care, as well as development of new ways of learning
6. 1:1 Support and guidance
• Further growth & development of clinical supervision, clinical team de-briefing,
coaching and mentoring, to improve evidence based practice and promote resilience
Information and Consultation
We believe that the views of our staff are fundamental when considering change in the long, short
and medium term, be it in relation to our estate, clinical services or the development of services. We
involve our staff in all decisions about our future strategy, their working environment and the
development of services.
Consultation with our staff this year led to the development of our “Building Team BCH” programme
which supports our teams to work better together. Our staff have also told us what is important in
their leaders and our newly refreshed Leadership Development programme is having really positive
results.
At a monthly Chief Executive’s Briefing, open to all staff members, the Chief Executive and other
Executive Team members and senior staff provide information to staff on significant issues and
developments in the Trust to ensure they are kept fully informed and engaged. Presentations at
Chief Executive’s Briefing between April 2013 – March 2014 have covered the following areas:
38
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Star of the Month
Irwin Unit – Eating Disorders Unit at Parkview Clinic
MCRN Young Person’s Advisory Group
Launch of the Dignity Giving Suit
Rare Diseases
POONS – Paediatric Outreach Oncology Nurse Specialists
TACTIC – Testing Appropriately at Correct time Improves Care
E-Vision at BCH
Health and Wellbeing – putting our people at the heart of what we do
Fundraising – It’s more than just the money
Safe Clinical Handover Project
InTent 2013 summary video
Rare Diseases Strategy
Parkview Redevelopment
Building Team BCH – Top 10 Team Maker Tips
Noma in Ethiopia
Public Health for Children at Birmingham Children’s Hospital
Building Team BCH – Your ‘InTent’ … Our Intent
Listening to You
Next Generation Launch
Pathway to PEPR
The Trust intranet provides a central location for a diverse and continually updated range of
information for staff, from Trust policies and guidance, to recruitment toolkits and information
about each ward and department. All presentations and videos from Chief Executive Briefings are
also available on the intranet, allowing access for staff who are unable to attend the briefing
sessions.
This year saw the launch of our Managers Brief, which is a monthly publication where we update
managers on all the issues affecting them or their staff, it includes key messages from the Chief
Executive, new developments or policy changes and has been very well received. Many teams have
used this as the basis for local briefings with their teams.
Monthly budget reports are distributed to managers and we continue to report on the financial
position of service lines with this information available to a range of staff including our joint
consultative committee meetings with our staff side organisations.
Raising Concerns at Work
Encouraging our staff to have the confidence to raise any concerns they may have at work has
continued to be of importance to us throughout 2013. To support our updated Whistle Blowing
procedures we have introduced an internal intranet page to clarify how staff can raise concerns
about work both internally and externally. We have also updated our Employment Contract to
emphasise the importance of creating an open and transparent culture with regard to raising
concerns at work. Our ‘Speak out on Safety’ campaign signposted staff to how and who they could
speak to about a concern.
Mandatory induction and refresher training for all staff includes risk management training which
encourages staff to report incidents by explaining why it is important that every incident, including
near misses, is reported. This is so that we can monitor the safety of processes, identify areas that
must be improved, and learn from our experiences.
39
In addition to encouraging staff to take part in the annual national Staff Survey, we ask clinical staff
to take part in an annual Staff Safety Survey to enable us to understand the safety culture of the
organisation and identify areas that may need development.
We have also embedded new systems especially for trainee doctors to raise concerns. Our Doctors
in Training Safety Hotline provides a mechanism for concerns about safety to be raised at an early
stage, before any harm is caused. Our Trainee Advice and Liaison Service (TALS) has been designed
to mimic our Patient Advice and Liaison Service (PALS). The aim of the service is to help resolve
issues and provide information and advice, which can include how to escalate any concerns. The
issues raised through these mechanisms are all reported in the monthly Trust Board reports.
Health & Wellbeing
We formally launched our strategy for improving the health and wellbeing of staff, children and
families. The cornerstone of the strategy is our responsibility to promote improved health outcomes
for patients. We want to be ambassadors for initiatives that reduce risk to health, and to promote
healthy lifestyles by example and through our services. In order to achieve this we must also meet
the health and wellbeing needs of our most valued resource – our staff.
We have continued to work closely with Occupational Health and Staff Support Providers to ensure
the service meets the needs of our staff.
Occupational Health Service Activity 2011/12 – 2013/14
2011/12
2012/13
2013/14
Number of Referrals
311
376
392
Number of Pre-Employment Screening Assessments
988
1277
1379
A large proportion of staff referrals to the Occupational Health Service and staff support services
during 2013/14 related to stress related sickness. In response to this, as part of our Health and
Wellbeing Strategy, we have introduced a full risk assessment process and conducted trust wide
stress audits to raise awareness and promote a more proactive approach to identifying and
supporting staff who may be vulnerable to stress at work. We have also introduced an additional
support service for staff called The Big White Wall which provides advice, guidance and support for
staff during difficult times.
In 2013/14 we repeated our previous year’s flu campaign with an aim to immunise every staff
member with the flu vaccination, with 86% of staff having had the jab we achieved the highest levels
in the whole country.
Throughout 2013/14 the Trust has focused on improving attendance at work with a combination of
early intervention programmes and facilitating return to work schemes.
In 2012, the Trust took a decision to work towards achieving an ambitious sickness absence rate of
3% or lower. At the time the average sickness absence rate for NHS organisations across England
was 4.37%. In December 2013, the average sickness absence rate for NHS originations across
England had decreased to 4.25%. Across the NHS organisations in the West Midlands region the
average sickness rate is 4.2%.
Whilst it is recognised that we have yet to achieve our ambitious internal target it is worth noting
that our Trust is well within national and regional sickness absence rates. Furthermore there are
many departments within the organisation who have consistently managed sickness absence within
the target of 3%.
40
Our sickness rate is regularly monitored and incorporated in our Resources Report and Safety
Dashboard to help us understand where there may be staff pressures and where this has the
potential to affect the quality of care.
Sickness levels – Trust-wide and directorate 2010/11 – 2013/14
2010/11
2011/12
2012/13
2013/14
Clinical Support Services
3.68%
3.30%
3.13%
3.35%
Medical
2.90%
3.81%
4.42%
4.35%
Specialised Services
4.33%
4.01%
4.00%
3.64%
Surgical
3.43%
2.98%
3.10%
2.94%
CAMHS
3.85%
4.14%
4.57%
3.31%
Corporate
3.64%
3.52%
2.95%
2.87%
Trust-wide
3.64%
3.66%
3.71%
3.48%
Directorate
The Trust takes a robust approach to monitoring sickness absence and supporting staff to be able to
undertake their role safely. It is anticipated that the prioritisation of interventions aimed at
supporting the psychological wellbeing of staff both at work and home over the previous and
forthcoming year will enable the organisation to improve attendance at work and enable attainment
of the target.
Pensions and Benefits
Accounting policies for pensions and other retirement benefits are set out in note 1.4 to the
accounts. Details of senior managers’ remuneration can be found in the Remuneration Report.
Ill health retirements and redundancies
There was one ill health retirement in 2013/14 with a value of £66k, which will be borne by the NHS
Business Services Agency (Pensions Division).
A number of redundancies occurred during the year. Details associated with these are as follows:Redundancies 2013/14
Exit Package Cost Band
Number of
Compulsory
Redundancies
2
Number of Other
Departures Agreed
0
Total Number of
Exit Packages by
Cost Band
2
£10,000-£25,000
1
0
1
£25,001-£50,000
2
1
3
£50,001-£100,000
0
0
0
£100,001-£150,000
0
0
0
£151,001-£200,000
0
0
0
Total Number of Exit Packages
5
1
6
£81,000
£29,000
£110,000
<£10,000
Total Resource Cost
41
Equal Opportunities
Our Diversity and Inclusion Strategy sets out our commitment to ensuring equality and human rights
will be taken into account in everything we do, both as an employer and a provider of healthcare.
We achieved the Personal, Fair and Diverse accreditation from NHS Employers and the
implementation of the equality delivery system is on track.
The standards laid out in our Recruitment and Selection Policy are applied to all candidates for posts
and the Trust’s Recruitment and Selection Toolkit provides advice on equal opportunities. The aim
of the policy is to ensure that all applicants who declare a disability are offered an interview if they
meet the minimum requirements for the post. Monitoring and auditing is used to help identify and
eliminate possible discrimination and to constantly improve recruitment processes.
All employees that become disabled during their employment are managed through the sickness
policy or capability policy and all efforts are made to ensure ongoing employment with reasonable
adjustments, training and career development.
Other Trust policies which ensure equal opportunities for all staff include:
•
Maternity Leave policy
•
Flexible and Family Friendly Working Policy
•
Dignity at Work Policy, which describes our processes to provide a positive working
environment with zero tolerance to bullying and harassment
Breakdown of our personnel as at 31 March 2014 :-
Directors including Non Executives
Other employees
Male
(Number)
7
Female
(Number)
4
Male
(%)
64%
Female
(%)
36%
662
2808
18%
82%
Social and Community Issues
It is our ambition to be the employer and service provider of choice and an advocate for children and
young people in Birmingham and the West Midlands. This means more than providing acute health
care. It also means taking the opportunities provided by our position in the community, and using
our specialist knowledge and skills to help improve health outcomes and future opportunities for
children and young people, whatever their ethnic, cultural or social background.
Working to meet this ambition requires us to engage with our service users and the community to
find out what they want and need. It's also important that we look to the future to make sure we are
prepared for the challenges to come over the next 20 years. As the population in Birmingham and
the West Midlands rises it is becoming increasingly diverse and the population of children and young
people is expected to rise dramatically. We need to make sure our future strategy is able to meet
the changing needs of our community.
Being a champion for children and young people is one of our strategic objectives. We believe that
developing our position as an advocate and provider of public health advice will help improve the
lives of the children and young people who use our services and who live in the West Midlands.
We have a range of initiatives that will help us meet these goals:
42
•
Our Health and Wellbeing Strategy sets out our commitment to using every opportunity to
improve the health and wellbeing of the children, young people and families we see at the
hospital. We do this through Making Every Contact Count (MECC) - an initiative that asks all
NHS staff to deliver brief healthy lifestyle advice in the right way at the right time. Over the
last year this work has been having a positive impact through supporting parents to stop
smoking, referring children to local healthy weight groups, and giving out healthy start
vitamins to prevent vitamin D deficiency.
•
Healthwatch Birmingham is a new organisation set up to provide an independent voice for
the people of Birmingham and to help shape and improve local health and social care
services. We have started working with them to ensure that young people are able to
participate.
•
Our Widening Participation Team helps us deliver our priority to improve opportunities for
our most junior members of staff by supporting them to develop their careers. The team
also works with community partners to offer apprenticeships, internships and work
experience to young people. This has been further enhanced in 2013/14 with the approval
of our unit to support employment and training for young people with a learning disability.
•
We are working with the Birmingham Muslim community to develop a wider understanding
of organ donation and have had a number of very successful events.
•
The Young Person’s Advisory Group (YPAG) is growing as an influential voice both within the
hospital and in the wider NHS community, providing views on developments to our services
and on the NHS Future Forum and NHS Constitution.
•
We are becoming a national leader in our learning disability work, particularly in
engagement with patients and families from Asian communities.
Environmental Matters
Details of the impact of the Trust’s business on the environment are set out in the Sustainability
Report.
Going concern
After making enquiries, the Directors have a reasonable expectation that we have adequate
resources to continue in operational existence for the foreseeable future. Monitor’s Risk Assessment
Framework assesses the risk to the continuity of services. Using these measures we have the lowest
level of risk with the Continuity of Service Rating reporting that we have sufficient financial
headroom and liquidity. In March the Board of Directors approved the Monitor Operational Plan
which identified that for the next 2 financial years the Trust will be reporting the lowest level of risk
for both Capital Servicing and Liquidity. Looking further ahead the Board of Directors will sign a 5
year “Declaration of Financial Sustainability” in late June as part of the Monitor Strategic Planning
process. The plan submitted for the next 2 years is based on the Trust’s downside case and since
publication there have been no events that warrant a revision of the forecast financial positions and
ratings.
For the reasons stated, the Directors continue to adopt the going concern basis in preparing the
accounts.
43
……………………………………..
Sarah-Jane Marsh
Chief Executive
44
Directors’ Report
Operating & Financial Review
With 2013/14 being another challenging period for the NHS it is pleasing that the Trust again ended
the year achieving its key financial targets and delivering another strong set of results. Given the
wider financial environment it was perhaps unrealistic to expect a performance on a par with the
preceding financial years so the surplus of £8.1m should be regarded as an excellent achievement as
we exceeded the £6.3m surplus achieved in 2012/13.
The creation of the Trust’s wholly owned subsidiary, Birmingham Children’s Hospital Services Limited
and the opening of our new Outpatient Pharmacy, The Medicine Chest, in January 2013 was a
fantastic development and 2013/14 was the first full year that this was operational. The Medicine
Chest provides an opportunity to provide cost effective specialist outpatient pharmacy services.
From a financial perspective as a fully-owned subsidiary of the Trust the performance of The
Medicine Chest has been consolidated into the overall accounts of the Trust resulting in Group
Accounts being produced for the first time. The £8.1m surplus reported above is that of the Group
with the Trust generating a surplus of £8.2m and the subsidiary a loss of £0.1m. A loss was
anticipated in the subsidiary’s first year of operation due to start-up costs.
The increased surplus was not reflected in an increase in earnings before interest, tax, depreciation
and amortisation (EBITDA) which at 6.6% for the financial year was down from 7.2% in 2012/13. This
8% decrease on 2012/13’s position is a result of:
•
•
•
•
•
•
The Trust being increasingly affected by the method of reimbursement for emergency care
for activity over a specific threshold agreed with commissioners. This activity is paid at 30%
of the national tariff and does not fully reflect the costs incurred in treating these patients.
Continued provisions set aside for the impact of workforce issues in Community CAMHS and
Junior Doctors plus new provisions for the impact of organisational change at the Trust.
The costs of providing additional capacity within the Trust outside of core working hours.
Inflation and cost pressure levels being higher than expected especially in Estates and
Utilities.
The costs of transforming services at the Trust and planning for the Next Generation project.
Continued difficulty in fully realising the cost efficiency targets.
Overall income increased by 5.6% over the past year up to £246 million. Underpinning this position
was strong growth in clinical income (up £20 million (10.1%)) on the previous year. The percentage
of total income derived through clinical activities rose for the third year running up from 87% in
2012/13 to 90% in 2013/14.
Clinical income levels were driven by increases in the mix and number of patients treated. Overall
activity was up 6.1% compared with a year ago. The table on page 46 shows the activity changes
experienced by the organisation over the past six years. On average we treated 40 more patients
every day at the Trust compared to 2012/13, the greatest increase in this six year period and almost
twice the increase experienced in 2012/13. Outpatients and Day Cases accounted for the majority of
these whilst ED attendances which exceeded 50,000 for the first time ever accounted for three extra
attendances per day.
45
Patient Activity 2008/9-2013/14:2013/14 2012/13 2011/12 2010/11 2009/10 2008/09
Revised Outpatient
Attendances
ED Attendances
Inpatient (I/P)
Admissions:
Emergency
admissions
Day-case
Admissions
Inpatient
Admisisons
Total I/P
Admissions
Total Patient
Episodes
164,370
152,820
147,276
147,292
143,291
141,088
2013/14
% change
108%
50,296
49,335
47,592
46,274
45,142
45,585
102%
15,039
14,854
13,935
14,143
11,898
11,544
101%
20,749
18,951
17,816
16,131
16,258
15,296
109%
6,719
6,491
7,532
6,809
6,385
5,980
104%
42,507
40,296
39,283
37,083
34,541
32,820
105%
257,173
242,451
234,151
230,649
222,974
219,493
106%
The increase in Outpatient attendances in 2013/14 alone mirrored the combined increase in the
previous four financial years with both new and follow-up attendances increasing.
It cost just under £236 million to run the Trust during the year; a 4.5% increase on 2012/13. The two
highest spend categories, employees and drugs, have seen increases of 1.3% and 14.0% respectively.
With 2012/13’s employee expenses including a number of high-value non-recurrent costs this
reported 1.3% increase is not representative of the 5% increase in the number of employees.
Excluding these non-recurring costs the true year on year increase is 3.9%. The cost of running the
estate has experienced a rise of 10% in 2013/14.
We employed 113 more staff at the end of March 2014 than at the beginning of April 2013, with an
average increase over the year of 151 additional staff. Doctors and nursing staff experienced yearon-year growth of 5.9% and 2.4%. The average cost of our employees was 1% less in 2013/14 than in
2012/13 which reflects the skill mix changes across the Trust arising out of key developments, such
as the expansion of the Paediatric Intensive Care Unit and the “New Ways of Working” project
following the work on Junior Doctor rotas in 2012/13 and the associated Deanery visits.
During the year we saved £5.6 million in planned cost releasing savings (£8.1 million in 2012/13),
which contributed towards the nationally determined efficiency target. This represents 66% of the
target we set at the beginning of the year (76% of the 2012/13 target was achieved). Although
£8.4m was the in-year target for 2013/14 it was the impact of the non-recurrent element of the
2012/13 programme carried forward that caused difficulties combined with the impact of increased
activity levels. It was acknowledged that 2013/14 would be a difficult year for delivering savings
whilst plans for trust-wide schemes were developed for 2014/15. We have been mindful of this as an
issue in setting our target for 2014/15 where there is a more considered mix of local and trust-wide
requirements. We improved on our system of ensuring that these cost savings did not impact on the
safety and quality of services delivered; as part of this every savings scheme was signed off by at
least two clinicians including the Chief Medical Officer as well as the Chief Nurse.
Investment in maintaining our estate and the development of new facilities and equipment
replacement is currently funded from the surpluses that we make. During 2013/14 £10.6 million was
46
invested in new capital schemes with some of these schemes due for completion during the 2014/15
financial year. The overall capital spend in the year was lower than planned as important decisions
were taken to delay the implementation of key strategic schemes and these will form the basis of
the ongoing capital programme especially as we develop the requirements of the Next Generation
project. During the course of the year it was pleasing to see the conclusion of the following schemes:
•
•
•
Emergency Department remodelling;
Refurbishment of Outpatients; and
Respiratory development.
All these developments have helped to increase the capacity of the hospital and contribute to
improving the care provided.
During the year the Trust has further developed its work looking at the provision of a new hospital to
ensure that in 10 years time the Trust continues to be in a position to deliver world class children’s
services. The analysis we have undertaken to date indicates that over the next decade the Trust will
need to develop new facilities if it is to meet the challenges of continuing to deliver high quality care.
In December 2012 the Board received the strategic outline case that presented options for the
future site of the hospital. After considering this analysis it was decided that more detailed work
should continue. This work will examine the development of a hospital on the Steelhouse Lane site
or the development of a new facility on the health campus at Edgbaston, in close proximity to
University Hospitals Birmingham NHS Foundation Trust (UHB). The option of a move to a health
campus in Edgbaston has support from the Board of Directors and other key partners including the
UHB, University of Birmingham and Birmingham Women’s Hospital NHS Foundation Trust. The next
stage of the project is to undertake a more detailed assessment through the development of an
outline business case and then ensure formal public consultation.
Our trading position is reflected in our cash balances; these have continued to improve over the
medium term such that we had £48.6 million in cash or cash equivalents at the end of the financial
year (£36.2 million in 2012/13). Despite the extensive capital programme, cash increased by £12.4
million in the year which will allow further reinvestment in 2014/15 and beyond.
Fundraising income through Birmingham Children’s Hospitals Charities increased, despite the wider
economic recession, at £5.6 million (2012/13 £3.4 million). In 2013/14 we continued the Cancer
Centre Appeal with a view to raising £4.0 million to improve the facilities for younger children
receiving treatment for cancer at the hospital. It is expected that this target will be reached during
the first half of 2014/15.
Given the growth in population, changes in medical technology and high rates of inflation compared
to that assumed in the NHS financial settlement, the Trust will have to make £28 million of savings
over the next four years. This is part of the £20 billion of efficiencies that the former NHS Chief
Executive announced would be required nationally and is reflected in Monitor’s financial
assumptions for the same period. With austerity measures due to continue to at least 2017 and with
significant cost pressures occurring in 2015/16 the Trust’s approach to cost improvements and
efficiencies has to change.
Our financial position provides a sound foundation to address the challenges resulting from the
national savings priorities. We have plans in place to achieve the majority of the required savings in
2014/15 through improving operational and management effectiveness, changing the composition
and reward of our workforce, our use of information and technology, transforming the processes
across the organisation and building on our skills and knowledge to deliver commercial success.
47
As part of this process we will continue to work in partnership with our commissioners to ensure
that children are treated in the most appropriate setting for their condition.
The Trust continues to be actively engaged with the Department of Health and Monitor on a number
of financially orientated national groups which enables it to be at the forefront of decision and policy
making.
During the year the Board approved a revised framework which complemented the existing financial
strategy of the Trust. This was termed “realising our long-term ambitions – a framework for
delivering high quality value based healthcare”.
Finance Statements
The Trust’s accounts have been prepared under a direction issued by Monitor.
The Trust has complied with the cost allocation and charging requirements set out in HM Treasury
and Office of Public Sector Information Guidance.
The Trust has complied with the requirement that the income from the provision of goods and
services for the purposes of the health service in England must be greater than the income from the
provision of goods and services for any other purposes.
Financial risk management objectives and policies
Our Finance and Resources Committee oversees the cash management and investment strategy
which is based on Monitor best practice and is reviewed by our auditors. Following the changes to
the calculation of public dividend capital all surplus cash is retained within Government Banking
Services accounts thereby negating any risk of loss through inappropriate investments. Cashflow
forecasts are updated on a weekly basis to ensure that no cashflow and liquidity risks are evident.
Looking to the future cashflow planning is undertaken for the Trust’s long-term modelling with the
risk rating impact through the Continuity of Service Risk Rating and its greater focus on liquidity now
being incorporated.
The Committee also scrutinises all our major capital investment and business cases above delegated
threshold of the Investment Committee. This scrutiny ensures such developments fall into line with
our service strategy and are affordable and provide value for money.
With the increased importance of efficiency savings the Committee has scrutinised the delivery of
the savings plan during the year to ensure that the approach does not impact on the quality of
services provided. This has extended to our Commissioners with whom our CIP Governance
Structure has been shared.
The Trust’s activities expose it to a variety of financial risks, though due to their nature the degree of
exposure is reduced compared to that faced by many business entities. The financial risks are mainly
credit and inflation risks with minimal exposure to market or liquidity risks. The nature of how the
Trust is financed exposes it to a degree of customer credit risk. The Trust regularly reviews the level
of actual and contracted activity with commissioners to ensure that any income risk is resolved at a
high level at the earliest available opportunity. The Trust mitigates its exposure to credit risk through
regular review of receivables due and by calculating a bad debt provision.
The Trust has exposure to annual price increases of medical and non-medical supplies and services
arising out of its core healthcare activities. This risk is mitigated through, for example, transferring
the risk to suppliers by contract tendering, negotiating fixed purchase costs and in the case of
external agency staff costs via the operation of the Trust’s own staff bank.
48
Details of other risks and uncertainties facing the Trust are described in the Annual Governance
Statement (Page 178)
Contractual arrangements
The organisations with whom the Trust has contractual or other arrangements which are essential to
the business of the Trust are:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Sodexo – patient, staff and visitor catering services
St Paul’s Transport – taxi service for patients, staff and light goods
B Braun Sterilog (Birmingham) Ltd – medical devices sterilisation services
AAH Pharmaceuticals Ltd – pharmaceutical wholesaler
NHS Supply Chain – procurement services
NHS Blood and Transplant – supply of blood, organs and tissue
St John’s Ambulance – PICU retrieval services
A4 MTS – non-emergency patient ambulance services
McKesson – staff payroll services
Healthcare at Home –nursing/logistics services to enable patients to receive treatments at
home
Medco Healthcare - nursing/logistics services to enable patients to receive treatments at
home
NHS Shared Business Services – supply of procurement and financial services
Newton Europe – service transformation advisors
EC Harris and Provex - advisors on the Trust’s Estate Strategy
Bupa Home Healthcare Ltd - nursing/logistics services to enable patients to receive
treatments at home
Partnerships
During 2013/14 the Trust has entered into or continued with formal arrangements with the
following organisations, which are essential to the Trust’s business:
•
Birmingham Children’s Hospital Pharmacy Limited (BCH Pharmacy). This company is a
wholly owned subsidiary of Birmingham Children’s Hospital Health Services, which is a
wholly owned subsidiary of the Trust. BCH Pharmacy is responsible for the operation of The
Medicine Chest, the new Outpatient Pharmacy located at the front of our Steelhouse Lane
site (see above)
•
Sandwell and West Birmingham Hospitals NHS Trust. This is the continued arrangement
with Sandwell and West Birmingham Hospitals NHS Trust for the provision of a joint Estates
Management Service.
•
University Hospitals Birmingham NHS Foundation Trust. The trust has entered into
discussions for the purpose of the development of a virtual healthcare campus through use
of common and linked clinical and IT systems.
49
Actions taken to make employees aware of the financial factors affecting the Trust
•
Monthly budget reports are available electronically to managers and we continue to report
on the financial position of service lines with this information available to a range of staff.
During the year we have continued to expand the use of service line financial information
and enhanced the level of information available to staff and clinicians. Localised training is
undertaken for both core financial duties and service line information.
•
The learning from the previous survey is shaping the Finance Department’s strategy and
objectives. The Finance Department has invested in the HFMA e-learning package which is
suitable for all healthcare professionals and anyone who wants to gain an awareness and
understanding about aspects of NHS Finance.
•
A survey of the Trust’s Ward Managers included specific questions around the support and
information around financial issues. This will be acted upon in the development phase of
future training programmes.
•
The Finance Department has assisted in the Trust’s Consultant Development Programme
which seeks to broaden the knowledge base of the next generation of clinical leaders at the
Trust.
•
A detailed Resources Report is contained within the monthly Public Board of Directors
papers which are available for all staff. The Resources Report is also circulated and
presented at the Trust’s Joint Consultative and Negotiation Committee.
•
The Trust’s Financial Plan for 2013/14-2015/16 was presented at the Trust’s Senior Medical
and Dental Staffing Committee.
•
One of the Finance Department’s objectives is to launch a training programme for all
managers in the Trust. Development of this programme commenced in January 2014 and
will be complete in early 2014/15.
•
The Trust’s Budget Holders took part in a national survey as part of KPMG’s Internal Audit
programme which used its client base as the baseline. The Trust scored above average in the
majority of areas with the output of this survey being used to influence the training and
reporting requirements going forward.
Policy and payment of creditors
We liaise closely with our suppliers to ensure there are no unintentional cash problems. We are
aiming to comply with the target of all payable invoices to be paid within 30 days. It is disappointing
that we have failed to meet our target of 95% during 2013/14. However, the in-year performance is
much improved on 2012/13 with an average improvement of 8% per month so we are heading in
the right direction. We did not incur any interest charges under the Late Payment of Commercial
Debts Act 1998.
50
Creditors BPPC Value % Cumulative 2012/13-2013/14:-
Counter Fraud
One of the basic principles of public sector organisations is the proper use of public funds. The
Counter Fraud service at BCH aims to prevent fraudulent activity which threatens this principle.
Informing staff of their responsibilities, encouraging them to think about how their behaviour is a
major control against fraud, and helping them spot fraud and raise concerns are at the core of
developing a counter fraud culture. This has been achieved by the inclusion of counter fraud training
at the core of our mandatory training programme, supplemented with an online learning module.
Staff have responded, telling us about concerns where they work and allowing us to tackle those
issues, investigate worries and make necessary improvements. Together with other sources of
intelligence this has helped us develop a risk-prioritised programme of fraud prevention. We aim to
build on this approach in 2014/15, creating a work plan which gets to the heart of where fraud may
be a risk in our organisation so that we can put in the necessary controls to safeguard public funds.
During the year NHS Protect undertook a focussed assessment of the Trust’s anti-fraud work. The
Trust performed well against this assessment with a number of recommendations made to improve
the Trust’s anti-fraud processes. These are being implemented during the course of the year.
51
Health and Safety Performance
The most significant risks to the non-clinical safety of our patients, staff and visitors are monitored
by our Non-Clinical Risk Coordinating Committee.
A Non-Clinical Safety Report is presented every two months to our Quality Committee to provide
assurance about what is being done to make sure our environment and practices are as safe and
secure as they can be.
In 2013/14 there have been:
•
No Dangerous Occurrences as defined in Reporting of Injuries Diseases and Dangerous
Occurrences Regulations (RIDDOR)
•
No Diseases as defined in RIDDOR
•
Two Major Injuries as defined in RIDDOR
o A member of staff tripped up steps
o A member of staff tripped and fell answering an emergency buzzer
•
No HSE improvement notices
•
No HSE prohibition notices
•
Eleven fires:
o Small Fire in wall mounted heater
o Small Fire in wall mounted fan
o Small fire involving electrical socket to washing machine
o Staff reported smell of burning caused by lighted paper in microwave
o Small fire involving heating element in oven
o Small fire in electrical switchgear
o Small Fire in accumulated rubbish outside hospital on Steelhouse Lane
o Microwave caught fire while in use
o Small fire in a roll of paper towels placed beneath food trolley heating lamps
o Small fire in medical equipment (CritiCool machine)
o Air handling unit drive belt overheating causing belt to snap
Although we report eleven fires this year compared with only two last year, this does not indicate an
increase in the number of small fires, rather a change in the definition of small fire to be consistent
with that used by the fire and rescue service.
•
One Non-Clinical Safety related Serious Incidents Requiring Investigation. A compression
flange sited on a water main ingress pipe failed. Water caused flooding in the immediate
vicinity of electrical infrastructure.
•
No non-clinical safety related Never Events.
52
Enhanced Quality Governance Reporting
Birmingham Children’s Hospital NHS Foundation Trust is continually striving to improve the quality
of the services it provides, in terms of safety, patient experience and clinical effectiveness. Quality
continues to be at the heart of our strategic objectives which ensures a constant focus on quality at
all levels of the Trust, including meetings of the Board and its committees.
Every Board meeting agenda is aligned to these strategic objectives and the Board of Directors
receives reports describing progress in and risks to achieving our goals. This includes an integrated
Quality Report, which provides an overview of the main indicators of quality across the Trust. This
includes high risks, incidents, mortality, patient experience, safeguarding and infection control, as
well as progress against our safety strategy, and quality projects such as the Safety Thermometer
and our programme of Quality Walkabouts.
This Quality Report is considered by the Board of Directors every month alongside our Resources
Report, which provides details of the Trust’s financial performance and examines the Trust’s activity
levels, access to our services and workforce indicators, such as sickness levels, turnover, and targets
for mandatory training and appraisal. This report helps the Board identify where pressures at work
may be having an impact on our staff, which could in turn impact on the quality of services.
At the beginning of 2012/13 - following an independent governance review - we established a new
committee structure, which aimed to support the Board to focus on the right things by
strengthening the committees that report to it. The Finance and Investment Committee became the
Finance and Resources Committee, with a widened remit to consider all the Trust’s resources,
including the most important – our staff. A new Quality Committee was set up which receives
information about patient safety, non-clinical safety, patient experience, staff engagement and
regulatory compliance. At each meeting the Committee undertakes a detailed review of a quality
theme identified as an area that needs greater focus.
In 2013/14 the Quality Committee considered the following themes:
• The Francis Report
• Safe Clinical Handover
• Team working for Better Patient Care
• The Berwick Report
• The Safety of the Hospital at Weekends
• Play Review
• The Ward Manager
• The Nursing Workforce
In February 2013 our Internal Auditor completed a review of the Trust’s Quality Governance
arrangements against Monitor’s Quality Governance Framework. This review found that the Trust
meets Monitor’s criteria, and provides ‘significant assurance’ that the Trust’s arrangements are
sound. A small number of areas were identified that could be improved, and we have been
implementing the recommendations of the Internal Auditor during 2013/14 so we can ensure that
our quality governance arrangements are the best they can be.
The Board Assurance Framework (BAF) provides a structure and process to enable the Board to
understand and focus on the risks to achieving the organisation’s strategic objectives and to assist
the Board in discharging its responsibility for internal control. The content of and processes
surrounding the BAF were reviewed by the Internal Auditor in 2013/14. This has provided us with
further ideas of how to improve the usefulness of the BAF as a tool to manage and monitor our
53
strategic risks. This has resulted in the construction of a new framework and a refresh of all the
strategic risks that will be incorporated into the BAF for 2014/15.
All reports to the Board and its committees detail any potential impact on compliance with the Care
Quality Commission’s (CQC) 16 core essential standards of quality and safety. This information together with the Board’s regular reviews of quality - provides an oversight of areas which might be
at risk of non-compliance with the standards.
In 2013 both the Trust’s locations, at Parkview and Steelhouse Lane, received a routine,
unannounced inspection from the CQC.
On 20, 22 and 25 of November 2013 the CQC inspected our main site at Steelhouse Lane, to assess
compliance with the following standards:
•
•
•
•
•
Care and welfare of people who use services
Cooperating with other providers
Safeguarding people who use services from abuse
Supporting workers
Assessing and monitoring the quality of service provision
The review at Steelhouse Lane found full compliance with the standards reviewed.
On 13 and 22 of August 2013 the CQC inspected our Tier 4 (inpatient) Child and Adolescent Mental
Health Service at Parkview to assess compliance with the following standards:
•
•
•
•
•
Respecting and involving people who use services
Care and welfare of people who use services
Management of medicines
Staffing
Assessing and monitoring the quality of service provision
The review of CAMHS at Parkview found two minor non compliances with the standards reviewed.
The first was in relation to ‘respecting and involving people who use services’ (Outcome 1). The CQC
found that people who used the service understood the care and treatment choices available to
them and their views and experiences were taken into account in the way the service was provided.
However, people's privacy, dignity and independence were not always respected. The inspection
also identified that young people had to ask to use toilet facilities as they were sometimes locked.
The second non compliance was in relation to ‘management of medicines’ (Outcome 9). Specifically
the inspection identified minor concerns about the management and safe storage of young people's
medicines. A compliance action was issued asking for improvements to be made. The service was
compliant against all other standards.
We have taken the following actions at Parkview to improve against these two standards:
•
A standardised care plan template for the use of non-psychiatric medicine has been devised
•
Standardised care plans as required psychiatric medicines have been developed
•
Monitoring of compliance with care plans has been built into the monthly cycle of audit of
Nursing Care Quality Indicators
•
New thermometers, recording documentation and spot checks have been introduced for drugs
fridges
54
•
Spot checks and reminders have been put in place for expired medicines
•
A consistent approach has been put into place relating to locking toilet doors which are now
only locked in exceptional circumstances, this arrangement is subject to regular spot checks
•
The Temporary Locking Policy has been updated
•
Each young person at risk of self harming has a care plan in place which includes any
environmental controls that may be required
We have had a phenomenal year for our diversity and inclusion agenda. A lot has been achieved but
we know we can do more and we are 100% committed to building on the strengths of diversity and
inclusion to make Birmingham Children’s Hospital a great place to work and be cared for. This
agenda is important in today's environment for several reasons, including an increasingly
multicultural world and recognition that different perspectives are important especially when
delivering world class healthcare.
The aims of our diversity and inclusion strategy are:•
To be the employer of choice
This aim is about making our Trust a great place to work for all staff so we can attract and retain
the very best workforce. Some of our key successes in year include:o
o
o
o
o
•
Sixth form career fair October 2013
Learning Disabilities career fair held on 23rd January 2014
The widening participation scheme continues to grow
The Health and Wellbeing steering group
Equality and Diversity Week
To meet the needs of our diverse public
This aim is about making sure our services and employees provide services to our public that
meet their individual needs. Some of our key successes in year include:o
o
o
•
Launch of our end of life care packages by our chaplaincy department to educate
and support staff and to provide them with the skills, attitude, knowledge and ethics
for Islamic End of Life Care
Launch of our Transition policy to help the process of empowering and preparing the
young person and their family rather than a ‘transfer’ to an adult hospital.
Redesign of our gowns called the Dignity Giving Suit
Ensure we meet regulatory requirements
This aim is about making sure our Trust meets and exceeds our regulatory requirements in
relation to the Equality Act, Public Duty and NHS Equality Delivery System. Some of our key
successes in year include:o
o
o
Publication of our service and workforce data in one report on our internet site
Full trust data cleanse of our workforce data
Embedding the Equality and Diversity steering group to monitor our progress
55
•
Strong corporate reputation and community profile
This aim is about making sure our Trust supports our local community and their needs to ensure
we are leading the way and setting the example. The equality and diversity agenda touches all
that we are about and all that we do. Some of our key successes in year include:o
o
o
Women in Business Toolkit launched with Birmingham Chamber of Commerce
Improved relationships with community health, local authority and third sector who
are all part of our health referral pathways
Dr Christopher Chiswell, Public Health Consultant, joined us. Chris has joined our
Equality and Diversity steering group and also chairs our Health and Well Being
group.
The Trust staff profile based on ethnicity is broadly in line with our 2012 and 2011 data. The 2011
Census indicates 57.9% of the Birmingham population is from a White ethnic origin and 42.1% from
BME. Office for National Statistics data from 2009 indicates 85.6% of the West Midlands population
is from a white ethnic origin and 14.4% from BME. This shows that there is still more work to do to
ensure that our workforce is representative of Birmingham and the patients we serve.
The age composition of our workforce has remained relatively static in comparison with our 2012
data. However we have seen a slight increase in 16-20 and over 46 year olds. With the launch of our
Youth Academy project in 2014 we hope to see further increases at 16-20 year old. This is really
important to us to ensure we have a workforce fit for the future but are also supporting young
people to secure employment in our local area.
We have seen a significant drop in 2013 of staff who were registered as ‘not declared’. This has
resulted in an increase of 1% of staff registered as ‘disabled’ to 3.64%. This is still significantly lower
than the staff survey results 2013 which indicated 18% (312 employees) of respondents had a long
standing illness, health problem or disability. This information is crucial to ensure we are an
employer of choice and support our workforce by making reasonable adjustments.
We have seen an increase in staff declaring their religion/belief across many categories compared to
2012. 44.74% of our workforce have declared themselves as Christian, this is an increase by 1.95%
from the 2012 data. We have also seen an increase in staff declaring their religions as Atheism 8.5%,
Buddhism 0.43%, Hinduism 3.07%, Islam 4.48% and Judaism 0.17%. When compared to the 2011
Census for West Midland Region we are over representative of all religious groups with the
exception of Christianity and Sikhism. Again this information is important to ensure we meet and
understand the diverse needs of our public.
The Trust is satisfied that there are no material inconsistencies between the Annual Governance
Statement, the Annual Report, the Quality Report, and the annual and quarterly Board statements
required by the Compliance Framework.
More information about quality governance and quality can be found in our Quality Report at page
101 and in the Annual Governance Statement at page 178.
Consultations
Over the past year children, young people and families have been consulted on or participated in
numerous activities. Much of the involvement of children and young people has been co-ordinated
through our young people’s participation groups.
56
Participation
We have three active groups within our trust:
1. Young Persons’ Advisory Group (YPAG). YPAG have organised and participated in a number
of important initiatives throughout the year which have included:•
The Big Discussion - a one day conference, supported by Healthwatch Birmingham,
organised in conjunction with youth members from Royal College of Paediatrics & Child
Health and the National Children’s Bureau. The event was hosted by Aled Jones from
Radio 1’s The Surgery. Maggie Atkinson, Children’s Commissioner of England, and Kath
Evans, Head of Patient Experience at NHS England, were keynote speakers. The aim of
the day was to bring young people and healthcare professionals together to discuss
issues that are important to young people around four key themes: mental health,
signposting and transition, communication and health education. It was a sell-out event
that brought a fantastic opportunity for shared learning that we hope will bring about
real change.
•
YPAG residential weekend - 11 young members of YPAG attended a residential weekend
at an outdoor activity centre in the Forest of Dean which was arranged in conjunction
with the University of the First Age (UFA). The objectives of the weekend were to
develop leadership skills and provide training in research and evaluation skills. The
weekend launched a research project to help support the Trust’s response to the report
of Robert Francis QC into the findings of his investigations into the Mid Staffordshire
NHS Foundation Trust. Feedback from the weekend was incredibly positive.
•
Presentation at the Partners in Paediatrics Annual Conference
•
Change Day 2014 – young people came in to read to patients
•
Patient Led Assessment of the Care Environment (PLACE)
•
Health Foundation visit
•
Multi-faith organ donation event
•
Young persons’ quality walkabouts
•
Tea@ – a forum facilitated by a member of the patient experience team for parents to
share their experiences in an informal setting over tea and biscuits.
2. Research YPAG. The research young persons’ group are now very well known for their
research activities. The group have contributed to international, national and local
initiatives including:•
Advising local researchers and pharmaceutical companies on the design of their trials
•
Commenting and helping to design patient information leaflets
•
Providing guidance to the National Health Research Authority
57
•
Engaging with formulations professionals in research
•
Generally raised awareness of how young people can actively contribute to research
•
Presentation of the results of YPAG research into compassion and excellent care to our
Council of Governors, Chief Executive, Chief Nurse and other staff. The presentation
was very well received and we are committed to liaising with our young people on
further research projects in the future
Research YPAG have contributed to the BCH Trust’s Research programme and have made
significant contributions to individual investigators who have sought their advice, as well as
helping the Research & Development Director develop some of the wider Trust strategic
thinking. Many researchers know little about the achievements of this group or understand
the value of involving young people in research but the group is helping to change this
mindset.
The group were also involved in the National Generation R Event in September 2013
(http://viewer.zmags.com/publication/62b8f2e9), attended by Dame Sally Davies and
assisted Dr Heather Duncan from our PICU unit with an ethics application for a large
research study that should open at BCH this year.
3. Following the successful engagement with children and young people last year in the
development of the successful CAMHS website, a young persons’ participation group has
been set up for CAMHS. Details of the activities of this group will be provided in the 2014/15
annual report.
During the year, young people have been involved in the interview process for:
•
•
•
BCH Chair
BCH Consultants (Gastroenterology, Anaesthetic & Psychiatry), clinical and other
allied health professionals
Chief Executive Officer, Healthwatch Birmingham
58
Please do extend our thanks to the young people who took part, their
comments were really very helpful and provided the adult panel with valuable
additional insight into the candidates skills and abilities. We had extremely
positive feedback from all the interviewees about the interview process
overall and about the young people’s panel in particular.
Polly Goodwin, Chair of Healthwatch Birmingham
Our children and young people have been involved in engagement projects within BCH and across
the NHS. We will continue to develop partnership working through 2014/15.
Consultations
During 2013/14, we consulted with YPAG, children, young people, patients, parents and families on:•
•
•
•
•
•
•
•
•
•
•
Changes to specialised services specifications
The development of an information DVD for cardiac services
Televisions
Equality and diversity
The development of self harm information in conjunction with the CAMHS emergency
response team
Development / improvements to the KIDS retrieval service
Epilepsy services
‘Prescribe’ - research project
‘Listening to You’ - the development of a set of resources to help parents raise concerns if
they are worried about their child’s condition
Activity books for our emergency department
Youth proofing a number of documents including psychology and neurophysiology leaflets
Nominations and presentations
We nominated YPAG for an Institute of Asian Business award in the category ‘Outstanding
Contribution to Society’ and were shortlisted. Two of our young people attended the dinner and
said they “had a lovely evening even though we didn’t win … it was a great honour to make the
shortlist of three”.
The chair of YPAG was elected as a Public Governor to our Council of Governors.
Statement as to disclosures to auditors
So far as each individual director is aware, there is no relevant audit information of which the Trust’s
auditor is unaware. Each Director has taken all the steps they ought to have taken as a Director in
order to make themselves aware of any relevant audit information and to establish that the Trust’s
auditor is aware of that information. The directors consider that the annual report and accounts,
taken as a whole, are fair, balanced and understandable and provide the information necessary for
patients, regulators and other stakeholders to assess the trust’s performance, business model and
strategy.
59
The Trust maintains a Register of Interests of Directors and Governors that may be accessed via the
Trust’s Publication Scheme available on the Trust’s website.
60
Remuneration Report (Information not subject to audit)
Appointments & Remuneration Committee
We apply the principles of good corporate governance in relation to the Directors’ remuneration
defined in the Companies Act 2006 and interpreted for NHS Foundation Trusts.
The remuneration, terms and conditions of employment of Executive Directors are determined by
the Appointments and Remuneration Committee, a committee of the Board of Directors.
In 2013/14 the Committee was chaired by the Trust’s Interim Chairman and members included two
Non-Executive Directors. The Trust’s Chief Executive Officer, Company Secretary and external
experts in matters relating to appointments and/or remuneration attend by invitation to provide
advice and assist the Committee in their consideration of matters such as benchmarking
remuneration at the Trust with other Foundation Trusts and similar external, non-NHS organisations.
Appointments & Remuneration Committee - Members' attendance 2013/14
Member
06/11/2013
Total
Keith Lester, Interim Chairman

1/1
Judith Green, Senior Independent Director

1/1
Elaine Simpson, Non-Executive Director

1/1
Roger Peace, Non-Executive Director

1/1
Through the leadership of a Non-Executive Director and member of the committee, the Trust
commissioned the services of PriceWaterhouseCoopers (PwC) to review its approach to executive
and senior management remuneration. Expressions of interest were sought from 6 companies and 5
companies tendered a proposal. From this 3 companies were selected for a formal interview. PwC
were the preferred bidder and appointed. The process was transparent and through the leadership
of the lead Non-Executive Director the committee assured itself of the independence of the award.
The fee for this piece of work was £31,000.
The Committee approved the recommendation that individual executive performance would not be
linked through remuneration, as this felt counter intuitive and would not add value to the
contribution of the executives in achieving the objectives of the Trust. The findings of the job
evaluation exercise indicated that the Deputy Chief Executive Officer & Chief Finance Officer role
required a broader range of skills than the other Executive Director roles within the Trust. It was
agreed that the Executive Directors’ pay be increased with effect from 1 December 2013.
No element of the remuneration of Executive Directors was subject to performance conditions in
2013/14, although performance is reviewed through the appraisal process. There are no non-cash
benefits or elements of remuneration that are not cash, other than the Lease Car Scheme. All
contracts are permanent with notice periods of six months.
The terms and conditions of contract and the remuneration of the Chairman and Non-Executive
Directors are determined by the Nominations Committee, a committee of the Council of Governors.
Non-Executive Directors receive no benefits or entitlements other than expenses and are not
entitled to termination payments.
The appointment of the Chairman and Non-Executive Directors can be terminated by the agreement
of the majority of the Council of Governors at a General Meeting of the Council of Governors.
61
Senior Manager Service Contracts
A senior manager is defined as an Executive or Non-Executive Director of the Board.
Senior Manager Service Contract Details
Senior Manager
Title
Date of
Contract
Unexpired
Term
Notice
Period
Term ended
January 2014
10 months
1 month
(informal)
1 month
(informal)
1 month
(informal)
Mrs Joanna Davis
Chairman
01/11/2003
Mr Keith Lester
Interim
Chairman
Deputy
Chairman
01/12/2003
Deputy
Chairman
Non- Executive
Director
Non- Executive
Director
Non- Executive
Director
Chief Executive
Officer
01/05/2008
Term ended
February
2014
1 month
01/06/2010
26 months
08/02/2012
1 month
03/07/2012
28 months
01/09/2010
Deputy Chief
Executive
Officer & Chief
Finance Officer
Chief Medical
Officer
01/11/2009
N/A Permanent
appointment
N/A Permanent
appointment
Mrs Michelle
McLoughlin
Chief Nursing
Officer
01/08/2007
Mr Tim Atack
Chief Operating
Officer
17/09/2012
Mrs Theresa
Nelson
Chief Officer for
Workforce
Development
06/06/2011
Mrs Judith Green
Mr Colin Horwath
Professor Jon
Glasby
Mrs Elaine
Simpson
Mr Roger Peace
Ms Sarah-Jane
Marsh
Mr David
Melbourne
Dr Vinod Diwakar
01/04/2006
09/10/2009
N/A Permanent
appointment
N/A Permanent
appointment
N/A Permanent
appointment
N/A Permanent
appointment
Provision for
compensation
for early
termination
None
None
None
1 month
(informal)
1 month
(informal)
1 month
(informal)
1 month
(informal)
6 months
None
6 months
None
6 months
None
6 months
None
6 months
None
6 months
None
None
None
None
None
The information in the above table is accurate as at 31 March 2014. In the following month, April 2014, 2 NonExecutive Directors, Mr Colin Horwath and Mrs Elaine Simpson, were re-appointed until 31 May 2016 and 28
February 2015 respectively.
62
Information Subject to Audit : Salary and Pension entitlements of Senior Managers
2013/14 Remuneration and Pensions Table
Name and Title
Ms Joanna Davis
Mr Keith Lester
Mrs Judith Green
Mr Colin Horwath
Professor Jon Glasby
Mrs Elaine Simpson
Mr Roger Peace
Ms Sarah-Jane Marsh
Mr David Melbourne
Dr Vinod Diwakar
Mrs Michelle McLoughlin
Mr Tim Atack
Mrs Theresa Nelson
Mr Philip Foster
Dr Fiona Reynolds
Taxable
Benefits
(bands of
£5000)
£000
(to nearest
£100)
£00
35-40
0
0
25-30
0
15-20
Notes
Chairman
Non-Executive Director/Interim
Chairman
Non-Executive Director/Deputy Chair,
Engagement and Participation
Non-Executive Director/Deputy Chair,
Strategy and Partnerships
Non-Executive Director
Non-Executive Director
Non-Executive Director
Chief Executive Officer
Chief Financial Officer and Interim /
Deputy Chief Executive
Chief Medical Officer
Chief Nursing Officer
Chief Operating Officer
Chief Officer for Workforce
Development
Interim Chief Finance Officer
Interim Chief Medical Officer
1st April 2013 to 31st March 2014
Annual
Long-term
PerformancePerformancerelated Bonus
related
Bonuses
(bands of
(bands of
£5000)
£5000)
£000
£000
Salary & Fees
Pensionrelated
Benefits
(bands of
£2500)
£000
Total
(bands of
£5000)
£000
0
0
35-40
0
0
0
25-30
0
0
0
0
15-20
15-20
0
0
0
0
15-20
2,4
10-15
10-15
10-15
120-125
0
0
0
42
0
0
0
0
0
0
0
0
0
0
0
(15.0)-(12.5)
10-15
10-15
10-15
115-120
2,8
130-135
27
0
0
15.0-17.5
155-160
2
2
2
170-175
100-105
100-105
24
50
50
0
0
0
0
0
0
22.5-25.0
2.5-5.0
7.5-10.0
195-200
110-115
115-120
2
100-105
24
0
0
5.0-7.5
110-115
7
5
35-40
40-45
0
0
0
0
0
0
32.5-35.0
125.0-127.5
70-75
165-170
965-970
217
0
0
202.5-205.0
1,190-1,195
3
6
63
Notes
1) The definition of Senior Managers includes only the Chief Officers and the Non-Executive Directors. These are the senior officers of the Trust having
Board of Director voting powers.
2) Taxable Benefit relates to lease cars and car allowances for personal vehicle use.
3) Ms Joanna Davis left the organisation on 1 February 2014.
4) Ms Sarah-Jane Marsh returned to work from maternity leave in June 2013.
5) Dr Fiona Reynolds covered the post of Chief Medical Officer during a period of sickness absence of Dr Vinod Diwakar from April 2013 until September
2013.
6) Mrs Judith Green left the organisation on 28 February 2014.
7) Mr Philip Foster was Interim Chief Finance Officer until August 2013.
8) Mr David Melbourne was Interim Chief Executive Officer during Ms Sarah-Jane Marsh’s maternity leave.
64
2012/13 Remuneration and Pensions Table
Salary & Fees
Name and Title
Notes
(bands of
£5000)
£000
Ms Joanna Davis
Mr Keith Lester
Mrs Judith Green
Mr Colin Horwath
Professor Jon Glasby
Mrs Elaine Simpson
Mr Roger Peace
Mr Zubair Khan
Ms Sarah-Jane Marsh
Mr David Melbourne
Dr Vinod Diwakar
Mrs Michelle McLoughlin
Mr Tim Atack
Mrs Theresa Nelson
Mr Philip Foster
Mr David Eltringham
Chairman
Non-Executive Director/Interim
Chairman
Non-Executive Director/Deputy Chair,
Engagement and Participation
Non-Executive Director/Deputy Chair,
Strategy and Partnerships
Non-Executive Director
Non-Executive Director
Non-Executive Director
Non-Executive Director
Chief Executive Officer
Chief Financial Officer and Interim /
Deputy Chief Executive
Chief Medical Officer
Chief Nursing Officer
Chief Operating Officer
Chief Officer for Workforce
Development
Interim Chief Finance Officer
Chief Operating Officer
1st April 2012 to 31st March 2013
Annual
Long-term
PerformancePerformancerelated Bonus
related
Bonuses
(Total to
(bands of
(bands of
£5000)
£5000)
nearest £100)
£00
£000
£000
Taxable
Benefits
Pensionrelated
Benefits
(bands of
£2500)
£000
Total
(bands of
£5000)
£000
4
40-45
0
0
0
0
40-45
5
25-30
0
0
0
0
25-30
6
15-20
0
0
0
0
15-20
7
15-20
0
0
0
0
15-20
14
13
8
15-20
10-15
10-15
10-15
135-140
0
0
0
0
32
0
0
0
0
0
0
0
0
0
0
0
0
0
0
10.0-12.5
15-20
10-15
10-15
10-15
150-155
9
125-130
27
0
0
17.5-20.0
145-150
12
160-165
95-100
50-55
24
50
4
0
0
0
0
0
0
5.0-7.5
10.0-12.5
120.0-122.5
170-175
115-120
175-180
95-100
47
0
0
0.0-2.5
105-110
35-40
40-45
0
22
0
0
0
0
102.5-105.0
15.0-17.5
140-145
60-65
925-930
206
0
0
290.0-292.5
1,235-1,240
10
11
65
Notes
1) The definition of Senior Managers includes only the Chief Officers and the Non-Executive Directors. These are the senior officers of the Trust having
Board of Director voting powers.
2) Benefit in kind relates to lease cars.
3) Other Remuneration relates to work not directly related to Chief Officer duties.
4) Ms Joanna Davis commenced sick leave on 16th April 2012.
5) Mr Keith Lester took up position as Interim Chairman from 4th July 2012.
6) Mrs Judith Green and took up position as Deputy Chair, Engagement and Participation from 4th July 2012.
7) Mr Colin Horwath took up position as Deputy Chair, Strategy and Partnerships from 4th July 2012.
8) Ms Sarah-Jane Marsh started Maternity Leave from 1st November 2012.
9) Mr David Melbourne took up position as Interim Chief Executive from 1st November 2012.
10) Mr Philip Foster took up position as Interim Chief Finance Officer from 1st November 2012.
11) Mr David Eltringham resigned his position as Chief Operating Officer from 14th September 2012.
12) Mr Tim Atack took up position as Chief Operating Officer from 17th September 2012.
13) Mr Mohammed Zubair Khan ended his term as Non Executive Director on 31st December 2012.
14) Mr Roger Peace took up position as Non Executive Director from 4th July 2012.
66
2013/14 Pensions Table
Name and Title
Ms Sarah-Jane Marsh
Mr David Melbourne
Dr Vinod Diwakar
Mrs Michelle McLoughlin
Mr Tim Atack
Mrs Theresa Nelson
Mr Philip Foster
Dr Fiona Reynolds
Notes
Chief Executive Officer
Chief Financial Officer and Interim
/ Deputy Chief Executive
Chief Medical Officer
Chief Nursing Officer
Chief Operating Officer
Chief Officer For Workforce
Development
Interim Chief Finance Officer
Interim Chief Medical Officer
2
1
Real increase/
(decrease) in pension
and related lump sum
at age 60
1st April 2013 to 31st March 2014
Total accrued
Cash
Cash
pension and
Equivalent
Equivalent
related lump
Transfer
Transfer
sum at age 60
Value at 31
Value at 31
at 31 March
March 2014
March 2013
2014
Real Increase/
(decrease) in
Cash
Equivalent
Transfer
Value
Employers
Contribution
to
Stakeholder
Pension
(bands of £2500)
£000
(bands of
£5000)
£000
To nearest
£1000
To nearest
£1000
To nearest
£1000
To nearest
£100
(15.0)-(12.5)
85-90
240
272
(32)
0
15.0-17.5
150-155
791
691
100
0
22.5-25.0
2.5-5.0
7.5-10.0
130-135
125-130
120-125
632
706
567
523
531
518
109
175
49
0
0
0
5.0-7.5
35-40
184
159
25
0
32.5-35.0
125.0-127.5
105-110
105-110
558
518
414
0
144
518
0
0
Notes
1) The Real increase in pension and related lump sum at age 60 has been compared with a zero balance last year.
2) The Real decrease in cash equivalent transfer value is due to a period of maternity leave.
As Non-Executive members do not receive pensionable remuneration, there will be no entries in respect of pensions for Non-Executive members.
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. A CETV is a payment made
by a pension scheme, or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and
chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a
67
consequence of their total membership of the pension scheme, not just their service in a senior capacity to which the disclosure applies. The CETV figures,
and from 2004-05 the other pension details, include the value of any pension benefits in another scheme or arrangement which the individual has
transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional
years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the institute and Faculty
of Actuaries.
Real Increase/(Decrease) 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 pension scheme or arrangement) and
uses common market valuation factors for the start and end of the period.
2012/13 Pensions Table
Name and Title
Ms Sarah-Jane Marsh
Mr David Melbourne
Dr Vinod Diwakar
Mrs Michelle McLoughlin
Mr Tim Atack
Mrs Theresa Nelson
Mr Philip Foster
Mr David Eltringham
Notes
Chief Executive Officer
Chief Financial Officer and Interim /
Deputy Chief Executive
Chief Medical Officer
Chief Nursing Officer
Chief Operating Officer
Chief Officer For Workforce Development
Interim Chief Finance Officer
Chief Operating Officer
1st April 2012 to 31st March 2013
Cash
Cash
Real Increase/
Equivalent
Equivalent
(decrease) in
Transfer
Transfer
Cash
Value at 31
Value at 31
Equivalent
March 2012
March 2012
Transfer
Value
Real increase/
(decrease) in
pension and
related lump
sum at age 60
Total accrued
pension and
related lump
sum at age 60
at 31 March
2013
Employers
Contribution
to
Stakeholder
Pension
(bands of
£2500)
£000
(bands of
£5000)
£000
To nearest
£1000
To nearest
£1000
To nearest
£1000
To nearest
£100
10.0-12.5
85-90
272
234
38
0
17.5-20.0
150-155
691
587
104
0
5.0-7.5
10.0-12.5
120.0-122.5
0.0-2.5
102.5-105.0
15.0-17.5
130-135
125-130
120-125
35-40
105-110
115-120
523
531
518
159
414
446
486
471
0
151
0
372
37
60
518
8
414
74
0
0
0
0
0
0
68
Expenses Paid to Directors 2013/14
Name
Total Expenses Paid on Payslips for 2013/14
Ms Joanna Davis
NIL
Mr Keith Lester
£2,423.90
Mrs Judith Green
£704.58
Mr Colin Horwath
NIL
Professor Jon Glasby
NIL
Mrs Elaine Simpson
£1,121.48
Mr Roger Peace
NIL
Ms Sarah-Jane Marsh
£22.70
Mr David Melbourne
£172.49
Dr Vinod Diwakar
NIL
Mrs Michelle McLoughlin
NIL
Mr Tim Atack
NIL
Mrs Theresa Nelson
NIL
Mr Philip Foster
£1,227.68
Mrs Fiona Reynolds
NIL
Expenses paid to Governors 2013/14
Name
Total Expenses Paid 2013/14
Mrs Karen Kelly
£166.44
Mrs Bernadette Weeks
£222.37
Median Remuneration
Reporting bodies are required to disclose the relationship between the remuneration of the highestpaid director in their organisation and the median remuneration of the organisation’s workforce.
The banded remuneration of the highest paid director at the Trust in the 2013/14 financial year was
£170,000-£175,000 (2012/13, £160,000-£165,000). This was 6.13 times (2012/13, 5.88 times) the
median remuneration of the workforce, which was £27,901 (2012/13, £27,625).
In 2013/14, 15 employees (2012/13, 15) received remuneration in excess of the highest-paid
director.
The slight increase in the ratio is a result of the remuneration of the highest paid director increasing
due to the receipt of Clinical Excellence Awards whilst the median salary has increased slightly. This
increase in the median salary is a consequence of a 1% pay award all staff received in 2013/14. The
changes in the mix of workforce reported within Note 4.2 have not impacted upon the median salary
of the Trust.
Off Payroll Engagements
The following tables outline the Trust’s position with regard to Off-Payroll Engagements during
2013/14.
69
Table 1: For all off-payroll engagements as of 31 March 2014, for more than £220 per day and that
last for longer than six months
No. of existing engagements as of 31 March 2014
0
Of which...
No. that have existed for less than one year at time of reporting.
0
No. that have existed for between one and two years at time of
reporting.
No. that have existed for between two and three years at time of
reporting.
No. that have existed for between three and four years at time of
reporting.
No. that have existed for four or more years at time
0
0
0
0
Table 2: For all new off-payroll engagements, or those that reached six months in duration,
between 1 April 2013 and 31 March 2014, for more than £220 per day and that last for longer than
six months
No. of new engagements, or those that reached six months in duration,
between 1 April 2013 and 31 March 2014
No. of the above which include contractual clauses giving the trust the
right to request assurance in relation to income tax and National
Insurance obligations
No. for whom assurance has been requested
2
0
2
Of which...
No. for whom assurance has been received
0
No. for whom assurance has not been received
2
No. that have been terminated as a result of assurance not being
received.
0
Both of the off-payroll engagements above were subject to a risk based assessment. In both cases
this has necessitated the Trust seeking confirmation that the correct amount of tax has been paid. In
both cases the individual has left the Trust with assurance continuing to be sought. Should this not
be forthcoming then the matter will be referred to the HMRC for further investigation.
Table 3: For any off-payroll engagements of board members, and/or, senior officials with
significant financial responsibility, between 1 April 2013 and 31 March 2014
No. of off-payroll engagements of board members, and/or, senior
officials with significant financial responsibility, during the financial
year.
0
70
No. of individuals that have been deemed “board members and/or
senior officials with significant financial responsibility” during the
financial year. This figure should include both off-payroll and on-payroll
engagements.
0
……………………………………
Sarah-Jane Marsh
Chief Executive
71
NHS Foundation Trust Code of Governance
Council of Governors
Constitutionally formed, the Council of Governors has the following key responsibilities:
•
Strategic – Providing advice on our general direction and ensuring that our plans assist in the
delivery of our long-term goals;
•
Guardianship – Ensuring that the Board of Directors conform to the terms of authorisation,
acting as a trustee of the Trust;
•
Advisory – Providing advice to the Board of Directors to ensure that we continue to deliver
services to meet the needs of the members, patients, parents, families and the wider local
communities.
The Council of Governors is specifically responsible for:
•
•
•
•
•
•
•
•
•
Representing the views of the members and acting as a source of information on members’
needs;
Working with the Board of Directors to inform the future strategic direction and
development plan;
Appointing (and removing) the Chairman and Non-Executive Directors;
Setting the salary levels of the Chairman and Non-Executive Directors;
Approving the appointment of the Chief Executive Officer;
Appointing the External Auditor;
Receiving copies of our annual reports, annual accounts and the External Auditor’s report;
Holding the Non-Executive Directors individually and collectively to account;
Approving any amendments to the Core Constitution.
The Board of Directors is legally accountable for the services we provide and is specifically
responsible for:
•
•
•
•
•
Setting the strategic direction (having taken into account the Council of Governors’ views);
Ensuring that clinical services provide high-quality and safe care for patients, parents and
their families;
Ensuring that governance arrangements are implemented to provide assurance that there
are safe systems of internal control in place;
Ensuring that a rigorous performance management framework is implemented which
ensures that we continue to be a high performer against national and local targets;
Ensuring that we are at all times compliant with our Terms of Authorisation.
The Constitution sets out the key responsibilities of the Board of Directors. The accountability
framework defines the committees of the Board and sets out within the approved terms of
reference the responsibilities for each of these committees. Non-Executive Directors are members
(or the Chair) of each of these committees.
Composition of the Council of Governors
The Council of Governors comprises 18 elected governors (10 public governors, one carer governor,
three patient governors and four staff governors) and nine appointed governors (from four Primary
72
Care Trusts (PCTs) and five partner organisations). The PCT and Extended Schools posts are currently
vacant as these organisations no longer exist. The Council of Governors will consider alternative
governors in 2014/15.
The Council of Governors is chaired by the Interim Chairman, Mr Keith Lester. The Vice Chair and
Lead Governor is Public Governor for Birmingham, Mr Philip Crombie.
Composition of the Council of Governors and Attendance at Meetings 2013/14
Governor
Constituency/Class
Tenure
Attendance
Zaira Akhtar
Patient
3 years from February 2014
N/A
David Akuoko
Birmingham
Term ended September 2013
1/3
Professor Ian Blair
Birmingham City University
3 years from November 2012
2/6
Hilary Brown
University of Birmingham
5/6
Iona Clayton
Birmingham
3 years from September 2013
(second term)
3 years from September 2013
Martin Cossum
Sandwell
Term ended January 2014
4/5
Philip Crombie
Birmingham
6/6
Tim Edwards
Shropshire / Staffordshire
3 years from September 2013
(third term)
3 years from April 2011
Ian Evans-Fisher
Rachel Evitts
Herefordshire /
Worcestershire
Staff – Nursing
3 years from September 2013
(second term)
3 years from September 2013
Robert Foster
Shropshire / Staffordshire
Carl Harris
Staff – Clinical
3 years from September 2011
(second non-consecutive
term)
3 years from November 2012
5/6
Chris Jones
Birmingham
3 years from March 2014
N/A
Karen Kelly
Staff – Non Clinical
3 years from September 2011
6/6
Mark Kelly
Birmingham
Resigned
Dr Michael Kuo
Staff – Medical / Dental
3 years from November 2012
4/6
Joshua Millwood
Patient
Term ended January 2014
3/5
Ellie Milner
Patient
Term ended January 2014
2/5
Jenny Robinson
Carer
Term ended September 2013
3/3
Valerie Seabright
Birmingham City Council
3 years from November 2012
4/6
Sarah Simon
Coventry / Warwickshire
Resigned
Brian Stokes
Term ended September 2013
3/3
Dr Robert Sunderland
Dudley / Walsall /
Wolverhampton
Staff – Medical / Dental
Term ended September 2013
0/3
Anthony Veal
Solihull
4/6
Elizabeth Walker
Carer
3 years from September 2013
(third term)
3 years from September 2013
Bernadette Weeks
Staff – Nursing
Term ended September 2013
2/3
Emma Wilson
Patient
Resigned March 2014
1/6
1/3
5/6
4/6
1/3
6/6
2/3
73
Timothy Wilson
Dudley / Walsall /
Wolverhampton
3 years from September 2013
3/3
Directors are invited by the Council to attend meetings of the Council of Governors to present
reports and information.
Directors’ attendance at Council of Governors Meetings
Director
Position
Attendance
Keith Lester
Interim Chairman
5/6
Professor John Glasby
Non-Executive Director
2/6
Judith Green
Non Executive Director (until February 2014)
3/6
Colin Horwath
Non-Executive Director
0/6
Roger Peace
Non-Executive Director
2/6
Elaine Simpson
Non-Executive Director
3/6
Sarah-Jane Marsh
Chief Executive Officer (from June 2013)
2/4
Tim Atack
Chief Operating Officer
4/6
Vin Diwakar
Chief Medical Officer (from September 2013)
2/3
Philip Foster
Interim Chief Finance Officer (until June 2013)
1/2
Michelle McLoughlin
Chief Nursing Officer
4/6
David Melbourne
Chief Finance Officer/Deputy CEO
5/6
Theresa Nelson
Chief Officer for Workforce Development
4/6
Council of Governors Elections 2013/14
Two elections were held during 2013/14. In Autumn 2013, seven vacant positions to the Council of
Governors were filled. In Spring 2014, two vacant positions were filled. However there were no
candidates for vacant public positions in Sandwell and Coventry/Warwickshire and only one of the
two vacant patient posts was filled.
Autumn 2013
Constituency/Class
Turnout
Successful Candidate
Public: Hereford/Worcestershire
Uncontested
Ian Evans-Fisher
Public: Solihull
Uncontested
Anthony Veal
Public: Birmingham
6.6%
Philip Crombie
Public: Birmingham
6.6%
Iona Clayton
Public: Dudley/Walsall/Wolverhampton
4.6%
Timothy Wilson
Patient/Carer:
5.4%
Elizabeth Walker
Staff: Nursing
Uncontested
Rachel Evitts
74
Spring 2014
Constituency/Class
Turnout
Successful Candidate
Patient
Uncontested
Zaira Akhtar
Public: Birmingham
8.2%
Chris Jones
Declaration of Interests of the Council of Governors
All members of the Council of Governors are required to make known at each meeting any interest
they have in the matters being discussed. They also make an annual declaration of interests which is
recorded in the Register of Interests. The Board of Directors is satisfied that the Governors hold no
material interests in organisations where those organisations or related parties are likely to do
business, or are possibly seeking to do business with Birmingham Children’s Hospital NHS
Foundation Trust.
The Register of Interests of the Council of Governors is held by the Company Secretary and can be
accessed by contacting:
The Company Secretary
Birmingham Children’s Hospital NHS Foundation Trust
Steelhouse Lane
Birmingham
B4 6NH
Relationship between the Council of Governors and the Board of Directors
Governors’ views are shared with the Board of Directors through the formal meetings of the Council,
which is chaired by the Interim Chairman, who presides over the Board of Directors. The Executive
and Non-Executive Directors are invited to attend the meetings to present reports and information.
In addition, the Council of Governors and the Board of Directors hold two joint meetings a year
where the Governors contribute to the development of the Trust’s strategic direction and vision.
Governors are also involved in the governance structure through membership of and attendance at
Board sub-committees, including the Patient Experience and Participation Committee, the Learning
Disabilities Project group and the Diversity and Inclusion Steering Group. The Organ Donation
Committee is chaired by a public governor, Mr Ian-Evans Fisher, with support from the Senior
Independent Director.
In 2013/14 the Council of Governors established a Governors Scrutiny Committee, to provide a
forum to support the Council to meet its new obligations under the Health and Social Care Act 2012,
in particular, to hold the Non-Executive Directors to account.
Board of Directors
The Board of Directors is made up of the Interim Chairman, six Non-Executive Directors and six
Executive Directors, including the Chief Executive Officer, with the Non-Executive members having
the voting majority.
All the Non-Executive Directors of the Board are considered to be independent.
The Trust also has non-voting Directors who attend the Board for the relevant agenda item to
provide operational advice and support.
75
Day-to-day management of the Trust is delegated to the Chief Executive Officer. The Chief Executive
Officer, the Chief Officers, Directors and Clinical Directors are responsible for the effective delivery
of the strategy and annual plan. They are also responsible for the operational management of the
organisation.
The appointment, length of appointment and removal of Non-Executive Directors is agreed by the
Nominations Committee and approved by the Council of Governors.
Senior Independent Director/Deputy Chairman
Mr Keith Lester was appointed Senior Independent Director in October 2008. When he was
appointed Interim Chairman in July 2012, Judith Green, another Non-Executive Director was
appointed Senior Independent Director. The principal responsibilities of the role include:
•
•
•
Representing to the Board any stakeholders’ concerns when all other communication
channels have been exhausted or are considered inappropriate;
Acting as a point of contact for Governors to raise concerns which have not been resolved or
addressed by the Chief Executive Officer or other Executive Directors;
Being available to the Governors through periodic attendance at the Council of Governors
meetings.
In 2013/14 the role of Deputy Chair has been shared between Judith Green and Colin Horwath as
follows:
•
Judith Green, Deputy Chair, Engagement & Participation: Deputy Chair of the Council of
Governors;
•
Colin Horwath, Deputy Chair Strategy & Partnerships: Deputy Chair of the Board of
Directors.
Meetings of the Board of Directors
The Board of Directors met a total 11 times in 2013/14. Individual attendance at those meetings is
set out below:Non-Executive Directors
Name
Role
To
Mr Keith
Lester
Mrs Judith
Green
Mr Colin
Horwath
Professor Jon
Glasby
Mrs Elaine
Simpson
Mr Roger
Peace
Appointment /
Reappointment date
From
Board
Attendance
Interim Chairman
July 2012
Feb 2015
11/11
Deputy Chair, Engagement &
Participation
Deputy Chair, Strategy &
Partnerships
Non-Executive Director
July 2012
10/10
May 2010
Feb 2014
(retired)
May 2014
June 2013
June 2016
8/11
Non-Executive Director
Feb 2014
Feb 2015
9/11
Non-Executive Director
April 2013
July 2016
10/11
11/11
76
Executive Directors
Name
Role
To
Ms Sarah-Jane
Marsh
Mr David
Melbourne
Dr Vinod
Diwaker
Mrs Michelle
McLoughlin
Mrs Theresa
Nelson
Mr Tim Atack
Mr Philip
Foster
Dr Fiona
Reynolds
Appointment /
Reappointment date
From
Board
Attendance
Chief Executive Officer
(returned from maternity leave
June 2013)
Chief Finance Officer / Deputy
Chief Executive
Chief Medical Officer (sick leave
April to Sept 2013)
Chief Nursing Officer
June 2009
(substantive)
Present
9/9
Nov 2009
Present
11/11
Aug 2009
Present
7/7
Aug 2007
Present
11/11
Chief Officer for Workforce
Development
Chief Operating Officer
Sept 2011
Present
11/11
Sept 2012
Present
9/11
Interim Chief Finance Officer
Nov 2012
June 2013
3/3
Interim Chief Medical Officer
April 2013
Sept 2013
4/4
Balance, Completeness and Appropriateness of the Board
The Executive Directors and Non-Executive Directors of the Board provide a balance and breadth of
knowledge, experience and skills. The Executive Directors have at a senior level considerable NHS
experience in a range of areas including medicine, nursing, strategic and operational planning,
research and workforce development. Their expertise is complemented by the Non-Executive
Directors who have extensive experience in commerce, banking, accounting, audit, research, family
law, education, marketing, social care, education and community relations. The Nominations
Committee and the Remuneration Committee consider the balance and breadth of knowledge,
experience and skills required on the Board at each appointment and reappointment of directors.
Background of Board Members
Sarah-Jane Marsh – Chief Executive Officer
Appointed :
June 2009 (returned from maternity leave June 2013)
Experience :
Sarah-Jane joined the NHS via the Graduate Management Scheme, holding
various roles in Primary and Secondary Care and at the Department of Health,
before promotion to Director of Planning and Productivity at Walsall Hospitals
NHS Trust. Appointed Chief Operating Officer at BCH in December 2007, and Chief
Executive Officer in March 2009, the Trust has been under her leadership for 5
years now. As well as her CEO role, Sarah-Jane is an active Coach, nurturing
emerging leaders from across the region. She has also recently taken up the Chair
of the West Midlands Provider CEO Group. Her special interests are quality and
service improvement, and patient, family and staff engagement.
77
Qualifications :
BA (Hons) History, MA Russian and Eastern European Studies, MSc Health Care
Management
Michelle McLoughlin – Chief Nursing Officer
Appointed :
August 2007
Experience :
Michelle is a qualified adult, community and paediatric nurse, with vast
experience of providing clinical care in a variety of acute and community
healthcare settings. Michelle joined Birmingham Children’s Hospital as a Specialist
Liaison Nurse in 1991, progressing to Chief Nursing Officer in 2007. Michelle is
also Chair of the Birmingham Health Forum, which focuses on Safeguarding in the
city; Caldicott Guardian; and professional lead for the Allied Health Professionals
and Health Care Scientists. Michelle is responsible for quality, patient experience
and participation; infection prevention and control; safeguarding and facilities.
Michelle is passionate about Patient Experience and Children and Young People
Participation, and is widely recognised as a thought leader in the field of
Children’s Nursing.
Qualifications :
MSc, RGN, RSCN, DN
Dr Vinod Diwakar – Chief Medical Officer
Appointed :
August 2009 (sick leave April to September 2013)
Experience :
Vinod has been a Consultant Paediatrician at Birmingham Children’s Hospital
since 2002, and held a variety of clinical leadership roles in medical education and
quality improvement. He was appointed as deputy Chief Medical Officer in 2007
and Chief Medical Officer in 2009. Vinod holds the following national roles: Chair
of the NHS England Paediatric Medicine Clinical Reference Group; chair of the
Acute Care subgroup of the Children and Young People’s Outcomes Forum;
Clinical Associate of the Health Foundation; Member of the Department of Health
Future Forum Expert Working Group on the NHS Constitution; CQC inspector. His
major interests are in patient safety, service and workforce redesign, healthcare
education, and policy development.
Qualifications :
MBBS, MRCP (UK), FRCPCH, MMedEd
Tim Atack – Chief Operating Officer
Appointed :
September 2012
Experience :
Tim started his career in the field of IT, working for both NHS and commercial
providers. With a growing interest in using information and IT to transform and
improve healthcare, he moved into the hospital sector, holding various roles
before becoming Director of ICT at Sandwell and West Birmingham Hospitals. In
this role he took on more development and operational responsibilities,
ultimately becoming Chief Operating Officer. Tim took a similar role in Coventry
before being appointed as the Director of Performance and ICT at Birmingham
Children’s Hospital in 2010, and was appointed as Chief Operating Officer in
September 2012. As a parent of three children who have been treated by BCH,
Tim is passionate about working smarter to improve the service to every child we
care for.
78
Qualifications :
BSc (Hons) Maths and Computing
David Melbourne – Chief Finance Officer/ Deputy Chief Executive
(Interim Chief Executive between November 2012 and June 2013)
Appointed :
November 2009
Experience :
David joined the NHS from KPMG in the late 1990s and has held a variety of Board
positions in Derbyshire, Lincolnshire and Birmingham. David joined BCH in late
2009 and his current roles include Board responsibility for finance, information
and technology, performance, fundraising, estates and capital planning. He is
Deputy Chief Executive and board member of Birmingham Children’s Trading
Limited, the wholly owned subsidiary that operates the outpatient pharmacy. He
is also a board member and chair of finance at the Health Exchange - a
community interest company that provides health advice to communities across
the West Midlands. He was selected as NHS Director of Finance of the year in
December 2011.
Qualifications :
BA (Hons) Economics and History, ACA, CPFA, MBA
Theresa Nelson – Chief Officer for Workforce Development
Appointed :
Appointed June 2011 as Director of Workforce.
Appointed as Chief Officer for Workforce Development in September 2011.
Experience :
Theresa joined the NHS in 2003 following a long career with Marks and Spencer.
She joined University Hospitals Birmingham as a HR manager and her career
developed through many senior roles including Director of HR at Good Hope
Hospital and Head of Organisational Development at Heart of England Foundation
Trust. She held a national role as Lead for Clinical Leadership at the Department of
Health and continues to champion clinical leadership through her regional lead
role for the LETB. Theresa is passionate about workforce development and getting
the best out of people through staff engagement, culture development and
coaching. She is also the LETC lead for nursing workforce planning.
Qualifications :
FCIPD; NLP Practitioner and Executive Coach
Fiona Reynolds – Interim Chief Medical Officer
Appointed :
April – September 2013 (sick leave cover for Dr Vinod Diwaker)
Experience :
Fiona joined Birmingham Children’s Hospital in 2002 as a Consultant Paediatric
Intensivist and is currently Deputy Chief Medical Officer. Fiona is chair of the
National Training Committee for Training in Intensive Care and is Clinical Lead for
the Trust’s electronic prescribing project. In 2012, Fiona led implementation of
BCH becoming a major trauma centre. Fiona’s research interests include
resuscitation and capacity modelling in PICU.
Qualifications :
BSc, MBChB, FRCA
Phil Foster – Interim Chief Finance Officer
79
Appointed :
November 2012 – June 2013
Experience :
Joined the NHS after working within private accounting practice. In over 24 years
within the NHS has worked in various senior roles within acute (district general
and specialist hospitals) and mental health services.
Qualifications :
CPFA
Keith Lester – Interim Chairman
Appointed :
February 2007- reappointed for a further three year term in February 2010, and
for a further two year term in February 2013 (Interim Chairman from July 2012
until April 2014)
Experience :
Keith is a highly experienced corporate Director and seasoned business
practitioner with over 35 years in the financial sector. Formerly Regional Director
of a major clearing bank, leading its corporate business of large private and public
companies, Keith’s particular experience is in leadership and risk management. He
has also been a business consultant and lecturer in financial management for
MBA courses at Aston University. Keith has been a non-executive Director for 10
years and brings breadth of experience including planning, organisational and
strategic skills, together with strong analytical disciplines. He has also served as
Chair of Audit Committee.
Qualifications :
AIIP, Henley Management College, Fellow of Chartered Institute of
Bankers, Associate of Institute of Directors
Roger Peace – Non Executive Director
Appointed :
July 2012 – reappointed for a further three years in April 2013
Experience :
Roger qualified as a Chartered Accountant with KPMG. From 1992 to 2005 he held
various positions with Severn Trent Plc, including Chief Financial Officer for their
environmental services division based in the US, where he helped build a $300m
division through a series of acquisitions. From 1999 to 2002 he was Managing
Director of the EMEA operations and from 2002 Sustainable Development
Director looking at growth opportunities. Roger joined Learndirect in 2005 as
Chief Financial Officer and was appointed Chief Executive in 2013, during which
time he has been responsible for the management buy-out with Lloyds
Development Capital and the subsequent merger with JHP Group Ltd. More
recently he led the successful bid for the driving theory test for the Driving
Standards Agency and the acquisition of Tabs Training Ltd.
Qualifications :
BA (Hons) Economics, MBA, FCA
Professor Jon Glasby – Non Executive Director
Appointed :
June 2010 - reappointed for a further two year term in June 2011 and for a further
three years in April 2013
Experience :
Jon is Professor of Health and Social Care and Director of the Health Services
Management Centre at the University of Birmingham. A qualified social worker
by background, he is involved in national and international research, teaching,
80
consultancy and policy advice around topics such as integrated care,
personalisation and long-term care for older people. Jon is the author of a series
of leading textbooks around health and social care, and is Editor-in-Chief of the
Journal of Integrated Care. From 2003 to 2009 he was the Secretary of State's
representative on the Board of the UK's Social Care Institute for Excellence.
Qualifications :
BA (Hons) History, MA/DipSW Social Work, PhD Social Policy, PG Cert Teaching
and Learning in Higher Education
Colin Horwath – Non Executive Director
Deputy Chairman, Strategy and Partnerships
Appointed :
May 2008 - reappointed for a further three year term in May 2011 and a further
two year term from May 2014
Experience :
Audit Partner, KPMG, with responsibility to develop public sector audit practice in
the Midlands.
Qualifications :
BSc, CIPFA, ACA, PIIA
Elaine Simpson – Non Executive Director
Appointed :
February 2012 - reappointed for a further one year term in February 2013 and a
further one year term in February 2014
Experience :
Elaine joined the Board following 25 years experience in Local Government
education, including 5 years as a Chief Education Officer, and 10 years working as
a Managing Director in the private sector. In Serco she developed and ran their
Education and Children's Services Business. She holds a range of Chair and NED
posts across the private, public and third sector. These include Chairing the
National Children's Bureau and an independent schools group. Her particular
interests are patient voice and engagement and developmental play and
education.
Qualifications :
BSc (Hons) Maths, Post-Graduate Diploma in Guidance and Counselling, PostGraduate Management Qualification
Mrs Judith Green – Non Executive Director
Deputy Chairman, Engagement & Participation/Senior Independent Director
Appointed :
February 2007- reappointed for a further three year term in February 2010 and
for a further one year term in February 2013. Retired February 2014.
Experience :
A family lawyer and a children’s advocate for 21 years. Former Member of the
Law Society Family and Children’s Panels. 12 years experience in post-graduate
education administration and a governor of three King Edward Foundation
Schools. Currently Vice-Chair of King Edward VI Camp Hill Boys School and main
Foundation Governor since 1994.
Qualifications :
BA Hons English; Solicitor
81
Evaluation of the Board of Directors
The Board of Directors has continuously reviewed its compliance with the Code of Governance and
has identified one area where it has chosen to follow a different approach to that set out by
Monitor. This relates to the recommendation that Executive Directors should be subject to review
and reappointment at regular intervals of no more than five years. We have chosen to maintain our
existing management and contractual arrangements for Executive Directors.
Directors and Governors are required on an annual basis to give a clear pledge to the code of
conduct and accountability, which encompasses the Nolan principles and Code of Governance.
Performance of the Board of Directors, its committees and individual Directors has been evaluated
in accordance with the Code of Governance. This included:
•
•
•
•
•
•
•
•
Annual appraisal and Performance Development Review for each Executive Director by the
Chief Executive (reviewed six-monthly);
Annual appraisal and Performance Development Review of Chief Executive by the Chairman
(reviewed six-monthly);
Discussion of performance of Executive Directors at Appointments and Remuneration
Committee;
Annual performance and development reviews of each Non-Executive Director by the
Chairman;
Discussion of performance of Non-Executive Directors (including the Chairman) at the
Nominations Committee;
Independent Governance Review by Capsticks and Good Governance Institute Alliance – a
review of the governance structures and information flows to the Board. This resulted in the
implementation of a new structure for 2012/13 and redesigned reporting to the Board;
Annual Review of each Board committee;
Internal Audit of quality governance arrangements.
Declarations of Interests
All members of the Board of Directors are required to make known at each meeting any interest.
This information is also recorded in the Register of Interests. The Board is satisfied the Directors hold
no material interests in organisations where those organisations or related parties are likely to do
business, or are possibly seeking to do business, with Birmingham Children’s Hospital NHS
Foundation Trust.
The Register of Interests of the Board of Directors is held by the Company Secretary and can be
accessed by contacting:
The Company Secretary
Birmingham Children’s Hospital NHS Foundation Trust
Steelhouse Lane
Birmingham
B4 6NH
82
Audit Committee
The Audit Committee provides an independent and objective review of our financial and corporate
governance, assurance processes and risk management across the whole the Trust. The
Committee:•
•
•
Provides assurance of independence for external and internal audit.
Ensures that appropriate standards are set and compliance with them is monitored.
Monitors corporate governance; e.g. compliance with the terms of the Trust’s Licence,
Constitution, Codes of Conduct, Code of Governance, standing orders, standing financial
instructions and maintenance of registers of interest.
Governance, Risk Management and Internal Control
The Committee reviews the adequacy of:
• The structures, processes and responsibilities within the Trust for identifying and managing
key risks;
• All risk and control related disclosure statements;
• The underlying assurance processes that indicate the degree of the achievement against our
corporate objectives;
• The policies for ensuring that there is compliance with relevant regulatory, legal and code of
conduct requirements;
• The operational effectiveness of relevant policies and procedures;
• The policies and procedures relating to fraud and corruption as set out in Secretary of State
Directions and as required by the NHS Counter Fraud and Security Management Service;
• Our ‘whistle blowing’ procedures to ensure that arrangements are in place for the
proportionate and appropriate investigation and follow-up of allegations;
• Our procedures for recording and reviewing staff and Board member interests in accordance
with the UK Bribery Act 2010;
• Our procedures for recording staff and Board member gifts and hospitality in accordance
with the UK Bribery Act 2010.
Internal Audit
The Audit Committee ensures that there is an effective internal audit function established by our
management that meets Government Internal Audit Standards and provides appropriate
independent assurance to the Audit Committee, Chief Executive and Board of Directors. This is
achieved by:
•
•
•
•
•
Consideration of the appointment of the internal audit service, the audit fee and any
questions of resignation and dismissal;
Review and approval of our Internal Audit strategy, operational plan and more detailed
programme of work, ensuring that this is consistent with the audit needs of the
organisation;
Consideration of the major findings of internal audit work (and management responses) and
ensuring co-ordination between the Internal and External Auditors to optimise audit
resources;
Ensuring that the Internal Audit function is adequately resourced and has appropriate
standing within the Trust;
Annual review of the effectiveness of Internal Audit.
83
We last tendered in respect of our internal auditors in 2013. We awarded a 5 year contract (3 years
with the option to extend for another 2 years). The value of internal audit services is £77,000
including VAT (£63,286 excluding VAT). Our internal auditor also provides non audit services, the
value of the non audit services provided is £73,000 including VAT.
External Audit
The Committee reviews the work and findings of the External Auditor, who are appointed by our
Council of Governors, and consider the implications of the External Auditor’s work and our response
to it.
We last tendered in respect of our external auditors in 2013. We awarded a 3 year contract with the
option to extend for a further 2 years. The value of external audit services is £76,000 including VAT.
Our external auditor also provides non audit services, the value of the non audit services provided is
£72,000 including VAT.
Other Assurance Functions
The Audit Committee reviews the findings of other significant assurance functions, both internal and
external to our organisation, and considers any implications to the governance of the Trust. These
include, but are not be limited to, consideration of any reviews by the Department of Health or
Regulators/Inspectors (e.g. Monitor, Care Quality Commission, and NHS Litigation Authority, etc.)
and professional bodies with the responsibility for the performance of staff functions (for example,
Royal Colleges, accreditation bodies etc.).
Where the External Auditor provides non-audit services, these are overseen by the Audit
Committee. The Audit Committee is assured that the External Auditor’s internal controls and
appropriate challenge by the Committee ensure that auditor objectivity and independence is
safeguarded.
Financial Reporting
The Audit Committee monitors the integrity of the financial statements of the Trust and any formal
announcements relating to the Trust’s financial performance.
The Audit Committee is chaired by Mr Colin Horwath, a Non-Executive Director. The membership
includes two other Non-Executive Directors, although we currently have a vacancy on this
committee following the retirement of Mrs Judith Green, Non Executive Director, in February 2014.
The Committee is also supported by an independent advisory member.
The Chief Finance Officer and appropriate Internal and External Audit representatives normally
attend meetings of the Committee. The Chairman of the Trust and Chief Executive are invited, and
other executive directors may be invited, to attend any meeting of the Committee, particularly when
the Committee is discussing areas of risk or operation that are the responsibility of that director.
The Chairman and Chief Executive are invited to attend at least annually, to discuss with the Audit
Committee the process for assurance.
Meetings are required to be held not less than four times a year. Members of the committee must
attend at least 4 meetings a year, but are encouraged to aim to attend all scheduled meetings. At
least once a year the Committee meets privately with the External and Internal Auditors.
The Audit Committee has met on 8 occasions during the year to carry out its duties. The 2013/14
Annual Programme of the Committee had a thematic approach to the assurance process and to
meet the requirements of the Department of Health Audit Committee checklist (designed to assess
the effectiveness of the Committee) and addressed the following key themes:
84
•
•
•
•
•
•
•
•
•
Committee Effectiveness;
Cyber Fraud;
Finance function review;
Bribery & Corruption;
Hospitality Guidance;
Board Assurance Framework;
Review of year-end statements;
Annual Accounts and Quality Report;
Finance, Performance and Workforce risks assurance.
The Committee also:
•
•
•
Received and considered reports on the work of the Local Counter Fraud Specialist;
Reviewed and approved draft Annual Accounts, Annual Governance Statement and the
Annual Report prior to adoption by the Board;
Received and considered reports from the internal and external auditors and in particular
focused on the implementation of the recommendations arising from these reports.
Audit Committee Attendance 2013/14
Member
Colin Horwath,
Chairman
Judith Green*
Non Executive
Director
Elaine
Simpson, Non
Executive
Director
April
2013
√
May
2013
√
July
2013
√
Sept
2013
√
Oct
2013
√
Dec
2013
√
Jan
2014
√
Mar
2014
√
Total
√
√
X
√
√
√
√
-
6/7
X
√
√
√
√
√
√
√
7/8
8/8
* Judith Green retired as a Non Executive Director in February 2014 and her membership of the Audit
Committee ceased from that date.
In addition, Maxine Penlington, Advisory Member, has attended 6/8 Audit meetings.
85
Nominations Committee
The Nominations Committee is a committee of the Council of Governors. The Committee is
responsible for the identification and nomination of non-executive directors (including the
Chairman), giving consideration to succession planning and the balance of skills, expertise and
experience required on the Board of Directors.
The Committee also oversees the terms and conditions of employment and remuneration of all NonExecutive Directors for the approval of the Council of Governors.
During 2013/14 the Nominations Committee made the following decisions, which were
recommended to and accepted by the Council of Governors:
1. Jon Glasby is reappointed for a three year term from 1 June 2013
2. Roger Peace is reappointed for a three year term from 25 April 2013.
3. Christine Braddock is appointed Chair / Non-Executive Director for a three year term from
May 2014.
Nominations Committee – Members’ attendance 2013/14
Apr
2013
Y
Dec
2013
Y
Total
Mr Philip Crombie, Lead Governor, Public - Birmingham
Y
Y
2/2
Mr Brian Stokes, Governor, Public – Dudley / Walsall /
Wolverhampton
Y
n/a
1/1
Mr Tim Edwards, Governor, Public – Staffordshire / Shropshire
Y
N
1/2
Ms Hilary Brown, Governor, Partner – University of
Birmingham
Y
Y
2/2
Ms Valerie Seabright, Governor, Partner – Birmingham City
Council
Y
N
1/2
Mr Ian Evans-Fisher, Governor, Public – Hereford and
Worcestershire
N
Y
1/2
Mr Keith Lester, Interim Chairman
2/2
86
Foundation Trust Membership
Eligibility Criteria
Membership of Birmingham Children’s Hospital NHS Foundation Trust is open to:
•
•
•
•
Any person who is or has been a patient/service user of Birmingham Children’s Hospital in
the last five years
Any person who is or has been a parent/carer of a patient/service user of Birmingham
Children’s Hospital in the last five years
All permanent staff members
Any member of the public aged 10 or over who lives in one of the following constituencies:
o Birmingham
o Sandwell
o Solihull
o Walsall, Wolverhampton and Dudley
o Staffordshire and Shropshire
o Coventry and Warwickshire
o Herefordshire and Worcestershire
Membership Numbers
The Trust set and achieved a target of 10,000 members by 2010/11 and aimed to sustain this level
for 2012/13 and 2013/14. The number of members in each constituency in March 2012, March 2013
and March 2014 is shown below:Membership 2012/2013/2014
Constituency
Members
31 March 2012
3,947
Members
31 March 2013
3,956
Members
31 March 2014
3,377
Total Patient/Carer
Members
Total Staff Members
4,516
4,524
4,071
2,913
3,027
3,098
GRAND TOTAL
11,376
11,507
10,546
Total Public Members
87
Membership Strategy
Our membership has fallen slightly in the past 12 months. This is, in part, due to a drive we have had
to update our database to ensure that all our members are current. However, we have not invested
as much time and energy in our membership as we would have liked over the past 12 months and
we aim to improve on this over the coming year.
We aim to increase our membership during 2014/15 by:
•
•
•
•
•
•
•
Increasing membership communication through our website and in general
Distributing regular newsletters
Encouraging young people to join the Young Person’s Advisory Group (YPAG) and thereby
become Foundation Trust members if they are not already
Demonstrating achievements of members to encourage new members to join
Supporting Governors to communicate with members and the public
Publicising ways for members to get involved, including:
o Consultations
o Council of Governors meetings
o Public Board meetings
o Celebrations
o Events
o Annual General Meeting
Encouraging members to communicate with Governors through the Trust website
Members can communicate with Governors by contacting the Chairman’s Office:
0121 333 8433
[email protected]
Birmingham Children’s Hospital NHS Foundation Trust
Steelhouse Lane
Birmingham
B4 6NH
Details of how to contact some of the Governors by direct email can also be found on the Council of
Governors page on the Trust website: www.bch.nhs.uk.
88
Regulatory Ratings
Regulatory Ratings 2012/13
Rating
Finance risk rating
Governance risk rating
Annual Plan
2012/13
4
Quarter 1
Quarter 2
Quarter 3
Quarter 4
4
4
4
4
Green
Green
Green
Green
Green
Annual Plan
2013/14
4
Quarter 1
Quarter 2
Quarter 3
Quarter 4
(predicted)
4
4
4
4
Green
Green
Regulatory Ratings 2013/14
Rating
Finance risk rating
Continuity of Service Risk
Rating
Governance risk rating
4
Green
(Amber/Green at
Q1)
Amber/
Green
Green
Explanation of the risk ratings
Monitor uses the risk ratings as a guide to the intensity of scrutiny under which we operate. At the
end of each annual assessment and quarterly review, each foundation trust receives risk ratings and
a summary of key issues to be followed up by the Board or Monitor.
The Financial and Governance risk ratings are primarily based on a defined set of indicators. Monitor
also uses other sources of information to confirm or challenge this assessment.
Monitor’s regulatory regime changed from 1 October 2013 with the implementation of the Risk
Assessment Framework. This impacted upon the metrics used to measure both the governance and
financial ratings.
Summary of Birmingham Children’s Hospital NHS Foundation Trust’s Performance in 2013/14
The Trust self-assessed itself across all ratings for each quarter. These self-assessed ratings have
been confirmed by Monitor for Quarter 1, Quarter 2 and Quarter 3. Monitor is due to report in June
on our Quarter 4 assessment and we expect this to confirm our self-assessment.
Governance
The Trust planned to be green across all the ratings for the year with the exception of Quarter One
where performance against the Referral to Treatment (RTT) 18 week target was expected to drop
below 90%. Actual performance was below 90% in Q1 triggering an Amber/Green rating. From Q2
onwards the Trust met the RTT admitted patients 18 weeks target in Q2 with a number of actions
taken to increase capacity and improve performance.
The Governance Rating is therefore predicted to be Green under the Risk Assessment Framework
which would also have been reported as Green under the previous Compliance Framework.
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Financial
Following the implementation of the Risk Assessment Framework (RAF) in 2013/14 the methodology
and metrics of the financial risk ratings used by Monitor changed in Quarter 3. In Quarter 1 and 2 the
Trust reported a Finance Risk Rating (FRR) of 4 which was per the plan and was the second lowest
level of risk. From Quarter 3 the measure was the Continuity of Service Risk Rating (CoSRR). Again
the Trust scored a 4 in both quarters which was per plan and importantly the lowest level of
reported financial risk.
The Trust’s Financial Risk rating is therefore predicted to be a 4 under the Risk Assessment
Framework and would have been a 4 under the previous Compliance Framework.
The move to the Risk Assessment Framework has had no impact upon the Trust’s Regulatory ratings.
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Staff Survey Report
Approach to Staff Engagement
Our staff are the most important part of our hospital. We cannot deliver excellence for children and
young people unless we have excellent staff. Part of our commitment to our staff is to have
excellent communication, excellent engagement and always be open to listening to new and
innovative ideas.
Our People Strategy sets out how we intend to focus on genuine engagement with our staff to
develop their support for radical service redesign and continued improvements in organisational
performance. An important element of this is the national staff survey which our staff take part in
every year. Our staff engagement score nationally has improved by 3% (3.74 to 3.84), as has our
score around motivation, training and recommendation. Our staff are also telling us that they enjoy
their roles and feel more involved in decision making.
We are still seeing a high level of staff reporting stress, pressure, harassment and bullying, and
clearly these need to be of significant focus for the next 12 months to ensure our workforce
wellbeing is supported, that we are proactive, not reactive, and are addressing staff concerns.
Retention of our workforce and ongoing attraction of highly skilled and motivated staff is essential
for the future of BCH, especially given our ambitious Next Generation plans.
Our local engagement score overall shows that 61% are positive about working at BCH, with 23%
sitting in the middle (neither agree nor disagree) and 16% giving negative feedback.
We have work to do to:
•
•
•
Maintain the engagement of those that are positive
Encourage our less engaged staff to become more positive
Find out how to help those giving negative feedback to feel more positive
From the assessment of the results, we have identified there are three key themes that we should
focus on for the coming 12 months. These are:
•
•
•
Staff wellbeing (especially mental health and stress)
Promoting positive behaviours both from staff and patients and families
Further build on our Team working programmes
Survey Plans 2014/15
Moving forward we will be surveying our staff more regularly with the introduction of the Friends
and Family Test for staff which is a national initiative, as well as our local questions. This will provide
an opportunity for staff to feedback their views about the hospital.
Friends and Family Test for Staff Questions:
• How likely are you to recommend Birmingham Children’s Hospital to friends and family if
they needed care or treatment?
• How likely are you to recommend Birmingham Children’s Hospital to friends and family as a
place to work?
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BCH Local Questions:
•
•
•
•
•
•
•
At BCH I feel I am motivated to do a great job
I regularly get feedback and feel appreciated for what I do
I understand how what I do contributes to achieving BCH objectives and priorities
I feel encouraged and able to put forward ideas that help improve quality and safety
The team I work with make my working life enjoyable
My manager shows genuine care about my health and wellbeing
I feel I am shown respect by everyone I work with
Survey Plans 2014/15
Quarter 1
(Apr – Jun 14)
Friends and Family
Test for Staff
(Full)
Quarter 2
(Jul – Sep 14)
Friends and Family
Test for Staff & Local
Questions
(Full)
Quarter 3
(Oct-Dec 14)
National Staff
Survey
Quarter 4
(Jan – Mar 15)
Friends and Family
Test for Staff & Local
Questions
(Full)
(Sample)
Summary of 2013/14 performance
N.B. national average is the average of specialist acute trusts, not all trusts.
Staff Survey 2013 – Response Rate
Response Rate
2013 National
Average
49%
2013 Results
2012 Results
59%
46%
Variance 20122013
+13%
Staff Survey 2013 – Most Improved Scores
Most Improved
Where we improved the most compared to
2012
KF26. Percentage of staff having equality and
diversity training in last 12 months
KF10. Percentage of staff receiving health
and safety training in last 12 months
KF25. Staff motivation at work
2013
National
Average
66%
2013
Results
2012
Results
66%
45%
Variance
20122013
+21%
77%
76%
65%
+11%
3.91
3.83
3.73
+0.10
2013
Results
2012
Results
24%
19%
Variance
20122013
+5%
Staff Survey 2013 – Least Improved Scores (*lower the score the better)
Least Improved
Where we are least improved compared to
2012
*KF18. Percentage of staff experiencing
harassment, bullying or abuse from patients,
relatives or the public in last 12 months
2013
National
Average
21%
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Staff Survey 2013 – Highest Ranking Scores
Highest Ranking
Where we ranked the highest against other
acute specialist trusts in England
KF6. Percentage of staff receiving jobrelevant training, learning or development in
last 12 months
KF14. Percentage of staff reporting errors,
near misses or incidents witnessed in the last
month
KF21. Percentage of staff reporting good
communication
between
senior
management and staff
KF22. Percentage of staff able to contribute
towards improvements at work
KF26. Percentage of staff having equality and
diversity training in last 12 months
2013
National
Average
81%
2013
Results
2012
Results
81%
81%
Variance
20122013
=
92%
92%
93%
-1%
35%
34%
29%
+5%
72%
72%
67%
+5%
66%
66%
45%
+21%
Staff Survey 2013 – Lowest Ranking Scores (*lower the score the better)
2013
National
Average
2.85
2013
Results
2012
Results
3.07
3.05
Variance
20122013
+0.02
KF4. Effective team working
3.81
3.72
3.77
-0.05
*KF11. Percentage of staff suffering workrelated stress in last 12 months
*KF13. Percentage of staff witnessing
potentially harmful errors, near misses or
incidents in last month
*KF20. Percentage of staff feeling pressure in
last 3 months to attend work when feeling
unwell
34%
40%
43%
-3%
30%
35%
30%
+5%
24%
29%
30%
-1%
Lowest Ranking
Where we compared least favourably against
other acuter specialist trusts in England
*KF3. Work pressure felt by staff
Action Plans for Improvement, Future Priorities and Targets
We have identified further themes for improvement from the 2013 Staff Survey and plan to take the
actions described below.
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Staff Survey Improvement Plan 2013:-
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Sustainability Report
Introduction and Commitment
Birmingham Children’s Hospital NHS Foundation Trust is committed to reducing its impact on the
environment. We recognise our environmental obligations and are committed to delivering carbon
savings.
The Trust is working towards embedding sustainability into all aspects of service delivery and
development - ensuring it sits alongside quality of patient experience, effectiveness of services and
safety for patients and staff. We are working to reduce carbon emissions and improve our
environmental sustainability. We are currently working to refresh our sustainability strategy.
Energy
The Trust’s total energy consumption for 2013/14 is estimated at 25,277.34 MWh. This is a
reduction of 7,078 MWh from the previous financial year (2012/13).
Total energy consumption 2010/11 – 2013/14 (MWh)*
2010/11
2011/12
2012/13
2013/14
Oil
18.03
71.51
226.80
-
Gas
16,637.75
13,247.72
22,035.02
15,141.43
Electricity
7,518.36
7,238.90
10,044
10,085.91
TOTALS
24,174.14
20,558.13
32,305.37
25,227.34
*Some of the data for energy has been estimated as at the time of compiling this report the data is
not yet available from suppliers.
As part of our commitment to reduce carbon emissions, we installed a Combined Heat and Power
(CHP) plant which has been in operation since September 2010. The CHP generates most of the
electricity, hot water and heating required at our Steelhouse Lane site. In 2013/14, the CHP plant
generated 12,089 MWh of heat and 9,617 MWh of electricity. This equates to around 90% of the
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total heat and 100% of the electricity demand at the Steelhouse Lane site. In addition to the CHP
plant, the Trust has made arrangements to purchase electricity generated from renewable sources
via the GPS energy procurement service.
The Trust’s energy costs have reduced from the previous financial year (2012/13).
*Some of the data for energy has been estimated as at the time of compiling this report the data is not yet
available from suppliers.
Water
Water consumption has increased over the last three years. The graph below shows our water
consumption trends for 2011/12 to 2013/14.
*Some of the data for water has been estimated as at the time of compiling this report the data is not yet
available from suppliers.
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Waste
The Trust has reduced the amount of general waste sent to landfill by 87 tonnes and increased the
amount of general waste that is sent for recycling by 60 tonnes. The graph below shows the volume
of waste generated by treatment type for 2011/12 to 2013/14.
Waste generation (tonnes) by treatment type 2011/12 to 2013/14:-
Carbon Emissions
A sustainable, low carbon NHS offers an opportunity to save money while helping to create a quality
resilient healthcare service.
A large proportion of the Trust’s carbon emissions derive from energy consumption, water and
waste.
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Carbon Emissions 2011/12 to 2013/14 for energy consumption:-
Carbon emissions for 2011/12 to 2013/14 from water consumption:-
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Carbon emissions for 2011/12 to 2013/14 from waste by treatment type:-
Carbon Reduction Commitment (CRC) Performance
The Trust has been mandated to report on carbon emissions resulting from energy consumption as
part of the government’s ‘Carbon Reduction Commitment (CRC) Energy Efficiency Scheme’. The
Trust estimates its carbon emissions for 2013/14 as part of the CRC to be around 5,416 tonnes of
carbon. This is a reduction from the previous year where CRC emissions were 5,489 tonnes of
carbon as illustrated in the table below.
The Trust will be exempt from reporting under the CRC for energy consumption related emissions
for Phase II (post April 2014).
The Trust’s CRC carbon emissions 2012/13 and 2013/14 and related costs:2012/13
CRC emissions (tonnes of carbon)
CRC cost to the Trust (based on £12 per
tonne of carbon)
5,489
2013/14
(*Estimated)
5,416*
£65,868
£64,992*
Note: CHP plant heat and electricity has been excluded (as per the CRC rules). Small gas meters that consume
less than 73,200 KWh have also been excluded (as per the CRC rules).
Carbon Saving Measures
We committed resources during 2013/14 to deliver carbon reduction projects and have identified
areas completed and additional areas for improvement during 2014/15.
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Carbon saving measures:Carbon Saving Projects
Completed, Planned or Principle Being Followed
Project area
Objectives
Installation of software which automatically To reduce the Trust’s electricity demands and
shuts down PCs when not in use
reduce CO 2 emissions
Commence programme for installation of To reduce the Trust’s electricity demands and
variable speed drives and ensure all new reduce CO 2 emissions
installations are equipped with VSDs.
Establish a Sustainability Working Group with To facilitate a reduction in energy and water
key managers across facilities, estates, consumption, reduce waste generation and
procurement,
IT,
clinical,
transport, promote recycling, and move the Trust
communications, etc.
towards more sustainable modes of travel
Continuation of the replacement of the Ozone To reduce the risk of detrimental effects on
damaging R22 refrigeration plant
the environment
Commencement of programme for installation To reduce the Trust’s electricity demands and
of intelligent lighting controls
reduce CO2 emissions
Improved heating and ventilation controls
To reduce the Trust’s heating demands and
reduce CO2 emissions
Procurement policy
To reduce the risk of detrimental effects on
the environment
Installation of Smart metering at the main To enable the Trust to accurately measure
hospital site
energy use to enable management of
efficiency and reduce CO2 emissions
Carry out review and update of current To enable the Trust to accurately report
statutory Display Energy Certificates (DECs)
energy use to enable management of
efficiency and reduce CO2 emissions
Introduction / completion of active waste To enable the Trust to reduce the impact on
segregation
land fill reduce costs’ & reduce the risk of
detrimental effects on the environment
Designing new buildings and refurbishments To reduce the risk of detrimental effects on
to be as energy efficient as possible
the environment
Moving to paper and bottle free Board To reduce the risk of detrimental effects on
meetings
the environment
ATOM – Ambulance Taxi Operational To reduce the Trust’s heating demands and
Management
reduce CO2 emissions
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Section 3
Our Quality Report
101
Chief Executive’s Statement on Quality
At Birmingham Children's Hospital, we pride ourselves on placing quality and safety at the heart of
all we do. In that context, I am pleased to report that 2013/14 has been another great year, where
we have not only further embedded our quality focus, but have also worked on a range of safety
projects, helping us develop even better ways of doing things, and ensuring we deliver the very
highest standards our children, young people and families deserve.
Our Hospital Handover Project is vastly improving the quality and consistency of information our
doctors and nurses exchange about a patient’s condition between shifts, in the specialties where we
have piloted it. This is part of a Health Foundation funded initiative, which we plan to implement
across our hospital over the coming months, and we hope will benefit other hospitals too.
We are also leading the way on the development of the first NHS wide tool to measure harm done to
children whilst they are in hospital. The national Safety Thermometer, which measures things like
urinary tract infections, blood clots and falls, is not really sensitive to the potential risks in children
and young peoples’ healthcare. Our tool, called SCAN - Safer Children Audit No Harm, has been
endorsed by NHS England, and we are working with them to support a roll out to other children’s
units across the UK.
These, and our many other systems for assessing and monitoring the quality and safety of care, were
reviewed this year by the Care Quality Commission (CQC), who visited us in November as part of a
routine inspection. In addition, its inspectors observed how we treat children and young people, and
spoke to staff, patients and families who said that they “cannot fault the care” we provide and in
their really positive inspection report, confirmed that we had met all five of the essential CQC
standards they were considering.
But the quality and safety improvement journey is never over, there are always areas where we can
do better, and this year is no exception. The numbers of operations we have to cancel, the length of
time children and young people have to wait for an MRI scan, and our staff satisfaction score in the
National NHS Staff Survey are all things we desperately want to improve on. There can surely be
nothing worse than preparing your child and family for major surgery, only for it not to go ahead, or
to wait too long for an MRI scan when the results determine next steps in your child's treatment. It is
equally important that we keep an eye on how happy our staff are, and to make sure they are fully
supported, so that they are able to deliver the very best services. Put simply, happy staff means
happy patients. We have significant plans to make improvements in each of these areas, which you
can read more about in the following pages.
None of our day to day work, or improvement activity, would be possible without listening to, and
engaging with our children, young people, families and staff, to really understand what is most
important to them, and what we need to do to improve. We do this in many ways - through our
patient and family feedback app, mystery shoppers, surveys, events and more. Our Young Person’s
Advisory Group has continued to provide the perfect sounding board for many of our decisions at
the hospital, whilst also setting out its own agenda, and quite rightly holding us to account for its
delivery.
We have many challenges, and exciting times ahead, and will be doing all we can to achieve our
objectives of delivering safe, high quality care to every child and young person, alongside a fantastic
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patient and family experience. It is what we are here for, and if we cannot get this right, then
nothing else we do really matters.
To the best of my knowledge the information contained in this Quality Account is accurate.
Sarah-Jane Marsh
Chief Executive
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Priorities for Improvement
‘Every child and young person cared for by BCH will be provided with safe, high quality care and a
fantastic patient experience’.
It is a key priority for the Trust to ensure that the care we give is of the highest quality and safe and
that when children are with us the experience they have when they’re here is a good one.
Our clinical and quality strategy helps us focus on ensuring that we continually monitor and improve
our systems for promoting and enhancing patient safety and reducing avoidable harm.
We do this by working in partnership with our children, young people, families and staff to ensure
their opinions are heard, feedback is acted on and lessons are learned. Our Participation and Patient
Experience Strategy ensures that we engage and involve children, young people and families in the
planning, provision and evaluation of all aspects of our services as outlined in section 242 of the NHS
Act.
In the last year we have moved to a more real time data collection and responsiveness. This has
been enhanced by a new communications tool – the feedback app - and is also increasingly being
supported by the use of social media including Facebook and Twitter. The app has provided an
opportunity for parents, children and young people to let us know about their experience, both
positive and not so good, in real time and for staff to respond directly in real time too.
There are many other ways we gather information so we can understand where we need to improve
to make our quality of care better:
Listening to the children, young people and families that use our services There are lots of ways
they can tell us what they think, and we take account of it all to work out what’s most important to
them:
•
•
•
•
Complaints, comments and concerns
Surveys
Feedback App
Consultations
•
•
•
•
Feedback cards
Patient stories
Websites like NHS Choices and Patient Opinion
Mystery Shoppers
•
Listening to our staff - The views of the staff who work in our hospital every day are vital
and we encourage them to tell us what they think through surveys, consultations and
feedback events. It’s also really important that we keep an eye on their happiness and make
sure they’re fully supported so that they are able to deliver the best services they can.
•
Listening to others - The views of BCH groups like the Young Person’s Advisory Group help
us focus on how to make the improvements that are needed.
•
Analysing information about the quality of services, such as patient safety incidents and
clinical audits.
•
Using best practice examples - national targets and learning from and benchmarking with
other organisations.
Using this information has helped us to identify Quality Priorities, which are the main areas we want
to focus on to improve quality. Each priority has a goal and a way of measuring our progress in
reaching these which will be detailed on the forthcoming pages. This is however not an exhaustive
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list of priorities. These relate to the three elements of quality: Patient Experience, Clinical
Effectiveness and Safety. The priorities we are reporting on this year are:
Patient Experience
Food and Nutrition
Play and Activities
Tertiary Inpatient Referrals
Cancelled operations
MRI scan waits
Clinical Effectiveness
Staff Survey
Nursing Care Quality Indicators
Asthma Care
Health Promotion
CAMHS User Service
Satisfaction
Safety
Extravasation injuries
Pressure Ulcers
Healthcare Acquired Infections
in PICU
Reducing Rates of Clostridium
Difficile
Preventing MRSA
Reducing MSSA
Reducing Medication Incidents
Resulting in Harm
Reducing Life Threatening
Events, Cardiac and
Respiratory Arrests
Mortality –Zero Avoidable
Deaths
Some of the key projects and highlights of our quality strategy planned for 2014/15 are outlined
below:
•
•
•
•
•
•
Implement and embed the Safer Clinical Systems Handover Project Trust wide
Pilot and review the use of the Safety Case approach as a method for embedding quality
review of service delivery across the organisation
Support the development of the national Paediatric Safety Thermometer building upon the
SCAN work
Re-launch the Sepsis Care Pathway
Implement SHINE 12 – ‘Listening to You’ – a tool to understand parental concerns and
improve the format for handing over care between a parent and a nurse
Improving situational awareness by introducing the proven ‘huddle’ model to improve
communication and address underlying cultural causes for safety failures
We can map these indicators into the wider priorities of the NHS for Children and Young People
based on the NHS Outcomes Framework as outlined below:
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QUALITY
STRAND
QUALITY DOMAIN
(NHS OUTCOMES FRAMEWORK)
BCH QUALITY INDICATOR
Nursing Care Quality Indicators
Asthma Care
Health promotion
Effectiveness
Preventing people from dying
prematurely
Nursing Care Quality Indicators
Asthma care
Health Promotion
Enhancing quality of life for people with
long-term conditions
Food and Nutrition
Nursing Care Quality Indicators
Health promotion
CAMHS Service User satisfaction
Safety
Patient Experience
Helping people to recover from
episodes of ill health or following injury
Food and nutrition
Play and activities
Tertiary inpatient referrals
Cancelled operations
Friends and Family Test
Ensuring that people have a positive
experience of care
MRI waits
Treating and caring for people in a safe
environment; and protecting them from
avoidable harm
Pressure ulcers
Reducing Healthcare Acquired Infections in
PICU
Reducing rates of C.Difficile
Preventing MRSA
Reducing MSSA
Medication Incidents
Acute life threatening events, Cardiac Arrests
and Respiratory Arrests
Zero avoidable deaths
Extravasation injuries
These priorities and what we’ve achieved in 2013/14 are set out over the next few pages of this
Quality Account.
In 2014/15 we will also develop indicators report on some additional priorities that we have been
developing during 2013/14:
Safety:
Patient Experience:
Paediatric Safety Thermometer
Learning disabilities
Palliative and End of Life Care
Clinical Effectiveness: Implementing the Sepsis Care Bundle
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Listening to Patients and Families
Food and Nutrition
Good quality and tasty food helps our children and young people get better more quickly and
improves their experience of hospital.
We previously measured how well we were doing with the food we provide by asking children,
young people and their families two questions which were ‘I can choose what I want from the menu’
and ‘I am happy with the choice I am given at mealtimes’.
We have changed the way we collect feedback on food in 2013/14 so can’t make a comparison
against previous years for these two questions. We have begun assessing our food provision for the
first time using the new PLACE assessment. This involves patients and volunteers from outside the
hospital assessing and giving feedback about the quality of food that we provide.
How have we done?
This year we are showing information about positive and need to improve comments and PLACE
assessments and the percentage of positive and need to improve comments received and captured
in our patient experience database both of which are shown below:
Figure 1: Positive v need to improve comments relating to food in 2013/14
“Please ensure
portions are big
enough for
teenagers”
“Chips are on the menu too much
I would like pasta and wraps to be
added on”
“A lot of variety
on the dinner
menus and we
like the MAPLE
system”
107
PLACE assessments are undertaken by local volunteers and children/young people who work as a
team to assess how the environment supports patients’ privacy and dignity, food, cleanliness and
general building maintenance.
The assessors score questions which are then used to give a percentage score indicating the
assessment of quality by the review team. Our PLACE food assessment scores for our Child and
Adolescent Health facility at Parkview and the main city centre hospital site are outlined below:
Figure2: PLACE assessment scores for Parkview and Steelhouse Lane sites 2013
Parkview (CAMHS)
87.1 %
Steelhouse Lane Site
86.9%
While we have received more positive patient experience feedback about our food than need to
improve comments its clear the percentage of need to improve comments is still too high.
The average PLACE score for food across England 2013 was 85%. We have scored above the average
rating for food at both Parkview and the main hospital site at Steelhouse Lane. We are pleased with
our PLACE food assessment scores but know based on feedback that we still have a lot to do to make
things better.
What are we doing to improve?
•
•
•
•
Continuing to work with our partners to reduce the amount of sugar and salt in the food we
provide.
Changed how we receive patient experience feedback about food. We continue to receive
comments into our Patient Experience Database. Children, young people and families can
also send us comments via our real time feedback app.
Trained our staff to deliver health promotion advice about health diets through our Making
Every Contact Count initiative.
Our catering partner Sodexo has also employed a Patient Experience and Food Service
Manager.
We will continue to analyse how we’re doing throughout the year but will report on our annual
performance in our 2014/15 Quality Account.
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Listening to Patients and Families
Play and Activities
Ensuring children and young people have enough to do in terms of play opportunities remains a very
important quality indicator for us. We know play is important for development and can also be a
distraction from some of the stressful and unpleasant aspects of clinical care.
It’s important that we know that play opportunities are easily accessible, age appropriate and that
toys and equipment are in good condition. We categorise feedback about play and activities as
either ‘positive’ or ‘need to improve’.
How have we done?
Figure3: Play and Activities: Positive v Need to Improve Feedback 2012/13 and 2013/14
“There isn’t enough choices
for all ages and it’s mainly
for young children”
“The DVD
player on our
bedside TV
was not
working”
“Your colouring
books are great can I
take this one home
please?”
We have seen a swing from a majority of positive comments in 2012/13 to a majority of ‘need to
improve’ comments in 2013/14. Looking at the comments received a significant number of the ‘need
to improve’ comments related to the provision of TVs for children and young people. We know this
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is an area of concern for a lot of families and carers and we have a specific project in place to make
this better. It’s disappointing our feedback isn’t better but we have a number of improvements we
are going to be working on which are outlined below.
What are we doing to improve?
As well as the project to look at better access to TVs we are doing a lot of work to make sure we get
better at providing the right play and activities.
Improving normalising play and activities was a key objective for 2012/2013 and the introduction of
play and recreational facilitators was critical in helping to achieve this.
The Play and Recreational Facilitators have been in post since October 2013. The role of the Play
and Recreational Facilitators is to provide ‘normal’ play.
Many of the successful candidates have a nursery nurse background and also help with Health
Promotion advice. The facilitators have one to one sessions with children and young people who
require more play support but also run larger craft sessions to encourage interaction with other
children (which are particularly useful where children have a long stay in hospital). There have been
many patient comments collected about the positive impact they are having on their experience.
Within two months of the new role one of our Facilitators was nominated for a star of the month for
Outstanding Patient Care.
Other things we are doing to improve include:
•
Our Play Charter sets out our vision for play and recreation and aims to be a catalyst for
everyone at the hospital to continually examine, review and improve their provision for
babies, children and young people’s play and informal recreation and leisure time.
•
Promoting the Play Centre and James Brindley School – a weekly timetable has been
produced detailing what activities run throughout the hospital (school, youth club and play
centre). ‘Activity ward boards’ are being produced to raise awareness of these activities.
•
Stay and Play – held weekly in the Play Centre. Parents are encouraged to bring their child,
where during facilitated play, positive parenting messages are shared. This has received very
positive feedback from parents.
•
Rhythm Time - music and singing classes for babies, toddlers and preschool children which
help develop confidence, creativity and coordination, accessible twice a week to all wards
and departments.
•
Activity Packs – available for children and young people on admission, ensuring their first
contact is a ‘play’ contact.
•
Learning Disability Booklet – a specialist booklet has been designed which helps children
with learning difficulties and autistic patients understand their hospital journey.
•
DITTO Distraction Device – each ward has been provided with a hand held device which
reduces anxiety related pain in children by engaging them in fun and games, whilst
undergoing medical procedures.
•
Standardised Playroom Project - is underway which provides funding for eight rooms
available which will create better play spaces and allow better access to play.
We will report on this indicator again in our 2014/15 Quality Account to let you know how we have
got on.
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Listening to Patients and Families
Tertiary Inpatient Referrals
Tertiary inpatients are patients whose care needs to be transferred from a medical team in another
hospital to BCH because we have a specific set of skills and expertise to treat them. When a child or
young person needs to come to BCH for urgent inpatient care from home or from another hospital,
it’s important that their admission is not delayed as this could have a negative impact on their care.
In 2010/11 we put processes in place to meet our goal.
How have we done?
Figure 4: Trend – tertiary referrals waiting over 24 hours for a bed October 2012 – March 2014
Making sure we admit children and young people who urgently need a bed within 24 hours
remained a challenge in 2013/14 as we continued to see more demand for our clinical services.
March 2014 has been an extremely busy month for us (including our busiest ever month in terms of
children and young people coming to our emergency department). We have also been admitting a
lot of children whose illness means they stay a long time in hospital. All of these factors put pressure
on our beds and we know this remains a big challenge for the hospital.
We have begun to measure tertiary inpatient waits in a slightly different way. Some of our clinicians
tell us that getting a child or young person needing a bed at BCH can sometimes require transfer
within 24 hours or that the child and young person could wait for 48 hours and that this will still be
appropriate and safe. Therefore we have started to look at a better measure of tertiary waits which
measures whether we have got a patient into a BCH bed within the timescale specified by our
clinical teams (the ‘clinical target time’).
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We have only just started measuring this indicator in this way. Below is an example of this
information from our March 2014 Board Quality Report:
Figure5: Tertiary referrals - Performance v Clinical Target Time March 2014
We will continue to report on our tertiary referral waits but will look to report the percentage of
patients who were given a BCH bed within the defined clinical timescale (as above) when we report
back in our 2014/15 Quality Account.
What are we doing to improve?
We are doing lots of work to make sure that our capacity is managed well and we make the best use
of all our beds.
Our Hospital Operations Centre (HOC), a clinically led centre which oversees the day to day use of
capacity, has really helped us improve our outcomes. We have been working hard to make sure that
the HOC helps us to manage the demand for our beds and prioritises our children and young people
into the right beds in the right clinical timeframe.
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Listening to Patients and Families
Cancelled Operations
There are times when we have to cancel operations because of emergencies like transplants which
can’t wait, or when another operation is more complex than expected, so it takes longer than
planned. Sometimes an operation can’t go ahead because there aren’t enough beds that day on
PICU to care for the patient after the operation. This can be very stressful and inconvenient for
children, young people and families as it can disrupt work, travel and child care arrangements. It is
also difficult and stressful for our staff to explain to anxious children, young people and their families
that an operation has had to be cancelled.
How have we done?
We have been working extremely hard over the past year to reduce the number of operations we
cancel. However it remains a significant challenge for us and we know we must do more to make
things better for our families and staff.
Figure 6: Cancelled operation national definition – comparative performance 2011/12, 2012/13 and 2013/14
The graph above outlines patients who were cancelled on the same day based on a national
definition of ‘Cancelled by a hospital for non medical reasons on the day of admission or after
admission’. This is a figure we report nationally.
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However this definition doesn’t include all patients who have their operations cancelled. There have
been 840 operations cancelled by the hospital in 2013/14 of which 510 fit the criteria for national
reporting.
The chart below shows the reasons for cancellation of the total 840 patients cancelled by the
hospital in 2013/14:
Figure 7: Cancelled operations 2013/14 by reason for cancellation
The single largest reason for the Trust having to cancel operations by far is the absence of PICU beds,
which accounts for 24% of all cancellations.
We also have some patients whose operation has been cancelled more than once, outlined below:
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Figure 8: Patients cancelled more than once (same specialty) 2013/14
“My daughter was due an operation
last week at the Birmingham
Children's Hospital which was
cancelled the day before. Then I was
given a call 5 days later asking us to
come in 2 days time at 4pm. On that
day at 10am I got a phone call
cancelling this operation too. This is
a lot of stress for an 8 year old”
We have not met our 2013/14 target, with the percentage of operations cancelled on the day at 1.1
% compared to our target of 0.8%. The total number of cancelled operations remains high and we
have a number of patients who have had their operations cancelled more than once. This is largely
due to the increasing numbers of children and young people that we see each year, which
increasingly complex conditions, plus availability of our Paediatric Intensive Care (PICU) beds and
capacity in our theatres.
What are we doing to improve?
PICU capacity
Last year we expanded our PICU to provide capacity for 31 beds, however to open a bed we need to
ensure that we have the right number of skilled staff to care for each child or young person. Like
other hospitals across the country, we find it hard to recruit staff to work in our PICU, so we have
been working with colleagues at other hospitals and NHS England to review PICIU capacity and find a
way to overcome these challenges.
Bed capacity
Between October and March we see many more patients who get ill because of the winter weather.
Our Winter Plan includes the opening of an additonal 17 ward beds as we know that increases in the
number of emergency admissions impacts on our ability to find a bed for a child or young person
who needs an operation. We have also provided a dedicated unit for infants and launched our ‘What
are we waiting for?’ project to look at the reasons why patients can’t go home sooner, which has
started to speed up discharge to free beds more quickly.
Theatre capacity
We have recruited more anaesthetists to ensure we don’t cancel operations because a member of
staff isn’t available.
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We have plans to convert an existing plaster room to create up to an additional half a theatre of
operating slots. Similarly we have developed a case to expand our interventional radiology capacity
equivalent to an additional theatre of capacity.
We have also agreed a significant improvement project to look at how we can use our theatres more
efficiently.
Improving processes
We are in the process of changing the way our surgical pathways work to ensure processes are
designed to reduce duplication and improve communication between staff and families.
We will continue to do everything we can to reduce our cancelled operations and report back on
progress in our 2014/15 Quality Account.
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Listening to Patients and Families:
MRI Scan Waits
Coming to hospital for a test such as a MRI scan can be a key step in a child or young person’s
pathway and understanding their treatment needs. Waiting for these tests can be an anxious time
for children, young people and families.
A real challenge has been providing MRI scans within six weeks of referral. This is because of the
availability of staff with the right skills which is also a problem for hospitals across the country. In
addition, children often need a general anaesthetic to have an MRI scan and it can be difficult to find
the capacity amongst our anaesthetists to staff the increasing numbers of lists we require to keep
waiting time down.
Often we have dealt with this issue by doing more ‘waiting list initiative’ work at the weekends but
this hasn’t been sustainable and we need better solutions as we recognise this is a real issue for our
children and families.
Patients, families and staff have told us that the waits for MRI scans cause anxiety and we, and our
Commissioners (who pay for our services), see it as a key challenge for us to address.
This is new indicator for 2013/14.
How are we doing?
The graph below shows the number of children and young people who were waiting over six weeks
for an MRI scan (the purple bars on the graph). This is based on a ‘snap-shot’ census date at the end
of each month. The bars in blue show how we are planning to reduce the number of patients waiting
over six weeks at the end of the month to zero by June 2014.
Figure 9: Number of patients waiting over 6 weeks at month end for MRI scans (based on DMO1 census dates)
GOAL: No patients
will wait more than
6 weeks for an MRI
after the end of the
month by June
2014
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A significant number of children and young people have waited over six weeks for an MRI scan. We
know this isn’t good enough and are aiming to make sure no child or young person waits more than
six weeks at the end of each month by June 2014.
What are we doing to improve?
Recruiting more Consultants
We have recruited two more Radiology Consultants who started in September and November 2013.
We have been planning to make sure their skills and capacity are used well by planning new rotas
which will commence in April 2014.
Changing the way we work
The radiographers who support the Consultants in carrying out the MRI scans have worked hard to
change the way they work to provide more time and capacity to carry out MRI scan lists.
Creating more capacity
We have continued to do additional work at weekends but have begun to extend the amount of
work we do during the day. From the beginning of 2014 Saturday working has become part of our
radiographers’ standard working hours.
Using a mobile scanner
We have tried to find capacity at other hospitals to do MRI scans but this hasn’t been possible, so we
have been using a mobile scanner which has helped speed up access. This will continue in 2014/15.
Making the most of the capacity we have
We have been using a tool to help us predict how much scanning capacity we will need. We have
introduced weekly reviews of the MRI lists to ensure capacity is used fully. We have also introduced
a second reminder phone call to families two days before their appointment to make sure they will
be attending. Also we have changed the letter about preparation for the anaesthetic which goes to
families to make sure children and young people are properly prepared and can be given sedation.
We will continue to make these changes and improvements so that no child or young person waits
over six weeks for their scan by June 2014. We will report on this in our 2014/15 Quality Account.
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Listening to our Staff:
Staff Survey
Our staff are critical in all that we do at the hospital and without them we wouldn’t be able to
provide the high quality care that we do. Knowing how our staff really feel about our services is a
really important indicator of quality. There is also a lot of evidence that shows that staff satisfaction
and motivation has a real impact on the quality of care that they deliver.
The NHS Staff Survey is one important way that we can understand how our staff feel about the
quality of care we give and how they feel about working here.
How have we done?
Figure 10: 2013 Staff survey results based on responses to ‘care of patients is my Trust’s top priority’ and ‘if a friend or
relative needed treatment, I would be happy with the standard of care provided by the Trust’
Figure 11: 2013 Staff survey results – Staff satisfaction scores 2012, 2013 and comparative Acute Specialist comparison
score for 2013
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59% of our staff completed the staff survey in 2013 compared to 46% in 2012.
There has been a small improvement in our results in 2013/14 but we would like to do much better.
Our overall satisfaction score has increased but is still slightly lower than the average for Acute
Specialist Trust elsewhere in the NHS.
What are we doing to improve?
We have a number of initiatives in place to support our staff and take care of their well being. Many
of these have been shaped by our annual ‘In-Tent’ event where we invite staff to a week of events
aimed at helping us understand how we can make things better for our children, young people,
families and staff, including:
•
Launch of a number of team building initiatives under the theme ‘Building Team BCH’.
•
Launch of our ‘InTent2Listen’ events for staff to discuss issues they think are important with
our Chief Executive and other Senior Executives.
•
Star of the Month scheme to acknowledge staff that demonstrate commitment to our Trust
values.
•
New Medical Directorate Team monthly award scheme to recognise the exemplary work of
their staff.
•
New ‘Team maker’ leadership training for managers to improve their leadership skills.
•
Development of conflict resolution officers to work with staff to amicably resolve any
tensions or disputes within the workplace.
•
Increased mentoring opportunities.
•
Values based staff appraisal process with greater focus on personal development and clarity
of objectives.
•
New ‘paired learning’ scheme to increase understanding and develop relationships between
clinical staff and management colleagues.
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•
Several staff health and wellbeing activities, such as new counselling services and a slimming
club.
We have a lot of work we want to do to improve and we will report on these indicators again in our
2014/15 quality account.
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Providing Even Better Nursing Care
Nursing Care Quality Indicators (NCQIs)
Our Nursing Care Quality indicators help us to understand if we are delivering excellent high quality
nursing care for our children and young people. Since they were launched we have added new
indicators (such as cannula care) and will continue to review them to make sure we are measuring
the things that are most important for our patients.
How have we done?
The graph below shows how we did for each of the care quality indicators in since we started
capturing the data electronically in September 2013.
Figure 12: % Compliance NCQI performance September 2013 –March 2014
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As in 2012/13 we have continued to perform well against our Nursing Care Quality Indicators. We
will continue to monitor and report on our NCQIs which are reviewed regularly by our Trust Board
via the monthly Trust Quality Report.
What are we doing to improve?
Our electronic system is up and running and that allows our ward nurses, managers and Clinical Lead
Nurses to view data in real time and make any changes to improve quality and safety much more
quickly. We are planning to roll out the Nursing Care Quality Indicator process to the other nonward based nursing services such as Hospital at Home and our KIDS retrieval and transport service.
In 2013 we changed from quarterly collection of data to monthly. We will continue to report on our
NCQIs comparing our performance in 2013/14 with 2014/15 in our next Quality Account. We have
more detail about two specific measures linked to our NCQIs relating to pressure ulcers and
extravasation which are outlined later in the Quality Account.
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Providing Even Better Nursing Care:
Asthma Care
When children and young people with asthma use an inhaler, it’s essential that they use it properly
to get the full benefits.
It’s also important that we ensure that they are involved in decisions about their care and we do this
by agreeing their care plan with them and giving them a copy.
Figure 13: BTS National Paediatric Asthma Audit 2012 and 2013 – Comparative BCH and National performance
How have we done?
During 2013/14 we have worked hard to embed adherence to the asthma care pathway in normal
clinical practice. We will have also amended our asthma care pathway to reflect the new NICE
Asthma Quality Standards.
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We have done well and improved our performance in 2013 compared to 2012 for both assessing
inhaler device technique and making sure a written care plan is in place. We continue to do really
well compared to the national figure from the Paediatric Asthma Audit.
What are we doing to improve?
We will continue to develop the Asthma Integrated Care Pathway to include the latest national
recommendations and to improve the quality of asthma care. There is ongoing reinforcement of
asthma care standards by regular training and education sessions for all members of the multi
disciplinary team.
We will update you again on how we are doing with asthma care in our 2014/15 quality account.
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Improving Health Outcomes
Health Promotion
We know we have a really important role to play in improving the general health of children and
young people and reducing health inequalities in addition to helping them when they are ill. We
have continued to work to support and advise children, young people and families on how to stay
healthy and see this as a real priority:-
How have we done?
We met all of our goals for the second year running.
We have also provided Making Every Contact Count and BMI training to 197 targeted staff (this is
part of a scheme agreed with our Commissioners). We have reviewed, updated and re-launched the
smoking and alcohol awareness information shown on screens in our outpatients department
What are we doing to improve?
We have employed a Public Health Consultant to support and advise our clinical staff on health
promotion and develop our health promotion strategy. This post is unique amongst hospitals in the
West Midlands. We are bringing our smoking referral pathway ‘in house’ as we believe it will deliver
a better service this way and we will continue to train our staff in health promotion/Making Every
Contact Count.
We will continue to report on how we are doing in our 2014/15 Quality Account.
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Improving Health Outcomes:
Child and Adolescent Mental Health Service (CAMHS) - User satisfaction
Measuring the difference our services make to the people who use them helps us to understand
what we are doing well and where we might need to make improvements.
How have we done?
Figure 14: CAMHS questionnaire ‘helpful’ and ‘improvement’ scores 2012/13 and 2013/14
We have not only met but improved our performance against the national target of 61% of people
feel that they have a better health outcome as a result of using CAMHS. Our children and young
people particularly have found the service has been helpful and they feel a bit better/much better
since being treated in CAMHS.
We have worked hard to improve our access for families with the average waiting time for first
appointment four weeks and 11.4 weeks to start treatment. We have redesigned our services to
improve clinical pathways so that children and young people get the right support, from the right
person with the right skills at the right time. We are pleased that the improvements that we have
made are reflected in the feedback from our families.
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What are we doing to improve?
As with all of our services we will continue to improve the way that we engage with young people to
gather feedback and support our service redesign over the coming year, including:
•
•
•
•
•
We have now launched our new website www.lotsonyourmind.org.uk This was named by
one of our young people and designed with the input from young people and their families.
This contains information about CAMHS but also self-help information for young people.
One of our young people designed our new feedback cards and posters so that we can
encourage users to feedback views about our service.
We are running regular focus groups that are supporting specific projects including a new
web based portal.
We are developing new care plans with the support of young people.
Young people are supporting our recruitment of consultant psychiatrists.
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Providing Even Better Nursing care:
Extravasation harm
When medicine is given into a vein, it can leak into and damage the surrounding tissue and cause a
potentially serious injury. This can be a particular problem for babies. We have developed a Nursing
Care Quality Indicator (NCQI) for cannula care which focuses on accurate observations, dressing
changes and reporting of early signs of an injury.
How are we doing?
We began measuring our extravasation harm rate using a tool called SCAN (Safer Children Audit No
Harm) in November 2013 and we have been better able to monitor how often extravasation harm
occurs.
The graph below shows the numbers of harms caused by extravastion we have picked up from the
audits we do using the SCAN tool.
Figure 15: Number of extravasation harms detected v number of patients surveyed November 2013 – March 2014
What are we doing to improve?
Monthly data has shown where incidents have occurred and we have targeted education via a
specialist nurse working in those areas. We will be using the data we are gathering to understand
what measures and goals we can define to reduce harm from extravasation.
We will report on this indicator in our 2014/15 Quality Account, outline the numbers of
extravasation harms we have been reporting, the steps we are taking to reduce them and how we
will look to measure if we are making things better.
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Providing Even Better Nursing Care
Pressure Ulcers
Some of our patients - in particular the sickest patients on PICU - are at risk of developing pressure
ulcers which, if left untreated, can become very serious. We are working toward the complete
eradication of pressure ulcers, in line with the ambition of the whole NHS.
How have we done?
Figure 16: Point prevalence of Grade 2 and above pressure ulcers April 2012 to March 2014
For the past two years we have monitored the prevalence of pressure ulcers on a monthly basis
using the adult Safety Thermometer.
On average we find between zero and one Grade 2 pressure ulcers per month. In the months where
there have been peaks we have reviewed each patient’s care to ensure that it was appropriate. The
peak in May 2013 was due to two patients who were admitted from home with pressure ulcers and
the increase in January and February 2014 was due to the addition of data from another patient
group which was predominately complex care. We provided education and training from the tissue
viability team to the ward nurses which effectively dropped the prevalence in March.
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What are we doing to improve further?
As of April 2014 we will use the Paediatric Safety Thermometer pilot to collect data about pressure
ulcers and in addition moisture lesions. Our initial test data has demonstrated that moisture lesions
are a particular problem in children and young people in hospital.
We will continue to monitor our pressure ulcers (and also moisture lesions) using the Paediatric
Safety Thermometer. Using the thermometer we will identify any areas where we need to target
education and training to make sure we improve. We will report again on pressure ulcers in our
2014/15 account and also update you on how we have been doing in terms of moisture lesions.
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Reducing Infection
Reducing Healthcare Acquired Infections in PICU
Our Paediatric Intensive care unit (PICU) cares for our sickest children and young people. They are
particularly vulnerable to acquiring infections which can complicate their care, extend their time in
hospitals and create worry and stress for their families. It’s important we do all we can to protect
them from infections. Many patients on PICU have Central Venous Catheter (CVC) lines and are on
ventilators and these can be sources of infection.
How have we done?
Figure 17: PICU CVC and VAP infection rates per 1000 CVC patient days/1000 ventilator days 2012/13 and 2013/14
We are doing really well in maintaining low rates of Central Venous Catheter (CVC) infection. In
2013/14 we reduced our target rate for CVC infection to less than 1.2 infections per 1,000 catheterpatient-days and we have met this target. We have also recently introduced the use of specially
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designed antimicrobial dressings for use with CVC lines in order to help reduce our infection rates
still further.
We have though, seen an increase in our Ventilator Associated Pneumonia rates over the last year,
and although these are still lower than when we first started measuring them, we have been looking
closely to see what we can do to improve these again.
We continue to monitor how well we comply with practices to prevent VAP infections and we are
putting into place a number of measures to improve these further. From the data we collect, we
have been able to determine certain groups of patients that are more at risk from VAP infections
than others, and we are therefore looking at how we can reduce the risk of these infections in these
particular groups of patients.
What are we doing to improve?
We will continue to develop the practices we have put in place and we now look at every infection in
detail to determine any preventable factors that we can learn from, so that we can continue to
reduce the rate of infections in PICU and across the hospital to a minimum level.
As outlined under our section on MSSA infections on page 136 we are also trialling a new skin
antiseptic for use with CVC lines which may help reduce infections in children and young people with
CVC lines even further. We will continue to report on CVC and VAP infections in PICU in our 2014/15
quality account.
In addition to measuring CVC and VAP infections, in 2013/14 we have started measuring urinary
tract infections that may be associated with the use of urinary catheters (UCA-UTI) and infections in
surgical wounds (SSI). Over the next year we will set targets for reducing the rates of these infections
and will report how we have done in our 2014/15 account.
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Reducing Infection:
Reducing Rates of Clostridium Difficile
Clostridium difficile are bacteria present naturally in the gut of around two-thirds of children and 3%
of adults. C.difficile does not cause any problems in healthy people. However, some antibiotics used
to treat other health conditions can interfere with the balance of 'good' bacteria in the gut. When
this happens, the bacteria can multiply and produce toxins, which cause illness such as diarrhoea
and fever. As C.difficile infections are usually caused by antibiotics, most cases happen in a
healthcare environment. Reducing rates of C.difficile in hospitals is a national priority.
How have we done?
Figure 18: Clostridium Difficile infections 2011/12, 2012/13 and 2013/14
We haven’t had any cases of C.difficile in 2013/14 that have been attributed to care at BCH so we
have met our target, which is really good news. One case of a cancer patient in December 2013 was
looked at by the Health Protection agency and was not attributed to care at BCH. This case was also
investigated at BCH which raised no concerns about care given at BCH.
However we know infection remains a key area of concern for our children, young people and
families and we always have to be vigilant to ensure we perform well, therefore we will report on
how we did in 2014/15 in our next quality account.
What are we doing to improve?
We are currently evaluating a new cleaning product called Virusolve in place of our traditional
cleaning products which we believe may be more effective help us continue to maintain our low rate
of C-difficile. We will report on the results of this evaluation in our next quality account.
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Reducing Infection
Preventing MRSA
Blood stream infections with MRSA can be very serious for people who are unwell and can result in
additional treatment and an increased length of stay.
Figure 19: Number of MRSA infections 2008/09 to 2013/14
How have we done?
For the third year in a row we have had no MRSA blood stream infections at all. This is very positive
but we will continue to report on MRSA infections in our 2014/15 quality account.
How will we maintain this?
In May 2013 we detected a cluster of patients with MRSA colonisation on one of our wards that
wasn’t attributable to the clinical care received at BCH. This did suggest however that our current
screening policy and techniques may not have been effective enough.
In order to continue protecting our children and young people we are trialling new ways to increase
our detection rate of MRSA. The pilot is ongoing and we will report on the outcome in our next
quality account.
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Reducing Infection
Reducing MSSA
MSSA is a common bacteria carried on the skin of 30% of the population. MSSA bloodstream
infection is a risk for some of our patients, especially those who have a central venous catheter
(CVC), surgical site infections and patients on Home Parenteral Nutrition.
How have we done?
Figure 20: Post 48 hours MSSA bloodstream infections 2011/12 to 2013/14
It has continued to be challenging to reduce the number of post 48 hours MSSA infections by 10%
with a similar number of infections to 2012/13 and we haven’t met our target. By studying each
infection we understand that CVCs remain the commonest cause of infection and that 40% of
infections are present within three weeks of line insertion and 90% affect children aged 1 and under.
What are we doing to improve?
Using the knowledge we have gained from looking at each infection we have introduced a series of
actions to reduce CVC related infections. We have also introduced a series of guidelines for taking
blood cultures. We have continued to review and analyse every MSSA infection in order to
understand how they occur and how we can prevent them.
We introduced a multi-disciplinary group (Doctors/Nurses/Infection Control and Nutritional care
teams) to look at all aspects of administering Home Parenteral Nutrition to reduce infection.
We are currently part of a study involving other hospitals looking at the use of a skin antiseptic called
Octenidine for use with CVC lines. Initial results are very encouraging and we will report on this trial
in our 2014/15 quality account as part of our MSSA indicator.
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Providing the Safest Possible Care:
Medication Incidents
We encourage staff to report every incident, from the most serious to near-misses. At BCH we use a
lot of medicines so there are many opportunities for errors to occur, and medication incidents are
the most frequently reported incident type. We want to see a high number of reported medication
incidents at a low level of harm, as this shows a good safety culture.
How have we done?
Figure 21: Number of medication incidents and levels of harm 2013/14
We have achieved our target of no medication errors resulting in serious harm. During the course of
the year we have reviewed our safety strategy and have redefined our targets around medications
incidents to:
•
•
Reduce the number of incidents of omitted doses resulting in more than minor/temporary
harm to zero.
Reduce the number of incidents involving incorrect dosage calculations resulting in more
than minor/temporary harm to zero.
What are we doing to improve?
•
We have revised our Drug Chart so that this is clearer and so that safety prompts, such as
review of antibiotics, are included
•
Changed from using codeine to oral morphine as this is believed to be safer. This has
involved a change in our practice as well as changing documents such as the Discharge
Prescription on our Day Surgery unit
•
Plans to move to stocking only one concentration of intravenous morphine across the Trust.
This is important because our incident investigations have shown that the act of diluting the
drug is the stage at which errors are often made
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•
Develop guidance to our ward staff to investigate medication incidents more thoroughly and
this will help us to identify trends in incidents more effectively
•
Lowering the number of omitted doses is a target of the Paediatric Safety Thermometer
This remains an important indicator relating to safety and quality and we will report on our new
safety strategy targets outlined above in our 2014/15 quality account.
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Providing the Safest Possible Care:
Acute Life-Threatening Events (ALTEs), Cardiac Arrests and Respiratory Arrests
Good monitoring on wards means that we will pick up deteriorating patients more quickly and avoid
preventable emergency and life-threatening events.
How have we done?
The graph below shows the total number of emergency events per 1000 admissions between
February 2013 and February 2014. We look at all these events to decide if they were predictable and
preventable. This helps us understand if there are things we can do better and help us
improve the care we give.
Figure 22: Incidents of emergency events per 1000 admissions February 2013 to February 2014
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We have continued to perform well with low levels of cardiac arrests, respiratory arrests and acute
life threatening events (ALTEs) means that we are monitoring and escalating clinical deterioration in
a timely manner.
We have had no ALTEs, respiratory or cardiac arrests that were seen to be both predictable and
preventable in 2013/14.
What are we doing to improve?
We will continue to review each event to identify any learning that could prevent or help predict
events in the future.
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Providing the Safest Possible Care:
Mortality
We have relatively low numbers of deaths at Birmingham Children’s Hospital and continue to review
every single death that occurs to make sure there were no avoidable factors and check that the
clinical care we are delivering is of the best quality.
We continue to look at our overall death rate per 1,000 admissions. Also we have specific ways of
looking at the deaths in some of our most complex and high risk areas with some of the sickest
children and young people (such as our PICU and cardiac surgery departments) to understand if the
numbers of deaths are within the expected numbers given the complexity of our patients.
How have we done?
Figure 23: Deaths per 1000 admissions February 2013 to March 2014
In 2013/14, deaths per 1,000 admissions have remained at a very similar level to the previous year.
In January 2014, we had significant concerns with the death of one of our patients who died very
quickly after developing an overwhelming infection. We investigated this in depth and although we
cannot say for certain, it is possible that had we recognised and treated this sooner, the patient may
not have died. We are deeply sorry that this happened and have learnt from it, making a number of
significant changes to the way in which we manage children with severe infections.
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Figure 24: PICU CUSUM monitoring
We continue to monitor deaths on our PICU using the CUSUM method outlined in figure 24 above.
This is a statistical way of helping us identify early when deaths occur when they are not expected.
Using the CUSUM method we haven’t identified any systemic care failings on PICU which have
contributed towards any of the deaths. Using this monitoring method in 2013/14 we did notice a
trend in deaths amongst patients who had illnesses being cared for by our Haematology and
Oncology teams. However, when each of the deaths was reviewed, no avoidable factors or care
failings were found.
Our PICU team also submits data to a database called PICANet which enables them to benchmark
our unit against other PICUs. This information continues to indicate we are well within the expected
range for deaths within our PICU given the range of conditions of the children and young people we
care for.
142
Figure 25: Cardiac Surgery CUSUM monitoring
Our cardiac surgery team also uses a CUSUM methodology to analyse the deaths which occur under
their care. There continues to be no concerns that any of the deaths in cardiac surgery were
avoidable in 2013/14. The team also submits data to the national Cardiac Clinical Audit Database
(CCAD) and use a further method called Variable Life Adjusted Display (VLAD) to look at mortality.
Using this method, outcomes continue to be better than expected given the complexity of the
children and young people the team treat.
What are we doing to improve?
We will continue to monitor mortality rates in a number of different ways to ensure that any
concerns are identified and that we learn from every death in case there was anything we could
have done differently.
Our safety team has been working to ensure the process for reviewing every death is completed and
reported quickly.
We have been studying some of the national measures to measure mortality such as Hospital
Standardised Mortality Ratios (HSMR) and Relative Risk, which are used to compare deaths rates in
adult hospitals. These two methods use statistical techniques to adjust the risk of a patient dying for
factors such as their age and their diagnoses. Unfortunately, these methods don’t adjust risk well for
children and young people, since the diseases, illnesses and statistical methods used are all based on
adults, therefore aren’t useful in helping us compare our death rates with other children’s hospitals.
We have raised this with NHS England and will be looking to work with them and other hospitals to
develop a better risk adjustment method which is more meaningful to compare hospitals that
provide care for children and young people.
We will report on our mortality rates in our 2014/15 Quality Account.
143
New Priorities to be developed in 2014/15
1. Sepsis Care
The rate of mortality from Septic Shock in children is approximately 10%. Survival is significantly
increased if antibiotics are given within an hour of diagnosis (as well as other treatment such as
intra-venous fluids). Lots of the children we treat are at high risk of sepsis, such as oncology patients
or those whose immune system is compromised. Our complex patients sometimes need unusual
antibiotics and sepsis can be difficult to detect.
What have we been doing?
We have developed a sepsis care pathway called Paediatric Sepsis 6 (based on the adult Sepsis 6)
which describes what must be done when a patient is suspected to have sepsis. This has been
piloted in PICU and has been introduced to the Emergency Department before a complete roll-out to
other areas of the hospital in 2014/15. We will report on this as a key indicator in 2014/15.
Measure
We previously said we would measure compliance with the sepsis care pathway, monitored by way
of audit. Auditing of our previous pathway was very challenging and we have recently introduced the
Paediatric Sepsis 6 as we believe that this will both be more effective in identifying and treating
children with sepsis, and be more straightforward to audit. We will report on our
progress in our 2014/15 Quality Account.
2. Learning difficulties
It is known nationally that children and young people with learning difficulties can face significant
challenges in accessing care and getting appropriate care.
Many aspects of care can be stressful for children and young people without learning difficulties and
even more so for those with learning difficulties. Families can also face challenges in unfamiliar
environments such as outpatients when bringing their children and young people to hospital.
We know we need to do our very best for this group of children and young people to make sure they
get the right care at the right time.
Measure
We will be working to develop measures relating to the quality of care we provide for children and
young people with learning difficulties in 2014/15 and will report on these in our 2014/15 Quality
Account.
3. Palliative and End of Life Care
It is always important that we provide high quality care but at end of life we only get
one opportunity to make sure this is delivered to the best of our abilities. Our families and
young people have told us that they value open and honest conversations about their care at this
difficult time.
Since 2012 we have worked with our partners, the West Midlands Paediatric Palliative Care Network
to improve upon palliative and end of life care and produced the following:144
•
The Purple pages are an extensive resource for staff packed with information about all aspects
of Palliative care which is also available as an app.
•
Advanced Care Pathway – a way of recording the detailed information that has been discussed
about what children, young people and families want in relation to end of life care.
•
Rapid Discharge Pathway and kit which supports children and young people to leave hospital
quickly so that they can spend whatever time they have left in the place that they choose,
usually either at home or a hospice.
•
Education – We have provided targeted education about palliative and end of life care. We have
prioritised Advanced Communication training to staff who have these difficult conversations
with families so that they are better able to deliver the messages with sensitivity.
•
We are also providing clinical supervision to staff so that they can debrief, reflect and internalise
what they have experienced and continue to care.
•
In 2013 we recruited a small team to specifically focus upon children, young people with
palliative care needs or at end of life.
Measure
During 2014 we will consider how to sensitively measure the impact of this work and will be
reporting on these measures in our 2014/15 Quality Account.
4. Paediatric Safety Thermometer
During the past two years we have used the national Safety Thermometer to measure harm in our
hospital.
We have demonstrated that this tool is not sensitive to the harms in children and young people’s
healthcare and have been working with other providers of acute children and young people’s
healthcare to design and test a prevalence tool which we named SCAN - Safer Children Audit No
Harm. This work focused upon extravasations, pain management, deteriorating patients and skin
integrity.
In 2013 this pilot work was endorsed by the Safety Team NHS England which has commissioned
Haelo (the team who produced the original Safety Thermometer) to develop this into a national
paediatric safety thermometer. We will be working closely with other hospitals to support this
ambition.
Measure
At this point the measures are still being tested and so the detail is not available. However it is
anticipated that the areas of nursing care that the tool will focus upon will be deteriorating patients,
skin integrity, extravasations, pain management and drug omissions. We will report on this in our
2014/15 Quality Account.
145
STATEMENTS OF ASSURANCE ON THE QUALITY OF OUR SERVICES
Review of Services
During 2013/14 Birmingham Children’s Hospital NHS Foundation Trust provided and/or subcontracted 37 NHS services.
Birmingham Children’s Hospital NHS Foundation Trust has reviewed all the data available to them on
the quality of care in all of these NHS services.
The income generated by the NHS services reviewed in 2013/14 represents 100 per cent of the total
income generated from the provision of NHS services by Birmingham Children’s Hospital NHS
Foundation Trust for 2013/14.
On a regular basis, the Board reviews the following data which enables a comprehensive
understanding of the three dimensions of quality – patient safety, clinical effectiveness and patient
experience across every service provided by the Trust:
Quality Report – this report includes details of the following:
•
•
•
•
•
•
•
•
•
•
Incident analysis
Mortality
Serious Incidents
Emergency clinical events
Never Events
Patient Feedback
Quality walkabouts
Formal complaints
PALS concerns
Surveys
Performance Report includes performance against our objectives relating to access to our services
Resources Report – in addition to financial performance this report includes the following:
•
•
Activity
Workforce indicators including:
- Rates of appraisals
- Mandatory training attendance
- Sickness rates and analysis
- Turnover
- Use of temporary staff
Consideration of these reports together provides an overview of areas in the Trust where there
might be concerns about the quality of care.
Members of the Board, senior hospital staff, Governors and members of the Young People’s
Advisory Group undertake regular Quality Walkabouts to the wards, where the focus is on either
safety or patient experience. The walkabout involves ward observations and discussions with
members of the ward multi-disciplinary teams, patients and families to identify any safety or patient
experience issues or concerns. The outcome of the walkabout is fed back to the ward staff with a
requirement to take action where improvements are necessary.
146
The Clinical Risk and Quality Assurance Committee has delegated responsibility from the Board for
reviewing risks to safety and quality and identifying and monitoring actions to address these risks
and improve quality. This Committee reports to the Quality Committee which is responsible for
driving the Trust’s quality strategy, bringing the three elements of quality together, allowing
integrated reporting to the Board of Directors.
In 2010/11 we developed a Safety Dashboard, which acts as an early warning system. It allows an
aggregated comparison of safety metrics against each ward and department and incorporates a
series of defined ‘triggers’ which, in combination, may indicate problems with safety or quality in a
specific area. The dashboard approach allows us to really focus on the areas where potential for
harm is the highest. Whenever the dashboard identifies a potential concern a more detailed analysis
is provided for the area in question and this is considered in depth at the Clinical Risk and Quality
Assurance Committee. During 2013/14 we expanded the range of metrics to include a range of
workforce metrics. This has allowed us to assess the potential impact of workforce challenges on
safety and acts as an early warning system.
Participation in Clinical Audit and National Confidential Enquiries
During 2013/14, 13 national clinical audits and one national confidential enquiry covered NHS
services that Birmingham Children’s Hospital NHS Foundation Trust provides.
During 2013/14 Birmingham Children’s Hospital NHS Foundation Trust participated in 100% of
national clinical audits and 100% of national confidential enquiries of the national clinical audits and
national confidential enquiries that it was eligible to participate in.
The national clinical audits and national confidential enquiries that the Trust was eligible to
participate in during 2013/14 are as follows: (see table below).
The national clinical audits and national confidential enquiries that Birmingham Children’s Hospital
NHS Foundation Trust participated in, and for which data collection was completed during 2013/14,
are listed below alongside the number of cases submitted to each audit or enquiry as a percentage
of the number of registered cases required by the terms of that audit or enquiry.
Table 1: National Clinical Audits and National Confidential Enquiries 2013/14 – eligibility, relevance,
participation and percentage cases submitted
NATIONAL CLINICAL AUDITS AND NATIONAL CONFIDENTIAL ENQUIRIES IN WHICH THE TRUST
WAS ELIGIBLE TO PARTICIPATE IN 2013/14
Audit
Relevant
Participation
% Cases
submitted
Paediatric asthma (British Thoracic Society)
Childhood epilepsy (RCPH National Childhood Epilepsy
Audit)
Paediatric intensive care (PICANet)
Paediatric cardiac surgery (NICOR Congenital Heart Disease
Audit)
Diabetes (RCPH National Paediatric Diabetes Audit)
Inflammatory Bowel Disease (IBD)
Cardiac arrhythmia (Cardiac Rhythm Management Audit)
Renal replacement therapy (Renal Registry)
Severe trauma (Trauma Audit & Research Network)
Maternal, infant and newborn programme (MBRRACE-UK)*
Yes
Yes
Yes
Yes
95%
100%
Yes
Yes
Yes
Yes
Ongoing
100%
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
99.8%
100%
100%
100%
82%
100%
147
Mental Health programme: National Confidential Inquiry
into Suicide and Homicide for people with Mental Illness
(NCISH)
Yes
Yes
100%
The reports of 4 national clinical audits were reviewed by the Trust in 2013/14 and the Trust intends
to take the following actions to improve the quality of healthcare provided:
Paediatric cardiac surgery (NICOR Congenital Heart Disease Audit)
•
•
•
•
•
•
•
It has been agreed that monthly reports will be sent to the Consultants highlighting where
there may be any missing data or coding errors.
The congenital data manager will circulate a subsequent list of cases to be signed off
accepting that they are happy with the data and it can be submitted, this will ensure that
there is a greater level of clinical engagement.
Extra training for new starters to ensure that they are aware of the importance of the
NICOR data and know what the definitions are and where they can find the online help
within HeartSuite.
BCH are currently adhering to NICOR submissions criteria with quarterly submissions of
data.
Data is extracted for reverse validation and any amendments needed are made to both the
local and NICOR data.
It has been agreed to update the discharge summary process to add in NICOR outcomes.
Changes are being made in the PICU data collection system to aid with the calculation of the
intubation days.
Severe trauma (Trauma Audit & Research Network) (2012)
No recommendations.
PICANet
Emergency readmission rates are being monitored closely as a key quality indicator. All unplanned
readmissions to PICU within 48 hours of discharge are subject to case note review and discussion at
the monthly departmental Morbidity & Mortality meeting.
Patient Suicide: the impact of service changes
• Removal of ligature points on in-patient wards
• Community services include an assertive outreach team
• Community services include 24 hour crisis teams as a point of access
• Follow up within 7 days of discharge from inpatient care
• Written policy on management of patients who refuse treatment
• Written policy on patients with a “dual diagnosis”
• Written policy on sharing information about risk with criminal justice agencies
• Written policy on multidisciplinary review and information sharing with families after a
suicide
• Front-line clinical staff receive training in the management of suicide risk at least every 3
years
148
The reports of 23 local clinical audits were reviewed by the Trust in 2013/14 and the Trust intends to
take the following actions to improve the quality of healthcare provided:
Emergency Department Documentation Audit
•
We have adapted Observation Unit documentation and approved via Health Records
Committee.
Care of Open Fractures in the Emergency Department
•
Complete a one page guideline for the management of open fractures to be included with
department guidelines.
Daily Documentation on PICU
• Developed training on how to perform I-PASS based handover.
Audit of the surgical protocol for patients with congenital adrenal hyperplasia
Guidelines to be updated :
•
Endocrine team to see patient prior to surgery and be responsible for prescription of
corticosteroids and IV fluids pre and post operatively
• Importance of IV fluid prescription to be highlighted in guidelines
• Signs/symptoms of adrenal crisis and management plan in guidelines
• Guidelines to be printed and attached to patient notes when requiring surgery
Surgical clerking of patients
• New generic clerking sheet to be designed and used Trustwide.
Audit on antiemetic prescribing in oncology
•
•
Guidelines to be changed for the route of ondansetron for antiemetic patients and to review
course length.
Further Education for trainees.
Participation in Clinical Research
The number of patients receiving NHS services provided by Birmingham Children’s Hospital NHS
Foundation Trust that were recruited during that period to participate in research approved by a
research ethics committee was 2400.
Figure 26: Participation in clinical research. Number of patients recruited into research approved by a research ethics
committee 2010/11 – 2013/14
149
The number of patients recruited to participate in research by a research ethics committee has fallen
in 2013/14. A large recruiting portfolio PICU study has closed which as expected has had an impact
on the recruitment for this year. We are due to open another large home grown portfolio study in
the May/June 2014 which should once again see an increase in recruitment.
Additionally we will continue to work to increase recruitment into clinical research in 2014/15 by:
•
focussing on National Clinical Trials day which is on 20th May. The BCH Research Team are
planning an exciting day to encourage staff, patients and parents to ask about research;
•
improving the profile of R&D. The Research and Development Manager is working with our
communications team to improve the BCH Research and Development intranet page and
website to increase the profile of Research and Development at BCH and encourage
recruitment.
One of our strategic objectives is to strengthen Birmingham Children’s Hospital’s position as a
provider of specialised and highly specialised services, so that we become the leading provider of
Children’s Healthcare in the UK. To help us achieve this, we are implementing a Research &
Development Strategy towards becoming a leader in paediatric clinical research.
Clinical research is important as it helps us to understand conditions and improve and discover new
treatments, resulting in improved quality of care for patients. A key priority for 2013/14 was to
reconfigure our Research Team to best support development of research at BCH.
An important indicator of research quality is the impact factor of the journals in which the research
is published, which reflects the number of times the journal is cited by other researchers and the
number of citations of particular publications over a period of time.
A good way of finding out how well we are doing on clinical research is to monitor the number of
peer reviewed research publications - excluding abstracts and letters - that we deliver each year.
When a research publication is reviewed by other professionals, or ‘peers’, this ensures that it is of a
high enough standard to be used to help develop treatments for patients. The number of peer
review publications in 2013 is outline below:
150
Figure 27: Number of peer reviewed publications 2009 to 2013
Use of the CQUIN Framework
A proportion of Birmingham Children’s Hospital NHS Foundation Trust’s income in 2013/14 was
conditional upon achieving quality improvement and innovation goals agreed between Birmingham
Children’s Hospital NHS Foundation Trust and any person or body they entered into a contract,
agreement or arrangement with for the provision of NHS services, through the Commissioning for
Quality and Innovation (CQUIN) payment framework.
The exception to this is the Quality Improvement Development Innovation Scheme (QIDIS) used by
the National Specialised Commissioning Team to support Trusts to improve the quality of care and
clinical outcomes for nationally designated services, replacing CQUIN arrangements for those
services.
Table 2: Schemes agreed for Quality Improvement and Innovation (CQUIN) 2013/14
Goal
Goal Name
Weight
Value
End of year
performance
1
SCAN (Safety Children Audit No Harm) (Paed Safety Therm)
23%
£285,167
Targets met
2.a
Friends and Family Test - Increased response rate
12%
£148,783
Targets met
2.b
Friends and Family Test - Improved performance on the staff FFT
8%
£92,989
Targets met
3
Safety Thermometer
5%
£61,993
Targets met
4.a
CAMHS - PBR
10%
£117,786
Targets met
5
Pharmaceutical Risk Assessment
20%
£247,971
Targets met
6
Childhood Obesity
23%
£285,167
Targets met
100%
£1,239,857
Total
151
Table 3: Schemes agreed for Quality Improvement Development Innovation Scheme (QIDIS) 2013/14
Goal
Goal Name
Weight
Value
End of year
performance
1a
Friends and Family Test - Increased response rate
6%
£200,536
Targets met
1b
4%
£133,691
Targets met
2
Friends and Family Test - Improved performance on the staff
FFT
SCAN (Safety Children Audit No Harm) (Paed Safety Therm)
10%
£334,227
Targets met
3
Quality Dashboards
10%
£334,227
Targets met
4
Highly specialised services - audit
10%
£334,227
Targets met
5
Preventing unplanned readmissions to PICU within 48 hours
10%
£334,227
Targets met
6
Haemtrack Monitoring
15%
£501,341
Targets met
7
Highly specialised services - other
20%
£668,454
Targets met
8
CAMHS Care Plans
15%
£501,341
Targets met
100%
£3,342,270
Total
The monetary total for the amount of income conditional upon achieving CQUIN and QIDIS goals in
2013/14 is detailed below:
Table 4: CQUIN and QIDIS income data 2013/14
2013/14
Percentage of income conditional upon achieving goals (total value £4.58m)
2.5%
Income not achieved £
0
Care Quality Commission
Birmingham Children’s Hospital NHS Foundation Trust is required to register with the Care Quality
Commission (CQC). Its current registration status is Green and is currently registered without any
conditions.
Registered to carry out the following legally regulated services:
•
•
•
•
•
•
Transport services, triage and medical advice provided remotely
Treatment of disease, disorder or injury
Assessment or medical treatment for persons detained under the Mental Health Act 1983
Surgical procedures
Diagnostic and screening procedures
Management of supply of blood and blood derived products
The Care Quality Commission has not taken enforcement action against Birmingham Children’s
Hospital NHS Foundation Trust during 2013/14.
Birmingham Children’s Hospital NHS Foundation Trust has not participated in special reviews or
investigations by the Care Quality Commission during 2013/14.
152
On 20, 22 and 25 of November 2013 the CQC undertook a routine, unannounced inspection of the
Trust’s services at our main site at Steelhouse Lane, to assess compliance with the following
standards:
•
Care and welfare of people who use services
•
Cooperating with other providers
•
Safeguarding people who use services from abuse
•
Supporting workers
•
Assessing and monitoring the quality of service provision
Birmingham Children’s Hospital NHS Foundation Trust was found to be meeting all the standards
outlined above.
On 13 and 22 of August 2013 the CQC undertook a routine, unannounced inspection of the Trust’s
Tier 4 (inpatient) Child and Adolescent Mental Health Service at Parkview to assess compliance with
the following standards:
•
Respecting and involving people who use services
•
Care and welfare of people who use services
•
Management of medicines
•
Staffing
•
Assessing and monitoring the quality of service provision
The inspection identified action was needed against the standard ‘respecting and involving people
who use services’ and ‘management of medicines’. The service was compliant against all other
standards.
Specifically the inspection identified minor concerns about the management and safe storage of
young people's medicines. The inspection also identified that young people had to ask to use toilet
facilities as they were sometimes locked. A compliance action was issues asking for improvements to
be made.
Birmingham Children’s Hospital has taken the following actions to the Tier 4 (inpatient) Child and
Adolescent Mental Health Service at Parkview improve against these two standards
•
A standardised care plan template for the use of non-psychiatric medicine has been devised
•
Standardised care plans for as required psychiatric medicines have been developed
•
Monitoring of compliance with care plans has been built into the monthly cycle of audit of
Nursing Care Quality Indicators
•
New thermometers, recording documentation and spot checks have been introduced for drugs
fridges
•
Spot checks and reminders have been put in place for expired medicines
153
•
A consistent approach has been put into place relating to locking toilet doors which are now
only locked in exceptional circumstances, this arrangement is subject to regular spot checks
•
The Temporary Locking Policy has been updated
•
Each young person at risk of self harming has a care plan in place which includes any
environmental controls that may be required.
Data Quality
Birmingham Children’s Hospital NHS Foundation Trust submitted records during 2013/14 to the
Secondary Uses Service for inclusion in the Hospital Episode Statistics which are included in the
latest published data.
The percentage of records in the published data which included the patient's valid NHS Number was:
99.21% for admitted patient care;
99.71% for outpatient care; and
99.23% for accident and emergency care.
The percentage of records in the published data which included the patient's valid General
Practitioner Registration Code was:
100% for admitted patient care;
100% for outpatient care; and
100% for accident and emergency care.
Birmingham Children’s Hospital NHS Foundation Trust’s Information Governance Assessment Report
overall score for 2013/14 was 91% and was graded green (satisfactory).
Birmingham Children’s Hospital NHS Foundation Trust was subject to the Payment by Results clinical
coding audit during the reporting period by the Audit Commission and the error rates reported in
the latest published audit for that period for diagnoses and treatment coding (clinical coding) were:
Diagnoses
% Error rate
Treatment (procedure)
Primary
Secondary
Primary
Secondary
20.5
29.9
6.6
22.6
191 cases (spells) were reviewed within the sample. The local focus for this sample of 191 spells was
Paediatrics as selected by our host Commissioner.
Note: the results of the audit should not be extrapolated further than the actual sample audited.
Performance against National Priorities
Table 6: Performance against National priorities 2013/14
National Priority
Target
Performance 2013/14
C-Diff
0 cases per year - locally agreed threshold
Target met – no cases
MRSA
1 case or less per year - locally agreed threshold
Target met – no cases
MSSA
Pre 48 hours
Monitoring only (but reduced)
154
All cancers; 31 day
wait for second or
subsequent
treatments
All cancers: 62 day
wait for first
treatment
All cancers: 31 day
wait from diagnosis
to first treatment
(96%)
All cancers: two week
wait from referral to
date first seen (93%)
Total time in A&E
1
Post 48 hours - 10% reduction
Target not met *
Surgery (94%)
Target met -100%
Anti cancer drug treatments (98%)
Target met – 100%
Radiotherapy (94%)
N/A
From GP referral to treatment (85%)
N/A - 66% (this target requires >5
patients to be applicable). In
2013/14 BCH had only 2 patients
on this pathway and 1 patient
was a shared breach. Of the 1.5
patients applicable for this target
1 patient met the target.
From consultant screening service referral
(90%)
N/A
Target met - 98.5%
Target met - 96.7%
95% of patients’ time taken from arrival to
discharge/admission < 4 hours.
90% admitted patients at the end of each
month
95% non admitted patients at the end of each
month
0 breaches
Target met - 97.2%
Emergency readmissions within 28 days of
discharge from hospital as a % of all relevant
admissions.
Monitoring only:
Age 0-15: 9.7%
Age 16 and over: 11.3%
Operations cancelled
on the day by the
hospital
<=0.8% each quarter across the year
Target not met* - 1.1%
Cancelled operations
and those not
admitted within 28
days
Certification against
compliance with
requirements
regarding access to
healthcare for people
with a learning
disability
Readmit >95% of those patients we cancel
within 28 days
Target not met* - 91%
18 weeks
Single Sex
Accommodation
Breaches
Emergency
Readmissions
Target met - 90.6%
Target met - 97.3%
Target Met
2
2
Fully compliant
155
*1
-Details for our performance relating to MSSA and what we are doing to improve can be found on page 136
-Details of our performance relating to cancelled operations and what we are doing to improve can be found
on pages 113 to 116
*2
Core National Indicators
Due to the time it takes central bodies to collate and publish some of the data, sometimes
comparative figures are not available at all (N/A). It should also be appreciated that some of the
‘Highest’ and ‘Lowest’ performing Trusts on some of the data may not be directly comparable to
Birmingham Children’s Hospital.
There are several core national indicators that are not applicable to Birmingham Children’s Hospital,
because they relate to adult patients/services only, or due to the specialist nature of many of our
services.
156
Hospital Readmissions: The percentage of patients readmitted to Birmingham Children’s Hospital
within 28 days of being discharged in 2013/14
Age
2011/12
2012/13
2012/13
2013/14
0-15
10.0%
9.97%
9.97%
9.7%
16 and over
11.0%
7.7%
7.7%
11.35%
National
Average
Highest
Trust
Lowest
Trust
N/A
Birmingham Children’s Hospital NHS Foundation Trust considers that these percentages are as
described for the following reasons:
Between 2010/11 and 2012/13 we undertook a monthly audit including a detailed review of every
emergency readmission and reported this to our commissioners. There were no concerns with the
discharge decision in any of the cases. The audit was funded by our host local PCT and has now
ended.
Readmissions continue to monitored on a specialty by specialty basis.
We intend to take the following actions to improve these percentages, and so the quality of its
services, by continuing to regularly monitor emergency readmissions to identify any concerns.
Staff Survey: Percentage of staff who would recommend the Trust to family or friends
BCH 2012
BCH 2013
2013 Acute Trust
Average
2013 Acute
Trust Lowest
2013 Acute Trust
Highest
83%
84%
88%
39.5%
93.9%
Birmingham Children’s Hospital NHS Foundation Trust considers that this percentage is as described
for the following reason:
We acknowledge that the result is slightly below the national average and that this has remained
consistent over the last few years.
Our plans to improve this percentage are outlined at page 120 to 121.
C.difficile: rate per 100,000 bed days of cases of C.difficile infection reported within the Trust
amongst patients aged 2 or over
2012/13*
1.2
2012/13
National Average*
17.3
2012/13
Highest Trust*
30.8
2012/13
Lowest Trust*
0.0
*Latest available comparative data from the HSCIC Information portal
157
Birmingham Children’s Hospital NHS Foundation Trust considers that this rate is as described for the
following reason:
There was one case of C.difficile in 2012/13.
The information above is based on the latest available data from the HSCIC information portal.
However, in 2013/14 we had no cases of C.difficile.
The actions we are taking to improve this rate and so increase the quality of our services through the
minimisation of the risk of C.Difficile are described at page 134
Patient Safety Incidents: the number and rate of patient safety incidents reported, and the
number and percentage of such patient safety incidents that resulted in severe harm or death
As there is not a nationally established and regulated approach to reporting and categorising patient
safety incidents, different trusts may choose to apply different approaches and guidance to
reporting, categorisation and validation of patient safety incidents. The approach taken to
determine the classification of each incident, such as those ‘resulting in severe harm or death’, will
often rely on clinical judgement. This judgement may, acceptably, differ between professionals. In
addition, the classification of the impact of an incident may be subject to a potentially lengthy
investigation which may result in the classification being changed. This change may not be reported
externally and the data held by a trust may not be the same as that held by the NRLS. Therefore, it
may be difficult to explain the differences between the data reported by the Trusts as this may not
be comparable.
October 2012 – March 2013*
October 2012 – March 2013
BCH
NRLS Cluster Average
1,203
n/a
Rate of patient safety incidents
per 100 patients (acute
specialist)
6.5
7.3
Percentage of such patient
safety incidents that resulted
in severe harm or death (small
acute)
0.1%
0.67%
Number of patient safety
incidents (acute specialist)
*Latest available comparative data from the HSCIC Information portal
Birmingham Children’s Hospital NHS Foundation Trust considers that this number and/or rate is as
described for the following reasons:
We are pleased to note the high number of reported incidents and the low percentage of these that
resulted in severe harm or death compared with the national average, as this indicates an open
safety culture.
Birmingham Children’s Hospital NHS Foundation Trust intends to take/has taken the following
actions to improve this number and/or rate, and so the quality of its services, by:
158
•
Actions we are taking to monitor and improve our safety culture are described on pages 161
to 162;
•
We investigate and learn from every incident;
•
We take actions to address safety issues identified through safety monitoring and analysis;
•
A more detailed breakdown of our 2013/14 patient safety incidents is outlined on page 163.
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Other information
Overview of Quality of Care
Complaints
We take all complaints about our services very seriously and ensure that the way we respond is
tailored to the individual and that we answer all of their concerns. Our Chief Executive is involved in
every response and writes personally to each individual. Responding to a complaint can include
meetings with clinical staff and senior managers, including the Chief Executive.
Formal complaints often originate in a concern raised with PALS (Patient Advice and Liaison Service)
which supports families in obtaining the response they need in the best way for them. We
encourage people to use our Formal Complaints service and PALS as, if something has gone wrong
we want to know about it so we can try to put it right, learn from it and improve. This information,
when combined with other quality information about our services, can also help us identify when
there are other problems.
Fortunately, compared to the numbers of patients we see every day, we receive very few formal
complaints. Each one is considered in detail and incorporated into our Safety Dashboard and our
Quality Report.
Figure 26: Numbers of formal complaints per month/per 1,000 admissions (This data is governed by local
definitions)
20
Complaints
15
Complaints per 1000 Admissions
10
5
0
In order to see whether there are any themes amongst the complaints we receive, we group the
issues raised in each complaint into categories. The pattern of complaints received about the 5 main
categories is set out below.
Figure 27: Pattern of complaints per top 5 categories, (This data is governed by local definitions)
50
Waiting, delays &
cancellations
40
Staff Attitude
30
20
Quality of Treatment
10
As part of the formal complaints investigation process, we identify any areas in which the Communication
quality of
0
the services could be improved, and make appropriate recommendations. These range from
Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
1011 1112 1112 1112 1112 1213 1213 1213 1213 1314 1314 1314 1314
Other
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reminders to staff about proper practices and behaviour, to fundamental changes in practice and
documentation. We regularly follow up on these recommendations to make sure action has been
taken.
As a result of these recommendations a number of changes have been made, including:
• Various: In multiple areas staff were required to attend advanced communication training;
• Cardiac: New process to be implemented to ensure that all patients who require a cardiac MRI
receive appointments in a timely fashion;
• CAMHS: We have reviewed the guidance for assessing the risks of patients taking ward leave;
• Histopathology: We have reviewed the process for managing newly diagnosed tumours;
• Complex Care: Daily planners for all patients are visible at the patient's bedside, so that all staff are
aware of their routine, including feeding plans. A Nurse in Charge Checklist has been introduced
that ensures that all patients have received their feeds, medications, observations and gives the
nurse in charge responsibility for checking that all care have been provided.
• Emergency Department: We have increased the number of staff in the ED who are trained in
breastfeeding;
• Ward 11: We have developed an escalation process and plan for home leavers returning out of
hours;
• Outpatients: We have purchased a hoist and wheelchair weighing scale;
• Maxillofacial: A new referral process has been implemented for referral to the Multi-Disciplinary
Team.
Incidents
We have robust systems for managing incidents. In 2012 we carried out a ‘Lean’ process on our
investigation management system to ensure it is as efficient as it can be. This means that
investigations can now be concluded more quickly, which is better for the patients and families
involved and allows us to start implementing learning from the incident earlier than we previously
could.
In 2013 our Internal Auditors gave an opinion of ‘significant assurance’ about our incident
management processes.
We encourage all members of staff to report all incidents, errors and near misses so we can make
improvements, work out what went wrong, identify themes and drive quality improvements in
everything we do. Our Quality Report, which is published on our website, includes information
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about incidents which any member of staff or the public can read.
Some of the major changes we have made as a result of learning from incidents and incident analysis
include:
•
•
•
•
•
We have redeveloped our observation and monitoring (PEWS) training so that it is clearer
for patients with very specialist conditions.
We are reviewing the Drugs and Therapeutics Committee approval process for one off drug
usage so that the process considers the risks and benefits of the proposed drug regime more
broadly (e.g. the risks and benefits of using specific devices for administration of the drug)
We are re-developing the WHO safer surgery process so that it is better aligned with and
compliments other existing checks.
We are exploring the risks and benefits of changing the concentration of IV morphine that is
stocked across the Trust.
We are developing our post-cardiac surgery handover sheet so that patient observation
parameters are clearly specified to facilitate management on PICU.
We monitor the numbers of patient safety incidents and the proportion of those which involve
harm. The high levels of incidents involving low or no harm and the very low proportion of incidents
that involve more than minor harm provide assurance that we have a good safety culture.
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Figure 28: Patient Safety Incidents by harm 2011/12-2013/14
Patient Safety Incidents by Harm Category 2011/12-2013/14
Year
Total
PSI
2011/12
2789
2012/13
2013/14
No
Harm
Minor, Non
Permanent Harm
Moderate, Semi
Permanent Harm
Severe, Severe
Permanent
Harm
Catastrophic,
Death
82%
17%
1%
0%
0%
2343
75%
24%
1%
0%
0%
2608
79%
19%
1%
0%
1%
The following will help us ensure we sustain and improve this positive position:
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•
•
•
•
•
•
•
•
We carry out an annual safety culture survey of all our clinical staff.
We carry out regular audits of incident reports to identify any staff groups, wards or
departments that may not be reporting all incidents.
A lower than expected number of reported incidents is one of the measures we use to
identify possible issues on wards or departments through our Safety Dashboard.
We run a Safety Hotline which trainee doctors can use to report any safety concerns and
obtain advice.
We run an advice service specifically for trainee doctors (Trainee Advice and Liaison Service
– TALS), which mirrors the processes of our Patient Advice and Liaison Service (PALS).
We have introduced a facility which allows staff to report an incident direct into our online
incident reporting system via a mobile phone.
Implementation of actions arising from reviews of incidents is robustly monitored.
Incidents are analysed to identify themes and significant safety issues.
Never Events
Never Events are very serious, largely preventable patient safety incidents that should not occur if
the relevant preventative measures have been put in place. There are 25 defined Never Events, 4 of
which are not relevant to BCH due to the services we provide. We have developed processes to
prevent these Never Events happening.
Two Never Events were reported and investigated during 2013/14. However, it should be noted that
in one of these cases, the incident occurred in March 2013.
Case 1:
A patient requiring a corrective procedure on both feet was due to have a staged operation,
operating on one foot at a time. The plan was to operate on the right limb first, however, and
incision was made on the left limb. The procedure was converted to a bilateral procedure with the
consent of the parents.
The investigation concluded that at that time the WHO Safer Surgery checking process had not
included a formal check of the operative site. A working group has been set up to improve the
application of the WHO Safer Surgery process. The group will lead on enhanced training and
consider modifications to the tools which support this process.
Case 2:
An Inner component was retained following insertion of a vascular access catheter required for
dialysis. The investigation concluded that there are certain types of equipment for which
departments independently manage their stock levels. This means that when equipment is
borrowed it may be of a slightly different model than the one usually used in that area. The design
of the device does not clearly suggest that the inner component should be removed and there was
no warning.
An evaluation of available vascular access devices has been carried out and a single device identified
for use in the organisation. A request has been made to the manufacturers and MHRA to consider
amending the labelling or packaging of the device to more clearly highlight the potential risk.
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Patient Experience
We work with children and young people every day to provide the best clinical experience possible.
We know there is a clear link between patient experience and how it influences clinical effectiveness
and safety and we also know that a fantastic patient experience goes well beyond the health
outcomes of children, young people and families at the trust.
There have been significant developments in how we capture, listen and act upon feedback from
children, young people & families. We want to hear about all aspects of experience, both positive
and that which could be improved. Importantly, where poor experience is reported actions are taken
to ensure improvements are made.
We hear about experiences from many different sources including; feedback cards, e mail, ward
walkabouts, verbal feedback; all collated on our in-house Patient Experience Database (PED). We
also have the Friends and Family Questionnaire and the Feedback App, as well as encouraging
children, young people and families, if they prefer to use the independent feedback site Patient
Opinion.
We have introduced Tea@ 3 a monthly forum where parents can share their experiences in an
informal setting over tea and biscuits.
In addition, this past year has seen an increase in the use of more qualitative approaches to try and
gain a better understanding of the experiences of children, young people and families "trying to see
the experience through their eyes" through the use of patient shadowing, mystery shopper, quality
walkabouts and patient stories.
Of all the feedback we receive, approximately 78% is positive and the positive comments continue to
reflect great satisfaction with nursing care, the overall experience of children, young people and
families, care by Allied Health Professionals and overall quality of care.
Our Patient Feedback App has gone from strength to strength. The first of its type in the NHS, the
app allows patients and families to send anonymous feedback directly to the manager in charge of a
particular area or department so it can be addressed in real time with no delays. The messages are
also published openly on our hospital website for patients and families to view too.
Since it was launched in 2013 we have received over 1,200 messages for 55 different areas from
children, young people and parents. The vast majority have been positive, with many leading to
changes and improvements. It has also been recognised nationally with a Guardian Public Service
Award for Digital Excellence, a PR Week Public Sector communications award and Birmingham
Chamber of Commerce Excellence in Innovation award.
We engage in conversation with our patients, families and supporters through social media too. We
have a strong presence on Facebook with 26,000 followers, one of the largest social media profiles
of all children's hospitals.
Each method brings its strengths and weaknesses and therefore utilising all methods enables the
Trust to better understand the patient’s experience and helps prioritise where to focus efforts on
action planning. The app and social media provide an opportunity for parents, children and young
people to let us know about their experience, both positive and not so good, in real time and for
staff to respond directly in real time too. They also support our ambition to be open and transparent
and encourage frank conversations as well as a great opportunity to interact directly with children,
young people and parents.
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To ensure responsiveness:
•
All feedback information is reviewed monthly for analysis and action.
•
It is scrutinised as part of an overall quality report by the Trust Board monthly.
•
This past year has seen the successful development of a new more accessible database to
provide improved data analysis.
Our KIDS transport team are a good example of a team who have acted on parent/carer feedback.
They have introduced the following improvements based on listening to parents and carers who
have had the extremely stressful experiences of having a critically ill child:
•
As a direct result of parent feedback, mobile phone chargers (with multiple adapters) and a
snack and a drink are provided to all the parents who travel in the ambulance. After only a
couple of weeks the team were getting positive parent feedback which has continued;
•
Some parents had asked about getting to destination hospitals, especially when it was more
remote centres like Leicester or Liverpool. Often whilst the one parent went in the
ambulance the other parent would travel in their car. Therefore, the team have purchased 4
Sat Navs and have programmed every UK PICU into them. They will offer to loan them to
the family and will give them a jiffy envelope with the KIDS address stamps on it so they can
post it back to the team.
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Examples of Patient and Carer Feedback:
‘To all the kind Nurses
on Ward 5, thank you
for looking after me
and helping me and
making me happy’
‘My son has only seen
a play specialist twice
in the last 10 months.
I’m concerned he will
fall behind as he has
special needs’
‘It is very difficult
for us to get
parking spaces’
‘Today it was over 20
minutes after our
appointment slot when we
were seen, and this was
9am in the morning. Please
try to be
more timely’
‘Took us over an hour in the
cubicle to see a Doctor, in
that time no one came and
advised us of the delay, I
thought they had forgotten
about us'
‘Give us an idea as to
how long the operation
will take, what order the
operations are done
and whereabouts in the
waiting list the patient
is’
‘I felt listened too and
the team were good at
explaining and
reassuring’.
‘A lovely housekeeper made
us feel so at ease and offered
us drinks on arrival and also a
sandwich. She was so lovely
and calm and made us feel
happy’.
‘Staff are very friendly and
care and attention in the
anaesthetic room was
excellent. Also very caring
staff who monitored our son
post operation’
.
‘Two visits in one
week and can’t
thank staff enough
for fantastic level of
care’
‘The Doctors were not very
friendly and didn’t put myself
or my scared son at ease.
Their bedside manner
requires attention’
‘The Kids Team told us
what was going on, we
knew when KIDS were
involved it all seemed
to get more organised’.
‘You are doing well,
everywhere is nice and
clean and tidy’.
‘Reception needs improving
and staff need to be aware of
the needs of deaf parents
and book an interpreter if
requested. Deaf parents
need an interpreter to
understand the information
and what is going on’ .
‘I liked choosing
my smell for my
sleepy gas’.
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Implementation of the national friends and family test for children and young people
We have continued to ask parents/carers and children and young people how likely they would be to
recommend our hospital to friends and family should they require similar care or treatment.
This year has seen the additional asking of children, young people and families who are seen and
discharged without admission from our Emergency Department (ED).
We have seen an improved response rate and overall score from last year.
In 2013/14 we asked 21% (13% in 12/13) of parents and 19% of children and young people, over the
age of 8 years whether they would recommend our hospital.
Our overall net promoter score was an impressive and improved 82% (73% 12/13).
Out of 2930 parents, 2895 were either likely or extremely likely to recommend Birmingham
Children’s Hospital to Friends and family.
Play and activities will remain high on the agenda for 2014/15 and we have recently recruited a new
Play Project Manager for play for a 6 month secondment that is reviewing both specialised and
normalising play provision in the trust. Hopefully to give a fuller service that will cover more out of
hours activities for children and young people. Also to help raise the profile of play, raise awareness
of what facilities are available and define roles within the team.
Strengthening the voice of children and young people will be a key priority for 2014/15 and we will
be building on the excellent work of our Young Person’s Advisory Group (YPAG) from last year.
Young Person Advisory Group
The Young Person’s Advisory Group (YPAG) at Birmingham Children’s Hospital hosted a unique
event which brought together local youngsters and healthcare professionals from all over the UK, to
discuss important health topics.
The Big Discussion welcomed health professionals from hospitals and councils across the country.
Representatives from the Care Quality Commission, NHS England, The Department of Health and the
National Institute for Health and Care Excellence were in attendance to hear about the important
areas faced by young people in the NHS.
The four key topics of the day were transition from paediatric to adult care, mental health, health
education/health promotion and communication between healthcare professionals and young
people.
We asked Iona Clayton the Chair of YPAG to work with her fellow YPAG members to produce a
statement on their work to strengthen the voice of children and young people in shaping the future
of care both at BCH and across the country in 2013/14. This is outlined below:
‘Over the past year, YPAG has continued to establish itself as a group who want change and
improvement in healthcare for young people, not only at Birmingham Children’s Hospital, but across
the NHS. Much of the work that YPAG did throughout 2013 was based upon the findings of The
Francis Report and involved members of YPAG conducting research at BCH. The content of these
research projects was developed during a residential trip which took place in June, during which,
members of YPAG undertook training as to how to conduct research effectively. As a group, we
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decided that we wanted to look at two aspects of care in particular, asking; how can excellent care
be achieved and how is compassion shown?‘
The research was carried out over the summer and involved speaking to patients and their families
as well as members of staff. After analysing and evaluating the data, members of YPAG then gave
presentations to some of the hospital’s executive team, outlining the findings of the research. As a
group, we felt this was particularly valuable, as it proved that young people offer a fresh perspective
and this enables healthcare professionals to have a more informed approach when making
decisions.
Another highlight has been YPAG’s involvement in the planning and organising of ‘The Big
Discussion’ which was an event held in April with the aim of bringing together young people and
health care professionals to discuss four issues. These were; mental health, communication, health
education and transition from paediatric to adult services. YPAG collaborated with two other groups,
the RCPCH Youth Advisory Panel and the National Children’s Bureau to coordinate the event. With
key-note speakers such as Kath Evans, Head of Patient Experience for NHS England and Maggie
Atkinson, the Children’s Commissioner, there was a great sense that the conversations taking place
during the day could instigate real change.
YPAG’s involvement in this project has not only helped raise awareness of the work we do as a group
but has demonstrated our capacity to work on a national level. Both of which, I feel are huge
achievements.
Alongside these projects, throughout the year, YPAG has continued to make valued contributions to
BCH. From offering advice on how the KIDS Ambulance Services could be improved, to forming
interview panels for several jobs within the hospital, YPAG has sustained a strong voice at BCH. After
such a successful year for YPAG in 2013, I am looking forward to the work that we will do in the
coming year. After our quarterly meeting in January, we decided as a group that one of the aims for
this year would be to increase patient representation within YPAG. I believe this will be achieved by
conducting more ward walkabouts to engage with patients. As well as this, we discussed the
possibility of starting a ‘buddy scheme’ in which young people from YPAG would pair up with
patients; this would also increase patient voice within the group.
Overall, YPAG has achieved a great deal in the past year and I am certain that we will continue to go
from strength to strength in order to overcome any challenges and show ourselves to be a key part
of BCH.
The Healing Environment
It is well evidenced that a positive environment helps people to heal. Basic needs are a quiet space, a
good diet and light which reduce the psychological effects of being ill. When we design new areas for
patient care we consider the operational requirements and also increasingly plan to provide a
Healing Environment.
We do this by,
• Reducing environmental stressors such as noise or a lack of privacy.
• Recognising the need for social interactions especially play and activities for children and
young people but also social support for parents.
• Providing activities which are emotionally and spiritually uplifting such as our Giggle Doctors,
Singing Medicine and our Chaplaincy service’s pastoral participatory work.
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• We also design to soften the environment by using sympathetic designs, colour and music.
STATEMENTS FROM STAKEHOLDERS
Commissioners
Birmingham South Central Clinical Commissioning Group (BSC CCG), as coordinating commissioner
for Birmingham Children’s Hospital NHS Foundation Trust (BCH), welcomes the opportunity to
provide this statement for their 2013/14 Quality Account.
A draft copy of the Quality Account was received by BSC CCG on the 25th April 2014 and the
statement has been developed from the information presented to date. Feedback on the draft
account has also been received from Birmingham CrossCity CCG and NHS England Area Team,
including specialised commissioning.
We have reviewed the content of the Quality Account and confirm that it complies with the
prescribed information, format and content as set out by Monitor and NHS England. The information
provided within this account is, to the best of our knowledge, accurate and fairly interpreted.
The account captures progress made by the Trust in 2013/14, identifies where further improvement
is required and details the actions needed to achieve these goals. We support the priorities set for
this year and recognise the areas identified by the Trust where more focus is required.
The number of cancelled operations and waiting times for MRI scans remain key priorities for
improvement and we are working closely with BCH and NHS England Area Team to monitor the
effectiveness of initiatives currently being implemented. In particular, there is focus on the impact of
these waits on patient safety and patient experience.
The report clearly reflects that the Trust is a learning organisation that is continually striving to
improve the quality of care across its services, with an open and transparent culture in place. This is
particularly evident through the innovative methods of capturing real time feedback from children,
young people and families, with examples of how this experience continues to drive improvement.
We welcome the continued focus on improving patient safety and recognise the positive steps that
are being taken, such as further expansion of the Hospital Handover Project, initiatives in place that
focus on reducing medication incidents and further development of both the safety dashboard and
paediatric safety thermometer.
During 2013/14, we have supported the Trust in raising awareness of the need to develop paediatric
mortality measures nationally in order for them to be used effectively to improve the quality of
services and we are keen to see progression of this work in the coming months.
Over the past year the Trust has reported two serious incidents classified as “Never Events”. The
CCG attended the root cause analysis meetings for these incidents and received assurance that
learning has been identified and robust actions put in place in order to prevent recurrence of these
types of incident. Updates on progress against the action plan and dissemination of learning have
been received at the CCG / BCH Clinical Quality Review Group (CQRG) meetings.
The Quality Account reflects a number of the performance quality indicators which are monitored
monthly, along with areas for improvement at the CCG / Trust CQRG. In addition to this we will
continue to discuss actions developed in response to recommendations from the Mid Staffordshire
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NHS Foundation Trust Public Inquiry and subsequent recommendations from the Berwick, Keogh
and Clwyd reports.
We also continue to be invited to the Trust’s Clinical Risk and Quality Assurance Committee and to
all Root Cause Analysis meetings following serious incidents, reflecting the open and transparent
relationship the CCG has with the Trust.
We have made some specific comments to the Trust directly in relation to the quality account which
we hope will be considered as part of the final document. These include; addition of supporting
narrative related to clinical audits, surveys and other quality data and inclusion of further
information on CQUIN outcomes.
Through this quality account and the ongoing quality assurance process, BCH have demonstrated
their commitment to continually improve the quality of services provided to children, young people
and families. As coordinating commissioner, we look forward to continuing to work in partnership
with the Trust and supporting them to deliver these quality priorities.
Dr Raj Ramachandram
Chair – Birmingham South Central Clinical Commissioning Group Quality and Safety Committee
14th May 2014
Birmingham Health Overview and Scrutiny Committee
In April 2014 Birmingham Health Overview and Scrutiny Committee notified us that they would not
be providing a statement relating to the 2013/14 Quality Account
Healthwatch Birmingham
Healthwatch Birmingham recognise that Quality Reports are a useful contribution to ensuring NHS
providers are accountable to patients and the wider public about the quality of the services they
provide. We welcome the opportunity to comment on the Quality Report for Birmingham Children’s
Hospital NHS Foundation Trust.
The presentation of the report and the way in which the information has been presented is
welcomed. It is an accessible report, the language used is clear and along with the simple design the
overall feel is that the report has been written for the wider public and it encourages readers to
continue reading.
We welcome the range of initiatives to improve the experience of patients, carers and visitors that
were implemented during the year such as the Friends and Family App, and we see as a real positive,
the work done with the Young Person’s Advisory Group supporting them to have greater autonomy
to hold the Trust to account.
There have been a lot of improvements in care and outcomes and where targets for improvement
haven’t been met, the report is transparent and honest and clearly shows how plans are in place to
work hard to continue to improve outcomes for Children, Young people and their relatives and care
givers.
The Trust’s commitment to reducing infection rates is commended especially for Clostridium Difficile
and MSSA. In addition, for the 3rd year in a row there have been no MRSA blood stream infections
which demonstrates the multi-disciplinary team work of staff and clinicians is achieving safer
outcomes for patients.
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The report documents the number of cancelled appointments and the reasons why the cancellations
occur as well as taking on board the distress caused for patients and families when these occur,
especially when operations are cancelled on multiple occasions.
The largest reason for the cancellation of an operation is the absence of PICU beds (accounting for
24% of cancellations). It is encouraging that the Trust clearly outlines steps in addressing this figure,
in particular in terms of securing higher levels of specialist staff needed to resource the PICU beds
and by looking at ways to make discharges speedier, especially over the pressured winter months.
Healthwatch Birmingham is pleased to see that the improving standards of overall care is taken
seriously across the entire Trust team, demonstrated in the Trust meeting all required standards in
an announced visit by the Care Quality Commission.
Healthwatch Birmingham looks forward to seeing the results of the Trust’s continued focus on
improving patient experience in the year ahead.
Paul Devlin
Chief Executive Officer, Healthwatch Birmingham
21st May 2014
Council of Governors
The Council of Governors is pleased to review and comment on Birmingham Children’s Hospital NHS
Foundation Trust’s Quality Account 2013/14.
The Account provides a thorough and well balanced view of safety, patient experience and clinical
effectiveness. We consider it accurately reflects the experience of the Governors throughout the
year. The Governors would like to praise the continued open and transparent culture at the Trust.
Last year, we encouraged the Trust to incorporate more of the patient’s voice in the Account this
year and we are pleased that this suggestion has been taken on board. The Trust is very good at
seeking feedback from patient and families and is proactive about the feedback it receives – using it
to inform service improvement. Our Patient Feedback App has gone from strength to strength this
year and, since its launch in 2013, we have received over 1,200 comments from children, young
people and parents through the App.
We are impressed by the achievements outlined in the report. The Governors are pleased to see the
continued improvement in managing infection control rates. There have been no cases of
Clostridium difficile (C-Diff) over the past year and no cases of MRSA for the third year in a row.
The Governors would like to recognise the day in day out commitment and value of our Hospital
Operations Centre (HOC). The HOC team work under continuous pressure to oversee the day to day
use of our capacity, which has helped to improve outcomes. We recognise the hard work that goes
in to making sure that the demand for our beds is managed appropriately to ensure our children and
young people are in the right beds in the right clinical timeframe.
The Governors are pleased to see that the Trust remains at the forefront of innovation. During the
past two years, the National Safety Thermometer has been used to measure harm in our hospital.
However, the Trust identified that the tool was not sufficiently sensitive to the harms in children and
young people so has collaborated with other providers to design and test a new tool (SCAN - Safer
Children Audit No Harm). In 2013, the pilot was endorsed by NHS England who has now
commissioned the development of SCAN as a national paediatric safety thermometer.
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Importantly, however, the report also makes it clear where the Trust has not met its objectives, such
as in relation to play and activities. The Governors note that there has been a swing from a majority
of positive comments in 2012/13 to a majority of ‘need to improve’ comments in 2013/14. The
improvement strategy is comprehensive and the Governors will be interested to see the impact this
will have on patient feedback in the next Account.
The Trust has invested a considerable amount of time in a wide variety of listening, engagement and
learning activities post Francis which has included the involvement of external experts, such as
Professor Michael West. Professor West has provided the Trust with expertise around the factors
that determine the effectiveness and innovativeness of individuals and teams at work. He has also
helped to provide focus on improving the well being of those who work within our Trust. This links
well to the clear aim of the Trust to improve our staff satisfaction score in the National NHS Staff
Survey.
During the year we have welcomed the CQC. They made an unannounced visit to the Trust in
November 2013 and concluded we were meeting all core standards. This is an incredible
achievement and a very positive endorsement by our Inspectors of the quality, service and care
provided by the Trust.
These are challenging times for the Trust and the NHS as a whole. Demand for our services continues
to grow and we have important decisions to make in respect of our future estate. The Governors are
confident that the Trust has the strong leadership and financial control necessary to be in a good
position to plan for the future without affecting safety, patient experience and clinical effectiveness.
Council of Governors of Birmingham Children’s Hospital NHS Foundation Trust
15 May 2014
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STATEMENT OF DIRECTORS’ RESPONSIBILITIES
IN RESPECT OF THE QUALITY REPORT
The Directors are required under the Health Act 2009 and the National Health Service (Quality
Accounts) Regulations 2010 as amended to prepare Quality Accounts for each financial year.
Monitor has issued guidance to NHS foundation trust boards on the form and content of annual
quality reports (which incorporate the above legal requirements) and on the arrangements that
foundation trust boards should put in place to support the data quality for the preparation of the
quality report.
In preparing the Quality Report, directors are required to take steps to satisfy themselves that:
•
the content of the Quality Report meets the requirements set out in the NHS Foundation
Trust Annual Reporting Manual 2013-14;
•
the content of the Quality Report is not inconsistent with internal and external sources of
information including:
o Board minutes and papers for the period April 2013 to June 2014;
o Papers relating to quality reported to the Board over the period April 2013 to June
2014;
o Feedback from the commissioners dated 13 May 2014;
o Feedback from governors dated 15 May 2014;
o The Trust’s complaints report published under regulation 18 of the Local Authority
Social Services and NHS Complaints Regulations 2009, dated 15 May 2014;
o The national staff survey 2013;
o The Head of Internal Audit’s annual opinion over the trust’s control environment
received at Audit Committee 23 May 2014;
•
The Quality Report presents a balanced picture of the NHS Foundation Trust’s performance
over the period covered;
•
the performance information reported in the Quality Report is reliable and accurate;
•
there are proper internal controls over the collection and reporting of the measures of
performance included in the Quality Report, and these controls are subject to review to
confirm that they are working effectively in practice;
•
the data underpinning the measures of performance reported in the Quality Report is robust
and reliable, conforms to specified data quality standards and prescribed definitions, is
subject to appropriate scrutiny and review; and the Quality Report has been prepared in
accordance with Monitor’s annual reporting guidance (which incorporates the Quality
Accounts regulations) (published at www.monitor-nhsft.gov.uk/annualreportingmanual) as
well as the standards to support data quality for the preparation of the Quality Report
(available at www.monitor-nhsft.gov.uk/annualreportingmanual)).
The Directors confirm to the best of their knowledge and belief they have complied with the above
requirements in preparing the Quality Report.
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By Order of the Board
Keith Lester, Interim Chair
Sarah-Jane Marsh, Chief Executive
How we have engaged people in setting priorities for improving quality
Foundation Trust Governors
• At quarterly meetings governors are provided with our Quality Report, Resources Report and
information on Trust developments.
• Governors take part in scheduled Quality Walkabouts.
• At meetings of the Council of Governors, governors take part in Quality Walkabouts and visit new
developments to better understand the Trust’s services and the issues that are important to
patients, families and staff.
• Twice a year we hold a joint meeting between the Council of Governors and the Board of
Directors to consider the future strategy of the Trust and developments within the Trust and the
NHS which are relevant to the Trust’s strategy.
• Governors are engaged in our governance structure, with governors as members of committees
and groups.
• A Public Governor chairs our Organ Donation Committee.
• The Governors Scrutiny Committee is an active sub-committee of the Council of Governors which
provides a forum for more detailed debate and challenge on quality and resources issues and
strategic developments.
• The Governors selected one of the quality indicators for review by the External Auditor and also
asked for another indicator to be audited additional to Monitor’s requirements.
Our Staff
• Our Board and Governor Quality Walkabouts involve engagement with staff as well as patients
and families.
• Surveys, including the national annual Staff Survey and our own Staff Safety Survey.
• Regular staff polls.
• Staff attendance at public Board meetings.
• Chief Executive Briefings.
• Our New ‘in-Tent 2 listen’ staff events.
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Our patients and families
• Quality Walkabouts.
• PLACE assessments.
• Direct patient feedback through feedback cards, feedback app and other means.
• Patient stories which accompany reports to the Board to help bring issues to life.
• Focus groups on particular issues.
• Mystery Shoppers.
• Taking account of concerns raised through formal complaints and the PAL Service.
• Surveys Consultation on potential new developments.
• Parent representatives on the Learning Disabilities Steering Group.
• Feedback from CAMHS parents and young people by way of an exit interview (Chi Esq).
How to provide feedback on the Quality Report
Despite the improvements in the quality of services we have seen over the last year, we know we’re
always learning about how things can be done even better.
At the heart of everything we do are our patients, their families and the communities that we serve.
That’s why we’re always interested in hearing from you – whether you have a suggestion on how we
can provide care more innovatively, or whether you had an experience you think we could improve
on.
We actively encourage people to get in touch and stay in touch with us, so if you have any ideas
about how we could make this Quality Account even better we’d like to hear from you.
To tell us about what you think, please contact our Communications Department on:
 0121 333 8535
 [email protected]
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STATEMENT OF THE CHIEF EXECUTIVE’S RESPONSIBILITIES AS THE ACCOUNTING OFFICER OF
BIRMINGHAM CHILDREN’S HOSPITAL NHS FOUNDATION TRUST
The NHS Act 2006 states that the chief executive is the accounting officer of the NHS foundation
trust. The relevant responsibilities of the accounting officer, including their responsibility for the
propriety and regularity of public finances for which they are answerable, and for the keeping of
proper accounts, are set out in the NHS Foundation Trust Accounting Officer Memorandum issued by
Monitor.
Under the NHS Act 2006, Monitor has directed Birmingham Children’s Hospital NHS Foundation
Trust to prepare for each financial year a statement of accounts in the form and on the basis set out
in the Accounts Direction. The accounts are prepared on an accruals basis and must give a true and
fair view of the state of affairs of Birmingham Children’s Hospital NHS Foundation Trust and of its
income and expenditure, total recognised gains and losses and cash flows for the financial year.
In preparing the accounts, the Accounting Officer is required to comply with the requirements of the
NHS Foundation Trust Annual Reporting Manual and in particular to:
•
•
•
•
•
observe the Accounts Direction issued by Monitor, including the relevant accounting and
disclosure requirements, and apply suitable accounting policies on a consistent basis;
make judgements and estimates on a reasonable basis;
state whether applicable accounting standards as set out in the NHS Foundation Trust
Annual Reporting Manual have been followed, and disclose and explain any material
departures in the financial statements;
ensure that the use of public funds complies with the relevant legislation, delegated
authorities and guidance; and
prepare the financial statements on a going concern basis.
The accounting officer is responsible for keeping proper accounting records which disclose with
reasonable accuracy at any time the financial position of the NHS foundation trust and to enable her
to ensure that the accounts comply with requirements outlined in the above mentioned Act. The
Accounting Officer is also responsible for safeguarding the assets of the NHS foundation trust and
hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.
To the best of my knowledge and belief, I have properly discharged the responsibilities set out in
Monitor's NHS Foundation Trust Accounting Officer Memorandum.
Sarah-Jane Marsh
Chief Executive
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Section 4
Annual Governance Statement
178
Annual Governance Statement
Scope of responsibility
As Accounting Officer, I have responsibility for maintaining a sound system of internal control that
supports the achievement of the NHS foundation 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 NHS
foundation trust is administered prudently and economically and that resources are applied
efficiently and effectively. I also acknowledge my responsibilities as set out in the NHS Foundation
Trust Accounting Officer Memorandum.
The purpose of the system of internal control
The system of internal control is designed to manage risk to a reasonable level rather than to
eliminate all risk of failure to achieve policies, aims and objectives; it can therefore only provide
reasonable and not absolute assurance of effectiveness. The system of internal control is based on
an ongoing process designed to identify and prioritise the risks to the achievement of the policies,
aims and objectives of Birmingham Children’s Hospital NHS Foundation Trust, to evaluate the
likelihood of those risks being realised and the impact should they be realised, and to manage them
efficiently, effectively and economically. The system of internal control has been in place in
Birmingham Children’s Hospital NHS Foundation Trust for the year ended 31 March 2014 and up to
the date of approval of the annual report and accounts.
Capacity to Handle Risk
Leadership
The Board of Directors is responsible for the management of key risks. Key risks are described within
the Board Assurance Framework which is considered every month by the Board of Directors and on
a regular basis by the Audit Committee. In addition, risks are clearly defined within the reports
presented to the Board by the Executive Directors. This process is supplemented on a quarterly basis
when the self-assessment of the financial, activity and service risks is made for submission to the
independent regulator, Monitor.
The Trust’s Risk Management policies clearly set out responsibilities for risk management within the
organisation. As Chief Executive Officer I have overall responsibility and accountability for risk
management. This is shared with the Executive Directors who are responsible for ensuring that the
risk management framework is systematically implemented and developed across the organisation.
In addition they, through the Board of Directors’ committee structure, are responsible for providing
assurance to the Board of Directors that risk management continues to be an essential element of all
management systems and corporate planning, as well as the setting of strategy and objectives. The
committees for 2013/14 included the Quality Committee and the Finance and Resources Committee,
which are both chaired by Independent Non-Executive Directors, with non-executive and executive
director membership. The sub-committees which monitor risks to safety, quality and workforce
objectives include the Clinical Risk and Quality Assurance Committee, the Non-Clinical Risk
Coordinating Committee, the Patient Experience and Participation Committee and the Strategic
Workforce Committee.
Staff Training & Guidance
A range of risk management and information governance training is provided to staff and there are
policies in place to describe their role and responsibilities in relation to the identification and
management of risk. This includes an online training resource for refresher training. This ensures
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that risks are actively managed at all levels of the organisation. The importance of feedback to staff
on incidents reported is stressed at all levels of training.
To ensure the quality of local management of incidents, we deliver training (level 2) for all local
managers. This is an interactive session which covers day-to-day management of risks at a local
level, investigation tips and techniques for managing incidents and complaints and guidance on how
to carry out robust risk assessment and how to use the risk register appropriately.
Level 3 ‘Risk Leaders’ training has been designed for members of staff that need a high level of
expertise in risk management. The session is focused on Root Cause Analysis techniques and
processes, includes some advanced risk management techniques and introduces the role and
development of assurance frameworks.
Training implications are considered as part of all Root Cause Analysis investigations. As a direct
result of learning from these investigations, changes have been made to mandatory training related
to medicines management, observation and monitoring, and resuscitation.
Bespoke risk management training has also been developed for Board members and directors to
enable them to fully understand their role and responsibilities in relation to risk management.
The Trust both through its clinical governance structure and training and education support team
continue to embrace and learn from good practice both nationally and internationally. Methods
used include:
• Attending and holding seminars and conferences on key aspects of safety and clinical
practice.
• Use of external reviews in how we organise our services and provide information to front
line managers and clinicians.
• Use of our internal audit partner to challenge current practice and provide examples of good
practice from across their client base.
• Using Root Cause Analysis to assess how we manage and improve when there has been a
significant event at the Trust.
The Risk and Control Framework
The Trust’s risk management policies ensure that risk management is embedded in the activities of
the organisation in a number of ways:
•
Both Corporate and Directorate objectives are risk assessed and inform the Board Assurance
Framework, which is reviewed regularly by the Board of Directors and the Audit Committee.
•
The Trust has achieved level 3 compliance with the NHS Litigation Authority (Clinical
Negligence Scheme for Trusts) Risk Management Standards. This demonstrates not only that
there are clearly defined and embedded policies in place to address risk but also that those
policies are monitored on an ongoing basis and that action is taken when those policies are
not effective.
•
Risks to information are managed through the use of the NHS Information Governance
Toolkit. The Trust’s policy provides a documented mechanism for the immediate reporting
and investigation of actual or suspected information security breaches/losses and potential
vulnerabilities/weaknesses within the Trust. The Information Governance Toolkit submissions
and the annual plan to improve compliance with the relevant standards is approved and
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regularly reviewed by the Regulatory Compliance Committee, which reports to the Board via
the Quality Committee. Following a self-assessment and submission the overall score against
the Information Governance Toolkit for 2013/14 was 91% and graded Green (‘Satisfactory’).
•
There are structured processes in place for incident reporting and the investigation of Serious
Incidents Requiring Investigation (SIRIs), complaints and litigation cases. Regular audits are
undertaken of these processes to ensure they are appropriately followed and are effective.
The outcomes of these audits are reported to the Clinical Risk and Quality Assurance
Committee.
•
Incident reporting is openly encouraged across the Trust through training, the use of online
incident reporting, and the communication of positive outcomes as a result of reporting of
incidents, errors and near misses. Ward inspections to check compliance with CQC standards
provide assurance that staff know how to report incidents.
•
A non-executive director is invited to participate in the Root Cause Analysis of every SIRI. This
helps ensure a good Board level understanding of risk management processes in the
organisation.
•
All papers presented to the Board of Directors and Board committees contain an assessment
of key regulatory or statutory impacts, including equality, diversity and human rights and
compliance with standards including NHS Litigation Authority risk management standards and
CQC essential standards of quality and safety.
•
The Trust attends and submits a performance, compliance and risk report to the Trust’s
Commissioner’s monthly Clinical Quality Review Group.
•
A representative of the Trust’s Commissioners is invited to attend the Trust’s monthly Clinical
Risk and Quality Assurance Committee and is invited to participate in the Root Cause Analysis
of SIRIs.
•
All quality initiatives and Cost Improvement Plans require a quality impact assessment, which
is scrutinised by the Chief Medical Officer or Chief Nursing Officer before approval.
•
Risk appetite is determined in relation to specific matters reviewed by the Board through
detailed consideration of risk and benefit analysis.
Key Quality Governance Arrangements
The Trust has continued to refine its approach to the analysis of incidents, potential incidents and
near misses, in order to identify and communicate learning points and necessary actions. This
commitment to developing an environment of honesty and openness, where mistakes and untoward
incidents are identified quickly and dealt with in a positive and responsive way, has been successful
in engaging clinical staff. This approach to learning is also informed by various sources of information
including surveys, patient and staff feedback, service reviews, and clinical audits.
A regular Safety Dashboard is produced for each Clinical Directorate, which incorporates an
overview of data such as incident reports, SIRIs, complaints and Nursing Care Quality Indicators
(NCQI) performance per ward/department to highlight potential issues or concerns about safety or
quality of services. The dashboard allows an aggregated review and comparison of these metrics
against each individual ward and department and incorporates a series of defined ‘triggers’ which, in
combination, may indicate problems with safety or quality in a specific area. This allows the
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Directorate Management Teams and Board committee responsible for safety to focus attention
where it may be required and acts as an early warning system. From 2012, the Safety Dashboard has
also identified the departments implementing a Cost Improvement Plan (CIP) so an assessment can
be made as to whether the project is affecting quality and safety. Workforce information is also
included, as indications of low staff engagement can act as an early warning about a possible impact
on our services.
In 2011/12 a Patient Safety Strategy was developed which maps out the Trust’s journey towards
safer care. The Strategy is updated each year and sets out a series of clearly defined, measureable
safety targets to achieving the Trust’s aim to eliminate any less than perfect care. These targets are
produced through a process of risk analysis, identifying areas for improvement through data sources
such as SIRIs, incident reporting, complaints, litigation and patient experience feedback, as well as
national guidance and best practice benchmarking. We believe that focussing our efforts on a
targeted list of specific projects will have a significant impact on the amount of harm which is
suffered by our patients.
The Trust’s values – which were agreed in consultation with staff – have been embedded during
2013/14 in our recruitment, induction and appraisal processes. This ensures that all new staff
demonstrate our values and that the behaviours of all staff and the decisions that we make are
rooted in our values. Commitment to these values – respect, trust, compassion, courage and
commitment - also encourages openness and transparency, which supports robust quality
governance arrangements centred on learning.
The Trust commissioned an external review of its governance structures in 2011/12 to ensure they
are fit for purpose and provide the Board of Directors with sufficient, high quality, timely
information. As a result of this review, the governance structure was redesigned to include two new
Board Committees:
•
Quality Committee, the aim of which is to provide strategic direction and overview of all
issues related to the quality of care and service provision, allowing integrated quality
reporting to the Board of Directors.
•
Finance & Resources Committee, to review all matters relating to resources, including
finance, investment, workforce and information technology, and to provide strategic
direction on negotiating the risk environment. The Committee also provides more detailed
scrutiny of the Trust’s operational performance and during the past 12 months has initiated
‘deep dive’ reviews into areas such as cancelled operations and diagnostic waiting times.
This new structure was implemented in 2012/13 and its effectiveness has been monitored on an
ongoing basis throughout 2013/14.
The Audit Committee, as part of its work programme:
• Examines and tests the effectiveness of the governance structure across the organisation to
provide assurance to the Board that risks are being identified and mitigated.
• Undertakes a structured review of the key corporate risks and assurance mechanisms
associated with these.
The Quality Report provides an overview of the main indicators of quality across the Trust, including
high risks, incidents, mortality, patient experience, safeguarding and infection control, as well as
progress against our Safety Strategy and quality projects. The report is considered every month by
the Board alongside our Resources Report, which, in addition to giving details of the Trust’s financial
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performance, examines the Trust’s activity levels, including the way people are accessing our
services; and workforce indicators, such as sickness levels, turnover, and mandatory training and
appraisal targets, to allow an assessment of the impact of activity levels on our staff. The two reports
together provide a broad perspective of all the factors that make up the Trust’s system of internal
control.
In February 2013 our Internal Auditor completed a review of the Trust’s Quality Governance
arrangements that ensure compliance with Monitor’s Quality Governance Framework. This review
found that the Trust meets Monitor’s criteria, and provides ‘significant assurance’ that the Trust’s
arrangements are sound. We have implemented the recommendations associated with this review
and have continued to monitor their impact. As a follow up our Internal Audit partner reviewed the
Trust’s response to the findings Sir Robert Francis into Mid-Staffordshire NHS Foundation Trust. This
provided significant assurance that Birmingham Children’s Hospital had responded in an appropriate
manner.
During 2013 both the Trust’s locations, at Parkview and at Steelhouse Lane, received an
unannounced inspection from CQC.
The Care Quality Commission visited the main Steelhouse Lane site for a routine unannounced
inspection during November 2013 focussing on the following standards:
•
Care and welfare of people who use the services.
•
Co-operating with other providers.
•
Safeguarding who use the services from abuse.
•
Supporting workers.
•
Assessing and monitoring the quality of service provision.
The Trust met all the standards and received a positive report from the Inspectors.
On 13 and 22 of August 2013 the CQC undertook a routine, unannounced inspection of the Trust’s
Tier 4 (inpatient) Child and Adolescent Mental Health Service at Parkview to assess compliance with
the following standards:
•
Respecting and involving people who use services.
•
Care and welfare of people who use services.
•
Management of medicines.
•
Staffing.
•
Assessing and monitoring the quality of service provision.
The inspection identified action was needed against the standard ‘respecting and involving people
who use services’ and ‘management of medicines’. The service was compliant against all other
standards.
Specifically the inspection identified minor concerns about the management and safe storage of
young people's medicines. The inspection also identified that young people had to ask to use toilet
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facilities as they were sometimes locked. A compliance action was issues asking for improvements to
be made.
Birmingham Children’s Hospital has taken the following actions to the Tier 4 (inpatient) Child and
Adolescent Mental Health Service at Parkview improve against these two standards
•
•
A standardised care plan template for the use of non-psychiatric medicine has been devised
Standardised care plans for as required psychiatric medicines have been developed
•
Monitoring of compliance with care plans has been built into the monthly cycle of audit of
Nursing Care Quality Indicators
•
New thermometers, recording documentation and spot checks have been introduced for drugs
fridges
•
Spot checks and reminders have been put in place for expired medicines
•
A consistent approach has been put into place relating to locking toilet doors which are now
only locked in exceptional circumstances, this arrangement is subject to regular spot checks
•
The Temporary Locking Policy has been updated
•
Each young person at risk of self-harming has a care plan in place which includes any
environmental controls that may be required.
The foundation trust is fully compliant with the registration requirements of the Care Quality
Commission.
As an employer with staff entitled to membership of the NHS Pension Scheme, control measures are
in place to ensure all employer obligations contained within the Scheme regulations are complied
with. This includes ensuring that deductions from salary, employer’s contributions and payments
into the Scheme are in accordance with the Scheme rules, and that member Pension Scheme
records are accurately updated in accordance with the timescales detailed in the Regulations.
Control measures are in place to ensure that all the organisation’s obligations under equality,
diversity and human rights legislation are complied with.
The foundation trust has undertaken risk assessments and Carbon Reduction Delivery Plans are in
place in accordance with emergency preparedness and civil contingency requirements, as based on
UKCIP 2009 weather projects, to ensure that this organisation’s obligations under the Climate
Change Act and the Adaptation Reporting requirements are complied with. The Trust has a
sustainability group that meets on a regular basis to develop and monitor implementation plans in
this area.
Major Organisational Risks:The major strategic risks faced by the organisation are regularly reviewed as part of the review of
the Board Assurance Framework.
RISK
Failure to ensure the staff
culture is aligned to the Trust’s
strategic
objectives
could
impact on achievement of the
MANAGEMENT & MITIGATION
• Seek feedback from staff through a range of means and
embed the output and associated actions into Trust reporting
systems.
• Embed results from local surveys and staff polls into
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Trust’s strategic objectives and
on the delivery of high quality
care and patient experience.
•
•
Planned reductions in funding
could impact on the delivery of
the Trust’s services, affect the
quality of care and patient
experience and impact on
achievement of the Trust’s
strategic objectives.
Under developed workforce
plans could impact on the
delivery of the Trust’s services,
affect the quality of care and
patient experience and impact
on achievement of the Trust’s
strategic objectives.
•
Failure to deliver our Cost
Improvement
Plans
could
impact on the delivery of the
Trust’s services, affect the
quality of care and patient
experience and impact on
achievement of the Trust’s
strategic objectives.
A delay in delivery of the
strategic outline case for the
new hospital project could
impact on achievement of the
Trust’s strategic objectives.
•
•
•
•
•
•
•
•
•
•
•
performance indicators and leadership appraisals with a goal
of 10% improvement each year.
Improve the regularity and quality of staff briefing.
Develop and deliver an organisational development plan
around team development and leadership.
Agreement of transition funding for community CAMHs
services with local NHS commissioners.
Respond to the commissioner consultation on the future of
children’s mental health services.
Identify and develop alternative service scenarios that will
better use public resources across the whole of the children’s
mental health budget.
Deliver improved workforce productivity through more
efficient use of the temporary workforce and re-profiling of
the total workforce.
Shift from junior medics to advanced practitioners.
Shift in WTE from nurses to support workers.
Review the medical administration function.
Improve experience and quality of clinical education
placements for all clinical staff.
Set a financial plan for 2014/15 that requires an achievable
CIP target;
Develop a two-tier approach to the efficiency requirements
required over the next three years.
Commission external support to examine flow and efficiency
through areas such as outpatients and theatres.
Strengthen PMO function and its monitoring mechanisms.
• Board-to-Board meetings planned with Birmingham Women’s
Hospital.
• Work with the Department of Health on alternative funding
streams for the commercial element of the funding stream.
• Develop a phased approach to the development of the new
hospital as part of the Next Generation project. Phase one
provides a legacy building on the Steelhouse Lane site.
The Board of Directors is satisfied that the actions taken have addressed the internal control issues.
Review of Economy, Efficiency and Effectiveness of the Use of Resources
The Trust has a range of processes embedded throughout the organisation to ensure that resources
are used economically, efficiently and effectively.
In reviewing the key risks of the organisation through the Board Assurance Framework the Board
considers the effectiveness of the internal controls compared with the risks. On a regular basis it also
reviews progress against the annual service plans and the financial plan that results from this. The
Board is supported in the process by a regular, in-depth review by the Finance and Resources
Committee of the Trust’s financial position, business cases for significant revenue and capital
investments, and the investment of cash balances.
The Audit Committee supports the delivery of effective, efficient and economic services through:
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•
Undertaking a range of reviews, including workforce, financial standing, arrangements to deliver
quality services and the effectiveness of the assurance process.
•
Considering the coverage of external and internal audit and reviewing progress on implementing
internal and external audit recommendations.
The Trust uses a comprehensive internal audit service as part of its assurance process. An annual
internal audit work programme is risk based and progress and amendments are reported to the
Audit Committee. The Head of Internal Audit has provided substantial assurance that there is
generally a sound system of internal control, designed to meet the Trust objectives, and controls are
generally being applied consistently. Significant assurance was given in the following reviews:
1. Financial management and financial reporting.
2. Board Assurance Framework & risk management.
3. CQC compliance.
4. Response to the Robert Francis report and impact on Birmingham Children’s Hospital.
5. Consultant job planning.
6. Medical revalidation.
7. Estates strategy.
8. Rota compliance.
9. Medicine Chest (subsidiary company).
A range of management processes are embedded within the operational management of the
organisation that provides a framework for ensuring that value for money is secured from the
resources available. These include:
•
•
•
•
•
Monthly review of management accounts by budget holders.
Monthly performance meetings at directorate level to assess progress against service and
financial plans, and quarterly meetings to pick up major performance and service issues.
The use of a patient level costing system available to decision makers that identifies the
resources used in the provision of care at a patient, HRG, specialty and directorate level.
The use of a programme management approach to the delivery of efficiency saving targets built
upon a clinician’s assessment of the impact of any such proposal on the quality of care.
The use of a range of benchmark information to assess the economy and efficiency of services
including with other specialist children’s hospitals.
The directors are required under the Health Act 2009 and the National Health Service (Quality
Accounts) Regulations 2010 (as amended) to prepare Quality Accounts for each financial year.
Monitor has issued guidance to NHS foundation trust boards on the form and content of annual
Quality Reports which incorporate the above legal requirements in the NHS Foundation Trust Annual
Reporting Manual.
Production of the Quality Report is led by the Chief Medical Officer and by a core group that includes
senior medical and nursing staff with explicit responsibilities for quality. The quality indicators
contained within the quality report cover the three elements of quality and arise from: the Trust’s
Strategic Objectives; the Safety Strategy; locally developed CQUIN schemes (Commissioning for
Quality and Innovation); national schemes; and engagement with patients, families and staff.
Performance against these indicators is regularly reported to the Board of Directors.
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The Quality Committee examines the impact that our staff have on the quality of services provided
by the Trust. A range of performance indicators, including both quantative and qualitative data is
reviewed on a regular basis.
Data Quality & Security
Each year the External Auditor undertakes a review of the data quality and accuracy of a selection of
the indicators reported in the Quality Report. This includes an indicator selected by the Council of
Governors. Since the first Quality Report the following indicators have been reviewed:
•
•
•
•
•
•
•
•
•
•
MRSA
MSSA
C.Difficile
Cancer waits
28 day readmissions
Patient safety incidents resulting in severe harm
Emergency Department Transfers
PICU infections
Cancelled operations
Diagnostic waiting times
This provides assurance in relation to these particular indicators and learning about data quality and
accuracy for other data management purposes.
The Trust recognises the importance of good data quality to measure the quality of our care and
organisational performance, to identify where we need to improve and to measure improvement.
The Trust uses data as part of daily operational management and regular performance management,
with a range of daily, weekly and monthly performance reports including those reviewed by the
Board of Directors. This led to the development of additional performance metrics and identified a
need to improve the data quality of some of our performance metrics. We established a Data
Quality Group to identify and address data quality issues and meet the Level 3 NHS Information
Governance Data Quality Standards.
A review of Trust data quality is included in the Internal Auditor’s annual plan to be completed in
early summer 2014.
There have been no serious lapses in data security in 2013/14.
Review of effectiveness
As Accounting Officer, I have responsibility for reviewing the effectiveness of the system of internal
control. My review of the effectiveness of the system of internal control is informed by the work of
the internal auditors, clinical audit and the executive managers and clinical leads within the NHS
foundation trust who have responsibility for the development and maintenance of the internal
control framework. I have drawn on the content of the quality report attached to this Annual report
and other performance information available to me. My review is also informed by comments made
by the external auditors in their management letter and other reports. I have been advised on the
implications of the result of my review of the effectiveness of the system of internal control by the
board, the audit committee and risk/clinical governance/quality committee and a plan to address
weaknesses and ensure continuous improvement of the system is in place.
My review has taken into account the work of the previous 12 months and is also informed in the
following ways:
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•
Through the Executive Directors and managers who have particular responsibilities for the
development and maintenance of the system of internal control and the Board Assurance
Framework.
•
A comprehensive review of all data available about quality of care across all services which
has been used to inform the Quality Account.
•
The Head of Internal Audit provides me with an opinion on the overall arrangements for
gaining assurance through the Board Assurance Framework with regard to the principal risks
considered by their work. This is complemented by a programme of agreed audit activity by
Internal Audit. This programme facilitates a review of existing controls and recommends
appropriate remedial actions or systems redesign. Reports from Internal Audit are presented
to the Audit Committee and any control issues are reported to the Board and managed by
the Executive Directors.
•
The results of the work undertaken by the External Auditors including their opinion on the
annual accounts.
•
The assessment of compliance with the CQC essential standards of quality and safety, the
NHS Litigation Authority risk management standards, the Information Governance Toolkit
and the results of staff and patient surveys.
•
The published results of the quarterly performance management process undertaken by
Monitor.
•
Annual performance indicators published by the Department of Health.
•
Through the Audit Committee, which receives the reviews of the Trust’s systems of internal
control, including the governance arrangements, as part of the audit programme, assisting
the Board with its responsibilities to strengthen and improve the effectiveness of the
assurance framework.
•
Through the Quality Committee which provides the strategic direction for the development
and implementation of effective quality governance, ensuring that quality is critically
reviewed to improve outcomes for children, young people and their families.
•
Through the Clinical Risk and Quality Assurance Committee, (which reports to the Quality
Committee), which provides leadership on the development and implementation of
effective clinical governance, including clinical audit, and monitors progress against the
Safety Strategy.
•
Through the Investment Committee, which reports to the Finance & Resources Committee
detailed scrutiny of the value, effectiveness and affordability of proposed investments.
•
Through the Strategic Workforce Committee, which reports to the Finance & Resources
Committee detailed scrutiny of the implementation of the workforce strategy and plans.
•
Through the Finance and Resources Committee, which provides the strategic direction for
the development of workforce strategies, and ensures appropriate systems of control are in
place in relation to investments and the financial position.
The Head of Internal Audit and the Audit Committee have advised me that substantial assurance can
be given that there is a generally sound system of internal control on key financial and management
188
processes, which are designed to meet the organisation’s objectives, and controls are generally
being applied consistently.
Conclusion
No significant internal control issues have been identified
Sarah-Jane Marsh
Chief Executive
189
Section 5
Financial Statements
190
Birmingham Children's Hospital NHS Foundation Trust
Statutory Accounts
Year ended 31 March 2014
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
Statement of the Chief Executive Officer's responsibilities as the Accounting Officer of Birmingham
Children's Hospital NHS Foundation Trust
The National Health Service Act 2006 ("2006 Act") states that the Chief Executive Officer is the Accounting
Officer of the NHS Foundation Trust. The relevant responsibilities of the Accounting Officer, including their
responsibility for the propriety and regularity of public finances for which they are answerable, and for the
keeping of proper accounts, are set out in the NHS Foundation Trust Accounting Officer Memorandum issued
by the Independent Regulator of NHS Foundation Trusts ("Monitor").
Under the 2006 Act, Monitor has directed Birmingham Children's Hospital NHS Foundation Trust to prepare for
each financial year a Statement of Accounts in the form and on the basis set out in the Accounts Direction. The
Accounts are prepared on an accruals basis and must give a true and fair view of the state of affairs of
Birmingham Children's Hospital NHS Foundation Trust and of its revenue and costs, changes in taxpayers'
equity and cash flows for the financial year.
In preparing the Accounts, the Accounting Officer is required to comply with the requirements of the NHS
Foundation Trust Annual Reporting Manual and in particular to:
observe the Accounts Direction issued by Monitor, including the relevant accounting and disclosure
requirements, and apply suitable accounting policies on a consistent basis;
make judgements and estimates on a reasonable basis;
state whether applicable accounting standards as set out in the NHS Foundation Trust Annual
Reporting Manual have been followed, and disclose and explain any material departures in the
financial statements; and
prepare the financial statements on a going concern basis.
The Accounting Officer is responsible for keeping proper accounting records which disclose with reasonable
accuracy at any time the financial position of the NHS Foundation Trust and to enable her to ensure that the
Accounts comply with requirements outlined in the above mentioned Act. The Accounting Officer is also
responsible for safeguarding the assets of the NHS Foundation Trust and hence for taking reasonable steps for
the prevention and detection of fraud and other irregularities.
To the best of my knowledge and belief, I have properly discharged the responsibilities set out in Monitor's
NHS Foundation Trust Accounting Officer Memorandum.
……………………………………………………………………………………………
Sarah-Jane Marsh
Chief Executive Officer
i
Date 29 May 2014
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
Foreword to the Accounts
Birmingham Children's Hospital NHS Foundation Trust
These accounts for the year ended 31 March 2014 have been prepared by Birmingham Children's Hospital NHS
Foundation Trust in accordance with paragraphs 24 and 25 of Schedule 7 to the National Health Service Act
2006 in the form which Monitor has, with the approval of HM Treasury, directed.
……………………………………………………………………………………………
Sarah-Jane Marsh
Chief Executive Officer
ii
Date 29 May 2014
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
Consolidated Statement of Comprehensive Income
Group
Trust
Year Ended
31 March
2014
Year Ended
31 March
2013
Year Ended
31 March
2014
Year Ended
31 March
2013
£000
233,709
£000
246,854
£000
233,709
Operating Income
NOTE
2
£000
246,098
Operating Expenses
3
(235,249)
(225,082)
(235,934)
(225,082)
10,849
8,627
10,920
8,627
OPERATING SURPLUS
FINANCE COSTS
Finance income
8
113
668
168
668
Finance expense - financial liabilities
Finance expense - unwinding of discount
on provisions
PDC Dividends payable
9
(447)
(469)
(447)
(469)
34
-
34
-
(2,466)
(2,558)
(2,466)
(2,558)
(2,766)
(2,359)
(2,711)
(2,359)
SURPLUS FOR THE YEAR
Other comprehensive income not to be
reclassified to income and expenditure
Impairments
8,083
6,268
8,209
6,268
-
(8,665)
-
(8,665)
Revaluations
(130)
12,877
(130)
12,877
(4)
(62)
(4)
(62)
7,949
10,418
8,075
10,418
NET FINANCE COSTS
Other reserve movements
TOTAL COMPREHENSIVE INCOME FOR
THE YEAR
All income and expenditure is derived from continuing operations.
There are no Minority Interests in the Trust, therefore the surplus for the year and the Total Comprehensive
Income are wholly attributable to the Trust.
1
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
Consolidated Statement of Financial Position
NOTE
Non-current assets
Intangible Assets
Property, plant and equipment
Investments in associates
Trade and other receivables
Other Financial assets
Total non-current assets
Current assets
Inventories
Trade and other receivables
Cash and cash equivalents
Total current assets
Current liabilities
Trade and other payables
Borrowings
Provisions
Other liabilities
Total current liabilities
Total assets less current liabilities
Non-current liabilities
Borrowings
Provisions
Other liabilities
Total non-current liabilities
Total assets employed
Financed by
Taxpayers' equity
Public Dividend Capital
Revaluation reserve
Income and expenditure reserve
Total taxpayers' equity
Group
31 March
31 March
2014
2013
£000
£000
Trust
31 March
31 March
2014
2013
£000
£000
11
12
16
22
20
303
100,792
1,399
102,494
178
95,040
1
1,251
96,470
303
100,792
1,399
600
103,094
178
95,040
1
1,251
96,470
21
22
25
4,000
13,925
48,610
66,535
3,955
12,714
36,173
52,842
3,817
13,721
48,516
66,054
3,955
12,714
36,173
52,842
26
27
31
29
(27,468)
(152)
(1,461)
(5,854)
(34,935)
134,094
(19,564)
(152)
(2,562)
(3,841)
(26,119)
123,193
(27,461)
(152)
(1,461)
(5,854)
(34,928)
134,220
(19,564)
(152)
(2,562)
(3,841)
(26,119)
123,193
27
31
29
(1,213)
(3,828)
(1,941)
(6,982)
127,112
(1,365)
(2,389)
(1,777)
(5,531)
117,662
(1,213)
(3,828)
(1,941)
(6,982)
127,238
(1,365)
(2,389)
(1,777)
(5,531)
117,662
87,723
12,641
26,748
127,112
86,222
12,771
18,669
117,662
87,723
12,641
26,874
127,238
86,222
12,771
18,669
117,662
33
The financial statements were approved by the Board of Directors and authorised for issue on their behalf by:
………………………………………………………………………………………
Sarah-Jane Marsh
Chief Executive Officer
2
Date 29 May 2014
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
Consolidated Statement of Changes in Equity
Group
Total
Public
Dividend
Capital
Revaluation
Reserve
Income and
Expenditure
Reserve
Taxpayers' Equity at 1 April 2012
Surplus for the year
Impairments
Revaluations - property, plant and equipment
Transfers in respect of assets disposed of
Other reserve movements
Taxpayers' Equity at 31 March 2013
£000
107,244
6,268
(8,665)
12,877
(62)
117,662
£000
86,222
86,222
£000
8,604
(8,665)
12,877
(45)
12,771
£000
12,418
6,268
45
(62)
18,669
Surplus for the year
Revaluations - property, plant and equipment
Public Dividend Capital received
Other reserve movements
Taxpayers' Equity at 31 March 2014
8,083
(130)
1,501
(4)
127,112
1,501
87,723
(130)
12,641
8,083
(4)
26,748
Total
Public
Dividend
Capital
Revaluation
Reserve
Income and
Expenditure
Reserve
Taxpayers' Equity at 1 April 2012
Surplus for the year
Impairments
Revaluations - property, plant and equipment
Transfers in respect of assets disposed of
Other reserve movements
Taxpayers' Equity at 31 March 2013
£000
107,244
6,268
(8,665)
12,877
(62)
117,662
£000
86,222
86,222
£000
8,604
(8,665)
12,877
(45)
12,771
£000
12,418
6,268
45
(62)
18,669
Surplus for the year
Revaluations - property, plant and equipment
Public Dividend Capital received
Other reserve movements
Taxpayers' Equity at 31 March 2014
8,209
(130)
1,501
(4)
127,238
1,501
87,723
(130)
12,641
8,209
(4)
26,874
Trust
3
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
Consolidated Statement of Cash Flows for the Year Ended 31 March 2014
Group
31 March
31 March
2014
2013
NOTE
Trust
31 March
31 March
2014
2013
£000
£000
£000
£000
10,849
8,627
10,920
8,627
Cash flows from operating activities
Operating surplus
Non-cash income and expense:
Depreciation and amortisation
3
4,980
5,631
4,980
5,631
Impairments
3
516
2,525
516
2,525
Loss on disposal
3
8
30
8
30
(310)
(325)
(310)
(325)
620
565
620
565
(1,211)
2,087
(1,007)
2,087
-
-
(600)
-
(45)
(320)
138
(320)
Increase/(Decrease) in Trade and Other Payables
8,045
(7,254)
8,038
(7,254)
Increase/(Decrease) in Other Liabilities
1,283
(2,039)
1,283
(2,039)
372
4,713
372
4,713
Other movements in operating cash flows
89
40
89
40
NET CASH GENERATED FROM OPERATIONS
25,196
14,280
25,047
14,280
113
668
168
668
(212)
-
(212)
-
(11,130)
(9,519)
(11,130)
(9,519)
(11,229)
(8,851)
(11,174)
(8,851)
Public dividend capital received
1,501
-
1,501
-
Interest element of PFI
(447)
(469)
(447)
(469)
(2,584)
(2,517)
(2,584)
(2,517)
Net cash used in financing activities
(1,530)
(2,986)
(1,530)
(2,986)
Increase in cash and cash equivalents
12,437
2,443
12,343
2,443
Cash and Cash equivalents at 1 April
36,173
33,730
36,173
33,730
48,610
36,173
48,516
36,173
Non-cash donations/grants credited to income
Amortisation of PFI credit
(Increase)/Decrease in Trade and Other Receivables
Decrease in Other Assets
(Increase)/Decrease in Inventories
Increase in Provisions
Cash flows from investing activities
Interest received
Purchase of intangible assets
Purchase of Property, Plant and Equipment
Net cash used in investing activities
Cash flows from financing activities
PDC Dividend paid
Cash and Cash equivalents at 31 March
25
4
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
Notes to the Financial Statements
1. Accounting policies
Monitor has directed that the financial statements of NHS foundation trusts shall meet the accounting
requirements of the Foundation Trust Annual Reporting Manual (FT ARM) which shall be agreed with HM
Treasury. Consequently, the following financial statements have been prepared in accordance with the FT
ARM 2013/14 issued by Monitor. The accounting policies contained in that manual follow International
Financial Reporting Standards (IFRS) and HM Treasury’s Financial Reporting Manual (FReM) to the extent
that they are meaningful and appropriate to NHS foundation trusts. The accounting policies have been
applied consistently in dealing with items considered material in relation to the accounts.
1.1 Accounting convention
These accounts have been prepared under the historical cost convention modified to account for the
revaluation of property, plant and equipment, intangible assets, inventories and certain financial assets and
financial liabilities.
These accounts have been prepared on a going concern basis as described in the Annual Report.
1.2 Consolidation
NHS Charitable Funds
The FT ARM requires NHS foundation trusts to consolidate the accounts of NHS charitable funds to which
they are corporate trustees. The Trust is not the corporate trustee to Birmingham Children’s Hospital
Charities. The Trust has further assessed its relationship to the charitable fund and determined it not to be
a subsidiary because the foundation trust has no power to govern the financial and operating policies of
the charitable fund so as to obtain benefits from its activities for itself, its patients or its staff.
Other Subsidiaries
The Group financial statements consolidate the financial statements of the Trust and all of its subsidiary
undertakings made up to 31 March 2014, together with the Group’s share of the results of joint ventures
and associates up to the 31 March 2014. The income, expenses, assets, liabilities, equity and reserves of
the subsidiaries have been consolidated into the Trust’s financial statements and group financial
statements have been prepared.
Subsidiary entities are those over which the trust has the power to exercise control or a dominant
influence so as to gain economic or other benefits. Joint ventures are separate entities over which the
trust has joint control with one or more other parties. The meaning of control is the same as that for
subsidiaries. Associate entities are those over which the trust has the power to exercise a significant
influence. The results of joint ventures and associates are accounted for using the equity method of
accounting. Any subsidiary undertakings, joint ventures or associates sold or acquired during the year are
included up to, or from, the dates of change of control.
5
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
All intra-group transactions, balances, income and expenses are eliminated on consolidation. Adjustments
are made to eliminate the profit or loss arising on transactions with joint ventures and associates to the
extent of the Group’s interest in the entity. Where subsidiaries’ accounting policies are not aligned with
those of the Trust (including where they report under UK GAAP) then amounts are adjusted during
consolidation where the differences are material, however there are no such differences at the reporting
date. In accordance with the NHS Foundation Trust Annual Reporting Manual a separate income and cash
flow statement for the parent (the Trust) has not been presented.
1.3 Income
Income in respect of services provided is recognised when, and to the extent that, performance occurs
and is measured at the fair value of the consideration receivable. The main source of income for the trust
is contracts with commissioners in respect of health care services.
The Trust accounts for the income of partially completed spells based on an average spell cost for the
anticipated specialty which is adjusted based on the length of stay to take into account any excess bed
days. Where income is received for a specific activity which is to be delivered in the following financial
year, that income is deferred.
The Trust receives income under the NHS Injury Cost Recovery Scheme, designed to reclaim the cost of
treating injured individuals to whom personal injury compensation has subsequently been paid e.g. by an
insurer. The Trust recognises the income when it receives notification from the Department of Work and
Pensions' Compensation Recovery Unit that the individual has lodged a compensation claim. The income is
measured at the agreed tariff for the treatments provided to the injured individual, less a provision for
unsuccessful compensation claims and doubtful debts.
Income from the sale of non-current assets is recognised only when all material conditions of sale have
been met, and is measured as the sums due under the sale contract.
1.4 Expenditure on employee benefits
Short-term employee benefits
Salaries, wages and employment-related payments are recognised in the period in which the service is
received from employees. The cost of annual leave entitlement earned but not taken by employees at the
end of the period is recognised in the financial statements to the extent that employees are permitted to
carry-forward leave into the following period.
Pension costs
Past and present employees are covered by the provisions of the NHS Pensions Scheme. The scheme is an
unfunded, defined benefit scheme that covers NHS employers, General Practices and other bodies,
allowed under the direction of the Secretary of State, in England and Wales. The scheme is not designed to
be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and
6
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
liabilities. Therefore, the scheme is accounted for as if it were a defined contribution scheme: the cost to
the NHS body of participating in the scheme is taken as equal to the contributions payable to the scheme
for the accounting period. Employers pension cost contributions are charged to operating expenses as
and when they become due.
For early retirements other than those due to ill health the additional pension liabilities are not funded by
the scheme. The full amount of the liability for the additional costs is charged to expenditure at the time
the Trust commits itself to the retirement, regardless of the method of payment.
1.5 Expenditure on other goods and services
Expenditure on goods and services is recognised when, and to the extent that they have been received,
and is measured at the fair value of those goods and services. Expenditure is recognised in operating
expenses except where it results in the creation of a non-current asset such as property, plant and
equipment.
1.6 Property, plant and equipment
Recognition
Property, plant and equipment is capitalised where:
It is held for use in delivering services or for administrative purposes;
It is probable that future economic benefits will flow to, or service potential be provided to, the
trust;
It is expected to be used for more than one financial year;
The cost of the item can be measured reliably; and
Individually they have a cost of at least £5,000; or
They form a group of assets which individually have a cost of more than £250, collectively have a
cost of at least £5,000, where the assets are functionally interdependent, have broadly
simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are under
single managerial control; or
They form part of the initial setting-up cost of a new building or refurbishment of a ward or unit,
irrespective of their individual or collective cost.
Where a large asset, for example a building, includes a number of components with significantly different
asset lives, e.g. Plant and equipment, then these components are treated as separate assets and
depreciated over their own useful economic lives.
Valuation
All property, plant and equipment assets are measured initially at cost, representing the costs directly
attributable to acquiring or constructing the asset and bringing it to the location and condition necessary
for it to be capable of operating in the manner intended by management.
7
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
Properties in the course of construction for service or administration purposes are carried at cost, less any
impairment loss. Cost includes professional fees but not borrowing costs, which are recognised as
expenses immediately, as allowed by IAS 23 for assets held at fair value. Assets in the course of
construction are valued at cost and are valued by a professional valuer as part of the three or five-yearly
valuation or when they are brought into use.
An increase arising on revaluation is taken to the revaluation reserve except when it reverses an
impairment for the same asset previously recognised in expenditure, in which case it is credited to
expenditure to the extent of the decrease previously charged there. A revaluation decrease is recognised
as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve
for the asset and, thereafter, to income. Gains and losses recognised in the revaluation reserve are
reported as other comprehensive income in the Statement of Comprehensive Income.
Equipment and fixtures are carried at cost less accumulated depreciation and any accumulated
impairment losses, as this is not considered to be materially different from the fair value of assets which
have low values or short economic useful lives.
Subsequent expenditure
Subsequent expenditure relating to an item of property, plant and equipment is recognised as an increase
in the carrying amount of the asset when it is probable that additional future economic benefits or service
potential deriving from the cost incurred to replace a component of such item will flow to the enterprise
and the cost of the item can be determined reliably. Where a component of an asset is replaced, the cost
of the replacement is capitalised if it meets the criteria for recognition above. The carrying amount of the
part replaced is de-recognised. Other expenditure that does not generate additional future economic
benefits or service potential, such as repairs and maintenance, is charged to the Statement of
Comprehensive Income in the period in which it is incurred.
Depreciation
Items of property, plant and equipment are depreciated over their remaining useful economic lives in a
manner consistent with the consumption of economic or service delivery benefits. Freehold land is
considered to have an infinite life and is not depreciated.
Property, plant and equipment which has been reclassified as ‘Held for Sale’ ceases to be depreciated
upon the reclassification. Assets in the course of construction and residual interests in off-Statement of
Financial Position PFI contract assets are not depreciated until the asset is brought into use or reverts to
the trust, respectively.
Revaluation
Revaluation gains are recognised in the revaluation reserve, except where, and to the extent that, they
reverse a revaluation decrease that has previously been recognised in operating expenses, in which case
they are recognised in operating income.
8
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
Revaluation losses are charged to the revaluation reserve to the extent that there is an available balance
for the asset concerned, and thereafter are charged to operating expenses.
Gains and losses recognised in the revaluation reserve are reported in the Statement of Comprehensive
Income as an item of “other comprehensive income”.
Impairments
In accordance with the FT ARM, impairments that are due to a loss of economic benefits or service
potential in the asset are charged to operating expenses. A compensating transfer is made from the
revaluation reserve to the income and expenditure reserve of an amount equal to the lower of (i) the
impairment charged to operating expenses; and (ii) the balance in the revaluation reserve attributable to
that asset before the impairment.
An impairment arising from a loss of economic benefit or service potential is reversed when, and to the
extent that, the circumstances that gave rise to the loss is reversed. Reversals are recognised in operating
income to the extent that the asset is restored to the carrying amount it would have had if the impairment
had never been recognised. Any remaining reversal is recognised in the revaluation reserve. Where, at the
time of the original impairment, a transfer was made from the revaluation reserve to the income and
expenditure reserve, an amount is transferred back to the revaluation reserve when the impairment
reversal is recognised.
Other impairments are treated as revaluation losses. Reversals of ‘other impairments’ are treated as
revaluation gains.
De-recognition
Assets intended for disposal are reclassified as ‘Held for Sale’ once all of the following criteria are met:
The asset is available for immediate sale in its present condition subject only to terms which are
usual and customary for such sales;
The sale must be highly probable i.e.:
o Management is committed to a plan to sell the asset;
o An active programme has begun to find a buyer and complete the sale;
o The asset is being actively marketed at a reasonable price;
o The sale is expected to be completed within 12 months of the date of classification as
“Held for Sale”; and
o The actions needed to complete the plan indicate it is unlikely that the plan will be
dropped or significant changes made to it.
Following reclassification, the assets are measured at the lower of their existing carrying amount and their
“fair value less costs to sell”. Depreciation ceases to be charged. Assets are de-recognised when all
material sale contract conditions have been met.
9
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
Property, plant and equipment which is to be scrapped or demolished does not qualify for recognition as
“Held for Sale” and instead is retained as an operational asset and the asset’s economic life is adjusted.
The asset is de-recognised when scrapping or demolition occurs.
Donated, government grant and other grant funded assets
Donated and grant funded property, plant and equipment assets are capitalised at their fair value on
receipt. The donation/grant is credited to income at the same time, unless the donor has imposed a
condition that the future economic benefits embodied in the grant are to be consumed in a manner
specified by the donor, in which case, the donation/grant is deferred within liabilities and is carried
forward to future financial years to the extent that the condition has not yet been met.
The donated and grant funded assets are subsequently accounted for in the same manner as other items
of property, plant and equipment.
1.7 Intangible assets
Recognition
Intangible assets are non-monetary assets without physical substance which are capable of being sold
separately from the rest of the trust’s business or which arise from contractual or other legal rights. They
are recognised only where it is probable that future economic benefits will flow to, or service potential be
provided to, the trust and where the cost of the asset can be measured reliably, and where the cost is at
least £5,000.
Internally generated goodwill, brands, mastheads, publishing titles, customer lists and similar items are
not capitalised as intangible assets. Expenditure on research is not capitalised.
Expenditure on development is capitalised only where all of the following can be demonstrated:
The project is technically feasible to the point of completion and will result in an intangible asset
for sale or use;
The trust intends to complete the asset and sell or use it;
The trust has the ability to sell or use the asset;
How the intangible asset will generate probable future economic or service delivery benefits, eg,
the presence of a market for it or its output, or where it is to be used for internal use, the
usefulness of the asset;
Adequate financial, technical and other resources are available to the trust to complete the
development and sell or use the asset; and
The trust can measure reliably the expenses attributable to the asset during development.
10
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
Software
Software which is integral to the operation of hardware, e.g. an operating system, is capitalised as part of
the relevant item of property, plant and equipment. Software which is not integral to the operation of
hardware, e.g. application software, is capitalised as an intangible asset.
Measurement
Intangible assets are recognised initially at cost, comprising all directly attributable costs needed to create,
produce and prepare the asset to the point that it is capable of operating in the manner intended by
management.
Subsequently intangible assets are measured at fair value. Revaluations gains and losses and impairments
are treated in the same manner as for Property, Plant and Equipment. Intangible assets held for sale are
measured at the lower of their carrying amount or “fair value less costs to sell”.
Amortisation
Intangible assets are amortised over their expected useful economic lives in a manner consistent with the
consumption of economic or service delivery benefits.
1.8 Leases
The Trust as lessee
Property, plant and equipment held under finance leases are initially recognised, at the inception of the
lease, at fair value or, if lower, at the present value of the minimum lease payments, with a matching
liability for the lease obligation to the lessor. Lease payments are apportioned between finance charges
and reduction of the lease obligation so as to achieve a constant rate on interest on the remaining balance
of the liability. Finance charges are recognised in calculating the Trust’s surplus/deficit.
Operating lease payments are recognised as an expense on a straight-line basis over the lease term. Lease
incentives are recognised initially as a liability and subsequently as a reduction of rentals on a straight-line
basis over the lease term. Contingent rentals are recognised as an expense in the period in which they are
incurred.
Where a lease is for land and buildings, the land and building components are separated. Leased land and
buildings are separately assessed as to whether they are operating or finance leases.
The Trust as lessor
Amounts due from lessees under finance leases are recorded as receivables at the amount of the Trust’s
net investment in the leases. Finance lease income is allocated to accounting periods so as to reflect a
constant periodic rate of return on the Trust’s net investment outstanding in respect of the leases.
11
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
Rental income from operating leases is recognised on a straight-line basis over the term of the lease.
Initial direct costs incurred in negotiating and arranging an operating lease are added to the carrying
amount of the leased asset and recognised on a straight-line basis over the lease term.
1.9 Private Finance Initiative (PFI) transactions
HM Treasury has determined that government bodies shall account for infrastructure PFI schemes where
the government body controls the use of the infrastructure and the residual interest in the infrastructure
at the end of the arrangement as service concession arrangements, following the principles of the
requirements of IFRIC 12. The Trust therefore recognises the PFI asset as an item of property, plant and
equipment together with a liability to pay for it. The services received under the contract are recorded as
operating expenses.
The annual unitary payment is separated into the following component parts, using appropriate
estimation techniques where necessary:
Payment for the fair value of services received;
Payment for the PFI asset, including finance costs; and
Payment for the replacement of components of the asset during the contract ‘lifecycle
replacement’.
Services received
The fair value of services received in the year is recorded under the relevant expenditure headings within
‘operating expenses’.
PFI asset
PFI transactions which meet the IFRIC 12 definition of a service concession, as interpreted in HM
Treasury’s FReM, are accounted for as “on-Statement of Financial Position” by the trust. In accordance
with IAS 17, the underlying assets are recognised as property, plant and equipment at their fair value,
together with an equivalent finance lease liability. Subsequently, the assets are accounted for as property,
plant and equipment and/or intangible assets as appropriate.
PFI liability
A PFI liability is recognised at the same time as the PFI assets are recognised. It is measured initially at the
same amount as the fair value of the PFI assets and is subsequently measured as a finance lease liability in
accordance with IAS 17.
The annual contract payments are apportioned between the repayment of the liability, a finance cost and
the charges for services. An annual finance cost is calculated by applying the implicit interest rate in the
lease to the opening lease liability for the period, and is charged to ‘Finance Costs’ within the Statement of
Comprehensive Income.
12
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
The element of the annual unitary payment that is allocated as a finance lease rental is applied to meet
the annual finance cost and to repay the lease liability over the contract term.
The service charge is recognised in operating expenses and the finance cost is charged to Finance Costs in
the Statement of Comprehensive Income.
An element of the annual unitary payment increase due to cumulative indexation is allocated to the
finance lease. In accordance with IAS 17, this amount is not included in the minimum lease payments, but
is instead treated as contingent rent and is expensed as incurred. In substance, this amount is a finance
cost in respect of the liability and the expense is presented as a contingent finance cost in the Statement
of Comprehensive Income.
Lifecycle replacement
Components of the asset replaced by the operator during the contract (‘lifecycle replacement’) are
capitalised where they meet the Trust’s criteria for capital expenditure. They are capitalised at the time
they are provided by the operator and are measured initially at their fair value.
The element of the annual unitary payment allocated to lifecycle replacement is pre-determined for each
year of the contract from the operator’s planned programme of lifecycle replacement. Where the lifecycle
component is provided earlier or later than expected, a short-term finance lease liability or prepayment is
recognised respectively.
Where the fair value of the lifecycle component is less than the amount determined in the contract, the
difference is recognised as an expense when the replacement is provided. If the fair value is greater than
the amount determined in the contract, the difference is treated as a ‘free’ asset and a deferred income
balance is recognised. The deferred income is released to the operating income over the shorter of the
remaining contract period or the useful economic life of the replacement component.
Assets contributed by the Trust to the operator for use in the scheme
Assets contributed for use in the scheme continue to be recognised as items of property, plant and
equipment in the Trust’s Statement of Financial Position.
1.10 Revenue government and other grants
Government grants are grants from Government bodies other than income from NHS organisations for the
provision of services. Where a grant is used to fund revenue expenditure it is taken to the Statement of
Comprehensive Income to match that expenditure.
1.11 Inventories
Inventories are valued at the lower of cost and net realisable value. Pharmacy stocks are valued using a
weighted average cost method. This is considered to be a reasonable approximation to fair value due to
the high turnover of stocks.
13
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
1.12 Financial instruments and financial liabilities
Recognition
Financial assets and financial liabilities which arise from contracts for the purchase or sale of non-financial
items (such as goods or services), which are entered into in accordance with the trust’s normal purchase,
sale or usage requirements, are recognised when, and to the extent which, performance occurs, ie, when
receipt or delivery of the goods or services is made.
Financial assets or financial liabilities in respect of assets acquired or disposed of through finance leases
are recognised and measured in accordance with the accounting policy for leases described above in note
1.8.
All other financial assets and financial liabilities are recognised when the trust becomes a party to the
contractual provisions of the instrument.
De-recognition
All financial assets are de-recognised when the rights to receive cash flows from the assets have expired or
the trust has transferred substantially all of the risks and rewards of ownership.
Financial liabilities are de-recognised when the obligation is discharged, cancelled or expires.
Classification and measurement
Financial assets are categorised as “fair value through income and expenditure”, loans and receivables or
“available-for-sale financial assets”.
Financial liabilities are classified as “fair value through income and expenditure” or as “other financial
liabilities”.
Financial assets and financial liabilities at “fair value through income and expenditure”
Financial assets and financial liabilities at “fair value through income and expenditure” are financial assets
or financial liabilities held for trading. A financial asset or financial liability is classified in this category if
acquired principally for the purpose of selling in the short-term. Derivatives are also categorised as held
for trading unless they are designated as hedges. Derivatives which are embedded in other contracts but
which are not “closely-related” to those contracts are separated-out from those contracts and measured
in this category. Assets and liabilities in this category are classified as current assets and current liabilities.
These financial assets and financial liabilities are recognised initially at fair value, with transaction costs
expensed in the income and expenditure account. Subsequent movements in the fair value are recognised
as gains or losses in the Statement of Comprehensive Income.
14
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
Loans and receivables
Loans and receivables are non-derivative financial assets with fixed or determinable payments which are
not quoted in an active market. They are included in current assets.
The trust’s loans and receivables comprise: current investments, cash and cash equivalents, NHS
receivables, accrued income and “other receivables”.
Loans and receivables are recognised initially at fair value, net of transactions costs, and are measured
subsequently at amortised cost, using the effective interest method. The effective interest rate is the rate
that discounts exactly estimated future cash receipts through the expected life of the financial asset or,
when appropriate, a shorter period, to the net carrying amount of the financial asset.
Interest on loans and receivables is calculated using the effective interest method and credited to the
Statement of Comprehensive Income.
Available-for-sale financial assets
Available-for-sale financial assets are non-derivative financial assets which are either designated in this
category or not classified in any of the other categories. They are included in long-term assets unless the
trust intends to dispose of them within 12 months of the Statement of Financial Position date.
Available-for-sale financial assets are recognised initially at fair value, including transaction costs, and
measured subsequently at fair value, with gains or losses recognised in reserves and reported in the
Statement of Comprehensive Income as an item of “other comprehensive income”. When items classified
as “available-for-sale” are sold or impaired, the accumulated fair value adjustments recognised are
transferred from reserves and recognised in “Finance Costs” in the Statement of Comprehensive Income.
Other financial liabilities
All other financial liabilities are recognised initially at fair value, net of transaction costs incurred, and
measured subsequently at amortised cost using the effective interest method. The effective interest rate
is the rate that discounts exactly estimated future cash payments through the expected life of the financial
liability or, when appropriate, a shorter period, to the net carrying amount of the financial liability.
They are included in current liabilities except for amounts payable more than 12 months after the
Statement of Financial Position date, which are classified as long-term liabilities.
Interest on financial liabilities carried at amortised cost is calculated using the effective interest method
and charged to Finance Costs. Interest on financial liabilities taken out to finance property, plant and
equipment or intangible assets is not capitalised as part of the cost of those assets.
15
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
Impairment of financial assets
At the end of the reporting period, the trust assesses whether any financial assets, other than those held
at ‘fair value through profit and loss’ are impaired. Financial assets are impaired and impairment losses
recognised if there is objective evidence of impairment as a result of one or more events which occurred
after the initial recognition of the asset and which has an impact on the estimated future cash flows of the
asset.
1.13 Provisions
The NHS foundation trust recognises a provision where it has a present legal or constructive obligation of
uncertain timing or amount; for which it is probable that there will be a future outflow of cash or other
resources; and a reliable estimate can be made of the amount. The amount recognised in the Statement of
Financial Position is the best estimate of the resources required to settle the obligation. Where the effect
of the time value of money is significant, the estimated risk-adjusted cash flows are discounted using the
discount rates published and mandated by HM Treasury.
Rate
Short-term (up to 5 years)
Medium term (over 5 and up to 10 years)
Long-term (over 10 years)
Real rate
-1.90%
-0.65%
2.20%
The exception to this is for early retirement provisions and injury benefit provisions which both use the
HM Treasury's pension discount rate of 2.8% in real terms.
When some or all of the economic benefits required to settle a provision are expected to be recovered
from a third party, the receivable is recognised as an asset if it is virtually certain that reimbursements will
be received and the amount of the receivable can be measured reliably.
When some or all of the economic benefits required to settle a provision are expected to be recovered
from a third party, the receivable is recognised as an asset if it is virtually certain that reimbursements will
be received and the amount of the receivable can be measured reliably.
A restructuring provision is recognised when the Trust has developed a detailed formal plan for the
restructuring and has raised a valid expectation in those affected that it will carry out the restructuring by
starting to implement the plan or announcing its main features to those affected by it. The measurement
of a restructuring provision includes only the direct expenditures arising from the restructuring, which are
those amounts that are both necessarily entailed by the restructuring and not associated with on-going
activities of the entity.
Clinical negligence costs
The NHS Litigation Authority (NHSLA) operates a risk pooling scheme under which the Trust pays an annual
contribution to the NHSLA, which, in return, settles all clinical negligence claims. Although the NHSLA is
administratively responsible for all clinical negligence cases, the legal liability remains with the Trust. The
16
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
total value of clinical negligence provisions carried by the NHSLA on behalf of the Trust is disclosed at note
31.3 but is not recognised in the NHS foundation trust’s accounts.
Non-clinical risk pooling
The Trust participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both
are risk pooling schemes under which the trust pays an annual contribution to the NHS Litigation Authority
and in return receives assistance with the costs of claims arising. The annual membership contributions,
and any “excesses” payable in respect of particular claims are charged to operating expenses when the
liability arises.
1.14 Contingencies
A contingent liability is a possible obligation that arises from past events and whose existence will be
confirmed only by the occurrence or non-occurrence of one or more uncertain future events not wholly
within the control of the Trust, or a present obligation that is not recognised because it is not probable
that a payment will be required to settle the obligation or the amount of the obligation cannot be
measured sufficiently reliably. A contingent liability is disclosed unless the possibility of a payment is
remote.
A contingent asset is a possible asset that arises from past events and whose existence will be confirmed
by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control
of the Trust. A contingent asset is disclosed where an inflow of economic benefits is probable.
Where the time value of money is material, contingencies are disclosed at their present value.
1.15 Public dividend capital
Public dividend capital (PDC) is a type of public sector equity finance based on the excess of assets over
liabilities at the time of establishment of the predecessor NHS trust. HM Treasury has determined that
PDC is not a financial instrument within the meaning of IAS 32.
A charge, reflecting the cost of capital utilised by the NHS foundation trust, is payable as public dividend
capital dividend. The charge is calculated at the rate set by HM Treasury (currently 3.5%) on the average
relevant net assets of the NHS foundation trust during the financial year. Relevant net assets are
calculated as the value of all assets less the value of all liabilities, except for (i) donated assets (including
lottery funded assets), (ii) average daily cash balances held with the Government Banking Services (GBS)
and National Loans Fund (NLF) deposits, excluding cash balances held in GBS accounts that relate to a
short-term working capital facility, (iii) for 2013/14 only, net assets and liabilities transferred from bodies
which ceased to exist on 1 April 2013, and (iv) any PDC dividend balance receivable or payable. In
accordance with the requirements laid down by the Department of Health (as the issuer of PDC), the
dividend for the year is calculated on the actual average relevant net assets as set out in the “pre-audit”
version of the annual accounts. The dividend thus calculated is not revised should any adjustment to net
assets occur as a result the audit of the annual accounts.
17
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
1.16 Research and Development
Expenditure on research is not capitalised, it is treated as an operating cost in the year in which it is
incurred.
Research and development activity cannot be separated from patient care activity and is not a material
operating segment within the Trust. It is therefore not separately disclosed.
1.17 Value Added Tax
Most of the activities of the NHS foundation trust are outside the scope of VAT and, in general, output tax
does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant
expenditure category or included in the capitalised purchase cost of fixed assets. Where output tax is
charged or input VAT is recoverable, the amounts are stated net of VAT.
1.18 Corporation tax
The Trust is a Health Service Body within the meaning of s519A ICTA 1988 and accordingly is exempt from
taxation in respect of income and capital gains within categories covered by this. There is a power for the
Treasury to dis-apply the exemption in relation to specified activities of a Foundation Trust (s519A (3) to
(8) ICTA 1988). Accordingly, the Trust is potentially within the future scope of income tax in respect of
activities where income is received from a non public sector source.
The tax expense on the surplus or deficit for the year comprises current and deferred tax due to the
Trust’s trading commercial subsidiaries, see note 7 to the financial statements. Current tax is the expected
tax payable for the year, using tax rates enacted or substantively enacted at the reporting date, and any
adjustment to tax payable in respect of previous years.
Deferred tax is provided using the balance sheet liability method, providing for temporary differences
between the carrying amounts of the assets and liabilities for financial reporting purposes and the
amounts used for taxation purposes. Deferred tax is not recognised on taxable temporary differences
arising on the initial recognition of goodwill or for temporary differences arising from the initial
recognition of assets and liabilities in a transaction that is not a business combination and that affects
neither accounting nor taxable profit.
Deferred taxation is calculated using rates that are expected to apply when the related deferred asset is
realised or the deferred taxation liability is settled. Deferred tax assets are recognised only to the extent
that it is probable that future taxable profits will be available against which the assets can be utilised.
1.19 Foreign exchange
The Trust's functional currency and presentational currency is sterling. Transactions denominated in a
foreign currency are translated into sterling at the exchange rate ruling on the dates of the transactions.
At the end of the reporting period, monetary items denominated in foreign currencies are retranslated at
18
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
the spot exchange rate on 31 March. Resulting exchange gains and losses for either of these are
recognised in the Trust’s surplus/deficit in the period in which they arise.
1.20 Third party assets
Assets belonging to third parties (such as money held on behalf of patients) are not recognised in the
accounts since the Trust has no beneficial interest in them. Details of third party assets are given in Note
25.2 to the accounts.
1.21 Losses and special payments
Losses and special payments are items that Parliament would not have contemplated when it agreed
funds for the health service or passed legislation. By their nature they are items that ideally should not
arise. They are therefore subject to special control procedures compared with the generality of payments.
They are divided into different categories, which govern the way that individual cases are handled. Losses
and special payments are charged to the relevant functional headings in expenditure on an accruals basis,
including losses which would have been made good through insurance cover had NHS foundation trusts
not been bearing their own risks (with insurance premiums then being included as normal revenue
expenditure).
However the losses and special payments note is compiled directly from the losses and compensations
register which reports on an accrual basis with the exception of provisions for future losses.
1.22 Critical accounting judgements and key sources of uncertainty
In the application of the Trust's accounting policies, management is required to make judgements,
estimates and assumptions about the carrying amounts of assets and liabilities that are not readily
apparent from other sources. The estimates and associated assumptions are based on historical
experience and other factors that are considered to be relevant. Actual results may differ from those
estimates and the estimates and underlying assumptions are continually reviewed. Revisions to
accounting estimates are recognised in the period in which the estimate is revised if the revision affects
only that period, or in the period of revision and future periods if the revision affects both current and
future periods.
The critical accounting judgements and key sources of estimation uncertainty that have a significant effect
on the amounts recognised in the financial statements are detailed below:
Modern equivalent asset valuation
As detailed in policy note 1.6 'Property, plant and equipment', a professional valuer provided the Trust
with a valuation of the land and building assets (estimated fair value and remaining useful life), based on
depreciated replacement value, using modern equivalent asset methodology. This valuation, based on
estimates provided by a suitably qualified professional in accordance with HM Treasury guidance, leads to
various significant increases and reductions in the reported fair value for a number of the Trust's building
19
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
assets. Future revaluations of the Trust's property may result in further material changes to the carrying
values of non-current assets.
Provisions
Provisions have been made for probable legal and constructive obligations of uncertain timings and
amount as at the reporting date. These are based on estimates using relevant and reliable information as
is available at the time the financial statements are prepared. These provisions are estimates of the actual
costs of future cash flows and are dependent on future events. Any difference between expectations and
the actual future liability will be accounted for in the period when such determination is made.
The carrying amounts of the Trust's provisions are detailed in notes 31.1 and 31.2 to the financial
statements.
1.23 Accounting standards that have been issued but have not yet been adopted
The following standards and interpretations have been issued by the International Accounting Standards
Board but have not yet been adopted within the FT ARM.
IFRS 9: Financial Instruments
IFRS 10: Consolidated Financial Statements
IFRS 11: Joint Arrangements
IFRS 12: Disclosure of Interests in Other Entities
IFRS 13: Fair Value Measurement
IAS 27: Separate Financial Statements
IAS 28: Associates and joint ventures
IAS 32: Financial Instruments - Presentation amendment
2
Operating segments
The Board as ‘Chief Operating Decision Maker’ has given due consideration to the issue of Segmental Reporting
and, after analysing the financial, reporting and performance decision making activities of the Trust, has
concluded that only one Operating Segment, “Healthcare”, is to be reported. This meets the requirements and
aggregation criteria laid out in IFRS 8. The provision of healthcare (including medical treatment, research and
education) is within one main geographical segment, the United Kingdom, and materially from Departments of
HM Government in England. Revenue from activities (medical treatment of patients) is analysed by customer
type in note 2.3 to the financial statements. Other operating revenue is also analysed in note 2.3 to the
financial statements and materially consists of revenues from healthcare research and development, medical
education and the provision of services to other NHS bodies.
20
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
2.1
Operating income (by classification)
Group
31 March
31 March
2014
2013
£000
£000
Income from Activities
Elective income
Non-elective income
Outpatient income
A & E income
Other NHS clinical income
Private patient income
Other non-protected clinical income
Total income from activities
Total other operating income
TOTAL OPERATING INCOME
(a)
(b)
(c)
43,153
33,728
23,429
4,933
115,714
344
427
221,728
24,370
246,098
43,377
34,178
22,425
4,824
97,114
412
421
202,751
30,958
233,709
Trust
31 March
31 March
2014
2013
£000
£000
43,153
33,728
23,429
4,933
115,714
344
427
221,728
25,126
246,854
43,377
34,178
22,425
4,824
97,114
412
421
202,751
30,958
233,709
a. Elective income includes £347k (31 March 2013: £1,192k) from The Royal Orthopaedic Hospital NHS
Foundation Trust which relates to payment for activity undertaken at the Trust on behalf of The Royal
Orthopaedic Hospital NHS Foundation Trust.
b. Other NHS clinical income represents income outside the scope of Payments by Results (PbR). This
income comprises funding from the NHS England and Clinical Commissioning Groups (CCGs) for PbR
exclusions.
c. Other non-protected clinical income relates to income from the NHS Injury Scheme in respect of road
traffic accidents (formerly RTA).
2.2
Operating lease income
There has been no operating lease income in either the current or previous accounting periods.
21
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
2.3
Operating income (by type)
Note
Income from activities
NHS Foundation Trusts
NHS Trusts
Strategic Health Authorities
CCGs and NHS England
Primary Care Trusts
Department of Health - other
Non-NHS: Private patients
Non-NHS: Overseas patients
NHS injury scheme
Non-NHS: Other
Total income from activities
(a)
(a)
(a),(b)
(a)
(c)
(d)
(e)
Group
31 March
31 March
2014
2013
£000
£000
347
216,128
344
780
427
3,702
221,728
1,192
106
17,555
179,612
147
412
4
421
3,302
202,751
347
216,128
344
780
427
3,702
221,728
1,192
106
17,555
179,612
147
412
4
421
3,302
202,751
4,499
8,829
310
1,162
1,488
5,404
3,298
7,320
10,441
4,821
5,252
3,124
4,499
8,829
310
1,162
1,488
6,160
3,298
7,320
10,441
4,821
5,252
3,124
(620)
24,370
30,958
(620)
25,126
30,958
246,098
233,709
246,854
233,709
Other operating income
Research and development
Education and training
Receipt of donated assets
Receipt of grants for capital acquisitions
Charitable/other contributions
Non-patient care services
Other *
Amortisation of PFI deferred
credits
Main scheme
Total other operating income
TOTAL OPERATING INCOME
Trust
31 March
31 March
2014
2013
£000
£000
Notes:
a. The Department of Health is regarded as the parent Department of NHS England, Clinical
Commissioning Groups (CCGs), NHS Trusts, NHS Foundation Trusts and the now demised Strategic
Health Authorities and Primary Care Trusts (PCTs). When combined these four areas are regarded as a
related party as outlined in Note 34.
b. The balance of Strategic Health Authority income for the period ended 31 March 2013 related to
contracts with the National Specialised Commissioning Team (NSCT). From 1 April 2014, the services
covered by these contracts are commissioned by NHS England and income is assigned accordingly.
c. NHS Injury Scheme income is subject to a provision for doubtful debts of 100% of debts over 2 years
old, 87.4% of debts between 1 and 2 years old and 12.6% of debts that are 1 year or less to reflect
22
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
expected rates of collection and the probability of not receiving income due to withdrawn cases or
exemptions.
d. Non-NHS other includes the income from activities by Non-English Health bodies: Wales, Scotland and
Northern Ireland.
e. All activity income is associated with Commissioner Requested Services. No activity is derived from
non-Commissioner Requested Services.
*Analysis of Other Operating Income: Other
Car parking
Estates recharges
Pharmacy sales
Clinical excellence awards
Catering
Property rentals
Other
Total
Group
31 March
31 March
2014
2013
£000
£000
464
462
3
10
104
102
1,152
1,019
21
22
7
1
1,547
1,508
3,298
3,124
23
Trust
31 March
31 March
2014
2013
£000
£000
464
462
3
10
104
102
1,152
1,019
21
22
7
1
1,547
1,508
3,298
3,124
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
3
Operating expenses
Services from NHS Foundation Trusts
Services from NHS Trusts
Services from PCTs
Services from other NHS Bodies
Purchase of healthcare from non-NHS bodies
Employee Expenses - Executive directors
Employee Expenses - Non-executive directors
Employee Expenses - Staff
Supplies and services - clinical (ex drug costs)
Supplies and services - general
Establishment
Transport (Business travel only)
Transport (other)
Premises
Increase in provision for impaired receivables
Increase in other provisions
Change in provisions discount rate
Drug costs (non-inventory drugs only)
Rentals under operating leases
Depreciation on property, plant and equipment
Amortisation on intangible assets
Impairments of property, plant and equipment
Audit fees payable to the external auditor
audit services- statutory audit
audit services -regulatory reporting
other auditor remuneration
Clinical negligence
Loss on disposal of other PPE
Legal fees
Consultancy costs
Training, courses and conferences
Patient travel
Car parking & Security
Insurance
Other services, eg. external payroll
Losses, ex gratia & special payments
Other
TOTAL
Group
31 March
31 March
2014
2013
£000
£000
2,246
3,371
1,391
76
113
16
136
111
8
1,191
1,094
172
172
151,203
149,357
21,379
18,897
2,736
2,181
2,387
2,288
437
338
1,153
1,028
8,853
8,065
663
363
851
87
8
26,573
23,308
613
417
4,847
5,458
133
173
516
2,525
55
25
73
2,192
8
198
1,833
1,449
111
173
90
1,376
13
174
235,249
24
54
22
123
1,859
30
214
572
1,531
116
109
117
396
391
93
225,082
Trust
31 March
31 March
2014
2013
£000
£000
2,246
3,371
1,391
76
113
16
136
111
8
1,191
1,094
172
172
151,198
149,357
21,379
18,897
2,735
2,181
2,385
2,288
437
338
1,153
1,028
8,853
8,065
663
363
851
87
8
27,267
23,308
613
417
4,847
5,458
133
173
516
2,525
55
25
73
2,192
8
198
1,833
1,448
111
173
90
1,376
13
174
235,934
54
22
123
1,859
30
214
572
1,531
116
109
117
396
391
93
225,082
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
4
Salary and Pension entitlements of senior managers
2013/14 Remuneration Table
Name and Title
Ms Joanna Davis
Ms Sarah-Jane Marsh
Mr David Melbourne
Mr Philip Foster
Mr Tim Atack
Mrs Michelle McLoughlin
Dr Vinod Diwakar
Mrs Theresa Nelson
Dr Fiona Reynolds
Mrs Elaine Simpson
Professor Jon Glasby
Mr Roger Peace
Mr Keith Lester
Mrs Judith Green
Mr Colin Horwath
Taxable
Benefits
(bands of
£5000)
£000
(to nearest
£100)
£00
3
2,4
35-40
120-125
0
42
0
0
2,8
130-135
27
7
2
2
2
35-40
100-105
100-105
170-175
2
5
Notes
Chairman
Chief Executive Officer
Chief Financial Officer and Interim /
Deputy Chief Executive
Interim Chief Finance Officer
Chief Operating Officer
Chief Nursing Officer
Chief Medical Officer
Chief Officer for Workforce
Development
Interim Chief Medical Officer
Non-Executive Director
Non-Executive Director
Non-Executive Director
Non-Executive Director/Interim
Chairman
Non-Executive Director/Deputy Chair,
Engagement and Participation
Non-Executive Director/Deputy Chair,
Strategy and Partnerships
1st April 2013 to 31st March 2014
Annual
Long-term
PerformancePerformancerelated Bonus
related
Bonuses
(bands of
(bands of
£5000)
£5000)
£000
£000
Salary & Fees
6
Pensionrelated
Benefits
(bands of
£2500)
£000
Total
(bands of
£5000)
£000
0
0
0
(15.0)-(12.5)
35-40
115-120
0
0
15.0-17.5
155-160
0
50
50
24
0
0
0
0
0
0
0
0
32.5-35.0
7.5-10.0
2.5-5.0
22.5-25.0
70-75
115-120
110-115
195-200
100-105
24
0
0
5.0-7.5
110-115
40-45
10-15
10-15
10-15
0
0
0
0
0
0
0
0
0
0
0
0
125.0-127.5
0
0
0
165-170
10-15
10-15
10-15
25-30
0
0
0
0
25-30
15-20
0
0
0
0
15-20
15-20
0
0
0
0
15-20
965-970
217
0
0
202.5-205.0
1,190-1,195
Notes
1) The definition of Senior Managers includes only the Chief Officers and the Non-Executive Directors. These are the senior officers of the Trust having Board of Director
voting powers.
2) Taxable Benefit relates to lease cars and car allowances for personal vehicle use.
25
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
3) Ms Joanna Davis left the organisation on 1 February 2014.
4) Ms Sarah-Jane Marsh returned to work from maternity leave in June 2013.
5) Dr Fiona Reynolds covered the post of Chief Medical Officer during a period of sickness absence of Dr Vinod Diwakar from May 2013 until July 2013.
6) Mrs Judith Green left the organisation on 28 February 2014.
7) Mr Philip Foster was Interim Chief Finance Officer until August 2013.
8) Mr David Melbourne was Interim Chief Executive Officer during Ms Sarah-Jane Marsh’s maternity leave.
2012/13 Remuneration Table
Salary & Fees
Name and Title
Notes
(bands of
£5000)
£000
Ms Joanna Davis
Ms Sarah-Jane Marsh
Mr David Melbourne
Mr Philip Foster
Mr David Eltringham
Mr Tim Atack
Mrs Michelle McLoughlin
Dr Vinod Diwakar
Mrs Theresa Nelson
Mrs Elaine Simpson
Professor Jon Glasby
Mr Zubair Khan
Mr Roger Peace
Mr Keith Lester
Mrs Judith Green
Mr Colin Horwath
Chairman
Chief Executive Officer
Chief Financial Officer and Interim /
Deputy Chief Executive
Interim Chief Finance Officer
Chief Operating Officer
Chief Operating Officer
Chief Nursing Officer
Chief Medical Officer
Chief Officer for Workforce
Development
Non-Executive Director
Non-Executive Director
Non-Executive Director
Non-Executive Director
Non-Executive Director/Interim
Chairman
Non-Executive Director/Deputy Chair,
Engagement and Participation
Non-Executive Director/Deputy Chair,
Strategy and Partnerships
1st April 2012 to 31st March 2013
Annual
Long-term
PerformancePerformancerelated Bonus
related
Bonuses
(Total to
(bands of
(bands of
nearest £100)
£5000)
£5000)
£00
£000
£000
Taxable
Benefits
Pensionrelated
Benefits
(bands of
£2500)
£000
Total
(bands of
£5000)
£000
40-45
135-140
0
32
0
0
0
0
0
10.0-12.5
40-45
150-155
125-130
27
0
0
17.5-20.0
145-150
35-40
40-45
50-55
95-100
160-165
0
22
4
50
24
0
0
0
0
0
0
0
0
0
0
102.5-105.0
15.0-17.5
120.0-122.5
10.0-12.5
5.0-7.5
140-145
60-65
175-180
115-120
170-175
95-100
47
0
0
0.0-2.5
105-110
10-15
15-20
10-15
10-15
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
10-15
15-20
10-15
10-15
25-30
0
0
0
0
25-30
15-20
0
0
0
0
15-20
15-20
0
0
0
0
15-20
925-930
206
0
0
290.0-292.5
1,235-1,240
26
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
2013/14 Pensions Table
Name and Title
Mr David Melbourne
Ms Sarah-Jane Marsh
Mrs Michelle McLoughlin
Mr Tim Atack
Dr Vinod Diwakar
Mrs Theresa Nelson
Mr Philip Foster
Dr Fiona Reynolds
Notes
Chief Financial Officer and Interim /
Deputy Chief Executive
Chief Executive Officer
Chief Nursing Officer
Chief Operating Officer
Chief Medical Officer
Chief Officer For Workforce Development
Interim Chief Finance Officer
Interim Chief Medical Officer
2
1
1st April 2013 to 31st March 2014
Cash
Cash
Real Increase/
Equivalent
Equivalent
(decrease) in
Transfer
Transfer
Cash
Value at 31
Value at 31
Equivalent
March 2014
March 2013
Transfer
Value
Real increase/
(decrease) in
pension and
related lump
sum at age 60
Total accrued
pension and
related lump
sum at age 60
at 31 March
2014
Employers
Contribution
to
Stakeholder
Pension
(bands of
£2500)
£000
(bands of
£5000)
£000
To nearest
£1000
To nearest
£1000
To nearest
£1000
To nearest
£100
15.0-17.5
170-175
791
691
100
0
(15.0)-(12.5)
2.5-5.0
7.5-10.0
22.5-25.0
5.0-7.5
32.5-35.0
125.0-127.5
75-80
130-135
125-130
155-160
40-45
135-140
125-130
240
706
567
632
184
558
518
272
531
518
523
159
414
0
(32)
175
49
109
25
144
518
0
0
0
0
0
0
0
1) The Real increase in pension and related lump sum at age 60 has been compared with a zero balance last year.
2) The Real decrease in cash equivalent transfer value is due to a period of maternity leave.
As Non-Executive members do not receive pensionable remuneration, there will be no entries in respect of pensions for Non-Executive members.
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. A CETV is a payment made by a pension scheme, or
arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in
their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme,
not just their service in a senior capacity to which the disclosure applies. The CETV figures, and from 2004-05 the other pension details, include the value of any pension
benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to
the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework
prescribed by the institute and Faculty of Actuaries.
27
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
Real Increase/(Decrease) 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 pension scheme or arrangement) and uses common market
valuation factors for the start and end of the period.
Expected employer contributions to the NHS pension scheme for the next annual reporting period remain at 14% of the pensionable pay of scheme members. Employee
contributions are based on annualized, full-time salary. For directors where this figure falls between £70,631 and £111,377 the contribution rate is 13.5% of pensionable
pay, while it is 14.5% for those where this figure is in excess of £111,377.
2012/13 Pensions Table
Name and Title
Mr David Melbourne
Ms Sarah-Jane Marsh
Mrs Michelle McLoughlin
Mr David Eltringham
Mr Tim Atack
Dr Vinod Diwakar
Mrs Theresa Nelson
Mr Philip Foster
Notes
Chief Financial Officer and Interim /
Deputy Chief Executive
Chief Executive Officer
Chief Nursing Officer
Chief Operating Officer
Chief Operating Officer
Chief Medical Officer
Chief Officer For Workforce Development
Interim Chief Finance Officer
1st April 2012 to 31st March 2013
Cash
Cash
Real Increase/
Equivalent
Equivalent
(decrease) in
Transfer
Transfer
Cash
Value at 31
Value at 31
Equivalent
March 2012
March 2012
Transfer
Value
Real increase/
(decrease) in
pension and
related lump
sum at age 60
Total accrued
pension and
related lump
sum at age 60
at 31 March
2013
(bands of
£2500)
£000
(bands of
£5000)
£000
To nearest
£1000
To nearest
£1000
To nearest
£1000
To nearest
£100
17.5-20.0
150-155
691
587
104
0
10.0-12.5
10.0-12.5
15.0-17.5
120.0-122.5
5.0-7.5
0.0-2.5
102.5-105.0
85-90
125-130
115-120
120-125
130-135
35-40
105-110
272
531
446
518
523
159
414
234
471
372
0
486
151
0
38
60
74
518
37
8
414
0
0
0
0
0
0
0
28
Employers
Contribution
to
Stakeholder
Pension
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
4.1
Employee Expenses
Salaries and wages
Social security costs
Pension cost - NHS Pensions
Agency/contract staff
TOTAL STAFF COSTS
included within:
Costs capitalised as part of assets
Analysed into Operating Expenditure
Employee Expenses - Staff
Employee Expenses - Executive directors
Total Employee benefits excl. capitalised costs
Total
£000
123,142
10,705
14,089
4,458
152,394
31 March 2014
Permanent
£000
121,760
10,705
14,089
146,554
Total
£000
120,842
9,645
13,306
6,658
150,451
31 March 2013
Permanent
£000
120,287
9,645
13,306
143,238
Other
£000
1,382
4,458
5,840
Other
£000
555
6,658
7,213
-
-
-
-
-
-
151,203
1,191
152,394
145,363
1,191
146,554
5,840
5,840
149,357
1,094
150,451
142,144
1,094
143,238
7,213
7,213
The analysis above is for the Group and does not include any costs in respect of non-executive directors.
4.2
Average number of employees (WTE basis)
Medical and dental
Administration and estates
Healthcare assistants and other support staff
Nursing, midwifery and health visiting staff
Scientific, therapeutic and technical staff
Other
Total average numbers
of which
Number of Employees (WTE) engaged on capital
projects
Total
Number
398
785
262
1,100
545
4
3,094
31 March 2014
Permanent
Number
198
753
250
1,075
528
4
2,808
Other
Number
200
32
12
25
17
286
3
3
-
29
Total
Number
376
743
238
1,074
437
75
2,943
31 March 2013
Permanent
Number
189
675
234
1,051
408
68
2,625
Other
Number
187
68
4
23
29
7
318
3
3
-
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
4.3
Early retirements due to ill health
31 March
2014
1
66
No. of early retirements on the grounds of ill-health
Value of early retirements on the grounds of ill-health (£000)
31 March
2013
5
314
The cost of these ill health retirements will be borne by the NHS Business Services Authority (Pensions
Division).
4.4
Analysis of Termination benefits
Termination benefits were payable to 6 members of staff during the year, at a total cost of £110k.
4.5
Staff exit packages
Staff exit packages agreed during the year are summarised as follows:
Exit Package Cost Band
< £10,000
£10,000 - £25,000
£25,001 - £50,000
£50,001 - £100,000
£100,001 - £150,000
£150,001 - £200,000
> £200,000
Total Number of Exit Packages
Total Resource Cost - £'000
Number of
Compulsory
Redundancies
2
1
2
5
Number of
Other
Departures
Agreed
1
1
Total
Number of
Exit Packages
by Cost Band
2
1
3
6
81
29
110
Number of
Compulsory
Redundancies
1
1
2
-
Number of
Other
Departures
Agreed
4
2
4
-
4
10
Total
Number of
Exit Packages
by Cost Band
4
3
5
2
14
196
143
339
Equivalent staff exit packages agreed during 2012/13 were:
Exit Package Cost Band
< £10,000
£10,000 - £25,000
£25,001 - £50,000
£50,001 - £100,000
£100,001 - £150,000
£150,001 - £200,000
> £200,000
Total Number of Exit Packages
Total Resource Cost - £'000
30
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
4.6
Exit packages: other (non-compulsory) departure payments
Payments for non-compulsory departures in 2013/14 are analysed as follows:
Contractual payments in lieu of notice
Non-contractual payments requiring HMT approval*
Total
Number of
payments
agreed
1
1
Total value of
payments
£000
15
14
2
29
As a single exit packages can be made up of several components, each of which will be counted separately in
this note, the total number above will not necessarily match the total numbers in note 4.5 which will be the
number of individuals.
None of the payments above has a value exceeding 12 months’ salary for the individual concerned.
*Includes any non-contractual severance payment made following judicial mediation, and £14k relating to noncontractual payments in lieu of notice.
5.1
Analysis of operating lease expenditure
Minimum lease payments
TOTAL
5.2
31 March
2014
£000
613
31 March
2013
£000
417
613
417
31 March
2014
31 March
2013
£000
£000
429
409
1,183
-
899
-
1,612
1,308
Arrangements containing an operating lease
Future minimum lease payments due:
- not later than one year;
- later than one year and not later than five years;
- later than five years.
TOTAL
There are no future sublease payments receivables by the Trust in either the current or previous accounting
periods.
5.3
Limitation on auditor's liability
Limitation on auditor's liability as per agreement dated 25 April 2013
31
31 March
2014
£000
1,000
31 March
2013
£000
1,000
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
5.4
The late Payment of Commercial Debts (Interest) Act 1998
There are no amounts included within 'other interest payable' arising from claims made under this legislation in
either the current or previous accounting periods.
There has been no compensation paid to cover debt recovery costs under this legislation in either the current
or previous accounting periods.
5.5
Other audit remuneration
Other auditor remuneration paid to the external auditor is analysed as
follows:
Taxation compliance services
All other non-audit services
TOTAL
6
31 March
2014
£000
31 March
2013
£000
73
73
64
59
123
Discontinued Operations
There have been no discontinued operations in either the current or previous accounting periods.
7
Corporation Tax
No liability for corporation tax has arisen in either the current or the previous accounting period. The subsidiary
company, Birmingham Children’s Hospital Pharmacy Ltd, is in its initial trading period and set up costs have
driven a loss to date.
8
Finance Revenue
Interest on bank accounts
Interest on loans and receivables
TOTAL
Group
31 March
31 March
2014
2013
£000
£000
113
668
113
668
Trust
31 March
31 March
2014
2013
£000
£000
113
668
55
168
668
Interest on bank accounts has been earned from surplus funds held within the Government Banking Services
(GBS) during the year ended 31 March 2014. In the previous accounting period, interest on bank accounts was
earned from investing surplus funds in accordance with the Trust's Treasury Management Policy. Changes to
the calculation of PDC, as described in note 1.15, have meant continuation of investments has not been viable
for the current accounting period.
32
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
There is no interest on impaired financial assets included in finance income in either the current or previous
accounting periods.
9
Finance Expenses
Finance Costs on PFI obligations
Main Finance Costs
Contingent Finance Costs
TOTAL
10
31 March
2014
£000
31 March
2013
£000
295
152
447
317
152
469
Impairment of assets (PPE & intangibles)
Loss as a result of catastrophe
Other
Total Impairments charged to operating surplus / deficit
Impairments charged to the revaluation reserve
Total Impairments
31 March
2014
£000
516
516
31 March
2013
£000
2,525
2,525
516
8,665
11,190
Impairments within the current accounting period relate to damaged electrical infrastructure, written to
operating costs.
Impairments in the previous accounting period relate to the full revaluation of Land and Buildings as at 31
March 2013, undertaken by professional valuers holding appropriate Royal Institute of Chartered Surveyors
qualifications.
Of these impairments, £2,525k relate to new buildings and were written to operating costs, with the remaining
£8,665k relating to previously revalued assets and therefore written to the revaluation reserve and offset by
revaluation gains.
33
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
11.1
Intangible assets 2013/14
Valuation/Gross Cost at 1 April 2013
Additions - purchased / internally generated
Additions - donations of physical assets (non-cash)
Disposals
Valuation/Gross cost at 31 March 2014
Amortisation at 1 April 2013
Provided during the year
Disposals
Amortisation at 31 March 2014
11.2
Total
Software
licences
(purchased)
£000
693
212
46
(1)
950
£000
693
212
46
(1)
950
515
133
(1)
647
515
133
(1)
647
Intangible assets 2012/13
£000
540
193
(40)
693
Software
licences
(purchased)
£000
540
193
(40)
693
382
173
(40)
515
382
173
(40)
515
Total
Software
licences
(purchased)
Total
Valuation/Gross cost at 1 April 2012
Reclassifications
Disposals
Valuation/Gross cost at 31 March 2013
Amortisation at 1 April 2012
Provided during the year
Disposals
Amortisation at 31 March 2013
11.3
Intangible assets financing
£000
£000
Net book value
NBV - Purchased at 31 March 2014
NBV - Donated at 31 March 2014
NBV total at 31 March 2014
256
47
303
256
47
303
Net book value
NBV - Purchased at 31 March 2013
NBV total at 31 March 2013
178
178
178
178
34
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
12.1
Property, plant and equipment 2013/14
Total
Land
Buildings
excluding
dwellings
Valuation/Gross cost at 1 April 2013
Additions - purchased
Additions - donations of physical assets (non-cash)
Additions - grants / donations of cash to purchase assets
Reclassifications
£000
115,788
9,866
264
1,123
-
£000
15,648
-
£000
67,791
1,974
1,025
787
Assets
under
Construction
& POA
£000
2,305
5,373
(1,139)
Revaluations
Disposals
Valuation/Gross cost at 31 March 2014
(363)
(1,611)
125,067
15,648
(3)
71,574
20,748
4,847
516
(233)
(1,603)
24,275
-
95,092
1,079
4,621
100,792
15,648
15,648
Accumulated depreciation at 1 April 2013
Provided during the year
Impairments charged to operating expenses
Revaluations
Disposals
Accumulated depreciation at 31 March 2014
Net book value at 31 March 2014
Owned
On-SoFP PFI contracts
Donated
NBV total at 31 March 2014
All property plant and equipment within the Group belong to the Trust.
35
Plant &
Machinery
Information
Technology
Furniture
& Fittings
£000
26,168
1,439
239
63
309
£000
2,677
843
25
43
£000
1,199
237
35
-
6,539
(353)
(1,393)
26,472
(16)
(218)
3,354
9
1,480
1,045
1,916
(2)
2,959
516
516
17,412
2,197
(234)
(1,385)
17,990
1,554
598
(3)
(218)
1,931
737
136
6
879
63,818
1,079
3,718
68,615
6,023
6,023
7,680
802
8,482
1,388
35
1,423
535
66
601
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
12.2
Property, plant and equipment 2012/13
Valuation/Gross cost at 1 April 2012
Additions - purchased
Additions - donated
Impairments
Reclassifications
Revaluations
Assets
under
Construction
& POA
Plant &
Machinery
Information
Technology
Furniture
& Fittings
Total
Land
Buildings
excluding
dwellings
£000
108,427
£000
12,805
£000
59,554
£000
7,731
£000
25,160
£000
2,103
£000
1,074
8,530
-
6,002
973
1,049
395
111
454
-
7
110
325
12
-
(8,665)
-
(8,665)
-
-
-
-
(193)
-
4,901
(6,509)
1,117
301
(3)
9,890
2,843
6,959
-
66
5
17
(2,655)
-
(881)
-
(1,635)
(139)
-
115,788
15,648
67,877
2,305
26,082
2,677
1,199
18,377
-
8
-
16,529
1,235
605
Provided during the year
5,458
-
2,518
-
2,360
458
122
Impairments
2,525
-
2,525
-
-
-
-
Revaluations
(2,987)
-
(3,039)
-
42
-
10
Disposals
(2,625)
-
(881)
-
(1,605)
(139)
-
20,748
-
1,131
-
17,326
1,554
737
90,261
15,648
62,903
2,195
7,941
1,112
462
On-SoFP PFI contracts
1,199
-
1,199
-
-
-
-
Donated
3,580
-
2,644
110
815
11
-
95,040
15,648
66,746
2,305
8,756
1,123
462
Disposals
Valuation/Gross cost at 31 March 2013
Accumulated depreciation at 1 April 2012
Accumulated depreciation at 31 March 2013
Net book value - 31 March 2013
Owned
NBV total at 31 March 2013
36
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
13
Intangible assets acquired by government grant
There were no intangible assets acquired by government grant in either the current or previous accounting
periods.
14
Economic life of intangible assets
Min Life
Years
1
Max Life
Years
8
Economic life of property, plant and equipment
Min Life
Years
Land
Infinite
1
Buildings excluding dwellings
1
Plant & Machinery
1
Information Technology
1
Furniture & Fittings
Max Life
Years
Infinite
88
19
10
10
Software
15
16.1
Investments 2013/14
The Trust holds 100% of the share capital of Birmingham Children’s Hospital Health Services Ltd, a holding
company for further trading subsidiaries, with share value of £1k. This company is incorporated in the UK under
company number 08103783.
Birmingham Children’s Hospital Health Services Ltd holds 100% of the share capital of Birmingham Children’s
Hospital Pharmacy Ltd, also with share value of £1k. This company is incorporated in the UK under company
number 08104635. The principal activity of Birmingham Children’s Hospital Ltd is to provide an outpatient
pharmacy service.
The transactions of the wholly-owned subsidiaries are consolidated into the accounts of the Trust where
appropriate and presented under the ‘Group’ heading.
16.2
Investments 2012/13
During the 2012/13 financial year, the Trust acquired 100% of the share capital of Birmingham Children's
Hospital Trading Ltd, with share value of £1k. The transactions of this wholly-owned subsidiary company and of
its subsidiary were not of material value during the financial year and so were not consolidated into the Trust’s
accounts.
16.3
Investment Property
The Trust did not hold any investment property in either the current or previous accounting periods.
37
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
17.1
Fair value of investments in associates (and jointly controlled operations)
The Trust did not hold any investments in associates or jointly controlled operations in either the current or
previous accounting periods.
17.2
Disclosure of aggregate amounts for assets and liabilities of jointly controlled operations
The Trust did not hold any investments in associates or jointly controlled operations in either the current or
previous accounting periods.
18.1
Non-current assets for sale and assets in disposal groups
The Trust did not have non-current assets for sale and assets in disposal groups at either the current or
previous year-end.
18.2
Liabilities in disposal groups
The Trust did not have liabilities in disposal groups at either the current or previous year-end.
19
Other Assets
The Trust did not hold any pension scheme assets or other assets at either the current or previous year-end.
20
Other Financial Assets
The working capital for Birmingham Children’s Hospital Pharmacy Ltd has been provided by way of a cash loan
from the Trust which is subject to interest at a commercial rate plus a principle repayment schedule. At 31
March 2014 the remaining value of this loan was £600k. This is a financial asset to the Trust that is eliminated
on consolidation.
38
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
21.1
Inventory Movements – 2013/14
Group
Total
Drugs
Consumables
Carrying Value at 1 April 2013
Additions
£000
3,955
170
£000
1,029
170
£000
2,926
-
(308)
183
183
(308)
-
Carrying Value at 31 March 2014
4,000
1,382
2,618
Trust
Total
£000
3,955
170
Drugs
£000
1,029
170
Consumables
£000
2,926
-
(308)
-
(308)
3,817
1,199
2,618
Inventories recognised in expenses
Other
Carrying Value at 1 April 2013
Additions
Inventories recognised in expenses
Carrying Value at 31 March 2014
Neither the Trust nor the Group incurred any write-down of inventories or incurred any expenses in relation to
inventories in either the current or previous accounting periods.
21.2
Inventory Movements – 2012/13
Group
Carrying Value at 1 April 2012
Additions
Total
£000
3,635
320
Drugs
£000
951
78
Consumables
£000
2,684
242
Carrying Value at 31 March 2013
3,955
1,029
2,926
Trust
Carrying Value at 1 April 2012
Additions
Total
£000
3,635
320
Drugs
£000
951
78
Consumables
£000
2,684
242
Carrying Value at 31 March 2013
3,955
1,029
2,926
39
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
22
Trade and other receivables
Group
31 March
31 March
2014
2013
£000
£000
Current
NHS Receivables - Revenue
Receivables due from NHS charities
Other receivables with related parties
Provision for impaired receivables
Prepayments (Non-PFI)
Accrued income
PDC dividend receivable*
Other receivables - Revenue
Trust
31 March
31 March
2014
2013
£000
£000
6,925
135
(1,758)
1,692
4,201
118
2,612
6,650
105
(1,549)
1,560
3,467
2,481
6,925
135
(1,758)
1,692
4,201
118
2,408
6,650
105
(1,549)
1,560
3,467
2,481
13,925
12,714
13,721
12,714
1,399
1,251
1,399
1,251
1,399
1,251
1,399
1,251
TOTAL CURRENT TRADE AND OTHER
RECEIVABLES
Non-Current
Other receivables - Revenue
TOTAL NON-CURRENT TRADE AND OTHER
RECEIVABLES
*The Public Dividend Capital (PDC) dividend receivable at 31 March 2014 has arisen because the value of PDC
paid in the year was higher than the final calculated value.
The Trust has considered the Monitor requirements under IFRS 7 relating to credit risk. The majority of the
Trust's financial assets relate to money due from other NHS organisations. Other NHS organisations are
extremely unlikely to default on payments, and the Trust would only invest its cash deposits within a strict
investment policy. There are no transactions involving hedging, foreign currency or other investments prone to
market fluctuations. There is therefore no material exposure to credit, market or liquidity risks.
23.1
Provision for impairment of receivables
2013/14
£000
1,549
663
(454)
1,758
At 1 April
Increase in provision
Amounts utilised
At 31 March
40
2012/13
£000
1,301
363
(115)
1,549
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
23.2
Analysis of impaired receivables
31 March
2014
£000
31 March
2013
£000
Ageing of impaired receivables
Up to 30 days
31 to 60 days
61 to 90 days
91 to 180 days
Over 180 days
Total
28
22
37
243
1,428
1,758
38
20
64
159
1,268
1,549
Ageing of non-impaired receivables past their due date
Up to 30 days
31 to 60 days
61 to 90 days
91 to 180 days
Over 180 days
Total
2,984
165
313
243
611
4,316
1,934
431
140
340
14
2,859
24
Finance lease receivables
The Trust did not have any finance lease receivables at either the current or previous year-end.
25.1
Cash and cash equivalents
At 1 April
Net change in year
At 31 March
Group
31 March
31 March
2014
2013
£000
£000
36,173
33,730
12,437
2,443
48,610
36,173
Broken down into:
Cash at commercial banks and in hand
Cash with the Government Banking Service
25.2
99
48,511
Trust
31 March
31 March
2014
2013
£000
£000
36,173
33,730
12,343
2,443
48,516
36,173
36,173
Third Party Assets
The Trust did not hold any third party assets at either the current or previous year-end.
41
5
48,511
36,173
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
26.1
Trade and other payables
Group
31 March
31 March
2014
2013
£000
£000
Current
NHS payables - revenue
Other trade payables - capital
Other trade payables - revenue
Other taxes payable
Other payables
Accruals
TOTAL CURRENT TRADE AND OTHER
PAYABLES
Trust
31 March
31 March
2014
2013
£000
£000
1,909
959
10,936
3,121
2,353
8,190
1,950
1,100
4,957
3,108
2,044
6,405
1,909
959
10,936
3,121
2,450
8,086
1,950
1,100
4,957
3,108
2,044
6,405
27,468
19,564
27,461
19,564
The Trust did not have any non-current liabilities in respect of trade and other payables in either the current or
previous accounting period.
26.2
Early retirements included in NHS payables above
The Trust did not incur any expenditure in respect of early retirement in either the current or previous
accounting period.
27
Borrowings
Current
Obligations under PFI contracts (excl. lifecycle)
TOTAL CURRENT BORROWINGS
Non-current
Obligations under PFI contracts
TOTAL NON-CURRENT BORROWINGS
31 March
2014
£000
31 March
2013
£000
152
152
152
152
1,213
1,213
1,365
1,365
The Trust's borrowings relate to a PFI scheme for the refurbishment and management of previously dilapidated
buildings at sites on Whittall Street and Steelhouse Lane, entered into during 1998.
28
Prudential borrowing limit
Prudential Borrowing Limit disclosures are no longer required, the Prudential Borrowing Code having been
repealed by the Health and Social Care Act 2012.
42
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
29
Other liabilities
Current
Other deferred income
Deferred PFI credits
TOTAL OTHER CURRENT LIABILITIES
Non-current
Other deferred income
Deferred PFI credits
TOTAL OTHER NON-CURRENT LIABILITIES
30
31 March
2014
£000
5,758
96
5,854
31 March
2013
£000
3,757
84
3,841
1,417
524
1,941
1,296
481
1,777
Other Financial Liabilities
The Trust does not have any other financial liabilities not previously stated (31 March 2013 £nil).
31.1
Provisions for liabilities and charges
Other legal claims
Redundancy
Other
Total
Current
31 March
31 March
2014
2013
£000
£000
301
140
768
1,690
392
732
1,461
2,562
Non-current
31 March
31 March
2014
2013
£000
£000
234
1,674
1,920
2,389
3,828
2,389
Redundancy provisions relate to staffing restructures within operational departments. Other provisions relate
to settlements under equal pay claims. Provisions are discounted according to the estimated timing of the
associated cash flows utilising the discount rates described in note 1.13.
43
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
31.2
Provisions for liabilities and charges analysis
At 1 April 2013
Change in the discount rate
Arising during the year
Utilised during the year - cash
Reversed unused
Unwinding of discount
At 31 March 2014
Total
£000
4,951
8
1,570
(487)
(719)
(34)
5,289
Legal Claims
£000
140
426
(26)
(5)
535
Redundancy
£000
1,690
752
2,442
Other
£000
3,121
8
392
(461)
(714)
(34)
2,312
Expected timing of cash flows:
not later than one year
later than one year and not later than five
later than five years
TOTAL
1,461
3,594
234
5,289
301
234
535
768
1,674
2,442
392
1,920
2,312
31 March
2014
£000
31 March
2013
£000
37,549
29,051
31.3
Clinical Negligence liabilities
Amount included in provisions of the NHSLA in respect of clinical negligence
liabilities of Birmingham Children's Hospital NHS Foundation Trust.
The Trust is a member of the NHS Litigation Authority (NHSLA) Clinical Negligence Scheme, therefore all clinical
negligence claims are recognised in the accounts of the NHSLA. Consequently, the Trust has no provision for
clinical negligence claims. The NHSLA will provide a schedule showing the claims recognised in the books of the
NHSLA on behalf of the Trust.
32
Contingent (Liabilities) / Assets
Value of contingent liabilities
Equal pay
Other
Gross value of contingent liabilities
Amounts recoverable against liabilities
Net value of contingent liabilities
31 March
2014
£000
31 March
2013
£000
-
(77)
(77)
35
(42)
The contingent liabilities for the previous financial year related to ongoing legal cases where there remained
uncertainty that a loss of economic benefit would arise. There are no such as at 31 March 2014. Cases where a
loss of economic benefit is probable have been provided for within the Statement of Financial Position.
The net value of contingent assets is £nil (2013: £nil).
44
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
In addition to the contingent liabilities and contingent assets for which values are supplied above, significant
estimation uncertainty arises from the calculation of provisions for settlements under equal pay claims. While
every care has been taken to assess the liabilities due under these claims using relevant and reliable
information as available at the time the financial statements are prepared, this inherent uncertainty gives rise
to a further contingent liability for which a value cannot be estimated.
33
Revaluation Reserve Movements
2013/14
£000
12,771
(130)
12,641
Revaluation reserve at 1 April
Impairments
Revaluations
Asset disposals
Revaluation reserve at 31 March
34
2012/13
£000
8,604
(8,665)
12,877
(45)
12,771
Related Party Transactions
Birmingham Children’s Hospital NHS Foundation Trust is a corporate body authorised by Monitor, the
Independent Regulator of NHS Foundation Trusts in exercise of the powers conferred by Schedule 7 of the
National Health Service Act 2006.
During the year none of the Board members or members of the key management staff or parties related to
them has undertaken any material transactions with Birmingham Children’s Hospital NHS Foundation Trust.
The Department of Health is regarded as a related party. During the period the Trust has had a significant
number of material transactions with entities for which the Department is regarded as the parent Department.
These entities are listed below with a disclosure of the total balances owed and owing as at the reporting date
and total transactions with the Trust for the reporting year.
Ms Michelle McLoughlin, an Executive Director of the Trust, is the partner of Mr Kevin Bolger, an Executive
Director of University Hospital Birmingham NHS Foundation Trust. The Trust's formal Service Level Agreement
with University Hospital Birmingham NHS Foundation Trust is for a variety of services that are individually
negotiated and agreed.
45
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
NHS in England
NHS England
NHS Birmingham Crosscity CCG
NHS Birmingham South And Central CCG
NHS Sandwell And West Birmingham CCG
Health Education England
University Hospital Birmingham NHS Foundation Trust
NHS Litigation Authority
NHS Solihull CCG
NHS Dudley CCG
Royal Orthopaedic Hospital NHS Foundation Trust
NHS Walsall CCG
NHS Redditch And Bromsgrove CCG
NHS Coventry And Rugby CCG
Birmingham Community Healthcare NHS Trust
NHS South East Staffs And Seisdon Peninsular CCG
Heart Of England NHS Foundation Trust
NHS South Worcestershire CCG
Department of Health
Birmingham Womens NHS Foundation Trust
NHS Wolverhampton CCG
Sandwell And West Birmingham Hospitals NHS Trust
Royal Wolverhampton NHS Trust
Other NHS
46
Receivables
£000
Payables
£000
Revenue
£000
Expenditure
£000
2,947
176
170
1,151
101
752
141
381
15
173
28
118
40
111
471
46
8
1
808
7,638
16
218
134
58
108
37
50
41
169
130
126
295
527
1,909
161,155
20,184
14,264
10,172
8,824
2,678
1,853
1,577
1,159
1,159
827
786
724
671
288
643
615
597
575
56
77
5,719
234,603
111
2,322
2,194
449
14
222
644
338
556
512
1,182
8,544
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
35
Contractual Capital Commitments
Commitments under contract at the date of the Statement of Financial Position are:
31 March
2014
£000
2,256
2,256
Property, plant and equipment
Intangible assets
Total
31 March
2013
£000
1,875
1,875
Contractual commitments at 31st March 2014 mainly comprise CT scanner replacement project (£1m),
Strategic Investment Schemes relating to Electrical Infrastructure (£0.6m), Estates maintenance commitments
(£0.3m) and final retentions on completed capital schemes (£0.2m).
36
Finance lease obligations
The Trust has no finance lease obligations arising in either the current or previous accounting period other than
those relating to an on-SoFP PFI scheme.
The on-SoFP PFI scheme is for the refurbishment and management of previously dilapidated buildings at sites
on Whittall Street and Steelhouse Lane, Birmingham, to bring them into use as offices, on-call accommodation
and general staff accommodation. The Scheme is with Riverside Housing Group (previously with English
Churches Housing Group (ECHG) who, in October 2006, merged with Riverside Housing Group).
The main agreements made between the Trust and ECHG (dated 22 August 1997 and 11 May 1998) outline the
arrangements for land and premises on 3 related sites of the former Birmingham General Hospital to be
transferred to ECHG under 3 separate Headleases for a term of 99 years at a peppercorn rent.
ECHG were to undertake development/ refurbishment works in respect of the premises under a separate
Development Agreement. On practical completion of those works ECHG granted secondary Underleases of the
newly refurbished premises to the Trust. These three Underleases are for a period of 25 years. The Trust has an
option to extend the Underleases in 5 yearly increments up to a maximum of 50 years.
47
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
37.1
On-SoFP PFI obligations (finance lease element)
Gross PFI liabilities
of which liabilities are due
- not later than one year;
- later than one year and not later than five years;
- later than five years.
Finance charges allocated to future periods
Net PFI obligation
of which liabilities are due
- not later than one year;
- later than one year and not later than five years;
- later than five years.
37.2
31 March
2014
£000
3,053
31 March
2013
£000
3,501
433
1,548
1,072
(1,688)
1,365
447
1,628
1,426
(1,984)
1,517
152
607
606
152
607
758
On-SoFP PFI commitments
The Trust is committed to make the following payments for on-SoFP PFIs obligations during the next year in
which the commitment expires:
31 March
31 March
2014
2013
£000
£000
Commitments in respect of the service element of the PFI
- not later than one year;
69
69
- later than one year and not later than five years;
207
276
- later than five years.
345
345
Total
621
690
The current on-SoFP PFI obligations are due to expire on 31st March 2023.
38
Off-SoFP PFI commitments
The Trust has not entered into any off-SoFP PFI agreements.
39
Events after the reporting period
There have been no events after the reporting period having a material effect on the accounts.
48
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
40.1
Financial assets by category
Group
31 March
31 March
2014
2013
£000
£000
Assets as per SoFP
NHS Trade and other receivables
Other Financial Assets
Cash and cash equivalents
Total
15,324
48,610
63,934
8,568
2,481
36,173
47,222
Trust
31 March
31 March
2014
2013
£000
£000
15,120
600
48,516
64,236
8,568
2,481
36,173
47,222
The financial assets as recorded above are denominated entirely in £ Sterling.
40.2
Financial liabilities by category
Group
31 March
31 March
2014
2013
£000
£000
Liabilities as per SoFP
Obligations under PFI
Trade and other payables
Other financial liabilities
Total
1,365
27,468
12,850
41,683
1,517
8,007
5,145
14,669
Trust
31 March
31 March
2014
2013
£000
£000
1,365
27,461
12,850
41,676
1,517
8,007
5,145
14,669
The financial liabilities as recorded above are denominated entirely in £ Sterling.
40.3
Fair values of current and non-current financial assets and financial liabilities at 31 March 2014
The Trust has considered the values of current and non-current financial assets and current and non-current
financial liabilities and has concluded that there is no significant difference between book values and fair values
that requires further disclosure in either the current or previous accounting period.
40.4
Maturity of financial liabilities
In one year or less
In more than one year but not more than two
In more than two years but not more than five
In more than five years
Total
Group
31 March
31 March
2014
2013
£000
£000
34,935
9,139
2,244
2,080
3,897
2,692
607
758
41,683
14,669
49
Trust
31 March
31 March
2014
2013
£000
£000
34,928
9,139
2,244
2,080
3,897
2,692
607
758
41,676
14,669
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
41
Changes in the benefit obligation and fair value of plan assets during the year for the amounts
recognised in the Statement of Financial Position and the Statement of Comprehensive Income
The Trust did not hold any plan assets at either the current or previous year end.
42.1
Losses and Special Payments
The Trust incurred losses or made special payments as follows:
31 March
2014
31 March
2014
31 March
2013
31 March
2013
Number of
cases
Total value
of cases
£000
Number of
cases
Total value
of cases
£000
4
11
2
102
10
5
5
340
7
22
10
114
3
18
1
346
7
9
15
45
4
1
1
13
35
24
5
29
67
181
15
33
45
391
LOSSES:
Losses of cash due to:
overpayment of salaries etc.
other causes
Bad debts and claims abandoned in relation to:
other
TOTAL LOSSES
SPECIAL PAYMENTS:
Compensation under legal obligation
Ex gratia payments in respect of:
personal injury with advice
Other employment payments
Special Severance payments
TOTAL SPECIAL PAYMENTS
TOTAL LOSSES AND SPECIAL PAYMENTS
The Trust did not incur any clinical negligence, fraud, personal injury, compensation under legal obligation of
fruitless payment cases where the net payment for the individual case exceeds £250,000 in either the current
or previous accounting period.
42.2
Recovered Losses
The Trust did not recover any losses in either the current or previous accounting period.
43
Risk Management Policies
The Trust's activities expose it to a variety of financial risks, though due to their nature the degree of the
exposure to financial risk is substantially reduced in comparison with that faced by business entities. The
financial risks are mainly credit risk and inflation risk, with limited exposure to market risks (currency and
interest rates) and to liquidity risk.
50
Birmingham Children's Hospital NHS Foundation Trust - Statutory Accounts Year to 31 March 2014
Financial instruments play a much more limited role in creating or changing risk than would be typical of listed
companies, to which the financial reporting standards may apply. The Trust has limited powers to borrow or
invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather
than being held to change the risks facing the Trust in undertaking its activities.
The Trust's treasury management operations are carried out by the finance department, within parameters
defined formally within the Trust's standing financial instructions and policies agreed by the board of directors.
Trust treasury activity is subject to review by the Finance and Resource Committee.
Credit risk
As a consequence of the continuing service provider relationship that the Trust has with NHS commissioning
organisations and the way those organisations are financed, the Trust is exposed to a degree of customer credit
risk, but substantially less than faced by business entities. In the current financial environment where NHS
commissioning organisations must manage increasing healthcare demand and affordability within fixed
budgets, the Trust regularly reviews the level of actual and contracted activity with commissioning
organisations to ensure than any income at risk is discussed and resolved at a high level at the earliest
opportunity available.
As the majority of the Trust's income comes from contracts with other public bodies, there is limited exposure
to credit risk from individuals and commercial entities. The Trust mitigates its exposure to credit risk through
regular review of receivables due and by calculating a bad debt provision.
Inflation risk
The Trust has exposure to annual price increases of medical supplies and services (pharmaceuticals, medical
equipment and agency staff) arising from its core healthcare activities. The Trust mitigates this risk through,
for example, transferring the risk to suppliers by contract tendering and negotiating fixed purchase costs
(including prices set by nationally agreed frameworks across the NHS) or reducing external agency costs via
operation of the Trust's own employee 'staff bank'.
Market risk
The Trust has limited exposure to market risk for both interest rate and currency risk.
Currency risk - the Trust is principally a domestic organisation with the great majority of transactions, assets
and liabilities being in the UK and Sterling based. The Trust has no overseas operations nor investments and all
Trust cash is held in Sterling at UK banks: Royal Bank of Scotland and the Government Banking Service (GBS).
The Trust therefore has minimal exposure to currency rate fluctuations.
Interest rate risk - other than cash balances, the Trust's financial assets and all of its financial liabilities carry nil
or fixed rates of interest. Cash balances at UK banks earn interest linked to the Bank of England base rate. The
Trust therefore has minimal exposure to interest rate fluctuations.
Liquidity risk
The Trust's net operating costs are incurred under annual service level agreements with NHS commissioning
organisations, which are financed from resources voted annually by Parliament. The Trust ensures that it has
sufficient cash to meet all its commitments when they fall due and retains sufficient cash balances to facilitate
this. The Trust is not, therefore, exposed to significant liquidity risks.
51