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Bridgewater Annual Report 2014/15 1

Annual Report and Accounts 2014/15(part year: 1 November 2014 to 31 March 2015)

Bridgewater Annual Report 2014/152


Bridgewater Community Healthcare NHS Foundation TrustAnnual Report and Accounts 2014/15(part year : 1 November 2014 to 31 March 2015)

Presented to Parliament pursuant to Schedule 7 paragraph 25 (4) (a) of the National Health Service Act 2006


Contents Page

1: Statement from Chairman and Chief Executive 7

2. Statement of the Chief Executive’s responsibilities as the Accounting 9

Officer of Bridgewater Community Healthcare NHS Foundation Trust

3: Strategic Report 10

4: Directors’ Report 50

5: Enhanced Quality Governance Reporting 84

6: Remuneration Report 85

7: Annual Governance Statement 91

8: Full Annual Accounts for the part year ended 31 October 2014 102

9: Appendices

Appendix 1: Board Attendance for year ended 31 March 2014 149

Appendix 2: Register of Director Attendance at Committee meetings

for year ended 31 March 2014 150

Appendix 3: Register of Director and Governor Attendance at Council

of Governor meetings for year ended 31 March 2015 152

Appendix 4: Quality Report 2014/15 155

10. Useful Contacts 156


We are delighted to present our first Annual Report and Accounts as an NHS Foundation Trust for the period 1 November 2014 to 31 March 2015. This part year report covers the accounts and highlights for the first five months as Bridgewater Community Healthcare NHS Foundation Trust (Bridgewater).

This has been a very exciting time for the Trust as we made history on 1 November 2014 by becoming one of the first two NHS community trusts to be awarded Foundation Trust status. This was a milestone for NHS community healthcare and identified Bridgewater as well managed, well governed leaders in the provision of high quality and safe community healthcare. The fact that we achieved Foundation Trust status at this stage shows that we have a major part to play in health services in this region and beyond. Our Foundation Trust licence gives us a sound footing on which to continue to develop our specialism in community service provision and support the implementation of new models of care outlined in the Five Year Forward View by NHS England and other national bodies.

We achieved our Foundation Trust licence in the same week as we signed up our 10,000th public member. This wide membership base provides us with a fantastic opportunity to engage and involve our members in developing services for our communities.

These achievements would not have been possible without the hard work and commitment of our staff and our Board, or conceivable without the support of our patients, members and partners. A great deal of hard work from a lot of people went into preparing us to become a Foundation Trust and it really is just the beginning of our story.

The main focus in the five months since we became a Foundation Trust has been the introduction of the Listening into Action programme which aims to build a culture and way of working that engages and empowers staff to make changes. During the period covered

1. Statement from Chairman and Chief Executive


by this report we have seen some real changes within the Trust, re-energising how we listen to staff and how we handle their feedback and I am confident that there will be significant changes to come.

In addition, we are already seeing changes to how our members and governors are involved in the Trust and are making a real contribution in many areas. We look forward to seeing their involvement increase steadily so that we realise all the benefits of being a Foundation Trust.

At the end of the year we celebrated our staff awards, which is always an inspiring event as we see first-hand some of the best and most touching examples of patient care. This is what our Trust is all about: care, compassion and quality.

We continue to strive to improve quality and the experience of our patients. Details of how we continually improve quality and monitor our progress are available in the 2014/15 Quality Report contained within this report.

As we enter our first full year as a Foundation Trust in 2015/16 we have many challenges. The Trust will begin the year with a new Chief Executive, Colin Scales, as Dr Kate Fallon retired at the end of March. We continue, like other public sector providers, to face tough financial conditions and increasing demand for services.

We take heart that we are facing the future as a leader in our field and with staff who have the best interests of our patients at heart. We look forward to working more closely with our members and governors to ensure that our strategy and objectives are truly responsive to our local communities and deliver the services they need.

A part year annual report and accounts is also available for the period 1 March 2014 to 31 October 2014 when we were operating as an NHS Trust.

Statement from Dr Kate Fallon, Outgoing Chief Executive (Retired 31st March 2015)

As Accounting Officer for the period in which this report refers, I can confirm that I concur with the contents of the annual report and accounts as they are presented.

I would like to take this opportunity to wish the organisation all the best for the future; it has been a pleasure serving as Chief Executive of Bridgewater for the past four years.

Dr. Kate Fallon

Colin Scales Chief Executive Officer

Harry Holden Chairman


2. Statement of the Chief Executive’s responsibilities as the accounting officer of Bridgewater Community Healthcare NHS Foundation TrustThe 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 Bridgewater Community Healthcare 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 Bridgewater Community Healthcare 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 him 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.



3. Strategic ReportProfile of the TrustBridgewater Community Healthcare NHS Foundation Trust (Bridgewater) is a leading provider of community health services in the North West of England. Established as a NHS Trust in November 2010, Bridgewater was awarded NHS Foundation Trust status by Monitor on 1 November 2014 and the Trust name was changed to Bridgewater Community Healthcare NHS Foundation Trust.

Our business is to provide community and specialised health services to 831,270 people living in Halton, St Helens, Warrington and Wigan. As a leading provider of community and specialist health services, we also deliver community dental services in these boroughs plus Bolton, Tameside, Glossop, Stockport and Western Cheshire. Our specialist health services in other areas include a GP practice in Willaston, Western Cheshire, lifestyle services in Western Cheshire and sexual health services in Trafford.


Our business modelOur mission is to improve local health and wellbeing in the communities we serve and we are working with our commissioners and partners to bring more care closer to home. The majority of our services are delivered in patients’ homes or close to where they live, such as clinics, health centres, GP practices, community centres and schools.

Covering four boroughs in the provision of core community services and a further five boroughs in its provision of specialist dental services, we operate in a complex health and social care market where many of our partners are also our competitors. We have a number of different commissioners in each borough including Clinical Commissioning Groups and Local Authorities.

The business model for Bridgewater is that of a corporate hub, providing strategic leadership, governance and support services to the local clinical directorates, with each having its own contract and cost centre. This enables us to offer locally designed services, meeting locally identified demand and patterns of need.

We provide universal lifelong care to individuals and communities to improve health and wellbeing of the whole population and specialist care for vulnerable people.


Specialists Care for Vulnerable Minorities

Personal Care for Long-TermConditions

Universal Services - Early Yearsto End of Life

Self-Care and WellbeingServices for Whole Populations

Cost benefit of large populationbase for small volume services

Better health, better valuemanagement

0-19 yrs, frail elderly, dementia-co-ordinating services for maximum impact

Working in partnership avoidingadmissions. Improving outcomes

The population we serve is living longer, however there is a prevalence of long term conditions such as diabetes, heart disease, lung disease and dementia. The geography of Bridgewater includes some of the most deprived communities in England, with the associated health and lifestyle challenges. We are uniquely placed to support a reduction in avoidable attendance and admission to hospital, working in partnership with patients, families and general practices. We are increasingly developing the provision of integrated care with hospitals and local authority partners.

Our Foundation Trust status supports real and meaningful engagement with our patients, partners and communities, through our active Council of Governors and over ten thousand Members.

At 31 March 2015 we employed 2784 WTE people – the majority of whom are frontline healthcare staff.

Our income for the part year 1 November 2014 to 31 March 2015 totalled £63.07m including £53.4m Clinical Commissioning Groups and NHS England, £6.8m from local authorities, £1.0m from NHS Health Education and £0.3m from other NHS Trusts.

The income from the provision of goods and services for the purposes of the Heath Service in England is greater than our income from the provision of goods and services for any other purposes. (As per section 43(2a) of the NHS Act 2006 (as amended by the Health and Social Care Act 2012)).


Our Services Bridgewater is commissioned to deliver a diverse range of community healthcare services in a number of boroughs including Halton, St Helens, Warrington and Wigan.

Our staff work in GP practices, health centres, schools and in many cases patients’ own homes.

The Trust also provides one inpatient unit, Newton Community Hospital, which has 30 beds plus outpatient facilities. We also deliver intermediate care and nursing support at Padgate House, Warrington, a facility owned and managed by Warrington Borough Council which provides care for 35 patients. Our therapists provide intermediate care and rehabilitation to patients at Alexander Court care home in Wigan.

Our community dental services carry out specialised clinical procedures for the specific needs of vulnerable people and children.


Indicator to be measured

Comments2013/14 full year position

2012/13 full year position

Many of our services support people throughout their lives and as a provider of care our focus is to keep people out of hospital. We provide ongoing care and support to vulnerable people and those with complex and long-term conditions.

The delivery of services is organised into operational directorate structures to support the delivery of a Bridgewater standard of service in all areas that we serve. These directorates are Adults Services Directorate, Children and Families Services Directorate and Specialised Services Directorate. Each is led by a general manager and supported by service managers and clinical managers for each care group.


Service Wigan St Helens Warrington HaltonAdult Continence • • • •Cancer & Palliative Care - medical • • • •Cancer & Palliative Care Specialist Nursing & Therapists • •Care Home Support • • •Lymphoedema Service •Community Matrons • • • •Integrated Teams • • • •District Nursing Domiciliary service • • • •District Nursing Out of Hours Service & evenings • • • •District Nursing Ear Care Service • • • •District Nursing Phlebotomy • • • •District Nursing Tissue Viability • • • •District Nursing Treatment Rooms • • • •District Nursing Support to Care Homes • • • •Stoma Care •Community Intravenous Therapies • • •Community Neurology Rehabilitation • • • •Acquired Brain Injury •Parkinson’s Nursing •Chronic Fatigue Syndrome •Community Neurosciences • •Community Integrated Equipment Service • • •Cardiac Rehabilitation • •Diabetes • • • •Respiratory/Chronic Obstructive Pulmonary Disease (COPD) •Heart Failure • • •Stroke Service •Ear Nose and Throat • •Musculoskeletal Clinical Assessment & Treatment Services (MSKCATS)

• •

Physio/Orthopaedics/Musculoskeletal • • •Podiatry & Biomechanics Service • • •Wheelchair, Specialist Seating • • • •Driving Assessment Services •Falls & Community Therapy • • • •Intermediate Care • • • •Community Hospital •Early Support Discharge Team •GP Out of Hours • •Walk in Centre • • •Pain Management •

A summary of our servicesAdult Services


Service Wigan St Helens Warrington HaltonChildren’s Audiology • • • •Newborn Hearing screening • • •Child and Adolescent Mental Health Service • • • •Eating Disorder Service •Child Safeguarding/Looked After Children • • • •Children’s Development • • •Children’s Therapies including Occupational Therapy, Physiotherapy, Speech & Language Therapy

• • •

Children’s Community Learning Disability Service • • Children’s Community Nursing & Complex Needs • • • •Children’s Continence • • •Children’s Continuing Healthcare • •Children’s Respiratory •Children’s Long Term Conditions •Child Health Service •Children Young People & Families Acute Community Nursing Team

•

Minor Illness Prevention Service •School Nursing • • • •Health Visiting • • • •Midwifery •Paediatric Liaison •Surgical Appliances •Child Health System Team •

Service Wigan St Helens Warrington HaltonAdult Learning Disability •Breastfeeding Support • • •Community Dental Services * • • • •Community Mental Health • • •Counselling Services •Dietetics (Children Young People & Families) • Dietetics •Diabetic Eye Screening •Dermatology • • • Health Improvement • • •Stop Smoking • •Neighbourhood Mums •

Children and Famillies’ Services

Specialised Services


Service Wigan St Helens Warrington HaltonHomeless and Vulnerable • • •Open Mind •Offender Health • • Sexual Health ** • •Speech and Language Therapy (Adults) • •Weight Management • •

Notes* Bridgewater also provides community dental services in Bolton, Tameside, Glossop,

Stockport and western Cheshire

** Bridgewater also provides sexual health services in Trafford

Please note: Bridgewater also provides a child lifestyle service in Western Cheshire.

As of 1st July 2014, Bridgewater delivers general practice services from the Willaston Surgery in Willaston, Western Cheshire.

Please note: these tables do not include every service Bridgewater is commissioned to provide in these areas.

A complete list of services provided in each area is available on our website www.bridgewater.nhs.uk

Specialised Services


Our 2014/15 Strategy on a page

OUR

STRA

TEGI

C OB

JECT

IVES

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ll be

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butio

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IUM

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fit

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deliv

er o

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supp

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sou

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and

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and

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and

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are

QUAL

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fe: W

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ple

from

av

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harm

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ca

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s ne

eds

and

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th

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ualit

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life

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treat

peo

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spon

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at t

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• W

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ex

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in e

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town

yea

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year

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prov

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lif

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a

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prop

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spe

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ote

wel

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the

com

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T TE

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OBJE

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Valu

es: P

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ncou

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nova

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Ope

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nest

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iona

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DRIV

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FOR

CHAN

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del

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car

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supp

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and

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nd

inde

pend

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ivin

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• To

del

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val

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oney

, be

finan

cial

ly

sust

aina

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and

be

com

mer

cial

ly

co

mpe

titiv

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• To

ach

ieve

Foun

datio

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ust

stat

us in

201

4

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•

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very

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CQC,

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S M

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2015

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are

Inte

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• M

axim

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oppo

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of F

ound

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tatu

s•

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prov

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the

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the

pote

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of

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prov

es p

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• Co

mpl

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our ‘

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wate

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view

prog

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and

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pa

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s an

d st

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and

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effe

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• M

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the

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nd te

chno

logy

that

is

avai

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ff, p

atie

nts

and

the

publ

ic.

• Cl

early

iden

tify

the

true

cost

s an

d pr

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of o

ur s

ervi

ces

• Co

mpl

ete

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deve

lopm

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of s

ervi

ce li

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porti

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nd

man

agem

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liver

the

requ

irem

ents

of t

he

regu

lato

ry fr

amew

orks

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view

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disc

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Principal RisksAt the beginning of 2014/15, the Board has identified and monitors strategic areas of risk for the organisation:

• A culture across all levels of the organisation that tolerates poor quality of service quality and provision and fails to support and encourage staff

• Substandard quality of care and service delivery due to failure adhere to best • Failure to adopt technology to improve quality and efficiency of healthcare• Limited commercial competitiveness• Financial/political initiatives affecting the health economy that influence increasing

demands without sufficiently matched income growth • Failure to consistently deliver services that meet contractual obligations • Failure to sustain and demonstrate long term financial viability• Impact of the Cost Improvement Programmes including failure to deliver and impact

on quality of care• Failure to maintain and improve sound systems of governance and effective internal

control• Inconsistent data between similar services across Boroughs • Failure to demonstrate benefits of organisational transition and structures • Loss of income• Failure to maintain financial viability• Reputational damage

More detail on these risks and their likely impact is available within our Annual Governance Statement.

PerformanceThis section highlights the Trust’s performance against strategic objectives. However, it is important to note that as a part year report much of the performance data we use is contained within our full year Quality Report for 2014/15.

The section below highlights progress against our strategic objectives during the reporting period and also contains full year data for additional measures we are required to report on.

A separate section of the Strategic Report provides detail on our financial performance.

Progress against our Strategic Objectives 2014/15During 2014/15 we had four strategic objectives, including one related to the achievement of Foundation Trust status. During the five months from 1 November 2014 to 31 March 2015, we made significant progress against each objective.

Strategic Objective: To deliver high quality, safe and effective care which meets both individual and community needs

• We achieved the required progress against the majority of our Quality Improvement Priorities for 2014/15 as evidenced in our Quality Report.

• We saw an increase in the percentage of patients expressing their overall satisfaction DRIV

ERS

FOR

CHAN

GE

• M

anag

e ou

r rel

atio

nshi

ps w

ith

partn

ers,

sta

keho

lder

s,

pa

tient

s an

d th

e pu

blic

to

ensu

re c

larit

y of

info

rmat

ion,

pr

omot

e jo

int w

orkin

g an

d en

sure

con

tinui

ty o

f car

e.•

Deve

lop

and

impl

emen

t the

obje

ctiv

es c

asca

de a

nd

empo

wer s

taff

to p

rovi

de c

are

whic

h im

prov

es p

eopl

es’ l

ives

• Co

mpl

ete

our ‘

One

Br

idge

wate

r’ re

view

prog

ram

me

and

work

with

pa

tient

s an

d st

aff t

o de

sign

and

de

liver

effe

ctiv

e an

d

resp

onsi

ve s

ervi

ces

• M

axim

ise

the

effe

ctiv

enes

s of

IT a

nd te

chno

logy

that

is

avai

labl

e to

sta

ff, p

atie

nts

and

the

publ

ic.

• Cl

early

iden

tify

the

true

cost

s an

d pr

ice

of o

ur s

ervi

ces

• Co

mpl

ete

the

deve

lopm

ent

of s

ervi

ce li

ne re

porti

ng a

nd

man

agem

ent

• De

liver

the

requ

irem

ents

of t

he

regu

lato

ry fr

amew

orks

• Re

view

our

Inte

grat

ed

Bu

sine

ss P

lan

and

disc

uss

our

plan

s wi

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with

key

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ders


with their care and treatment, up to 99% in 2014/15 from 98% at the end of March 2014.

• In November we were delighted to be named winners of the 2014 Health Service Journal (HSJ) Managing Long Term Conditions Award for the creation of our Integrated Neighbourhood Teams in Wigan. The Teams have helped to create more

than 1,000 case management plans for high risk patients with long-term conditions and contributed to a 43 per cent drop in visits to A&E and a 38 per cent fall in

emergency admissions. The Teams work alongside colleagues from Wigan Council, Wrightington, Wigan and Leigh NHS Foundation Trust and Wigan Clinical

Commissioning Group.

• In December 2014 our Leigh Walk-in-Centre supported North West Ambulance Service (NWAS) to prevent 88 attendances at Wigan Accident and Emergency

through participating in the NWAS Pathfinder Scheme. The centre provided advice and an alternative destination for treatment to NWAS crews to help reduce winter pressures in the local healthcare system in the Wigan borough.


• Our community nursing teams in Halton and St Helens have also been working with NWAS to develop and introduce individual community care plans for those patients who frequently call emergency services in crisis situations. This aims to reduce the likelihood of the patient being transported to hospital by giving the patient increased confidence in managing their own care.

• In January 2015 we introduced a wider choice of treatment room clinics in Warrington to enable patients to receive treatment more quickly and at a time and place that is convenient for them.

• We worked with our partners in Warrington to look at how sharing data between health and social care professionals affects care and if we can make any improvements.

• We began working in partnership with the School of Medicine and Dentistry at the University of Central Lancashire to further develop our community placements for

undergraduate medical students.

• Details of other service developments during the year are available in the part year annual report for Bridgewater Community Healthcare NHS Trust.

Strategic Objective: To deliver innovative and integrated care close to home which supports and improves health, wellbeing and independent living

• In November we launched Florence simple telehealth technology within Orthopaedic triage and Musculoskeletal physiotherapy services in Warrington. Patients receive a series of texts to check if they are progressing as expected following injections. This allows patients to respond at a convenient time and avoids the need for additional appointments, thereby freeing up more appointment slots within the service.

• We introduced a text messaging reminder service for patients using our Musculoskeletal Care and Treatment service to reduce the number of patients failing

to attend their appointments.

• Our inpatient unit at Newton Community Hospital has been working to support patients who are assessed as being at high risk of a fall. Weekly audits have demonstrated that 96% of patients are at high risk and a number of measures have

been introduced which have led to an overall reduction in the incidents of falls among inpatients at the hospital.


• In early 2014/15 we joined the #hellomynameis social media campaign by reminding staff to go back to basics and provide a proper introduction when greeting patients and to help to build trust between patients and staff.

• In March we launched a new Bridgewater web page for people with learning disabilities. This dedicated interactive page has been designed to be compatible with

touch screen devices and contains a range of information in easy read format, including details of learning disability services in each of our boroughs and local support groups and charities for people with learning disabilities.

• We have been using a new Echo crowdsourcing tool to gain the views of staff on different areas of our organisation. Staff have contributed ideas on areas including administration support and children’s services. The Echo tool allows staff to submit ideas, comment on them and vote for the best ones to take forward.

• From 1 January 2015 it became mandatory for all Bridgewater services to provide patients with an opportunity to provide feedback on services via the national Friends

and Family questionnaire format. The test had been implemented in Bridgewater since 2013 and the questions are included in our standard “Talk to Us” patient feedback form. During the reporting period, 12,896 people responded to the question. Details are available in our Quality Report.

Strategic Objective: To deliver value for money, be financially sustainable and be commercially competitive.

• At the end of the financial reporting period covered by this report we achieved our key financial targets including generating a surplus of £0.154m for the part year

1 November 2014 to 31 March 2015 to fund contingencies. We ended the period with a cash balance of £5.9m, sufficient to fund in excess of 10 days operating expenses. At the end of the reporting period we achieved savings of £5.9 million as our

contribution to addressing the financial challenges in the health and social care system in each of the areas we serve. Details of these savings are as follows:


• We successfully gained contracts to deliver:

• St Helen’s Paediatric Speech and Language contract • Offender Health provision for Barton Moss Secure Children’s Home and St Catherine’s Secure Children’s Home in partnership with Greater Manchester West

Mental Health NHS Foundation Trust• Oral Surgery contract for Sandbach• Community Dentistry working in partnership with Wirral Community NHS Trust

taking on the new area of Vale Royal which encompasses Winsford and Northwich • A place on the Salford Public Health Services Procurement Framework • A place on the National Childhood Influenza Immunisation Service Framework

• During the reporting period we retained contracts for the delivery of:

• Offender Health at Her Majesty’s Prison and Young Offenders Institute Hindley in partnership with Greater Manchester West Mental Health NHS Foundation Trust

• Sexual Health Services in Warrington• Homeless and Vulnerable Services in Wigan• Infection Control services in Halton, St Helens and Warrington• School Nursing in Halton• Oral Surgery contracts for Cheshire West & Chester and Warrington

• In late 2014 we launched our Bridge Builder Community Trust Fund. This new charity was set up to allow Bridgewater staff, patients and members to raise funds to make a significant and positive difference to the lives of people in our local community. Through fundraising activity and donations, ‘Bridge Builder’ will provide small grants to voluntary and community groups, promoting and improving health and

wellbeing across Widnes, Runcorn, St Helens, Warrington and the Wigan Borough. Bridge Builder’s Registered Charity Number is 1068887.

CIP 2014/15 £Clinical Services 2,834,574Support Services 825,420Non-Pay 2,244,648Total 5,904,642


Strategic Objective: To achieve Foundation Trust status in 2014• On 1 November 2014 we achieved Foundation Trust status, becoming one of the first

two community trusts in the country to be awarded this licence.

• In November we held our inaugural formal meeting of the Foundation Trust Council of Governors and continued to develop the role of our governors during the remainder of the year. At our December Council of Governor meeting we focused on one of our first priorities - to develop the role of Governors in spreading the message about our Trust and our role to improve the health and wellbeing of our communities.

• In December we held a strategic planning exercise for our Service Managers and Clinical Managers.

• Our Chief Executive, Dr Kate Fallon, who had led us from a community provider arm of a Primary Care Trust to becoming one of the first community Foundation Trusts retired at the end of March. The appointment of her successor Colin Scales,

previously Bridgewater’s Chief Operating Officer was announced just before the end of the reporting period.

• During the week 23 to 27 March we held the latest of our successful Census Weeks to ask patients what they thought of our services and to encourage patients to become members of our Foundation Trust.

Our Quality Report in Appendix 4 contains more detail on specific service and qualityimprovements which have been made throughout the year.

Short-term objectivesDuring the year we also set ourselves additional objectives to support the delivery of our Strategic Objectives. Some of the key highlights are listed below:

Manage our relationships with partners, stakeholders, patients and the public to ensure clarity of information, promote joint working and ensure continuity of care

Staff Health and Wellbeing As at 31 March, Bridgewater employed 2784 WTE staff, the majority of whom are clinically trained, including district nurses, health visitors, specialist nurses, occupational therapists, speech and language therapists, physiotherapists and assistant practitioners.

The sickness absence rate for the Trust for this period was 5.40%. The latest data for benchmarking purposes (December 2014) shows the average for community trusts is 8.5%. The average rate for Trusts in the North West region is 5.4%.

The number of working days lost due to sickness absence was 18,209 and the average number of working days lost per member of staff during this period was 12.

Measures taken to reduce the sickness absence rate during the period include improving information provided to managers, including monthly absence reports.


In addition, an annual health and wellbeing week was held for staff in January which attracted 128 staff to a market place at various sites across the Trust which provided health checks plus advice on health improvement, occupational health services and counselling.We continue to provide health and wellbeing support to all staff via counselling from Wellbeing Partners and Insight (our Employee Assistance Programme).

2013/14 2014/15 Trust Improvement/ Deterioration

Trust National Average Trust National AverageResponse rate 39% 53% 38% 48% 10% deterioration

* Please note, the figures refer to the predecessor organisation prior to 1 November 2014

The five Key Findings for which Bridgewater Community Healthcare NHS Foundation Trust compares most favourably with other community trusts in England


Top five ranking scores Trust National Average

Trust National Average

% of staff experiencing physical violence from staff in

last 12 months1% 1% 1% 1% 0% improvement

% of staff believing the trust provides equal opportunities for career progression or promotion

91% 91% 94% 91% 3% improvement

% of staff experiencing harassment, bullying or abuse from staff in the last 12 months

18% 20% 16% 19% 2% improvement

% of staff experiencing physical violence from patients,

relatives or the public in the last 12 months

4% 9% 5% 8% 1% deterioration

% of staff witnessing potentially harmful errors, near misses or

incidents in the last month20% 26% 20% 23% 0% improvement

Staff Survey Results

Staff Survey The Trust takes part in the national annual NHS staff survey which provides us with feedback on how we are doing and how staff are feeling in relation to 29 key findings. The survey was sent to a sample of 850 staff in October 2014 and 316 staff responded by the closing date. This is a 38% response rate which is below the average for community trusts in England. This is a lower response rate than the 2013 NHS Staff Survey results when 331 staff completed the survey giving a 39% response rate.

Our overall staff engagement score was 3.67. This was an improvement on our 2013 staff engagement score of 3.61 but is below the average of 3.75 for other community trusts. Possible scores range from 1 to 5 with 1 indicating that staff are poorly engaged (with their work, their team and their trust) and 5 indicating that staff are highly engaged.




We acknowledge that there has been a slight deterioration in the overall response rate however with the exception of the percentage of staff that have been appraised in the past 12 months there are no significant changes since the key finding since the 2013 survey, although it needs to be noted that there are a number of key factors where the Trust score is either below or average when compared to other community trusts.

Future priorities and targetsDuring the year, the Trust also introduced the Staff Friends and Family Test. More detail on this test and the results is available in our Quality Report.

The results from both surveys need to be considered in the context of a period of significant organisational change. The Trust is committed to taking the survey feedback on board to ensure that our workforce is a healthy and motivated one. We will be developing a staff survey action plan to address staff concerns and will continue to work with staff side and staff in the development and achievement of the action plan. We are also currently running a Listening into Action programme (LiA) to ensure that staff opinions are not just listened to, but acted upon.

Employee EngagementThe key development during the year was signing up to Listening into Action (LiA) – a national programme that will help us to engage and empower our clinicians and staff. In addition to radically improving how engaged and valued our staff feel, LiA will support managers to lead through engagement and give teams permission to make positive changes. It will fundamentally change how we work.


Bottom five ranking scores Trust National Average Trust National Average% of staff agreeing that their role makes a difference to

patients88% 91% 87% 90% 1% deterioration

% of staff agreeing that feedback from patients /

service users is used to make informed decisions in their

directorate / department

- - 41% 52%No information from

previous year

% of staff having well-structured appraisals in

last 12 months35% 37% 32% 38% 3% deterioration

% of staff reporting good communications between

senior management and staff21% 29% 23% 33% 2% improvement

% of staff agreeing that they would feel secure raising concerns about unsafe

clinical practice

- - 65% 72%No information from

previous year

The five key findings for which Bridgewater Community Healthcare NHS Foundation Trust compares least favourably with other community trust in England


The main work on this programme started in October 2014 with the launch of the LiA Pulse Check to gain a benchmark of staff views and concerns.

In total, 1080 staff responded to the LiA Pulse Check in October and November 2014. The key areas that were identified as mattering to staff included Leadership, Estates, Communication, Staff Development, Staff Wellbeing, use of Agency Staff, Service Line Management, SystmOne Patient Administration System, Morale, Recruitment, IT, Procurement systems sharing ideas.

Following the initial Pulse Check a Trust-wide sponsor group was set up to lead a range of projects to tackle the issues raised by staff. Within the first few months there have been a number of quickly introduce benefits, including a centralised meeting room booking system, Trust credit cards to support procurement, information on email etiquette and the provision of mobile phones to staff who previously did not have access to them. Weekly sessions were also launched to allow any member of staff to call in to see the Trust’s Director of People, Planning and Development to ask questions or raise issues on an individual basis.


The Trust has a range of communications channels designed to keep staff informed and to support two-way dialogue and engagement. These include a monthly Team Brief system led by the Chief Executive. This contains key messages to keep staff informed on new developments, changes to guidance and policy and performance (including HR performance measures and financial performance). Staff also receive a fortnightly Bridgewater Bulletin e-newsletter, have access to the Trust intranet and a monthly Chief Executive’s blog for staff all of which are used to highlight progress against our strategic objectives. The Trust is also active across a variety of social media channels.

As a Community Trust with a dispersed workforce, the Trust also uses text messaging to alert staff to any urgent issues and to support emergency planning arrangements. Staff are also encouraged to follow the Trust’s social media accounts on Twitter and Facebook. A new staff voicemail for use in emergencies or bad weather was also introduced during the year to help alert staff to advice and information.

Staff are also kept involved in the business of the Trust via a range of events, including those with a focus on quality improvement and specific professional forums.

The Trust offers a full range of education and training courses and more detail on this is included in our Quality Report 2014/15.

Celebrating our staffWe celebrate the achievements of our staff throughout the year through our “Stars of the Month” scheme, which allows staff to celebrate the work of their colleagues throughout the year and receive a certificate from the Chief Executive. During the year staff submitted 184 separate nominations for individual colleagues or teams as part of the scheme.


In October we introduced an Employee of the Month scheme to run in conjunction with our Stars of the Month and build on its success.

The annual highlight of our reward and recognition is our Staff Awards ceremony, held in March every year. This year the winners were presented with their trophies at an event at Haydock Park Racecourse on 11 March. The winners were as follows:

Clinical Employee of The Year: Karen Anwyll – Community Nursery Nurse, based at Castlefields Health Centre, Runcorn.

Outstanding Contribution to Innovation: Sarah Shone, Musculoskeletal Physiotherapist based at Platt Bridge Health Centre, Wigan

Team of the Year: Children’s Community Nurse Team based at Woodview Child Development Centre, Widnes

Non-Clinical Employee of the Year: Hazel Williams, Admin Officer, The Bridges Learning Centre, Widnes


Patient Choice Award: Community Connection Point/Hospital Avoidance Nurses based at Albion Street Clinic, St Helens

Employee of the Year: Alison Pearson, Highly Specialist Speech & Language Therapist based at Warrington, chosen from all our Stars of the Month.

Chairman’s Award for Lifetime Achievement: John Ward, Retired Board Secretary

A number of our colleagues also received recognition throughout the year from external bodies. They included:

• Nicola Monaghan –invited to join the Institute of Health Visiting Fellowship Programme• Sarah Logan – Awarded Queen’s Nurse Title• Nicola Broad – Awarded Queen’s Nurse Title• Wigan Integrated Neighbourhood Team – won Health Service Journal Award for Managing Long Term Conditions• Wigan Continence Care Service – Awarded Continence Care Team Award• Annette Dunning – John Moores University Award in recognition of her support to

another student


Equality, Diversity and Inclusion Bridgewater’s mission ‘to improve local health and promote wellbeing in the communities we serve’ can only be fulfilled if we recognise the diversity and differing, individual needs of the people within these communities. Our Equality Statement demonstrates our commitment to providing health care services and employment that is equitable and free from discrimination and to upholding the values of dignity and respect for our staff and patients and their families and carers.

Within the large population served by the Trust there are groups that suffer worse health, poorer long term outcomes and shorter lives than the rest of the population. The Equality Act provides for nine protected characteristic groups that are recognised as suffering inequality when compared to the rest of the population. These protected characteristics are age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation. In addition, the Trust has recognised and committed to improving health inclusion for other vulnerable groups within our population, including those disadvantaged by lower socio-economic status, chaotic lifestyles (drug and alcohol abuse), the homeless, destitute asylum seekers and refugees, sex workers and carers.

In order to reduce health inequalities in our communities, the Trust must work to improve inclusion in healthcare by understanding and removing the barriers to access. We aim to:

• Ensure that the services we provide are accessible to all• Develop services which best meet the needs of our diverse communities• Employ, develop and retain a workforce which at all levels reflects the diversity and

make-up of the population we serve• Ensure that staff have information on equality, diversity and health inclusion• Eliminate from our services, policies and decision making any adverse impact on the

promotion of equality or potential adverse effect on any particular groups or communities

Health inequalities are a key feature of the framework within which all NHS organisations operate. This includes the Health and Social Care Act 2012, the NHS Constitution, the NHS Outcomes Framework and the Five Year Forward View.

The articles within the Human Rights Act 1998 have a big impact on healthcare, for example the right to life, the right not to be tortured or treated in an inhuman or degrading way and the right to respect for family and private life, home and correspondence. The FREDA (Fairness, Respect, Equality, Dignity and Autonomy) principles of human rights are important in the day-to-day work of all NHS trusts and this is reflected in two of the CQC essential standards (person centred care and dignity and respect). These basic rights are also reflected within the Trust’s values and are assessed and monitored through the equality analysis of services and policies, through the Talk to Us patient survey and through patient complaints and feedback.

The Trust operates its equality governance within the above frameworks and also within the requirements of the Equality Act 2010 and in particular the general and specific duties of the Public Sector Equality Duty. In order to demonstrate compliance with the duties the Trust produces an annual Public Sector Equality Duty (PSED) Summary report and uses the national NHS Equality Delivery System (EDS2) framework to assess and grade equality


performance for staff and patients. The information provided within the PSED and EDS2 is used, along with the information in the equality analysis of services and current national equality and inclusion initiatives to produce Equality Objectives and an Equality and Health Inequalities Action Plan that set out the plans for the coming years to improve equality performance across the Trust.

All services have an equality analysis that seeks to identify barriers for service users whether they be access barriers or assistance or attitude barriers. All service redesigns undergo an equality analysis to assess potential impacts, positive or negative, on the protected characteristic and vulnerable groups. Patient access is monitored through the PSED using population information from the 2011 Census.

The Trust believes in equality of opportunity for all staff. Staff breakdown is monitored as part of the annual PSED and from April 2015 we will be monitoring race/ethnicity in nine key indicators set down in the NHS Workforce Race Equality Standard.

We regularly monitor the gender distribution among our workforce and as at 31 March our figure our total workforce consisted of 2964 (91.5%) females and 274 (8.5%) males.

Our Board of Directors is composed of 3 (43%) female and 4 (57%) male directors and among senior managers (band 8a to 8d) 28 (61%) were female and 18 (39%) are male.

As part of the PSED employee relations cases are monitored for any potential discrimination issues, this includes dignity and respect and bullying and harassment. Within the last year figures were too low to report, but no issues were identified in the analysis. The NHS Staff Survey 2014 shows that 94% of staff believe the Trust provides equal opportunities for career progression and promotion, which is above the national average for community trusts.

All staff undertake annual mandatory eLearning training, this includes a module on equality and diversity and all new staff attending corporate induction receive the newly updated health inclusion information. Compliance with these is monitored at Board level.

There is a suite of human resources policies in place to support, advise and protect staff, these include Dignity and Respect at Work; Disciplinary; Grievance and Absence Management policies. All policies undergo a review that includes checking by a member of the health inequalities and inclusion team. Each policy has an equality impact assessment that is reviewed during the bi-annual policy review and a member of the health inequalities and inclusion team sits on the final policy approval group.

The Trust is committed to the Two Ticks, Age Positive, Mindful Employer and Personal Fair Diverse Champions initiatives and this is reflected in job advertisements.

The Trust has no current or previous equal pay claims against it.

Existing and new staff with disabilities are supported in their work through the implementation of reasonable adjustments recommended by Occupational Health and the Access to Work scheme. Staff have access to occupational health and counselling services when required. Reference is made to the particular needs of employees with disabilities in the Absence Management; Dignity and Respect at Work and Recruitment policies.


The health inequalities and inclusion team are planning to focus on barriers to access for our patients in the coming year. This will mean work on several fronts, including the following:

• Signing of British Deaf Association British Sign Language Charter• Production of reasonable adjustments guidance for Trust staff• Production of religion and belief guidance for staff• A rolling programme of access audits of Trust services• Review of language interpretation and translation provision• Awareness raising through the Personal Fair Diverse Trust Champions• Submission to Stonewall Workplace Equality Index

Detailed Trust equality information such as our Equality Statement, the Public Sector Equality Duty reports, our EDS (and EDS2) grading results and service equality analysis are published on our website www.bridgewater.nhs.uk.

Engagement and Consultation with patientsA key element of our engagement with our patients is through our Patient Partners programme. More than 190 Patient Partners are signed up with the Trust and are actively working with services to identify and implement service improvements.

The Trust also uses a range of methods to seek patient feedback including the use of patient stories, and patient surveys using our “Talk to Us” form which includes the Friends and Family Test questions. More detail on this work is available in our Quality Report (Appendix 4).

There were no formal public consultations during the period 1 November 2014 to 31 March 2015.


Patient Advice and handling of complaints We recognise that when people have issues or concerns we should aim to resolve these as soon as possible. Our Patient Services function helps patients, carers and families resolve any issues and concerns.

Bridgewater is committed to the Ombudsman’s Principles for Remedy in its complaints handling procedure. This ensures that when handling complaints we are getting it right, being customer focused, being open and accountable, acting fairly and proportionately, putting things right and seeking continuous improvement.

More detail on our approach is contained within our Policy and Procedure for the Handling of Compliments, Comments, Concerns and Complaints which is available on our website www.bridgewater.nhs.uk.

More detail on the number and nature of patient enquiries and complaints received during the year 2014/15 is available in our Quality Report.

Working in partnershipEach of the boroughs where we provide the majority of community services has an Executive Director or General Manager link with the Clinical Commissioning Group, local authority and other health service providers.

The Director of Corporate Development also has links with local Healthwatch organisations in each borough as well as the third sector, local charitable organisations and patient groups. Our meetings with local Healthwatch are used to discuss and highlight any local social and community issues. We also support their work to consult about our services. During the year


no social or community issues which would have a specific impact on our business were identified through these forums.

We also have representation on the Health and Wellbeing Boards in each borough and are members of the local partnership boards, where they exist.

Details on a range of partnership working projects are contained within our Quality Report.

Working in the communityAs a community trust we aim to make a significant positive difference to the health and wellbeing of local people, not just through the quality of the services we provide but by being a good corporate citizen.

An exciting development during the year was the establishment of the Bridge Builder Community Trust Fund which aims to fund local good causes to improve the health and wellbeing of people living in our local communities.

The fund will build our relationship and partnership with our communities by being open to community groups, voluntary and other not for profit organisations with charitable objectives based in the boroughs served by Bridgewater. Grants will be available for projects which could range from allotments and gardening clubs to holiday clubs and playgroups. A panel consisting of staff and governors has been set up to consider all applications. The first grants will be awarded early in the 2015/16 financial year.

Develop and implement the objectives cascade and empower staff to provide care which improves peoples’ livesA plan to revise our staff Performance Development Review process was introduced with the objective of creating an improved staff appraisal tool which links more clearly to the Trust objectives.


All corporate functions completed an Annual Business Planning process which was based on individual business plans for corporate directorates. These contained department specific objectives with a clear link to the Trust Strategic Objectives.

Complete our ‘One Bridgewater’ review programme and work with patients and staff to design and deliver effective and responsive servicesDuring the period 1 November 2014 to 31 March 2015 we completed the implementation of our new One Bridgewater clinical structures. Services were organised into three clinical directorates: Adults Services, Children and Families’ Services and Specialised Services. This will support the creation of a Bridgewater standard of service and lead to better sharing of good practice across the Trust. General Managers were appointed to the three directorates and appointments were made to Service Manager and Clinical Manager posts.

Maximise the effectiveness of IT and technology that is available to staff, patients and the public.We launched a mobile Electronic Patient Record app to support our Patient Administration System, known as SystmOne. A launch event explained the benefits of the SystmOne mobile app to help staff update and access information on the go and to support mobile working to become embedded in the trust.

Our Listening into Action programme has delivered a number of quick benefits for staff and patients since its launch in October. These included access to teleconferencing tools for all Trust staff. This will help to reduce unnecessary time spent travelling and reduce mileage claims by providing an alternative to face-to-face meetings where staff are based across different buildings and boroughs. It will also contribute to our environmental and sustainability objectives. Listening into Action also expedited other actions including the introduction of a number of Trust credit cards to support the procurement of goods and services via the intranet, to further support efficiencies. Another welcome development was the provision of free Wi-Fi at Newton Community Hospital for patients and visitors.

During early 2015 we piloted a new intranet platform with some staff as part of our commitment to development of a new state-of-the-art intranet. This will improve the availability of information through an improved document library and search facility, saving staff time. The intranet has been developed with help from a small staff group who have provided feedback and suggestions during every stage of its development.

Clearly identify the true costs and price of our services and complete the development of service line reporting and managementOur Service Line Reporting and Service Line Management processes and information continue to provide financial, workforce and operational activity data to managers and budget holders working in frontline healthcare services as well as staff in corporate functions. This information is increasingly being used to help us understand the cost of operating our services.

A realistic assessment of cost and price is a key part of any bids we submit to win new business or retain existing business. This will be an ongoing priority for the Trust during 2015/16.


Deliver the requirements of the regulatory frameworksDuring our first 5 months of operation as a Foundation Trust, we have declared and had verified the following risk ratings in line with the Monitor Risk Assessment Framework.

Table of Analysis - Monitor risk ratings

2014/15 Q1 Q2 Q3 Q4Continuity of service rating n/a n/a 4 4Governance rating n/a n/a Green Green

The Trust is required to register with the Care Quality Commission (CQC) and throughout the period, the Trust has continued to declare full compliance with the essential standards and remains registered, without conditions.

Our Quality Report contains more details of the CCGs inspection and assessment of our Trust and services.

Health and SafetyBridgewater has clear, consistent policies that set out the Trust’s commitment to complying with the statutory and mandatory requirements for Health and Safety, Fire Safety, Violence and Aggression, and Security.

Specific strategies aligned to the Trust’s mission and its Risk Management Strategy set the long-term direction for Health and Safety and Fire Safety management and performance. These strategies assist the Trust in protecting its employees and all others from the risks arising from its work activities, and there are six principal objectives intended to ensure the Trust is an organisation where there is: strong leadership for safety, a resilient safety management system, coherence of policies and procedures, compliance, competency and capability all set within a cycle of continuous improvement.

The Trust has engaged competent contractors to carry out compliance surveys across its premises for the management of asbestos, water hygiene, electrical and gas services, pressure vessels, medical gas systems, building structures and fire protection. Findings of these surveys, together with existing risk assessments, have been used to produce risk profiles for the estate so that informed decisions can be made about future improvements. Management of RiskThe Trust uses the web-based Ulysses Safeguarding Risk Management system for reporting strategic risks, operational risks and incidents.

During the year, following feedback from both Monitor and the CQC we prioritised the reporting and management of risk, with focused training for staff to address weaknesses in our systems. During the year there was an increase in risk reporting, which is viewed as a positive indication of an open and honest culture which encourages staff to report incidents so they may be investigated to learn lessons.


Further details on significant operational risks and serious untoward incidents are in the Annual Governance Statement whilst details on aspects of Patient Safety are in our Quality Report in Appendix 4.

Information Governance Security of patient and staff information is considered to be of paramount importance to the Trust. More detail on assessments of our systems, standards and processes for managing information is available in our Quality Report 2014/15.

Bridgewater does not routinely charge for information produced by the Trust. However, the Trust does set charges for information under The Freedom of Information and Data Protection (Appropriate Limit and Fees) Regulations 2004 which may apply for some requests. Therefore we can confirm that we comply with Department of Health and Treasury guidance for information requests.

Details of any serious incidents involving data loss or confidentiality breach are contained within the Annual Governance Statement within this report.

Emergency Preparedness, Resilience and Response (EPRR)As a provider of NHS-funded healthcare, the Trust has defined roles and responsibilities under the Civil Contingencies Act 2004, the Health & Social Care Act 2012, NHS England Emergency Planning Framework 2013, NHS England Core Standards for EPRR 2014 and other associated guidance.

All NHS-funded organisations must identify a Board-level Accountable Emergency Officer (AEO) who is responsible for ensuring they comply with legal and policy EPRR requirements. The Trust’s AEO is the Chief Operating Officer, who is supported in discharging these duties by the Head of EPRR.

We have an Emergency Planning Steering Group to coordinate and oversee the EPRR function and ensure that we have major incident, business continuity and other emergency plans which are regularly reviewed and tested. This group also monitors the action plans we have in place to address any areas for development which have been identified.

Planning for emergencies cannot be undertaken in isolation, so we work closely with the wider health economies in the areas we serve and take part in joint training and exercising opportunities. We are represented on the Greater Manchester, Cheshire and Merseyside Local Health Resilience Partnerships, each of which provides a strategic forum for joint planning for emergencies.

Some of the work covered during this reporting period for 2014/15 is highlighted below.

In November 2014 we submitted a declaration of full compliance to NHS England following our self-assessment against the Core Standards for EPRR.

Mersey Internal Audit Agency carried out a review of EPRR systems and procedures in the Trust and reported a rating of significant assurance to the Trust’s Audit Committee in December 2014.


Our major incident plan is a live document which is regularly updated to take account of any national or local changes. The latest version was presented to the Board for approval with the annual EPRR report in December 2014.

A key priority for 2015-16 is the implementation of revised on call arrangements, including a programme of training for rota members and other relevant staff.

Environmental management and sustainability: The core focus of the Trust’s work since its inception has been the consolidation of its accreditation to international Environmental Management System ISO 14001. Bridgewater is one of a handful of community healthcare trusts to have achieved this status and it takes the Trust well beyond the best practice requirements set out for the NHS. The Environmental Management System (EMS) focuses on four key themes, which form the basis of the EMS action plan: Energy Use in Buildings, Travel and Transport, Procurement and Waste. The EMS provides a framework, which helps to ensure that the Trust quantifies, monitors and reviews performance in all of these key areas.

Goal 1: A healthier environmentA healthier environment can contribute to better outcomes for all. This involves valuing and enhancing our natural resources, whilst also reducing harmful pollution and significantly reducing carbon emissions. Bridgewater has an overall carbon reduction target of 28% by 2020 (from 2013/14 baseline).

Goal 2: Communities and services that are ready and resilient for changing times and climatesWhen periods of heat, cold, flooding and other extreme events occur it is vulnerable people and communities that suffer the worst. Bridgewater will be part of multi-agency planning and organisational collaboration to provide a better solution to these events

Goal 3: Every opportunity contributes to healthy lives, healthy communities and healthy environments: Bridgewater will take every opportunity to support communities and people to be independent and self-manage conditions and events.

Success will only be achieved if Bridgewater as a whole takes positive action, if the Trust engages widely with staff, members and patients and if sustainability is embedded into the decision-making processes at every level. To achieve this aim the Trust has drafted an Environment Strategy to help Bridgewater and the communities it serves to become greener more resilient. The strategy will be published later in 2015.

2014/15 Environmental PerformanceFrom the information currently available the Trust’s (and its predecessor organisation) overall carbon footprint for 2014/15 (on a ‘like for like’ basis) is 11,739 tCO2e, equating to 5.6kg of CO2e per patient contact. This is an increase in the overall footprint of 4.5% since 2013/14.

The figures in this report reflect full year figures as seasonal variations in energy usage would distort any part year results.


Overall change in Carbon Footprint

Organisation Carbon Footprint using HM Treasury Scope Aggregations

0

2,000

4,000

6,000

8,000

12,000

10,000

14,000

HM Treasury Scope 1

HM Treasury Scope 2

HM Treasury Scope 3

Carb

on E

mis

sion

s (t

co2e

)

The increase is mainly the result of shifts in energy use in buildings, increases in UK Government carbon intensity figures and increased miles travelled by employees in their own cars in the delivery of services.

Breakdown of Carbon Footprint according to Scope categories used by the Treasury Sustainability Development Unit

Scope 1 - Direct Scope 2 - Indirect Scope 3 - Indirect

Carbon Footprint using the SDU model and Treasury Scopes 2014/15

0

500

1,000

1,500

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Energy, Travel, Procurment and Waste as a proportion of Carbon Footprint

Travel

Energy 2

Procurment and Waste

65%20%

15%

Proportions of Carbon Footprint

Please note that this graph represents only those elements that can be currently quantified. The figures use the CO2e conversion factors provided by the Sustainability Development Unit in the Sustainability Reporting Framework 2014/15, these may vary from other factors used by the Trust in previous years.

Carbon Emissions breakdown

Full Year 2014/15 Carbon Emissions (tC02) Units measuredEnergy* 1771 4.1 million kWhProcurement 7639 Non pay spend £22.5mTransport 1289 5.6 million kilometres Waste - 388 tonnes

*Initial analysis suggests the rise in tC02 is due in part to the change in the amount of C02 the government calculates it takes to produce and distribute a KWh of electricity and in part due to a decrease in gas use that has been offset by an increase in electricity use.

Energy Use in Buildings: overall there has been a 16% decrease in the number of kWh of energy Bridgewater used in its buildings to deliver health services for both electricity and gas combined falling from 4.8 million kWh in 2013/14 to 4.1 million kWh in 2014/15. However, despite this reduction there has been a 11% increase in the tCO2e between 2013/14 and 2014/15 rising from 1,593 to 1,771 tCO2e. Initial analysis suggests that this rise is due in part to the change in the amount of CO2e the government calculates it takes to produce and distribute a kWh of electricity (which has increased by 11% since 2013/14) and


in part to a decrease in gas use that has been offset by an increase in electricity use. The latter being more carbon intensive than the former.

Procurement: Using the information currently available the Trust’s carbon footprint from the procurement of goods and services is 7,639 tCO2e. The figures clearly show that procurement is by far the largest part of the Trust’s carbon footprint. The breakdown of the procurement data provides us with an indication of the carbon hotspots for procurement, which includes businesses services, pharmaceuticals and medical equipment and instruments. The Trust is planning to work on this area in the coming year.

Transport: It is calculated that employees travelled approximately 5.6 million km in their own vehicles in the delivery of community health services during 2014/15, which resulted in 1,289 tCO2e. This is a 35% increase in miles travelled and emissions and further work will need to be undertaken to understand the factors contributing to this, including if it can in part be attributed to changes in the data collection methodologies.

Waste: It is calculated that the Trust produced 388 tonnes of waste during the last 12 months. Of this 346 tonnes can be described as general or domestic waste. The Trust recycled or recovered 80% of this domestic waste through external contractors. In addition the Trust produced a further 42 tonnes of clinical waste almost all of which was used to produce energy from waste or was processed to produce solid recovered fuel which is used in place of fossil fuels in the manufacture of cement. The Trust will continue to look for ways to recyle more of our waste but the core aim will always be to reduce the amount of waste produced.

Success will only be achieved if Bridgewater as a whole takes positive action, if the Trust engages widely with staff, members and patients and if sustainability is embedded into the decision-making processes at every level. To achieve this aim the Trust has drafted an Environment Strategy to help Bridgewater and the communities it serves to become greener more resilient. The strategy will be published later in 2015.

In 2015 Bridgewater will also be rolling out a series of engagement events called ‘Healthy Environment, Healthy You’ to provide information and advice to staff and patients alike, about the way slight changes in our daily activities can have a huge impact on our own health and the health of the environment. This will be followed up with further activities aimed at each of the four EMS themes.

Anti-Fraud MeasuresAll NHS organisations in England and Wales have an appointed Anti-Fraud Specialist. The Audit Committee oversees a programme of counter fraud arrangements, including a contract with Mersey Internal Audit Agency for a local Anti-Fraud Specialist.

Bridgewater works with its specialist to protect staff and resources from fraudulent activities and all NHS employees have responsibilities when it comes to reporting suspicions or concerns relating to fraud, bribery or corruption.

Staff are regularly surveyed to help establish awareness levels of fraud within the NHS and staff are made aware of antifraud measures through the corporate induction and staff awareness sessions. Information on policies and guidance relating to fraud, including the Whistleblowing policy, is available on the Trust intranet for staff.


Additional DisclosuresPension Liabilities Past and present employees are covered by the provisions of the NHS Pensions Scheme. Details of the benefits payable under these provisions can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions. The scheme is an unfunded, defined benefit scheme that covers NHS employers, GP 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 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. A fuller explanation with regard to pension liabilities is included in the statutory accounts.

Financial Performance for 2014/15 IntroductionThe Trust’s accounts have been prepared under a direction issued by Monitor under the National Health Service Act 2006.

For the financial reporting period 1st November 2014 to 31st March 2015, Bridgewater Community Foundation NHS Trust has reported a small surplus of £0.154m this is the same figure as in the summarisation schedules that underpin the accounts.

The Trust had initially proposed an adjustment to the 2014/15 accounts amounting to £2.6m. This represents the capital value of all wheelchair and other community loan assets owned by the Trust, which have been purchased over a number of accounting periods. However, the new accounting treatment in respect of such items will only apply to the FT accounts. Therefore, only those costs incurred by the Trust in the five months from 1st November to 31st March 2015 may be properly capitalised.

Unfortunately, due to a variety of issues, the Trust did not meet the filing deadline of the 29th May 2015 for Monitor.

A review of the circumstances and contributory issues in relation to the missed deadline is being undertaken by the Trust together with an external review of the Trusts processes.

Accounting PoliciesThe accounts have been prepared to comply with International Financial Reporting Standards (IFRS) as modified by the Department of Health Manual For Accounts.Capital Expenditure

The Trust’s incurred £2.5m of capital expenditure in the accounting period. Of this £1.6m was expended on IT assets, £0.7m on medical equipment and £0.2m on building assets.

Treasury Policies and CashThe Trust had an end of year cash target of £4.1m. Actual cash was £5.9m supporting the requirement to achieve ’10 days of forward operating expenses’. The Trust did not have any requirements for short-term loans during 2014/15 nor placed any funds for investment purposes during 2014/15.


IncomeThe Trust generated income in the accounting period of £63.1m. Income derived from Clinical Commissioning Groups (CCGs) and NHS England was £53.4m. The vast majority of the Trust’s healthcare income is through ‘block service level agreements’.

The balance of the Trust’s income was generated as shown in the chart below. This highlights the categorisation of all the Trust’s income taken from the accounts.

NHS Injury Scheme £0.3M (0.5%)

NHS Trusts £0.2M (0.3%)

CCGs and NHS England £53.4M (84.7%)

Foundation Trusts £0.2M (0.2%)

Local Authorities £6.8M (10.7%)

Other £0.8M (1.2%)

NHS Other £0.5M (0.8%)

Education and Training £1M (1.6%)

Sources of Income 2014/15 M8-M12

Medical & Dental staff £3.7M (8.5%)

Qualified Nursing and Health Visiting staff £20.4M (46.9%)

Scientific, Therapeutic and Technical Staff £7.4M (16.9%)

Healthcare assistants and other support staff £2.9M(6.6%)

Administration and estates £9.1M (20.8%)

Others £0.1M (0.2%)

Employee Costs 2014/15 M8-M12

ExpenditureThe Trust’s main source of expenditure is Employee Costs (staff) totalling £43.5m, representing 69% of total expenditure. The chart below highlights the breakdown of these costs.


Expenditure on Operating Expenses, excluding employee costs, amounted to £19.2m. The chart below provides an analysis of this expenditure by category.

Operating Expenses 2014/15 M8-M12

Services from Other NHS Organisations £3.3M (17.4%)

Supplies and Services - Clinical £4.1M (21.5%)

Supplies and Services - General £1.3M (6.9%)

Establishment £1M (5.2%)

Transpost £1M (5.1%)

Legal Fees £0.1M (.7%)

Consultancy costs £0.3M (1.6%)

Premises £1.9M (9.8%)

Rental under operating leases - minimum lease payments £5M (25.8%)

Education and Training £0.1M (0.7%)

Other £1M (5.3%)

Events After the Reporting PeriodThere were no events after the reporting period.

Going ConcernThe financial statements have been prepared on a going concern basis. The Board receives monthly reports regarding the financial position of the Trust and updates on any key financial issues impacting the going concern basis for preparation of the financial statements. Additionally, as part of the annual planning cycle the Board reviews and approves the Trust’s five year financial plan. A detailed financial plan for 2015/16 has been presented to and reviewed by Monitor, the Trust’s financial regulator and no concerns have been raised as to financial sustainability.

The financial plan submitted shows a Continuity of Service Risk Rating of four. This planned rating is consistent with a rating of four actually achieved for 2014/15. This is the maximum rating achievable and provides assurance that the Trust has the liquidity to cover its operating expenses and is generating sufficient surplus to cover dividend payments.

The annual contracting round has been completed and the Trust is assured by signed contracts in relation to the majority of its forecast healthcare income.

The submitted financial plan for the two years includes a significant Cost Improvement Programme (CIP) of £6.6m for 2015/16 delivery of which is essential in order to achieve the


forecast financial position. Plans to deliver this CIP are part of a five year CIP plan based on a clinically led re-design programme which commenced in 2013/14.

Clinical Reference Groups (CRGs) lead each project (clinical services are grouped into three phases, each containing multiple services). Each service is supported by a project manager and clinical lead and is sponsored by an Executive Director.

Monitoring delivery is via the fortnightly CIP Programme Team (includes general managers, finance, HR, estates, information, service improvement, staff side and clinical governance). Monthly, there is a report presented to the Trust’s Finance Committee , a Board sub-committee chaired by a Non- Executive Director. Quality Impact Assessment (QIA) is reported to both the CIP Programme Team and Finance Committee in order to provide assurance that whilst the programme is on track from a financial perspective there is no compromise to quality or patient safety.

Future Financial PerformanceThe Trust faces a number of challenges over the next few years:

• Ensure expenditure levels are controlled in line with contractual income assumptions.• The Trust has significant Cost Improvement Programme (CIP) targets detailed above

for 2015/16 and beyond. This will require the Trust to continue to review all services to ensure that each service is performing efficiently whilst ensuring that the quality of service is not affected.


MED

IUM

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M

OBJE

CTIV

ES

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l pat

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s wi

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/16

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CTIV

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re w

hich

mee

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and

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and

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and

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and

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early

iden

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true

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of o

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ervi

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liver

the

requ

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of t

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regu

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ry fr

amew

orks

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arify

and

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mot

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lues

and

be

havi

ours

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ecte

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thin

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gewa

ter.

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sure

that

the

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thro

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5 ye

ar fo

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an.

Our Strategy for 2015/16


Our priorities for 2015/16In order to achieve our strategic objectives we will focus on the following short term objectives for 2015/16 and these will inform our business planning process.

• Manage our relationships with partners, stakeholders, patients and the public to ensure clarity of information, promote joint working and ensure high quality, integrated, evidence based, safe and patient-centred care.

• Develop and implement the objectives cascade and empower staff to provide care which improves peoples’ lives promoting the outcomes from Listening into Action, reducing bureaucracy and empowering staff to find solutions.

• Maximize the effectiveness of IT and technology that is available to staff, patients and the public.

• We will maximise the effectiveness of IT and technology used within the trust that is available to staff, patients and the public.

• Clearly identify the true costs and price of our services.

• Deliver the requirements of the regulatory frameworks.

• Clarify and promote the values and behaviours expected within Bridgewater.

• Ensure that the Trust maximises the opportunities afforded through the five year forward plan.


Our Integrated Business Plan (IBP) outlines our plans to develop our services, our workforce and focus on quality over the next five years. The plan also ensures that we can operate as a financially sustainable Foundation Trust.

After making enquiries, the directors have a reasonable expectation that the NHS Foundation Trust has adequate resources to continue in operational existence for the foreseeable future. For this reason, they continue to adopt the going concern basis in preparing the accounts.

The Strategic Report for Bridgewater Community Healthcare NHS Trust was approved on behalf of the Board on 26 May 2015.

Accounting Officer Colin Scales (Chief Executive)June 2015


4. Directors’ ReportDirectors’ statementAs directors, we take responsibility for the preparation of the Annual Report and Accounts. We consider the annual report and accounts, taken as a whole, to be 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.

The Board of Directors Bridgwater Community Healthcare NHS Foundation Trust was authorised and awarded its Foundation Trust Licence by the independent regulator Monitor on 1 November 2014.

The Trust Board has overall responsibility for leading and setting the strategic direction for the organisation. It is also takes a lead in holding the Trust to account for the delivery of the strategy, through monitoring performance and seeking assurance that systems of control are robust and reliable. This includes ensuring the delivery of effective financial control, high standards of clinical and corporate governance and promoting partnership working in the communities we serve. The Board is also responsible for shaping the culture of the organisation.

The Board consists of both Executive and Non-Executive Directors. We consider each Non-Executive Director to be independent. The length of each Non-Executive Director appointment is detailed in the biographies below.

The directors of the Bridgewater Community Healthcare NHS Trust for the period 1 November 2014 to the 31 March 2015 were as follows:

Harry Holden – ChairmanHarry was confirmed in the post of Chairman of the Trust in November 2010 when the Trust was established as a statutory body and was re-appointed as Chair on 1 April 2013.Prior to this he chaired the Board of Ashton, Leigh and Wigan Community Healthcare - the provider arm of NHS Ashton, Leigh and Wigan Primary Care Trust (PCT) and previously held roles on the board of the PCT, including the position of Vice-Chair.

During his career Harry served as a Chief Officer and member of the Cabinet at Wigan Council, holding the post of Director of Land and Property and Community Safety for 15 years. This role led him to becoming Chairman of the Community Safety Partnership Joint Commissioning Group. In these roles Harry provided strong leadership and worked with partners at all levels to develop a range of successful projects and organisations. Harry’s current term of office is until 1 November 2015.

Harry also chairs the Nominations and Remuneration Committee.

Qualifications Member Association of Building Engineers (M.B.Eng)Fellow Chartered Association of Building (F.C.I.O.B)


Dr Kate Fallon – Chief ExecutiveKate was appointed to the post of Chief Executive when the Trust was established in November 2010. Kate qualified as a doctor in 1978 and practised as a GP in Wigan for more than 20 years.

In 1997 Kate became a part-time Clinical Director at the local hospital group in Wigan, where she helped establish a range of innovative care pathways for patients with conditions such as diabetes, lung problems and cancer. When the Primary Care Trust (PCT) was established in Wigan in 2002 she was appointed Medical Director, responsible for maintaining professional standards in high quality care. In 2004 she left GP practice to focus full-time on developing community health services in the town, initially as Managing Director of Ashton, Leigh and Wigan Community Healthcare – a predecessor to Bridgewater Community Healthcare NHS Trust.

During this time Kate has represented community health providers on a range of national forums including the Department of Health Transforming Community Services Programme and the national Community Foundation Trust pilot.

Qualifications 1975 MA – First-Class Honours in Physiological Sciences, Oxford University.1978 MB BS – University of Newcastle.GMC Registration: 2431240.

Karen Bliss – Non-Executive Director Karen qualified as a Chartered Accountant in 1991 after joining PricewaterhouseCoopers as a graduate trainee. She has held a variety of roles within the company at senior management level and has worked in audit, business assurance and due diligence.

She was originally appointed to the Board of Ashton, Leigh and Wigan Community Healthcare in 2008 and appointed to the Board of Bridgewater in 2010. She was most recently appointed on 1 April 2013 for a term of office until 31 March 2017.

Karen holds the position of Chair of Audit Committee within the Trust.

Qualifications BA (Hons) Engineering, Cambridge UniversityFellow of The Institute of Chartered Accountants (FCA)

Steve Cash – Non-Executive Director Steve has held a number of senior roles in commercial management, strategic partnership and financial management spanning 30 years and currently holds a senior leadership position within the FTSE 100 company BT. He has broad leadership and business skills including strategy, finance, marketing, partnering and operational management.

He was originally appointed to the Board of Ashton, Leigh and Wigan Community Healthcare in 2008 and appointed to the Board of Bridgewater in 2010. He was most recently appointed on 1 April 2013 for a term of office until 31 March 2017.Steve also holds the position of Chair of the Finance Committee.


Qualifications Global Partner Vision programme – Harvard and Beijing UniversityDiploma in Marketing – Manchester UniversityBA Business Studies – University of Central Lancashire

Dorothy Keates - Interim Executive Nurse/ Director of GovernanceDorothy qualified as a State Registered Nurse in 1981 at Broadgreen Hospital and has worked for more than 35 years within the NHS. An experienced clinician she has worked in midwifery, as a district nursing sister and has undertaken a teaching qualification leading to her developing one of the first training courses for practice nurses. With a passion for nursing in community and primary care settings, she has undertaken managerial and leadership training to support her role as an NHS leader and has specialised in clinical governance and the implementation of quality initiatives across a number of organisations. She is passionate about delivering quality care for every patient and supporting staff to deliver a positive patient experience.

Dorothy joined the Board on 1 September 2014 on an interim basis.

Qualifications State Registered Nurse – NMC registration 80D1215EBA Hons Practitioner Leadership, Manchester Metropolitan UniversityMSc Leadership Development (Leadership and Management), Edge Hill University

Sue Musson – Non-Executive Director Sue moved to the UK after graduating and began her career in management consultancy working with the European Commission and UK government agencies and departments. She has more than 20 years’ experience as an Executive and Non-Executive Director in large commercial and public sector organisations. She currently runs her own management consultancy business and a property holding company.

She was appointed to the Bridgewater Board in January 2012. She resigned her position as a Non-Executive Director of Bridgewater on 31 December 2014.

Sue also held the position of Senior Independent Director. It is a requirement for Foundation Trusts to appoint a Senior Independent Director (SID) who is available to members and gov-ernors if they have concerns that cannot be resolved through normal channels. This position was held by Sally Yeoman from 1 January 2015.

Qualifications BA First-Class Honours in History (Columbia University, New York)


Christine Samosa - Director of People, Planning and DevelopmentChristine has more than 30 years’ experience in human resources, training and organisational development. She has spent the majority of her career in NHS organisations including primary care trusts, community trusts, mental health trusts and a specialist tertiary centre and held a director level position for more than 20 years. She has extensive experience of working with local and regional officers of the main trade unions within the NHS.

Christine joined Bridgewater on 9 November 2011 and on 1 November 2014, became a voting director on the Board.

Qualifications Fellow of the Chartered Institute of Personnel and Development.Masters Degree in Strategic HR Management with research into the impact of mergers and acquisitions on staff.

HR Director Development Programme at the NHS North West Leadership Academy

Bob Saunders - Non-Executive Director Bob started his career in environmental health in London and having worked in a number of local authorities was appointed to the post of Corporate Director at Wigan Council in 1989. In addition to responsibility for environmental health, housing, urban renewal, trading standards, licensing and community safety his portfolio also included corporate strategy, business planning and performance management.

Bob was originally appointed to the Board of Ashton, Leigh and Wigan Community Healthcare in 2009 and most recently re-appointed to the Bridgewater Board in April 2013 until 31 March 2017.

Bob also holds the position of Chair of the Quality and Safety Committee

Qualifications BSc Zoology (London)BSc Environmental Health (Aston) Royal Society of Health, Chartered Institute of Housing and Institute of AcousticsPost Graduate Diploma in Management Studies PRINCE 2 Project Manager

Colin Scales - Chief Operating Officer Colin joined the NHS in 1994 after leaving university and has undertaken a range of roles within commissioning, operational management and the Department of Health during his career. As an Executive Director he has been responsible for developing strong relationships between organisations, developing leadership capacity and introducing systems to support managers to improve the performance of services.

He has experience of working in a number of different NHS Trusts and was a member of a Trust Board that successfully achieved Foundation Trust status.

Colin joined the Trust on 9 November 2011. From 1 April 2015 Colin Scales was appointed to


the post of Chief Executive of the Trust.

Qualifications BA Hons Degree in Geography, University of SalfordCranfield University, School of Management, Strategic Leadership Executive Pro-gramme, May 2014NHS Top Leaders Programme 2014/15

Mike Treharne - Executive Director of FinanceMike is a finance professional with more than 30 years’ experience in the NHS and has been a Director of Finance for more than 16 years. He has held senior finance posts in a range of NHS organisations including primary care trusts, university hospitals, district general hospitals and health authorities. He has also sat on a number of national finance groups.

Mike joined the Board of Bridgewater on 28 February 2011 and also holds the post of Deputy Chief Executive. He has undertaken various development programmes including the Kings Fund Executive Director Development and study tours to Harvard & Berkley Universities and Melbourne, Australia.

Qualifications BSc (Econ) University College, CardiffMember of the Chartered Institute of Public Finance Accountants (CPFA)Executive Director Development Programme 2003/04 (run jointly by the NHS Leadership Centre and King’s Fund)

Dr Stephen Ward - Executive Medical DirectorSteve qualified as a doctor in 1978 and worked for 30 years in primary care, as a principal GP in a seven doctor practice in Leyland, Lancashire. He then took on a part time position as Medical Director for NHS Central Lancashire before moving to the role full time. He has always had an interest in NHS management and is enthusiastic about the role of new technologies for the management of long-term conditions.

Steve joined the Board of Bridgewater on 1 July 2011.

Qualifications MBChB (University of Liverpool)Diploma Developmental Paediatrics and Ascertainment (University of Salford)MA Clinical Leadership (Manchester Business School)GMC Registration: 2439200

Dorothy Whitaker - Non-Executive DirectorDorothy originally trained as a nurse and worked in London before returning to the North West. She has 20 years’ experience in the third sector and has undertaken a range of roles involving the development of innovative solutions to health and social care issues. Her final post was as Chief Officer for Blackburn with Darwen Council for Voluntary Service.


Dorothy was appointed to the Board of NHS Ashton, Leigh and Wigan Primary Care Trust in 2006 and later joined the predecessor organisation to Bridgewater (Ashton, Leigh and Wigan) Community Healthcare in March 2008. She was re-appointed to the Board of Bridgewater on 1 November 2014 for a term until 31 October 2015.

Dorothy also holds the position of Vice Chair.

Qualifications State Registered Nurse CertificateOU Post Experience Certificate – Handicapped Person in the Community.

Sally Yeoman - Non-Executive DirectorSally started her career working in services for adults with learning disabilities and has since had more than 10 years’ experience leading charitable organisations which support community, voluntary, not for profit and faith groups. She is an Institute of Directors certified Company Director and is currently Chief Executive Officer at Halton and St Helens Voluntary & Community Action.

Sally was appointed to the Board of Bridgewater on 1 January 2012 for a term until 31 December 2015. From 1 January 2015 Sally held the position of Senior Independent Director. It is a requirement for Foundation Trusts to appoint a Senior Independent Director (SID) who is available to members and governors if they have concerns that cannot be resolved through normal channels.

Qualifications BSc (Hons) in SociologyInstitute of Directors Certificate in Company Directorship

More detail on individual directors is available on the Board Profiles page of our Trust website www.bridgewater.nhs.uk

Trust Board meetingsThe Board of Directors met monthly during the reporting period, holding a total of 5 meetings. The Board rotates its meetings so that they are held in the main boroughs that we serve. Members of staff, the public and the media are entitled to attend part one of the meeting, the papers for which are made available on the Trust website www.bridgewater.nhs.uk

A Register of Director Attendance at Trust Board meetings is attached as Appendix 1.

Balance, completeness and appropriateness of Board membershipOur board is satisfied that it has the appropriate balance of knowledge, skills and experience to enable it to carry out its duties effectively. This is supported by the Council of Governors which takes into consideration the collective performance of the board via the nomination committee. Throughout the reporting period however, the Trust has seen the resignation of one non-executive director and will seek to appoint to board vacancies to ensure the balance of the board is maintained.


Performance Evaluation of Board The Board of Directors was not subject to any external assessment of its performance during the year. However, the function and performance of the Board was subject to a rigorous evaluation as part of the Monitor assessment process to become a Foundation Trust.

The performance of the Executive Directors is evaluated by the Chief Executive. The performance of the Chief Executive and Non-Executive Directors is evaluated by the Chairman on an annual basis. The performance of the Chairman is evaluated by the Senior Independent Director, having sought input from Directors and Governors on an annual basis. All senior managers’ contracts are permanent and not subject to any unexpired term. There is explicit provision for early or summary termination of employment included in the contracts of employment for all senior managers as a consequence of gross misconduct or other action which would lead or warrant the person unable or ineligible to fulfil their contract as a Trust Board Director. The terms of office for our Chairman and Non-Executive Directors are outlined in their board profiles above.

The process for appointment of the Chairman and Non-Executive Directors is agreed by the Council of Governors’ Nomination Committee. In summary the process includes: a review of the balance of skills, knowledge and experience on the Board; preparation of the role description and person specification; agreement of a suitable process of open competition to identify potential candidates; agreement of a short listing and interview process and finally, a recommendation to the Council of Governors on the appointment.

Non-Executive Directors’ appointments may be terminated on performance grounds or for contravention of the qualification criteria set out in the Constitution with the approval of three quarters of the Council of Governors or by mutual consent for other reasons. There is no provision for compensation for early termination or liability on the Trust’s part in the event of termination.

Register of interestsA Register of Directors’ Interests is maintained by the Trust and can be accessed on request to the Trust Secretary.

The Chairman has had no other significant commitments or any that have changed during the reporting year.

Director ExpensesDuring the reporting period, 5 Directors claimed a total of £8,000 relating to car allowances and associated travel expense reclaims.

Board committeesThe Board of Directors has five formal committees. A Register of Director Attendance at Board Committee meetings is attached as Appendix 2.

Audit Committee The aim of the Audit Committee is to provide the Board of Directors with a means of independent and objective review of financial and corporate governance, assurance processes and risk management across the whole of the Trust’s activities (clinical and


non-clinical) both generally and in support of the Annual Governance Statement.

A register of attendance for Audit Committee is as follows:

In addition, the Audit Committee:

• Provides assurance of independence for external and internal audit• Ensures that appropriate standards are set and compliance with them is monitored,

in non-financial, non-clinical areas that fall within the remit of the Audit Committee• Monitors corporate governance (e.g. compliance with codes of conduct, standing

orders, standing financial instructions, maintenance of registers of interests).• Ensures the provision of an effective system of internal control and risk management

including the Trust’s financial controls

During the financial reporting period for 2014/15 the Committee consisted of four Non-Executive Directors, one of whom is the Chair, and one of whom is the Chair of the Quality and Safety Committee.

The Committee has met on two occasions throughout the reporting period. The Chair Karen Bliss is a qualified Chartered Accountant, and the Director of Finance, Medical Director, and the Internal Audit Manager attend routine meetings of the Audit Committee.

External audit representatives and a representative of the local counter fraud service also regularly attend Audit Committee meetings as do Trust Directors and/or their staff in respect of issues which the Audit Committee consider to be of risk or special interest.

A schedule of attendance at the meetings is provided in Appendix 2 which demonstrates full compliance with the quorate requirements and regular attendance by those invited by the Committee.

The Trust’s internal audit function is carried out through Mersey Internal Audit. The Trust’s external auditors are Grant Thornton.

Self Assessment: During the financial reporting period for 2014/15 the Committee have complied with ‘good practice’ recommended through:

• Agreement of Internal and External Audit and Counter Fraud plans

Audit Committee Apr Jun Sept Dec Feb TotalKaren Bliss

Non-Executive Director (Chair) I I I I I 5/5

Steve Cash

Non-Executive Director (appointed to committee in Dec 2014)

I I 2/5

Baron Frankal

Non-Executive Director (left Trust 31/05/14)

AP 0/5

Bob Saunders

Non-Executive Director I I I I I 5/5

Dorothy Whitaker

Non-Executive Director I I I I AP 4/5


• Regular review of progress and outcomes, ie risks identified and action plans agreed• Private meetings with External and Internal Audit• Regular review of the Audit Committee workplan• Review of the Committee’s Terms of Reference

Audit Committee BusinessCounter FraudDuring the year, the Committee has reviewed the progress of the Local Counter Fraud Specialist’s programme of work. The Counter Fraud Plan has been delivered in accordance with the schedule of days agreed with the Committee at the start of the financial year.

Internal AuditThroughout the year the Committee has worked effectively with the internal auditors to strengthen the Trust’s internal control processes. The Internal Audit Plan has been delivered in accordance with the schedule of days agreed with the Committee at the start of the financial year. During the year, some agreed amendments to the plan had been approved by the Audit Committee. The Committee Chair reported these amendments to the Board.

During the year under review, Internal Audit has completed 26 reviews, covering both clinical and non-clinical systems and processes.

The following reports were issued with High Assurance during the year:

Financial & Commercial Systems & Processes• General Ledger• Non-pay Expenditure

The following reports were issued with Significant Assurance during the year:

Corporate governance systems and processes• Risk Management• Post Francis 2 Review 2013-14• Quality & Safety Committee Arrangements• SystmOne & IG Governance• SUI Follow Up Review

Financial & Commercial Systems & Processes• Income and Debtors• Cash and Bank• ESR (HR/Payroll)• Recruitment Processes Follow Up

Strategic Planning and Service Delivery Systems & Processes• Critical Application – SOEL Dental Health• Critical Application – Microsoft Data Warehouse• QIA/CIP Review• Performance Data Review• Emergency Preparedness• New Domain Review


The following reports were issued with Limited Assurance during the year:

Corporate governance systems and processes• Serious Untoward Incidents (SUI’s) including Actual Harm• Safeguarding Review

Financial & Commercial Systems & Processes• ESR (HR/Payroll)• Recruitment Processes• iOS Management• Telephony (VOIP) Review• Network Infrastructure Review• Financial Systems Technical Security Review

Strategic Planning and Service Delivery Systems & Processes• Data Consistency Review (Phase I)

The Committee has ensured that, where gaps in assurance are identified, appropriate action plans are agreed with management, and progress against these plans is regularly reviewed, by management, internal audit and the committee.

The Trust has established a finance committee which will look at the challenges and issues associated with financial planning and forecasting, and the Audit Committee will seek assurances in respect of the processes and work undertaken.

Auditor Disclosures So far as the directors are aware, there is no relevant audit information of which the NHS Foundation Trust’s auditors are unaware.

The directors have taken all steps that they ought to have taken as directors to make themselves aware of any relevant audit information. Furthermore, the Trust has made all relevant audit information available to the external auditors Grant Thornton and the cost of work performed by them in the accounting period is as follows:

Grant Thornton do not provide any non-audit services.Grant Thornton were previously the auditors to Bridgewater Community Healthcare NHS Trust and this had been the case for the 2014/15 period only. This arrangement was carried forward into the new Foundation Trust for 2014/15.

The duty to appoint the External Auditors now lies with the Council of Governors and it is anticipated that a competitive tendering process will take place for external audit services during 2015/16.

Category Amount (£000)Audit services 53Further assurance services 0Other services 0Total 53


Nominations and Remuneration Committee The overarching role and purpose of the Nominations and Remuneration Committee is to be responsible for identifying and appointing candidates to fill all the Executive Director positions on the Board and for determining their remuneration and other conditions of service.

Before an appointment is made, the Committee is responsible for evaluating the balance of skills, knowledge and experience on the Board and, in the light of this evaluation, prepare a description of the role and capabilities required for a particular appointment. The process for identifying suitable candidates includes using open advertising or the services of external advisers to facilitate the search; considering candidates from a wide range of backgrounds; on merit and against objective criteria. The Council of Governors Nominations Committee follows this process for Non-Executive appointments and the Trust Board Nominations and Remuneration Committee is responsible for the appointment of Executive Directors.

Kate Fallon, whilst not a member of the committee, attended in an advisory capacity, particularly in relation to the appointment of the Chief Nurse and the retirement of the Medical Director.

During this period, the Nominations and Remuneration Committee were responsible for the recruitment of two executive posts: Chief Executive Officer and Chief Nurse. Both appointments will commence on 1 April 2015.

The Chairman of the Trust chairs this Committee and in accordance with the NHS Foundation Trust Code of Governance it is comprised exclusively of Non-Executive Directors

Quality and Safety Committee The Quality and Safety Committee enables the Board to obtain assurance that high standards of care are provided by the Trust and, in particular, that adequate and appropriate governance structures, processes and controls are in place throughout the Trust.

The committee’s duties include the review and approval of the Trust’s Quality Strategy, underpinning frameworks and supporting plans/strategies and the agreement of quality governance priorities to inform strategy and to give direction to quality governance activities across service areas.

The Committee reviews compliance with policy in relation to Infection Prevention and Control, Health and Safety, Complaints, Claims, Incident reporting, Safeguarding and Equality and Diversity.

A schedule of attendance at the meetings is provided in Appendix 2.

Trust Efficiency and Assurance Committee (known as Finance Committee from 1 April 2015)The Committee is responsible for monitoring the overall financial performance of the organisation including the delivery of the cash-releasing efficiency savings and within this to be satisfied that any risks to quality have been mitigated to an acceptable level.

Its duties are to: • Oversee the financial performance of the organisation, reporting to the Board the likely

future financial position of the Trust.


• Ensure delivery of the Trust’s cash-releasing efficiency savings schemes (CRES). • Oversee the design and delivery of future CRES schemes. • Make recommendations as to the content of financial and investment policies. • Keep under review the content and application of the Trust’s financial, investment and

borrowing strategies and policies.

A schedule of attendance at the meetings is provided in Appendix 2.

The Investment Committee This Committee did not meet during the reporting period. Its responsibilities have now been incorporated into those of the Finance Committee.

Council of GovernorsThe Trust has a Council of Governors which consists of both elected and appointed governors. The Council of Governors contributes to the development of the Trust strategy and works with the Trust Board to forward plan. It will be involved in service development through member engagement. Governors have responsibility for the following decisions:

• Appointing the Chairman; • Appointing the Non-Executive Directors;• Approving the appointment of the Chief Executive;• Removing the Chairman and Non-Executive Directors; • Agreeing Non-Executive Directors’ terms and conditions, and • Approving changes to the Constitution. Governors’ responsibilities include:• Holding the Non-Executive Directors individually and collectively to account for the

performance of the Board; • Appointing and removing Auditors;• Receiving the Annual Report and Accounts;• Being consulted on proposed changes and providing feedback on the future direction

of the NHS Foundation Trust, and• Representing the interests of members and public.

The Trust was already operating a Council of Governors in shadow form, following elections in September 2013, in preparation for becoming a Foundation Trust. Following authorisation, formal Council of Governor meetings were held in November 2014, December 2014 and March 2015. Details of Director and Governor attendance at these meetings are available in Appendix 3.

The Council of Governors comprises a total of 33 Governor seats, of which 18 are elected Public Governors, nine are elected Staff Governors and six are appointed Partner Governors. The names of the Governors, the seats they hold and their appointment tenures are set out below: The Council is chaired by the Trust’s Chairman and the Lead Governor is John Prince.


Name Constituency ClassAppointed/

Nominated or Elected to post

Tenure

Irene Deakin PublicCommunity

DentalElected

14 October 2013 to 13 October

2016Three years

Nano Nagle Hill Public Halton Elected

Unopposed


2016Three years

Diane McCormick

Public Halton Elected

Unopposed


2016Three years

Dave Oldham Public Halton Elected

Unopposed


2016Three years

Sue Irvine PublicRest of England

Elected14 October 2013

to 13 October 2016

Three years

Peter Appleby Public St Helens Elected14 October 2013

to 13 October 2016

Three years

Rita Chapman

Public St Helens Elected14 October 2013

to 13 October 2016

Three years

Bill Harrison Public St Helens Elected14 October 2013

to 13 October 2015

Two years

Derek Maylor Public St Helens Elected14 October 2013

to 13 October 2015

Two years

Jean Ball Public Warrington Elected14 October 2013

to 13 October 2016

Three years

Liz Matthews Public Warrington Elected14 October 2013

to 13 October 2015

Two years

Derek Saunders

Public Warrington Elected27 January 2014

to 13 October 2015

Two years (will serve one year eight months)

G. Scott Baron Public Warrington Elected14 October 2013

to 13 October 2016

Three years

Julie Atherton Public Wigan Elected14 October 2013

to 13 October 2016

Three years

Sylvia Cunliffe Public Wigan Elected14 October 2013

to 13 October 2016

Three years




Tenure

James Roberts****

Public Wigan Elected

Unopposed


2015

Two years (will serve one year

and five months)John Prince

Lead Governor – elected 11

August 2014

Public Wigan Elected

Unopposed


2016Three years

Gary Young Public WiganElected

Unopposed


2015Two years

Charlotte Dixon*****

StaffClinical Support Services

Elected23 June 2014 to 22 June 2017

Three years

Carol Lever StaffAllied Health Professions

Elected Unopposed


2016Three years

Steven Lowe StaffAllied Health Professions

Elected Unopposed


2016Three years

Angela Akers Staff Dentists Elected14 October 2013

to 13 October 2016

Three years

Vikki Morris Staff Non-Clinical

SupportElected


2016Three years

Corina Casey-Hardman

Staff Nursing and Midwifery

Elected Unopposed


2016Three years

Karen Worthington

Staff Nursing and Midwifery

Elected Unopposed


2016Three years

Vacancy *** StaffNursing and Midwifery

Elected Three years

Vacancy Staff Doctors/Medical

Elected Three years

Cllr J Pearson Partner

St Helens Health and Wellbeing

Board

Nominated14 October 2013

to 13 October 2019

Six years

Janette Gray PartnerHigher

EducationNominated


2019Six years

Keith Cunliffe PartnerWigan Health and Wellbeing

BoardNominated


2019Six years




Tenure

Cllr Peter Lloyd Jones*

PartnerHalton Health and Wellbeing

Board Nominated

23 June 2014 to 13 October 2019

Six years

Mick Taylor Partner CVS Nominated14 October 2013

to 13 October 2019

Six years

Cllr Judith Guthrie**

Partner

Warrington Health and Wellbeing

Board

Nominated23 June 2014 to 13 October 2019

Six years

Changes to the Council of Governors during the year 2014/15:

*Peter Lloyd Jones, Partner Governor, Halton Council – in position since 23 June 2014, replacing the previous nominee Councillor Keith Morley

**Judith Guthrie, Partner Governor, Warrington Council – in position since 23 June 2014, replacing the previous nominee Simon Kenton

***Gill Yates, Staff Governor for Nursing and Midwifery – resigned position as at 1 November 2014 (position currently vacant)

****Jill Nye, Public Governor, Wigan, resigned position from 31 March 2014. Replaced by James Robert Roberts from 25 April 2014

*****Charlotte Dixon, Staff Governor, Clinical Support Services in position from 23 June 2014 (position previously vacant)

As a newly established Foundation Trust in our first year of operation, we are developing our systems for Governor engagement. Details of Governors for each constituency are available on our website and public members can get in touch with their governor through the dedicated email [email protected] or through contacting the Trust Secretary. Public governors hold regular meeting surgeries for their respective members to allow them to raise any comments, issues or concerns. Staff members are able to contact their governors via email or through normal internal communication channels.

Governor candidates for the Public and Staff Governor seats disclosed their interests as part of the election process and this disclosure requirement obliged Governors to declare any political affiliations and any financial or other interests in the Trust. A copy of these disclosures is lodged within the Governors section of the Trust’s website.

The senior independent director, Sally Yeoman is available to the governors if they have concerns that contact through the normal channels of chairman, chief executive, finance director or Trust secretary have failed to resolve or for which such contact is inappropriate. This information was made available to the Council of Governors via a presentation made by the SID and forms part of the role description for the SID.


All Directors of the Trust have a standing invitation to attend Council of Governors meetings and similarly all Governors are routinely invited to attend to observe those meetings of the Board of Directors which are held in public. All Directors of the Trust attend the Council of Governor meetings on a regular basis in order to develop an understanding of the views of the Governors and members on the Trust. The agendas for these meetings are structured to enable Governors to ask questions of the Board of Directors.

The Governors have not exercised their power under paragraph 10C of schedule 7 of the NHS Act 2006 to require one or more of the Directors to attend a Governor’s meeting for the purpose of obtaining information about the Trust’s performance of its functions or the Directors’ performance of their duties. They have not proposed a vote on the Trust’s or Director’s performance during the reporting year.

MembershipWe engage with our communities through our Foundation Trust members, who play an active role in helping to shape health services for the future. Membership is free and open to anyone aged 14 years and above who lives in England.

Our membership is divided into public and staff constituencies. Public members are allocated to their geographic constituency based on where they live and staff are added to the relevant constituency based on their job role. A breakdown of membership constituencies is provided in the table below.

Our staff are automatically enrolled as members unless they choose to opt out and as at the 31 March 2015 we had 2,812 staff members.

In October 2014, we achieved our ambition to recruit 10,000 public members representing


the nine North West boroughs served by the organisation. The number of members does not remain constant and following a routine cleanse of our database, by 31 March 2015 the number of public members stood at 9,694. However, this was an increase from 9,221 at the end of the 2013/14 reporting period.

Membership Constituency – Staff (as at 31 March 2015)Allied Health Professionals/ Other Registered Healthcare Professionals

455

Clinical Support Staff 478Medical and Dental 2Non Clinical Support Staff 756Registered Dentists 47Registered Medical Practitioners 36Registered Nurses and Midwives 1038

Total 2812

Membership Constituency – Public (as at 31 March 2015)Warrington 2036Community dental 179Ashton Leigh and Wigan 2688Halton 1193St Helens 1740Rest of England 1858

Total 9694

During the year our work in engaging our members was highlighted at a national conference in Durham aimed at patient engagement and membership leads. At this event Bridgewater highlighted how it has capitalised on the contributions made by its members and how their continued support has supported our ambition to make the organisation patient focused and focused on the provision of high quality patient care.

Our public members are recruited from those communities and play an important role in our business. Working with colleagues in the local authority, Clinical Commissioning Groups (CCGs) and hospital trusts we canvas the views of our members to find out what is working well and where we can make improvements.

Recruitment of members is supported by a robust system and procedure and our member information is protected by the Data Protection Act. These systems were scrutinised during the year by auditors from Mersey Internal Audit and were found to be robust. Our systems allow us to monitor whether our membership is representative of the communities we serve through monitoring protected characteristics including gender, age, ethnicity, disability. Monthly membership reports are shared with our Governor and Non-Executive colleagues and opportunities for engagement are regularly highlighted.

Our members regularly receive a newsletter outlining the main developments and achievements of the Trust and are invited to a number of public events including our annual staff awards, annual members meeting and annual general meeting. Members can decide


how involved they would like to be in the work of the Trust. Many have also attended one of several workshops, focus groups organised by our staff and partners looking at the work they do and how it might be improved to better meet the needs of the communities we serve.

As an organisation it is extremely important to find out what our members/patients think of the services we provide and in 2014 our Census Event provided us with the overwhelming approval.

When we asked the question of our members / patients if they would recommend the services we provide to their family friends 98 per cent of the 355 people who responded said they would.

This event was replicated during the week of March 23-27 2015 and the results of this exercise will be published in our annual report next year.

Our members and elected governors attend events including those organised by our Healthwatch and CCG colleagues. We also take the opportunity of attending key local events including the Disability Awareness Day in Warrington, the Vintage Steam Rally in Widnes and the Party in the Park in Leigh. These events provide a great opportunity of not only talking to our members, discussing our work, our plans for the future but recruiting new members too.

The continued support of our members in the work of the Trust is extremely valuable and we are extremely grateful to those members who have given up their time in support of our organisation. This includes reading patient leaflets, information sheets, and commenting on the development of our Internet site is extremely valuable and allows us to incorporate the views of those we serve in the information we produce.

This work is extremely important to us and is supported by our membership strategy and action plan which was updated in July 2014 to reflect the ambitions of the organisation’s five year plan. It is important our focus and that of our partners reflects the needs of our patients and members.

During 2015/16 there will be greater focus in engaging our members in the development of services and critically appraising the work we do in our main health centres and clinics.

If you wish to become a member, you can find out more and sign up online at www.bridgewater.nhs.uk/ft/ or contact our Membership Team on 01942 482672 or email [email protected] to find out more.

Any member – public or staff – can raise issues with governors representing the area in which they live or work through a dedicated email address [email protected]


Systems of Internal Control The Board and its subcommittees are responsible for monitoring the Trust’s governance structure and systems of internal control to ensure that risk is managed to a reasonable level and that governance arrangements exist to enable the Trust to adhere to its policies and achieve its objectives.

The Board assessed its own performance with regard to risk management and systems of internal control through the Quality Governance Assessment Framework (QGAF) and Board Governance Assessment Framework (BGAF) in preparation for our Monitor assessment. Ongoing assurance that the Board is sighted on its key strategic risks is provided in the Board Assurance Framework (BAF)

During the year we received an internal audit assessment of our systems of internal control and received a rating of “significant assurance”.

More detail is contained in the Annual Governance Statement.

NHS Foundation Trust Code of GovernanceBridgewater Community Healthcare NHS Foundation Trust has applied the principles of the NHS Foundation Trust Code of Governance on a comply or explain basis. The NHS Foundation Trust Code of Governance, most recently revised in July 2014, is based on the principles of the UK Corporate Governance Code issued in 2012. Annual Report: Code of Governance Requirements


Part of schedule A (see above)

Relating to Code of

Governance reference

Summary of requirement Trust Response

2: Disclose Board and Council of Governors

A.1.1 The schedule of matters reserved for the board of directors should include a clear statement detailing the roles and responsibilities of the council of governors. This statement should also describe how any disagreements between the council of governors and the board of directors will be resolved. The annual report should include this schedule of matters or a summary statement of how the board of directors and the council of governors operate, including a summary of the types of decisions to be taken by each of the boards and which are delegated to the executive management of the board of directors.

The Trust has a Governance manual which sets out the matters reserved to the Board. There is a clear description in this report which sets out the responsibilities of the council of Governors. The senior independent director has outlined to Governors her role in the resolution of any disputes between the CoG and the Board of Directors.

In this first year of operation the Trust is reviewing its schedule of matters reserved to the Board.

Contained within section 3 – Directors report

2: Disclose Board, Nomination Committee(s),

Audit Committee, Remuneration

Committee

A.1.2 The annual report should identify the chairperson, the deputy chairperson (where there is one), the chief executive, the senior independent director (see A.4.1) and the chairperson and members of the nominations, audit and remuneration committees. It should also set out the number of meetings of the board and those committees and individual attendance by directors.

Contained within section 3 – Directors Report and Appendix 2

2: Disclose Council of Governors

A.5.3 The annual report should identify the members of the council of governors, including a description of the constituency or organisation that they represent, whether they were elected or appointed, and the duration of their appointments. The annual report should also identify the nominated lead governor.

Contained within Section 3 – Directors report , Composition of Council of Governors



Relating to Code of



Additional requirement of

FT ARM

Council of Governors

n/a The annual report should include a statement about the number of meetings of the council of governors and individual attendance by governors and directors.

Contained within section 3 – Directors Report

Attendance is contained within Appendix 5

2: Disclose Board B.1.1 The board of directors should identify in the annual report each non-executive director it considers to be independent, with reasons where necessary.


2: Disclose Board B.1.4 The board of directors should include in its annual report a description of each director’s skills, expertise and experience. Alongside this, in the annual report, the board should make a clear statement about its own balance, completeness and appropriateness to the requirements of the NHS foundation trust.



FT ARM

Board n/a The annual report should include a brief description of the length of appointments of the non-executive directors, and how they may be terminated.


2: Disclose Nominations Committee(s)

B.2.10 A separate section of the annual report should describe the work of the nominations committee(s), including the process it has used in relation to board appointments.



FT ARM

Nominations Committee(s)

n/a The disclosure in the annual report on the work of the nominations committee should include an explanation if neither an external search consultancy nor open advertising has been used in the appointment of a chair or non-executive director.

Not applicable

2: Disclose Chair / Council of Governors

B.3.1 A chairperson’s other significant commitments should be disclosed to the council of governors before appointment and included in the annual report. Changes to such commitments should be reported to the council of governors as they arise, and included in the next annual report.

Contained within Section 3 – Directors report, in this case not applicable



Relating to Code of



2: Disclose Council of Governors

B.5.6 Governors should canvass the opinion of the trust’s members and the public, and for appointed governors the body they represent, on the NHS foundation trust’s forward plan, including its objectives, priorities and strategy, and their views should be communicated to the board of directors. The annual report should contain a statement as to how this requirement has been undertaken and satisfied.



FT ARM


n/a If, during the financial year, the Governors have exercised their power* under paragraph 10C** of schedule 7 of the NHS Act 2006, then information on this must be included in the annual report.

This is required by paragraph 26(2)(aa) of schedule 7 to the NHS Act 2006, as amended by section 151 (8) of the Health and Social Care Act 2012.

* Power to require one or more of the directors to attend a governors’ meeting for the purpose of obtaining information about the foundation trust’s performance of its functions or the directors’ performance of their duties (and deciding whether to propose a vote on the foundation trust’s or directors’ performance).

** As inserted by section 151 (6) of the Health and Social Care Act 2012)

Not applicable

2: Disclose Board B.6.1 The board of directors should state in the annual report how performance evaluation of the board, its committees, and its directors, including the chairperson, has been conducted.




Relating to Code of



2: Disclose Board B.6.2 Where there has been external evaluation of the board and/or governance of the trust, the external facilitator should be identified in the annual report and a statement made as to whether they have any other connection to the trust.

Not applicable

2: Disclose Board C.1.1 The directors should explain in the annual report their responsibility for preparing the annual report and accounts, and state that they consider 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 NHS foundation trust’s performance, business model and strategy. Directors should also explain their approach to quality governance in the Annual Governance Statement (within the annual report).

See also ARM paragraph 7.98


2: Disclose Board C.2.1 The annual report should contain a statement that the board has conducted a review of the effectiveness of its system of internal controls.


2: Disclose Audit Committee / control

environment

C.2.2 A trust should disclose in the annual report:

(a) if it has an internal audit function, how the function is structured and what role it performs; or

(b) if it does not have an internal audit function, that fact and the processes it employs for evaluating and continually improving the effectiveness of its risk management and internal control processes.

Contained within section 7 - Chair of Audit Committee’s Annual Report 2014/15



Relating to Code of



2: Disclose Audit Committee / Council of Governors

C.3.5 If the council of governors does not accept the audit committee’s recommendation on the appointment, reappointment or removal of an external auditor, the board of directors should include in the annual report a statement from the audit committee explaining the recommendation and should set out reasons why the council of governors has taken a different position.

Not applicable

2: Disclose Audit Committee C.3.9 A separate section of the annual report should describe the work of the audit committee in discharging its responsibilities. The report should include:

• the significant issues that the committee considered in relation to financial statements, operations and compliance, and how these issues were addressed;

• an explanation of how it has assessed the effectiveness of the external audit process and the approach taken to the appointment or re-appointment of the external auditor, the value of external audit services and information on the length of tenure of the current audit firm and when a tender was last conducted; and

• if the external auditor provides non-audit services, the value of the non-audit services provided and an explanation of how auditor objectivity and independence are safeguarded.

Contained within section 7 - Chair of Audit Committee’s Annual Report 2014/15

2: Disclose Board / Remuneration

Committee

D.1.3 Where an NHS foundation trust releases an executive director, for example to serve as a non-executive director elsewhere, the remuneration disclosures of the annual report should include a statement of whether or not the director will retain such earnings.

Not applicable



Relating to Code of



2: Disclose Board E.1.5 The board of directors should state in the annual report the steps they have taken to ensure that the members of the board, and in particular the non-executive directors, develop an understanding of the views of governors and members about the NHS foundation trust, for example through attendance at meetings of the council of governors, direct face-to-face contact, surveys of members’ opinions and consultations.

Contained within section 3– Directors Report

2: Disclose Board / Membership

E.1.6 The board of directors should monitor how representative the NHS foundation trust's membership is and the level and effectiveness of member engagement and report on this in the annual report.


2: Disclose Membership E.1.4 Contact procedures for members who wish to communicate with governors and/or directors should be made clearly available to members on the NHS foundation trust's website and in the annual report.



FT ARM

Membership n/a The annual report should include:

• a brief description of the eligibility requirements for joining different membership constituencies, including the boundaries for public membership;

• information on the number of members and the number of members in each constituency; and

• a summary of the membership strategy, an assessment of the membership and a description of any steps taken during the year to ensure a representative membership [see also E.1.6 above], including progress towards any recruitment targets for members.




Relating to Code of



Additional requirement of FT ARM (based on

FReM requirement)

Board / Council of Governors

n/a The annual report should disclose details of company directorships or other material interests in companies held by governors and/or directors where those companies or related parties are likely to do business, or are possibly seeking to do business, with the NHS foundation trust. As each NHS foundation trust must have registers of governors’ and directors’ interests which are available to the public, an alternative disclosure is for the annual report to simply state how members of the public can gain access to the registers instead of listing all the interests in the annual report.

See also ARM paragraph 7.33 as directors’ report requirement.

Register of Directors interests is available from the Trust Secretary

6: Comply or explain

Board A.1.4 The board should ensure that adequate systems and processes are maintained to measure and monitor the NHS foundation trust’s effectiveness, efficiency and economy as well as the quality of its health care delivery

Comply


Board A.1.5 The board should ensure that relevant metrics, measures, milestones and accountabilities are developed and agreed so as to understand and assess progress and delivery of performance

Comply


Board A.1.6 The board should report on its approach to clinical governance.

Comply


Board A.1.7 The chief executive as the accounting officer should follow the procedure set out by Monitor for advising the board and the council and for recording and submitting objections to decisions.

Comply


Board A.1.8 The board should establish the constitution and standards of conduct for the NHS foundation trust and its staff in accordance with NHS values and accepted standards of behaviour in public life

Comply



Relating to Code of




Board A.1.9 The board should operate a code of conduct that builds on the values of the NHS foundation trust and reflect high standards of probity and responsibility.

Comply


Board A.1.10 The NHS foundation trust should arrange appropriate insurance to cover the risk of legal action against its directors.

Comply


Chair A.3.1 The chairperson should, on appointment by the council, meet the independence criteria set out in B.1.1. A chief executive should not go on to be the chairperson of the same NHS foundation trust.

Comply


Board A.4.1 In consultation with the council, the board should appoint one of the independent non-executive directors to be the senior independent director.

Comply


Board A.4.2 The chairperson should hold meetings with the non-executive directors without the executives present.

Comply


Board A.4.3 Where directors have concerns that cannot be resolved about the running of the NHS foundation trust or a proposed action, they should ensure that their concerns are recorded in the board minutes.

Comply



A.5.1 The council of governors should meet sufficiently regularly to discharge its duties.

Comply



A.5.2 The council of governors should not be so large as to be unwieldy.

Comply



A.5.4 The roles and responsibilities of the council of governors should be set out in a written document.

Comply



A.5.5 The chairperson is responsible for leadership of both the board and the council but the governors also have a responsibility to make the arrangements work and should take the lead in inviting the chief executive to their meetings and inviting attendance by other executives and non-executives, as appropriate.

Comply



Relating to Code of





A.5.6 The council should establish a policy for engagement with the board of directors for those circumstances when they have concerns.

Comply



A.5.7 The council should ensure its interaction and relationship with the board of directors is appropriate and effective.

Comply



A.5.8 The council should only exercise its power to remove the chairperson or any non-executive directors after exhausting all means of engagement with the board.

Comply



A.5.9 The council should receive and consider other appropriate information required to enable it to discharge its duties.

Comply


Board B.1.2 At least half the board, excluding the chairperson, should comprise non-executive directors determined by the board to be independent.

Comply



B.1.3 No individual should hold, at the same time, positions of director and governor of any NHS foundation trust.

Comply


Nomination Committee(s)

B.2.1 The nominations committee or committees, with external advice as appropriate, are responsible for the identification and nomination of executive and non-executive directors.

Comply



B.2.2 Directors on the board of directors and governors on the council should meet the “fit and proper” persons test described in the provider licence.

Comply



B.2.3 The nominations committee(s) should regularly review the structure, size and composition of the board and make recommendations for changes where appropriate.

Comply



B.2.4 The chairperson or an independent non-executive director should chair the nominations committee(s).

Comply



Relating to Code of




Nomination Committee(s) /


B.2.5 The governors should agree with the nominations committee a clear process for the nomination of a new chairperson and non-executive directors.

Comply



B.2.6 Where an NHS foundation trust has two nominations committees, the nominations committee responsible for the appointment of non-executive directors should consist of a majority of governors.

Not applicable



B.2.7 When considering the appointment of non-executive directors, the council should take into account the views of the board and the nominations committee on the qualifications, skills and experience required for each position.

Comply



B.2.8 The annual report should describe the process followed by the council in relation to appointments of the chairperson and non-executive directors.

Comply



B.2.9 An independent external adviser should not be a member of or have a vote on the nominations committee(s).

Comply


Board B.3.3 The board should not agree to a full-time executive director taking on more than one non-executive directorship of an NHS foundation trust or another organisation of comparable size and complexity.

Comply



B.5.1 The board and the council governors should be provided with high-quality information appropriate to their respective functions and relevant to the decisions they have to make.

Comply



Relating to Code of




Board B.5.2 The board and in particular non-executive directors, may reasonably wish to challenge assurances received from the executive management. They need not seek to appoint a relevant adviser for each and every subject area that comes before the board, although they should, wherever possible, ensure that they have sufficient information and understanding to enable challenge and to take decisions on an informed basis.

Comply


Board B.5.3 The board should ensure that directors, especially non-executive directors, have access to the independent professional advice, at the NHS foundation trust’s expense, where they judge it necessary to discharge their responsibilities as directors.

Comply


Board / Commit-tees

B.5.4 Committees should be provided with sufficient resources to undertake their duties.

Comply


Chair B.6.3 The senior independent director should lead the performance evaluation of the chairperson.

Comply


Chair B.6.4 The chairperson, with assistance of the board secretary, if applicable, should use the performance evaluations as the basis for determining individual and collective professional development programmes for non-executive directors relevant to their duties as board members.

Comply


Chair / Council of Governors

B.6.5 Led by the chairperson, the council should periodically assess their collective performance and they should regularly communicate to members and the public details on how they have discharged their responsibilities.

As a new Foundation Trust, we intend to complete within our first year of operation.



Relating to Code of





B.6.6 There should be a clear policy and a fair process, agreed and adopted by the council, for the removal from the council of any governor who consistently and unjustifiably fails to attend the meetings of the council or has an actual or potential conflict of interest which prevents the proper exercise of their duties.

Comply


Board / Remuneration

Committee

B.8.1 The remuneration committee should not agree to an executive member of the board leaving the employment of an NHS foundation trust, except in accordance with the terms of their contract of employment, including but not limited to service of their full notice period and/or material reductions in their time commitment to the role, without the board first having completed and approved a full risk assessment.

Comply


Board C.1.2 The directors should report that the NHS foundation trust is a going concern with supporting assumptions or qualifications as necessary.

See also ARM paragraph 7.17.

Comply


Board C.1.3 At least annually and in a timely manner, the board should set out clearly its financial, quality and operating objectives for the NHS foundation trust and disclose sufficient information, both quantitative and qualitative, of the NHS foundation trust’s business and operation, including clinical outcome data, to allow members and governors to evaluate its performance.

Comply



Relating to Code of




Board C.1.4 a) The board of directors must notify Monitor and the council of governors without delay and should consider whether it is in the public’s interest to bring to the public attention, any major new developments in the NHS foundation trust’s sphere of activity which are not public knowledge, which it is able to disclose and which may lead by virtue of their effect on its assets and liabilities, or financial position or on the general course of its business, to a substantial change to the financial wellbeing, health care delivery performance or reputation and standing of the NHS foundation trust.

b) The board of directors must notify Monitor and the council of governors without delay and should consider whether it is in the public interest to bring to public attention all relevant information which is not public knowledge concerning a material change in:

• the NHS foundation trust’s financial condition;

• the performance of its business; and/or

• the NHS foundation trust’s expectations as to its performance which, if made public, would be likely to lead to a substantial change to the financial wellbeing, health care delivery performance or reputation and standing of the NHS foundation trust.

Would comply if appropriate


Board / Audit Committee

C.3.1 The board should establish an audit committee composed of at least three members who are all independent non-executive directors.

Comply



Relating to Code of




Council of Governors / Audit

Committee

C.3.3 The council should take the lead in agreeing with the audit committee the criteria for appointing, re-appointing and removing external auditors.

A task and finish group of the council of governors will work with the Chair of the Audit Committee to appoint the external auditors to the Trust.


Council of Governors / Audit

Committee

C.3.6 The NHS foundation trust should appoint an external auditor for a period of time which allows the auditor to develop a strong understanding of the finances, operations and forward plans of the NHS foundation trust.

Comply


Council of Gover-nors

C.3.7 When the council ends an external auditor’s appointment in disputed circumstances, the chairperson should write to Monitor informing it of the reasons behind the decision.

There have been no disputed circumstances leading to the need to end the contract.


Audit Committee C.3.8 The audit committee should review arrangements that allow staff of the NHS foundation trust and other individuals where relevant, to raise, in confidence, concerns about possible improprieties in matters of financial reporting and control, clinical quality, patient safety or other matters.

Comply


Remuneration Committee

D.1.1 Any performance-related elements of the remuneration of executive directors should be designed to align their interests with those of patients, service users and taxpayers and to give these directors keen incentives to perform at the highest levels.

The Trust does not have any performance related elements to the remuneration of its executive directors.



D.2.2 The remuneration committee should have delegated responsibility for setting remuneration for all executive directors, including pension rights and any compensation payments.

Comply


Council of Governors /


D.2.3 The council should consult external professional advisers to market-test the remuneration levels of the chairperson and other non-executives at least once every three years and when they intend to make a material change to the remuneration of a non-executive.

Comply



Relating to Code of




Board E.1.2 The board should clarify in writing how the public interests of patients and the local community will be represented, including its approach for addressing the overlap and nterface between governors and any local consultative forums.

Comply, included in section 3 - Directors report


Board E.1.3 The chairperson should ensure that the views of governors and members are communicated to the board as a whole.

Comply


Board E.2.1 The board should be clear as to the specific third party bodies in relation to which the NHS foundation trust has a duty to co-operate.

Comply


Board E.2.2 The board should ensure that effective mechanisms are in place to co-operate with relevant third party bodies and that collaborative and productive relationships are maintained with relevant stakeholders at appropriate levels of seniority in each.

Comply

Companies Act Disclosures Other disclosures required within the Directors’ Report that are relevant to our Trust are included within our Strategic Report. These are:

• Important events since in the end of the financial year affecting our Trust• An indication of likely future developments at the Trust• Policies applied during the financial year for giving full and fair consideration to applications for employment made by disabled persons, having regard to their aptitudes and abilities• Policies applied during the financial year for continuing the employment of, and for

arranging appropriate training for, employees who have become disabled persons during the period

• Policies applied during the financial year for the training, career development and promotion of disabled employees

• Actions taken in the financial year to consult employees or their representatives on a regular basis so that the views of employees can be taken into account in making decisions which are likely to affect their interests

• Actions taken in the financial year to encourage the involvement of employees in the Trust’s performance

• Actions taken in the financial year to achieve a common awareness on the part of all employees of the financial and economic factors affecting the performance of the Trust.


5. Enhanced Quality Governance ReportingThe Trust governs service quality through Board meetings, with monthly agenda items on quality and safety. Quality performance is discussed at the Board’s monthly Quality and Safety Committee and the Trust’s Senior Management Team also receives information regarding exceptions and concerns relating to quality. The Trust has a Quality Governance Assessment Framework (QGAF) in place when we became a Foundation Trust. In 2015/16 we will undertake a review of our governance arrangements against the well-led framework.

Our Quality Strategy outlines our quality priorities for 2014/15, which are linked directly to the Care Quality Commission five domains:

• Ensuring we are safe

• Ensuring we are effective

• Ensuring we are caring

• Ensuring we are responsive

• Ensuring we are well-led

Each year Trusts are required to publish a Quality Account as required by the NHS Act 2009 and the NHS (Quality Accounts) Regulations 2010. Our Quality Report discharges this responsibility in Appendix 4.

This document aims to provide a publicly available account and assurance on the quality of care we provide through providing evidence and progress against key quality measures. It includes a statement of assurance regarding quality from our Chief Executive, details of progress against our quality improvement priorities for 2014/15, targets agreed with our commissioners and an outline of the priorities for 2015/16.

The report also contains details of service improvements within Bridgewater and how we have worked with our partners to improve the quality of care we provide.

The Quality Report details the mechanisms and systems for ensuring the quality of services is maintained and details the processes in place for monitoring quality including the Quality Impact Assessment (QIA) process, Clinical Audit and how we seek feedback from patients and carers on their experience of our services.

The report also contains information on how we manage Infection, Prevention and Control, Safeguarding, Clinical Audit and training for our staff to ensure we deliver the highest quality services.

Information on how quality is managed through the governance framework is available in the Annual Governance Statement available within this report.

Our Quality Account 2014/15 is contained within Appendix 4 of this annual report.


6. Remuneration ReportAnnual statement on RemunerationAs Chair of the Remuneration Committee of the Trust I confirm that the remuneration committee has met on 3 occasions between 1st November 2014 and the 31st March 2015.

The main business conducted related to the process for the appointment of a new Chief Executive Officer (together with the Council of Governors) and the remuneration for that post, the appointment of a new Chief Nurse and the retirement of the Trusts Medical Director.

The Medical Director tendered his resignation and took a ‘flexible retirement ‘on 31st December 2014, returning to work on the 1st February 2015 on a part time basis. He has subsequently retired in full with effect from the 31st May 2015.

A new Chief Nurse was appointed with effect from 1st April and the salary for that post was determined using the NHS Very Senior Manager pay framework (VSM) using PCT band 4 scales as the accepted pay scale within the Trust.

The salary of the Chief Executive was determined following a market assessment using benchmarked information and also information provided by the specialist recruitment consultants who advised on the salaries of recent Chief Executive appointments that they had been involved in and the salaries of those candidates for the post that held current positions of Chief Executive in NHS organisations.

The committee agreed that a maximum salary of £150,000 could be offered to a successful candidate. The successful candidate was awarded a salary of £150,000.

There have been no changes to the remuneration of any other Director during the above period and the trust agreed that VSM/ Director salaries would not be increased during 2014/15 and 2015/16 and no cost of living increases have been awarded to Directors.

Harry Holden

Chairman


Senior remuneration policy With the exception of Directors and the CEO, all senior managers within the Trust are employed on Agenda for Change terms and conditions and associated salary scales. Bridgewater Community Healthcare NHS Foundation Trust has adopted the NHS VSM pay framework ( PCT Band 4) as the salary scale for all Directors. This provides a spot salary for each post, based on a % of the CEO salary. It should be noted that the salaries of all directors have not been increased as a result of an increase in the CEO salary on 1.4.2015. There is no facility for performance related pay within the Trusts pay structure. As a Community Trust , with the requirement to travel across a wide geographical footprint, all directors are entitled to receive a lease car or take a car allowance equivalent to £5,700 pa.

All Directors are set annual objectives, in line with the organisational strategy and objectives and are assessed against these on an annual basis. There is input into the assessment from the Chairman and CEO (for Directors ) . Should any director performance be determined to be at an unacceptable level, the Trust would use its agreed performance management policies and procedures.

The assessment period runs from 1st April to 31st March each year.

All Directors have been issued with NHS contracts of employment , with notice periods not exceeding six months. There is no provision for any additional payments to be made to Directors over and above their agreed salary level and car allowance. There is no payment for loss of office , other than those terms contained in section 16 of the Agenda for Change terms and conditions relating to redundancy situations.

Non-Executive Director RemunerationThe remuneration levels for the Chairman and Non-Executive Directors is as follows:Chairman: £40,000p.a

NED: £12,000p.a

Allowances for chairs of committees / SID: £1,500pa

There are no additional payments that are considered to be remuneration in nature.

The above remuneration levels were considered and agreed by the Council of governors in line with the Monitor guidance.

The tables shown on the following pages provide information on the remuneration and pension benefits for Senior Managers for the period 1 November 2014 to 31 March 2015. These tables plus their associated narrative (including pay multiples) are subject to External Audit review.

The remuneration report includes:• Salaries and Allowances Table• Pay Multiples• Exit Packages• Appointments & Remuneration Committee• Annual Statement on Remuneration

• Senior Remuneration Policy• Non Executive Director Remuneration• Pension Benefits - Table• Cash Equivalent Transfer Values (CETV)• Real Increase in CETV


Salaries and AllowancesPeriod from 1 November 2014 to 31 March 2015

Salary at 31.3.2015

Taxable benefits at

31.3.2015**

Performance pay and

bonuses at 31.3.2015

Long term performance

pay and bonuses at 31.3.2015

All pension-related

benefits at 31.3.2015*

TOTAL at 31.3.2015

Directors Name and title Bands of£5,000£’000s

Total tonearest £100

Bands of£5,000£’000s




Harry HoldenChairman 10-15 0 0 0 N/a 10-15

Kate FallonChief ExecutiveRetired on 31.3.15

55-60 21 0 0 0-2.5 60-65

Linda AgnewDirector of CorporateDevelopment

40-45 21 0 0 2.5-5 40-45

Dorothy KeatesInterim Executive Nurse/ Director of Governance

35-40 0 0 0 77.5-80 115-120

Mike TreharneDirector of Finance& Performance

40-45 21 0 0 0 45-50

Stephen WardMedical Director

15-20 10 0 0 0 15-20

Colin ScalesChief Operating Officer

40-45 24 0 0 0-2.5 40-45

Christine Samosa Director of People,Planning and Development

35-40 0 0 0 0 35-40

Bob Saunders Non-Executive Director

5-10 0 0 0 N/a 5-10

Karen Bliss Non-Executive Director

5-10 0 0 0 N/a 5-10

Steve Cash Non-Executive Director

5-10 0 0 0 N/a 5-10

Dorothy Whitaker Non-Executive Director

5-10 0 0 0 N/a 5-10

Sue Musson Non-Executive Director in post to 31/12/2014

0-5 0 0 0 N/a 0-5

Sally Yeoman Non-Executive Director

5-10 0 0 0 N/a 5-10

Band of Highest Paid Director’sRemuneration (£’000s)

60-65

Median Total Remuneration (£) *** 11,658

Ratio 5.4 All of the above Directors were in post for the 5 month period from 1 November 2014 to 31 March 2015 except where indicated.* Calculated in line with the prescribed guidance in Chapter 7 of the NHS Annual Reporting Manual for Foundation Trusts** The taxable benefits disclosed in the above table are car allowances which are received as cash.*** The median pay has been calculated for the 5 month period from 1 November 2014 to 31 March 2015.


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

The mid point of the banded remuneration of the highest paid director in Bridgewater Community Healthcare NHS Foundation Trust in the period from 1 November 2014 to 31March 2015 was £62,500. This was 5.4 times the median remuneration of the workforce which was £11,658 for the same period.

Total remuneration includes salary, non-consolidated performance-related pay, benefits-in-kind, but not severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions.

Exit Packages During the period from 1 November 2014 to 31 March 2015 there have been no exit packages agreed.

Appointments & Remuneration Committee The Appointments and Remuneration Committee is attended by all Non-Executive Directors and is chaired by the Chairman of the Trust.

The committee sets the levels of pay for Executive Directors - and senior managers not remunerated under Agenda for Change pay arrangements.

The committee approves the proposed appointment of Executive Directors. Contracts for Executive Directors are substantive unless or until the individual elects to resign the role or is removed from the role. Notice periods for such Directors is six months. There are no contractual provisions for the early termination of Executive Directors.

The Appointments Commission appoints Non-Executive Directors, generally on 3 year contracts which can be renewed on expiry. Notice periods are generally one month. There are no contractual provisions for the early termination of Non-Executive Directors.

Furthermore the committee operates an annual Performance Development Review process whereby whereby each individual has a named “parent”. At the outset, the postholder and parent jointly agree the objectives for the following year and performance against these is then jointly assessed after the twelve month elapses. The cycle is then repeated on an ongoing annual basis.


Period from 1 November 2014 to 31 March 2015

Real increase in pension at aged 60

Real increase in pension

lump sum at aged 60

Total accrued pension as aged 60 at 31 March

2015

Lump sum at aged 60 related

to accrued pension at 31 March 2015

Cash Equivalent

Transfer Value at 1 November

2014

Cash Equivalent Transfer

Value at 31 March 2015

Real increase in

Cash Equivalent Transfer

Value

Executive Directors Name





£’000s £’000s £’000s

Kate FallonChief ExecutiveRetired 31.3.2015

0-2.5 0-2.5 25-30 85-90 0 0 0

Linda AgnewDirector of CorporateDevelopment

0-2.5 0-2.5 30-35 90-95 593 620 8

Dorothy KeatesInterim Executive Nurse / Directorof Governance

2.5-5 10-12.5 20-25 70-75 392 484 88

Mike TreharneDirector of Finance& Performance

0-2.5 0-2.5 35-40 110-115 723 734 3

Stephen WardMedical Director

0 0 0 0 0 0 0

Colin ScalesChief Operating Officer

0-2.5 0-2.5 15-20 45-50 218 226 5

Christine SamosaDirector of People,Planning andDevelopment

0-2.5 0-2.5 35-40 110-115 696 699 0

Exit Packages (continued) * The Medical Director has opted out of the Pension Scheme and therefore no entries have been included above.There are no entries in respect of pensions for Non-Executive Directors as they do not receive pensionable remuneration. Additionally there were no contributions to Stakeholder Pensions on behalf of any of the Directors of the Trust.

Cash Equivalent Transfer ValuesThe benefits valued are the member’s accumulated 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 a 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 scheme, not just their service in a senior capacity to which the disclosure applies. The CETV figures, and the other pension details, include the value of any pension benefits in another scheme or arrangement which the

Pension Benefits


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 ofpension service in the scheme at their own cost. CETV’s are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries.

Real Increase in CETVThis 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). There has been a change in the actuarial factors set by the Government Actuary’s Department (GAD) with effect from 8 December 2011. NHS Pensions has used the most recent set of actuarial factors produced by GAD when calculating the CETV for inclusion in the remuneration report.


7. Annual Governance Statement

Organisation Code RY2November 2014 to March 2015 Annual Governance StatementScope of responsibilityAs 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. To the best of my knowledge and belief and from the assurances provided by Dr Kate Fallon, the previous accountable officer, I am assured that the chief executive responsibilities have been appropriately discharged over the period November 2014 to March 2015.

The Board Assurance Framework is submitted to the Board for review following scrutiny by the Quality and Safety Committee and these provide part of the information and assurance required. The Annual Governance Statement (AGS) is drafted by the Head of Risk Management. The Head of Internal Audit Opinion contributes towards the required assurance and this report has been reviewed by Quality and Safety Committee and the Board. The AGS is discussed at director management team and updated for any comments and a draft reported to the Board for information. It is then subsequently signed by the Chief Executive.

The purpose of the system of internal controlThe 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 Bridgewater Community Healthcare 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 Bridgewater Community Healthcare NHS Foundation Trust to the year ended 31 March 2015 and up to the date of approval of the annual report and accounts.

Capacity to handle riskAs set out in Section One of the Risk Management Strategy and Policy, the role of Executive Nurse/Director of Governance holds executive responsibility for establishing risk management across the Trust, with the Head of Risk Management reporting to them. The Head of Risk Management has responsibility for developing, embedding, and advising on risk management systems for operational risks identified by clinical and non-clinical support services and strategic risks developed by the Board.

Significant operational risks and incidents are reported to the Chief Operating Officer as they arise in directorates and on a monthly basis to the Quality Management Group (which, in turn, escalates exceptional information to the committee of the Board, the Quality and Safety


Committee), and Directors may offer immediate advice, intervention or support to mitigate the issue. Controls and Assurance that affect local operational process are managed and recorded by managers at a directorate level and monitored by the directorate General Manager at the Directorate Management Teams.

The Trust employs specialists, for example in Health and Safety, Medicines Management, Information Governance, Security, and Equality and Diversity, to maintain Trust adherence to regulations and additionally offer advice to staff and management on expected operational Controls and Assurances to mitigate and monitor risks.

All managers across the Trust maintain a responsibility for the safety of their staff and patients, and the safe and effective delivery of care as part of the Trust Objectives. Anything that presented a foreseeable hazard to these was risk assessed and documented on the Operational Risk Register residing on the Ulysses Risk Management System or, if something adverse occurred it was recorded on the same system as an incident.

The Head of Risk Management offers monthly training session to managers on risk assessment and management documented risk assessments on the Operational Risk Register, where they also receive advice and can raise uncertainties. Risks, complaints, and incidents are monitored and triangulated by the Quality Management Group and also the Quality and Safety Committee, with any thematic lessons to be learned provided to the Lessons Learned Group for Trust-wide dissemination in Team Brief cascade and via the Trust Intranet.

The risk and control frameworkThere are two types of risk monitored within the Trust; Strategic and Operational. In accordance with Section Two of the Risk Management Strategy and Policy, risks are identified from a range of sources set out in the Policy, including incidents, complaints, audits etc., considered for escalation to the Ulysses Risk Register or BAF and an assessment documented on that system. Documented risk information can be updated and amended for accuracy in Ulysses and saved (an audit trail held within the system) or a risk may be re-assessed and a new ‘version’ number applied indicating that the issue has been re-evaluated.

The Trust used a consistent risk assessment methodology as defined in the Risk Management Strategy for all risk (both Strategic and Operational) based on: -

• Hazard identification• Impact evaluation• Identification of Controls, Assurance and any gaps in these,• Using the NPSA Risk Matrix for grading and initially prioritising risks, and• Treating Control and Assurance gaps through Action Plans with completion dates to

reach target tolerable levels of risk

The Trust employs specialists, for example in Health and Safety, Medicines Management, Information Governance, Security, and Equality and Diversity, to maintain Trust adherence to regulations and additionally offer advice to staff and management on expected operational Controls and Assurances to mitigate and monitor risks.


All managers across the Trust maintain a responsibility for the safety of their staff and patients, and the safe and effective delivery of care as part of the Trust Objectives. Anything that presented a foreseeable hazard to these was risk assessed and documented on the Operational Risk Register residing on the Ulysses Risk Management System or, if something adverse occurred it was recorded on the same system as an incident.

The Head of Risk Management offers monthly training session to managers on risk assessment and management documented risk assessments on the Operational Risk Register, where they also receive advice and can raise uncertainties. Risks, complaints, and incidents are monitored and triangulated by the Quality Management Group and also the Quality and Safety Committee, with any thematic lessons to be learned provided to the Lessons Learned Group for Trust-wide dissemination in Team Brief cascade and via the Trust Intranet.

The most consistent set of principal Controls the Board expects are established policies and procedures. These have been inherited by the Foundation Trust since its function as an NHS Trust. Assurance of implementation and adherence to these standards and processes are monitored through staff training figures and incidents or complaints captured in the Integrated Performance Report and the Quality Dashboard to the Board. The Board focuses on patient and service experience as a reflection of the culture of the Trust.

A range of descriptive severity and likelihood examples are included in the Policy appendices to ensure a consistent approach to grading the severity and likelihood of a risk and this is reinforced in the monthly training sessions. The Board receives an annual risk management training session from the Head of Risk Management.

The Board have enshrined within the Policy the tolerable levels of risk, beyond which they require detailed information to be assured that steps are being taken to mitigate the likelihood or impact. Based on the NPSA (from the Aus/NZ risk methodology) 5 x 5 matrix used widely across the NHS, the Board considers any risks scoring 12 and above to be Significant and liable to further scrutiny and support, and any risks that possess a severity element adjudged to be Major (4) or Catastrophic (5) regardless of likelihood in order to be assured that the Controls that mitigate the risk remain sound.

A monthly Integrated Performance Report is submitted to the Board and the Quality and Safety Committee detailing performance and quality information on activity, incidents, staffing, CQUIN, and finance data. This is derived from the specialists with responsibility for this data who also detail any accompanying explanatory text for exceptions.

The Board and directors are accountable for the establishment and ongoing delivery of services within the requirements of the Provider Licence, risk assessment framework, and maintained regulatory compliance, including against CQC ratings and feedback from inspections leading up to achieving Foundation Trust status. The Quality and Safety Committee and the Board receive monthly summaries, and any exceptions, of service compliance with CQC Outcomes. Internally, directorates routinely undertake reviews of their services against the CQC Outcomes and these are collated by the Head of Clinical Governance, Quality and Effectiveness, monitored by the Chief Operating Officer and escalated in report form to directors.


1. Strategic risks are those principal risks recorded on the BAF that may foreseeably impede the ability of the organisation to deliver its objectives. These strategic principal risks recorded on the BAF are carried over from its previous status as an NHS Trust to the end of October 2014. Each of these retains Controls, Assurances and any gaps that are the responsibility of an executive director. The Assurances are those documents received by the Board. The strategic risk profile as at the end of March 2015 appears: -

• No Extreme Risks• Two risks scoring High (12)• Nine risks scoring High (8 to 10)

Two High (12) Strategic Risks: -14/15.5 Commercial competitiveness limited by failing to: -

• retain business• gain new business• respond adequately/in a timely manner to commissioning need• respond to emerging opportunities• adequately identify and engage appropriately with all strategic partners

14/15.18 Income loss: -• Income loss• Failure to maintain financial viability• Reputational damage

These two risks are inherently linked and in order to mitigate these, the Trust has effective ‘early warning systems’ in place and a finance section in the Integrated Performance Report, the Director of Finance monitors and signs off the pricing of services, a quarterly income risks paper to Board, and there is an executive lead for each tender. The Board has also been in receipt of an Annual Operating Plan, New Business Opportunities agenda item, and a Commercial/Business Development Strategy.

14/15.1 A culture across all levels of the organisation that: -• tolerates poor quality of service quality and provision• fails to support and encourage staff

14/15.2 Substandard quality of care and service delivery due to: -• failure adhere to best practice• inadequate capacity and skills• failure to adhere to agreed Trust policy and procedure• failure to recognise or embed lessons learned from adverse events

14/15.4 Failure to adopt technology to improve quality and efficiency of healthcare including: -

• mobile technology• technological innovation• telehealth• electronic patient record• single cross-borough Trust network platform• an investment programme that takes into account CCG disinvestment


14/15.7 Financial/political initiatives affecting the health economy that influence increasing demands without sufficiently matched income growth

14/15.8 Failure to consistently deliver services that meet contractual obligations: -• Commissioning for Quality and Innovation (CQUIN) targets• Care Quality indicators• Specific KPI breaches• agreed activity levels• quality schedules

14/15.9 Failure to sustain and demonstrate long term financial viability: -• poor forecasting of costs and to control expenditure• failure to identify income streams and opportunities• income fails to keep pace with increasing costs

With reference to strategic risk 14/15.9, the Trust experienced challenges in respect of its financial forecasting, in the last quarter of 2014/15. Particular pressures arose from non-pay items, including estate recharges, and agency expenditure. Going forward the Trust will need to improve its forecasting capability, and the Trust has commissioned a review of its processes in order to both identify areas for improvement and also to provide assurance for 2015/16.

14/14.10 Impact of the CIP programmes -• Non-delivery or slippage on the delivery of CIPs• Adverse influence of initiatives on quality of care• Failure to demonstrate realisation of CIP savings

14/15.12 Failure to maintain and improve sound systems of governance and effective internal control that: -

• offers clear and readily available escalation processes in a timely way• provides relevant and adequate Board assurance• offer sufficient quality assurance• mitigates reputational regulatory, and commercial damage• offer a proactive succession planning program

14/15.13 Inconsistent data between similar services across Boroughs: -• Activity recording• Data quality• Technology issues

14/15.15 Failure to demonstrate benefits of organisational transition & structures, specifically: -

• Matrix working• Lines of escalation and communications• Benefits realisation• Combining operational control and relationship management• Loss of commissioning legacy information


2. Operational risk: risks identified by operational staff and managers that may foreseeably impede the safe delivery of high quality service to patients on a day to day basis. The potential implication from this is that a high operational risk could adversely affect a service’s ability to meet the organisational objectives.

Operational risks are identified, assessed, and documented at service level and monitored by the Directorate Management Teams with any significant issues escalating to the Quality management Group and the Quality and Safety Committee (with strategic risks) for assurance.

The Operational Risk profile at the end of March 2015 comprises: -• 2 Extreme Risks• 61 High Risks• 401 Moderate Risks• 98 Low Risks

The Information Governance Team collates data from managers and Information Asset Owners and maintains an Information Governance Toolkit and reports this to the Information Governance Sub Group, and submits exceptions/risks to the Quality and Safety Committee. Services maintain operational risk assessments for any foreseeable Information Governance issues and report any Information Governance incidents on Ulysses. The Trust Caldicott Guardian (Executive Nurse/Director of Governance) and the Senior Information Risk Owner (Director of Finance) would be notified of any breaches of patient confidentiality that require notification to the Information Commissioner. There were no significant Information Governance incidents since inception as a Foundation Trust.

GovernanceDirectors oversaw all aspects of organisational performance and foreseeable risk, including unprecedented challenges in achieving financial duties, ongoing financial viability, delivery of Quality, Innovation, Productivity and Prevention (QIPP) initiatives, service pressures, and maintaining key relationships and partnership working across the wider local health economy and with Commissioners including engagement with Integrated Commissioning Plans and transformation programmes.

For the financial reporting period 1st November 2014 to 31st March 2015, Bridgewater Community Foundation NHS Trust has report a small surplus of £0.154m this is the same figure as in the summarisation schedules that underpin the accounts.

The Trust had initially proposed an adjustment to the 2014/15 accounts amounting to £2.6m. This represents the capital value of all wheelchair and other community loan assets owned by the Trust, which have been purchased over a number of accounting periods. However, the new accounting treatment in respect of such items will only apply to the FT accounts. Therefore, only those costs incurred by the Trust in the five months from 1st November to 31st March 2015 may be properly capitalised.

Unfortunately, due to a variety of issues, the Trust did not meet the filing deadline of the 29th May 2015 for Monitor.

A review of the circumstances and contributory issues in relation to the missed deadline is being undertaken by the Trust together with an external review of the Trusts processes.


Throughout 2014/15 the Trust developed the Council of Governors in preparation for Foundation Trust status, along with communication and engagement with the membership, key stakeholders and other partners. Governors have been in attendance at Board meetings and Quality and Safety Committee meetings for the presentation of information and assurance regarding Bridgewater risks and incidents. Routine quality meetings, and also performance meetings, are held with each of the Trusts commissioners (Clinical Commissioning Groups or NHS England depending on the service) in order that they receive assurance on service quality, risks, and are challenged on any exceptions are being addressed.

Policies, Procedures, and Clinical Guidelines and associated staff training/implementation are the most common form of Control for the majority of both Strategic and Operational risk. The Policy Approval Group has delegated responsibility for establishing Policy development guidelines, reviewing, and approving the Policies for the Trust. Built into the process for Policy development, each document can only be approved once evidence of an Equality Impact Assessment has been completed.

The Integrated Performance Report and the Quality Dashboard continue to be reviewed regularly by Board and the Trust’s Senior Management Team (SMT) into November 2014 through March 2015. Each responsible Director reviews his/her component contribution and these are triangulated to provide a holistic picture of outcomes and impact on service safety and delivery, and the strategic objectives of the organisation.

Over the past three years the Board has observed a steady increase in incident reporting that illustrates an increasing openness and honesty of staff to report incidents. With generic access available to Trust staff, they may report anonymously if they wish. During 2014/15 the Quality and Safety Committee noted a reduction in the overall volume of incidents compared to the equivalent previous period, and that this was due to more frequent and detailed review of incidents and more accurate reporting; the volume of Patient Safety Incident remained constant.

There was an Escalation Framework that ensured Board members were briefed on any significant events or risks between Board meetings. When this happened, Board members received an email entitled ‘Flash Report’ from the Trust Secretary, with detail including the nature of the issue, immediate remedial action, any likely media interest, long-term action, and to which Board or committee meeting a formal report on the issue will be presented.

The Bridgewater Quality Strategy was developed to ensure the Trust has adequate process-es and structures to provide a robust quality framework (monitored by the Quality and Safety Committee) for delivery of safe, effective care which includes the sharing of best practice and lessons learnt. This continued to be utilised from November 2014.

The Audit Committee oversees a programme of counter fraud arrangements, including the contract with MIAA for a Counter Fraud Officer. An MIAA Internal Audit Plan was developed and produced to address and ensure coverage of key risk areas of the Trust, with reference to strategic risks identified within the BAF, management requests into areas of potential gaps and weaknesses etc.

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.

Review of economy, efficiency and effectiveness of the use of resourcesThe Trust Efficiency Assurance Committee (TEAC) oversaw delivery of the Trust’s efficiency programmes, and provided appropriate assurance directly to the Board that delivery was on track and that the potential impact on services was adequately assessed.

Bridgewater had a robust process, monitored by the TEAC, which assessed the viability of, and risks to, the Trust’s Cost Improvement Plans (CIP) both from a financial stand point and a quality impact perspective.

Integral to the CIP was the rolling Quality Impact Assessment (QIA) programme, undertaken by the Trust’s QIA panel at the beginning of each project (at project scope stage), at the design stage, and immediately prior to sign off. If a scheme was foreseeably deemed to have an adverse impact on quality or patient safety, then the sponsor was required to address the concerns of the QIA panel and to resubmit for further assessment. If the panel’s concerns prevailed, the scheme would be replaced with another scheme. Overall responsibility for each project proceeding to implementation rested with the Executive Medical Director and the Executive Nurse. The Quality and Safety Committee was in receipt of quarterly QIA summaries for monitoring and assurance purposes. After the initial sign off of a CIP initiative, there was an ongoing process in place to monitor the progress and efficacy of the initiative on service quality and delivery.

Two High (12) Strategic Risks (14/15.5 and 14/15.18 earlier in this document) represent risks to income and financial viability. These two risks are inherently linked and in order to mitigate these, the Trust has effective ‘early warning systems’ in place and a finance section in the Integrated Performance Report, the Director of Finance monitors and signs off the pricing of services, a quarterly income risks paper to Board, and there is an executive lead for each tender. The Board has also been in receipt of an Annual Operating Plan, New Business Opportunities agenda item, and a Commercial/Business Development Strategy.

Information GovernanceThe Trust Caldicott Guardian (Executive Nurse/Director of Governance) and the Senior Information Risk Owner (Director of Finance) would be notified of any breaches of patient confidentiality that require notification to the Information Commissioner. There were no significant Information Governance incidents since inception as a Foundation Trust.


Annual Quality ReportThe directors are required under the Health Act 2009 and the National Health Service (Qual-ity 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.

The annual Quality Report has been developed in line with relevant national guidance. The Trust has a dedicated Quality and Safety Committee chaired by a Non-Executive Director. All data and information within the Quality Report is reviewed through this committee.

As a committee of the Board, the Quality and Safety Committee receives reports on safety and quality, including the Integrated Performance Report on a monthly basis. The Integrated Performance Report and the Quality Dashboard are also received directly by the Board.

Senior clinicians from the relevant services and specialist support officers have contributed data and knowledge into the report. The quality report is reviewed through both internal and external audit processes and comments have been provided by local stakeholders including commissioners, patients and the local authority.

Review of effectivenessAs 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 the Quality and Safety Committee and a plan to address weaknesses and ensure continuous improvement of the system is in place.

The Board considered its own performance as part of the Quality Governance (QGAF) and Board Governance Assurance (BGAF) Frameworks in place prior to Foundation Trust status. The Quality and Safety Committee and the Audit Committee both assessed their own performance and effectiveness using Self-Assessment Questionnaires. The Trust continued to comply with the HM Treasury/Cabinet Office Corporate Governance Code.

The Trust came under scrutiny by the Monitor team as part of its application for Foundation Trust status, Professor Sir Mike Richards, Chief Inspector of Hospitals, said at the time:

“Overall, we found services provided by Bridgewater Community Healthcare NHS Trust were safe, although there is need to improve systems for sharing learning from incidents across the Trust as a whole.

“Most of the patients and carers we met described staff as caring and compassionate and felt that services were responsive to people’s needs. We noticed that staff worked well in multidisciplinary teams across organisations to provide support to patients in the community.


“There was some evidence that waiting times could be longer than expected, and this was a source of frustration for some patients. I am sure the Trust will want to address that as a priority.”

The Chief Executive, supported by Directors, and with constructive critical challenge from the Non-Executive Members of the Board, continued to receive information and monitor plans and initiatives across the Trust during 2014/15 based on the solutions identified during 2013/14.

The Audit Committee has separate internal and external audit plans. The Committee meets on a bi-monthly basis with representation from both internal and external audit functions. The terms of reference have been reviewed in line with the Intelligent Board and Audit Committee Handbook publications. An annual work plan is produced which dovetailed with the Board’s calendar and continues from April 2014 into the period of Foundation Trust status. The Audit Committee’s primary role is to conclude upon the adequacy and effective operation of the organisation’s overall internal control system.

The main focus of an Audit Committee’s work is related to internal financial control matters, the maintenance of proper accounting records, the reliability of financial information, and a wider focus on the safety and quality of patient care. However, within Bridgewater the Audit Committee also considers the findings of Clinical Audit across operational services. The overall opinion from the Director of Audit was:

“Significant Assurance can be given that there is a generally sound system of internal control designed to meet the organisation’s objectives, and that controls are generally being applied consistently. However, some weaknesses in the design or inconsistent application of controls put the achievement of particularobjectives at risk.”

Although Significant Assurance has been identified, a range of actions have been developed to address risks identified in the audits and will be monitored by the Audit Committee in 2015/16. Follow up reports were provided to the Audit Committee regularly to confirm the Trusts actions and implementation of recommendations raised in Audit Reports.

An Internal Audit Plan was developed to address a set of specific concerns and potential risks raised by management. In addition, the BAF is the key document which MIAA consider when producing the Internal Audit Plan to ensure that they produce a risk-based Audit Plan bespoke to the Trust. During 2014/15 the Internal Audit function reviewed the following areas and offered: -

High Assurance: -• Nil

Significant Assurance: -• Emergency Preparedness Review• General Ledger• Income & Debtors• Non-Pay Expenditure• Treasury Management


• SystemOne and IG Governance Arrangements• Recruitment Processes Follow Up• Serious Untoward Incidents Follow Up• New Domain Review• Information Governance Toolkit• Safeguarding Follow Up Review

Limited Assurance: -• Telephony Review• Data Consistency Phase I Review• Network Infrastructure Review• Financial Systems Technical Security Review• School Nursing Service Review• 20 Working Day Dental Target• Specialised Services Governance Arrangements Review• ESR (HR/Payroll) Review

Detailed action plans have been developed in response to all recommendations from the MIAA reports, regardless of the overall level of assurance, and will be monitored by the Audit Committee and on occasion by, the Quality and Safety Committee with follow up visits planned by MIAA during 2015/16 to receive updates and assurance that these have been addressed.

The Audit Committee was in receipt of full reports and progress reports on all of the audits and recommendations during 2014/15.

The Quality and Safety Committee, with a Non-Executive Chair and with representation from Clinical Audit, Internal Audit, Executive Nurse/Director of Governance, Finance, HR, and support functions (Infection Control, Information Governance, Medicines Management etc.), met monthly and considered assurance on operational risk, safety, and quality issues and a monthly report from the Quality Management Group. The Chair of the Quality and Safety Committee also attended the Quality Management Group to observe the robustness of this meeting and the data that they received and discussed.

ConclusionAs Chief Operating Officer during the whole period that the previous Accounting Officer was in post, I can confirm that I am fully aware and was involved in the governance and systems of internal control in place prior to taking up my current role as Accounting Officer.The systems of internal control remain sound in that they have been reviewed and appear robust and are able to identify and escalate any significant issues speedily and appropriately to the proper level.

Accountable Officer: Colin Scales (Chief Executive)

Organisation: Bridgewater Community Healthcare NHS Foundation Trust

Signature:

Date: 12 June 2015


8. Full Annual Accounts for the part year ended 31 March 2015

Accounts for the period from 1st November 2014 to 31 March 2015

Foreword to the accountsThese accounts, for the period ended 31 March 2015, have been prepared by Bridgewater Community Healthcare NHS Foundation Trust in accordance with paragraphs 24 & 25 of Schedule 7 within the National Health Service Act 2006.



Audit opinion and report Independent auditor’s report to the Council of Governors of Bridgewater Community Healthcare NHS Foundation TrustOur opinion on the financial statements is unmodified

In our opinion the financial statements:• give a true and fair view of the state of the financial position of Bridgewater Community Healthcare NHS Foundation Trust as at 31 March 2015 and of its income

and expenditure for the five month period ended 31 March 2015; and• have been properly prepared in accordance with the NHS Foundation Trust Annual

Reporting Manual and the directions under paragraph 25(2) of Schedule 7 of the National Health Service Act 2006.

Who we are reporting toThis report is made solely to the Council of Governors of Bridgewater Community Healthcare NHS Foundation Trust, as a body, in accordance with paragraph 24(5) of Schedule 7 of the National Health Service Act 2006. Our audit work has been undertaken so that we might state to the Trust’s Council of Governors those matters we are required to state to them in an auditor’s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Trust and the Trust’s Council of Governors as a body, for our audit work, for this report, or for the opinions we have formed.

What we have auditedWe have audited the financial statements of Bridgewater Community Healthcare NHS Foundation Trust (‘the Trust’) for the five month period ended 31 March 2015 which comprise the statement of comprehensive income, the statement of financial position, the statement of cash flows, the statement of changes in taxpayers’ equity and the related notes.

The financial reporting framework that has been applied in their preparation is the NHS Foundation Trust Annual Reporting Manual issued by Monitor, the Independent Regulator of NHS Foundation Trusts.

Our assessment of riskIn arriving at our opinions set out in this report, we highlight the following risks that are, in our judgement, likely to be most important to users’ understanding of our audit.

Valuation of contract income from commissioning bodies and associated receivablesThe risk: The Trust receives a large proportion of its income from commissioners of healthcare services. It invoices its commissioners throughout the year for services provided, and at the year-end estimates and accrues for activity not yet invoiced. Invoices for the final quarter of the year are not finalised and agreed until after the year-end and after the deadline for the production of the financial statements. There is therefore a risk that the income from commissioners (and associated receivables) recognised in the financial statements may be misstated. We identified the accounting for the contract arrangements with commissioning bodies (in particular the consistency of the income with contract terms) as one of the risks that had the greatest impact on our audit strategy.


Income from commissioners

Other income from activities

Other income

Operating income 2014/15

Our response: Our audit work included, but was not restricted to, assessing the Trust’s accounting policy for revenue recognition, understanding management’s processes to recognise this income in accordance with the stated accounting policy, performing walk-throughs of management’s key controls over income recognition (for example controls over contract billing, pricing and agreement of contract variations) to assess whether they were designed effectively and substantively testing the income and associated receivables.

Our substantive testing included:• testing of recorded contract income amounts to signed contracts and agreed variations;• testing a sample of the contract variations to ensure they were accounted for appropriately and are not in dispute; and• testing of NHS debtors to after date receipts and supporting documentation.

The Trust’s accounting policy on revenue recognition is shown in note 1.1 to the financial statements and its analysis of its total operating income is included in notes 3 and 4.

Our findings:We did not identify any material errors in the valuation of income from commissioners from our testing, but we noted some non-trivial misstatements which we have reported to Those Charged with Governance at the Trust (the Audit Committee) in our Audit Findings Report. Management have decided to correct the majority of these misstatements, but provided us with a written response to confirm why they had decided not to amend the financial statements for one of the non-trivial misstatements. We have confirmed with the Audit Committee that they agree with management that, because of the immaterial impact, no adjustment need be made.

98%


Completeness of employee remuneration and operating expenses and associated payablesThe risk: The majority of the Trust’s expenditure relates to employee remuneration and operating expenses. Together they account for 99% of the Trust’s gross expenditure. The Trust pays the majority of this expenditure through its payroll and accounts payable systems and at the year-end estimates and accrues for un-invoiced expenses. Invoices for the final weeks of the year are not received and processed until after the year-end and in many cases after the deadline for the production of the financial statements. There is therefore a risk that the expenses (and associated payables) recognised in the financial statements may be misstated. We identified the completeness of employee remuneration and operating expenses (in particular the understatement of accruals) as risks that had the greatest impact on our audit strategy.

Depreciation and impairment 1%

Other operating expenses

Drugs

Expenditure 2014/15

Supplies and services

Other operating expenses

30%

Employee remuneration

69%

Our response: Our audit work included, but was not restricted to, understanding management’s processes to recognise payroll and accounts payable expenditure and year-end accruals for unprocessed invoices and expenditure incurred and not yet invoiced (GRNI), walking through management’s key controls over recognition of expenditure (for example, processing of adjustments and authorisation of payments) to assess whether they were designed effectively and substantively testing expenditure and associated payables.

Our substantive testing included:

• testing the reconciliation of employee remuneration expenditure in the financial statements to the general ledger and payroll subsystems;• performing a trend analysis of payroll costs to identify any unusual cost variations for

follow up;• sample testing payroll expenditure to source documents;• assessing whether the Trust’s processes for accruing for GRNIs were sufficiently robust to ensure that uninvoiced expenditure had been accrued for appropriately;• sample testing accruals to post year-end invoices; and• testing a sample of post year-end payments to confirm the completeness of accruals.


The Trust’s accounting policy for recognition of expenditure is shown in note 1, its analysis of employee remuneration costs is included in note 7 and its analysis of operating costs is included in note 5 to the financial statements.

Our findings:We did not identify any material errors in the completeness of the employee remuneration from our testing, but we identified one non-trivial misstatement in respect of this expenditure which we have reported to the Audit Committee in our Audit Findings Report. Management provided us with a written response to confirm why they have decided not to amend the financial statements for this non-trivial misstatement. We have confirmed with the Audit Committee that they agree with management that, because of the immaterial impact, no adjustment need be made.

We identified a material error and some non-trivial misstatements in the completeness of operating expenses from our testing which we have reported to the Audit Committee in our Audit Findings Report. Management agreed to amend the financial statements to correct the material error and all but one of these non-trivial misstatements. Management provided us with a written response to confirm why they have decided not to amend the financial statements for the non-trivial misstatement. We have confirmed with the Audit Committee that they agree with management that, because of the immaterial impact, no adjustment need be made.

Our application of materiality and an overview of the scope of our audit MaterialityWe define materiality as the magnitude of misstatement in the financial statements that makes it probable that the judgement of a reasonably knowledgeable person would be changed or influenced.

We determined materiality for the audit of the financial statements as a whole to be £1,142,000, which is 2% of the Trust’s gross operating costs. This benchmark is considered the most appropriate because users of the financial statements are particularly interested in how healthcare funding has been spent. We use a different level of materiality, performance materiality, to drive the extent of our testing and this was set at 75% of financial statement materiality. We also determine a lower level of specific materiality for certain areas such as senior officer remuneration.

We determined the threshold at which we will communicate misstatements to the Trust’s Audit Committee to be £57,000. In addition we communicate misstatements below that threshold that, in our view, warrant reporting on qualitative grounds.

Overview of the scope of our auditWe conducted our audit in accordance with International Standards on Auditing (ISAs) (UK and Ireland) having regard to the Financial Reporting Council’s Practice Note 10 ‘Audit of Financial Statements of Public Bodies in the UK (Revised)’. Our responsibilities under the Code and the ISAs (UK and Ireland) are further described in the ‘Responsibilities for the financial statements and the audit’ section of our report. We believe that the audit evidence we have obtained from our audit is sufficient and appropriate to provide a basis for our opinion.


We are independent of the Trust in accordance with the Auditing Practices Board’s Ethical Standards for Auditors, and we have fulfilled our other ethical responsibilities in accordance with those Ethical Standards.

Our audit approach was based on a thorough understanding of the Trust’s business and is risk based. The Trust’s payroll service is provided by a third party. Accordingly, our audit work was focused on obtaining an understanding of, and evaluating, relevant internal controls at both the Trust and its third party service provider.

Annual report

Allocation of audit fieldwork time

Otherstatements

We undertook substantive testing on significant transactions, balances and disclosures in the financial statements, the extent of which was based on various factors such as our overall assessment of the Trust’s control environment, the design effectiveness of controls over significant financial systems and the management of risks.

Other reporting required by regulations

Our opinion on other matters prescribed by the Audit Code for NHS Foundation Trusts is unmodified

In our opinion:

• the part of the Directors’ Remuneration Report subject to audit has been properly prepared in accordance with the NHS Foundation Trust Annual Reporting Manual

2014-15 issued by Monitor; and• the information given in the strategic report and directors’ report for the five month

financial period for which the financial statements are prepared is consistent with the financial statements.

Income from activities

Operating expenses

Employee remuneration

Other income andcosts

Non current assetsInventoriesCash and borrowings

Other net current assets

Public dividend capital and reserves

Journal entries

Accounting policies and other disclosures


Matters on which we are required to report by exceptionWe have nothing to report in respect of the following:

Under the Code we are required to report to you if, in our opinion:• the Annual Governance Statement does not meet the disclosure requirements

set out in the NHS Foundation Trust Annual Reporting Manual or is misleading or inconsistent with the information of which we are aware from our audit;

• we have not been able to satisfy ourselves that the Trust has made proper arrangements for securing economy, efficiency and effectiveness in its use of

resources; or• the Trust’s Quality Report has not been prepared in line with the requirements set

out in Monitor’s published guidance or is inconsistent with other sources of evidence.

Under the ISAs (UK and Ireland), we are also required to report to you if, in our opinion, information in the annual report is:

• materially inconsistent with the information in the audited financial statements; or• apparently materially incorrect based on, or materially inconsistent with, our knowledge of the Trust acquired in the course of performing our audit; or• otherwise misleading.

In particular, we are required to report to you if:• we have identified any inconsistencies between our knowledge acquired during the

audit and the directors’ statement that they consider the annual report is fair, balanced and understandable; or• the annual report does not appropriately disclose those matters that were communicated to the Audit Committee which we consider should have been disclosed.

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

What the Chief Executive is responsible for as accounting officer:As explained more fully in the Chief Executive’s Responsibilities Statement, the Chief Executive as Accounting Officer is responsible for the preparation of the financial statements in the form and on the basis set out in the Accounts Direction issued by Monitor and for being satisfied that they give a true and fair view.


What are we responsible for:Our responsibility is to audit and express an opinion on the financial statements in accordance with applicable law, the Audit Code for NHS Foundation Trusts issued by Monitor, and ISAs (UK and Ireland). Those standards require us to comply with the Auditing Practices Board’s Ethical Standards for Auditors.

CertificateWe certify that we have completed the audit of the financial statements of Bridgewater Community Healthcare NHS Foundation Trust in accordance with the requirements of Chapter 5 of Part 2 of the National Health Service Act 2006 and the Audit Code for NHS Foundation Trusts issued by Monitor.

Mark HeapDirectorfor and on behalf of Grant Thornton UK LLP

4 Hardman Square Spinningfields MANCHESTERM3 3EB

June 2015


8: Full Annual Accounts for the part year ended 31 March 2015

Accounts for the period from 1st November 2014 to 31 March 2015 Foreword to the accounts These accounts, for the period ended 31 March 2015, have been prepared by Bridgewater Community Healthcare NHS Foundation Trust in accordance with paragraphs 24 & 25 of Schedule 7 within the National Health Service Act 2006.

Colin Scales Chief Executive

Statement of Comprehensive Income

2014-15: For the 5

months ending 31

March 2015

Note £000

Operating income from patient care activities 3 62,045 Other operating income 4 1,021 Total operating income from continuing operations

63,066

Operating expenses 5, 7 (62,733) Operating surplus/(deficit) from continuing operations

333

Finance income 10 8 Finance expenses

-

PDC dividends payable

(187) Net finance costs

(179)

Surplus/(deficit) for the year from continuing operations

154

Other comprehensive income

Will not be reclassified to income and expenditure: Revaluations 14 360

Total other comprehensive income/(expense) for the

360

Page 104

period Total comprehensive income/(expense) for the period

514

Allocation of profits for the period:

Surplus for the period attributable to owners of the parent

154

Total comprehensive income for the period attributable to owners of the parent 514

Statement of Financial Position

Opening Position

31 March 2015

1 November 2014

Note £000

£000

Non-current assets Intangible assets

13 108

128 Property, plant and equipment 14 22,575

17,386

Trade and other receivables

19 640

686

Total non-current assets

23,323

18,200

Current assets Inventories

18 39

952 Trade and other receivables

19 10,038

11,746

Cash and cash equivalents

23 5,861

5,349

Total current assets

15,938

18,047 Current liabilities

Trade and other payables

24 (16,431)

(16,784)

Provisions

29 (34)

(47) Total current liabilities

(16,465)

(16,831)

Total assets less current liabilities

22,796

19,416 Non-current liabilities


24 -

-

Other liabilities

26 -

- Borrowings

27 -

-

Other financial liabilities

25 -

-

Provisions

29 -

- Total non-current

-

-

Statement of Comprehensive Income

Page 104


514



154



Opening Position

31 March 2015

1 November 2014

Note £000

£000


13 108


17,386


19 640

686


23,323

18,200


18 39


19 10,038

11,746


23 5,861

5,349


15,938



24 (16,431)

(16,784)

Provisions

29 (34)


(16,465)

(16,831)


22,796



24 -

-

Other liabilities

26 -

- Borrowings

27 -

-


25 -

-

Provisions

29 -

- Total non-current

-

-


Page 104


514



154



Opening Position

31 March 2015

1 November 2014

Note £000

£000


13 108


17,386


19 640

686


23,323

18,200


18 39


19 10,038

11,746


23 5,861

5,349


15,938



24 (16,431)

(16,784)

Provisions

29 (34)


(16,465)

(16,831)


22,796



24 -

-

Other liabilities

26 -

- Borrowings

27 -

-


25 -

-

Provisions

29 -

- Total non-current

-

-

Page 105

liabilities Total assets employed

22,796

19,416

Financed by Public dividend capital

4,962

4,121 Revaluation reserve

4,814

4,454

Income and expenditure reserve

13,020

10,841 Total taxpayers' equity

22,796

19,416

The notes on pages 25 to 62 form part of these accounts.

Colin Scales

Chief Executive Date 12 June 2015

Public dividend

capital Revaluation

reserve

Income and expenditure

reserve Total

£000 £000 £000 £000

Taxpayers equity at 1 November 2014 - brought forward 4,121 4,454 10,841 19,416 Opening adjustment

2,025 2,025

Surplus/(deficit) for the year - - 154 154 Revaluations - 360 - 360 Public dividend capital received 841 - - 841 Taxpayers equity at 31 March 2015 4,962 4,814 13,020 22,796

Information on reserves 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. Additional PDC may also be issued to NHS foundation trusts by the Department of Health. A charge, reflecting the cost of capital utilised by the NHS foundation trust, is payable to the Department of Health as the public dividend capital dividend. Revaluation reserve Increases in asset values arising from revaluations are recognised in the revaluation reserve, except where, and to the extent that, they reverse impairments previously recognised in operating expenses, in which case they are recognised in operating income. Subsequent downward movements in asset valuations are charged to the revaluation reserve to the extent that a previous gain was recognised unless the downward movement represents a clear consumption of economic benefit or a reduction in service potential. Income and expenditure reserve



Page 105

liabilities Total assets employed

22,796

19,416

Financed by Public dividend capital

4,962

4,121 Revaluation reserve

4,814

4,454

Income and expenditure reserve

13,020

10,841 Total taxpayers' equity

22,796

19,416

The notes on pages 25 to 62 form part of these accounts.

Colin Scales

Chief Executive Date 12 June 2015

Public dividend

capital Revaluation

reserve

Income and expenditure

reserve Total

£000 £000 £000 £000

Taxpayers equity at 1 November 2014 - brought forward 4,121 4,454 10,841 19,416 Opening adjustment

2,025 2,025

Surplus/(deficit) for the year - - 154 154 Revaluations - 360 - 360 Public dividend capital received 841 - - 841 Taxpayers equity at 31 March 2015 4,962 4,814 13,020 22,796

Information on reserves 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. Additional PDC may also be issued to NHS foundation trusts by the Department of Health. A charge, reflecting the cost of capital utilised by the NHS foundation trust, is payable to the Department of Health as the public dividend capital dividend. Revaluation reserve Increases in asset values arising from revaluations are recognised in the revaluation reserve, except where, and to the extent that, they reverse impairments previously recognised in operating expenses, in which case they are recognised in operating income. Subsequent downward movements in asset valuations are charged to the revaluation reserve to the extent that a previous gain was recognised unless the downward movement represents a clear consumption of economic benefit or a reduction in service potential. Income and expenditure reserve

Information on reserves

Public dividend capitalPublic 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. Additional PDC may also be issued to NHS foundation trusts by the Department of Health. A charge, reflecting the cost of capital utilised by the NHS foundation trust, is payable to the Department of Health as the public dividend capital dividend.

Revaluation reserveIncreases in asset values arising from revaluations are recognised in the revaluation reserve, except where, and to the extent that, they reverse impairments previously recognised in operating expenses, in which case they are recognised in operating income. Subsequent downward movements in asset valuations are charged to the revaluation reserve to the extent that a previous gain was recognised unless the downward movement represents a clear consumption of economic benefit or a reduction in service potential.

The notes on pages 114 to 148 form part of these accounts


Income and expenditure reserveThe balance of this reserve is the accumulated surpluses and deficits of the NHS foundation trust.

The opening adjustment of £2,025k reflects the change in accounting policy disclosed at note 1.4 with regard to capitalisation of wheelchair and home loans supplies as Property Plant and Equipment. This change in accounting policy also refle SoFP and related notes as summarised below:

• Property, plant and equipment - £2,946k debit (increase)• Inventory - £921k credit (decrease)• Income and Expenditure Reserve - £2,025k credit (increase)

Page 106

The balance of this reserve is the accumulated surpluses and deficits of the NHS foundation trust. The opening adjustment of £2,025k reflects the change in accounting policy disclosed at note 1.4 with regard to capitalisation

of wheelchair and home loans supplies as Property Plant and Equipment. This change in accounting policy also reflects the SoFP and related notes as summarised below:

- Property, plant and equipment - £2,946k debit (increase) - Inventory - £921k credit (decrease) - Income and Expenditure Reserve - £2,025k credit (increase)

Statement of Cash Flows

2014-15: For the 5

months ending 31

March 2015

Note £000

Cash flows from operating activities Operating surplus/(deficit)

333 Non-cash income and expense:

Depreciation and amortisation 5 643 (Increase)/decrease in receivables and other assets

1,754

(Increase)/decrease in inventories

(8) Increase/(decrease) in payables and other liabilities

(1,166)

Increase/(decrease) in provisions

(13) Net cash generated from/(used in) operating activities

1,543

Cash flows from investing activities Interest received

8 Purchase of property, plant, equipment and investment property

(1,655)

Net cash generated from/(used in) investing activities

(1,647) Cash flows from financing activities

Public dividend capital received

841 PDC dividend paid

(225)

Net cash generated from/(used in) financing activities

616 Increase/(decrease) in cash and cash equivalents

512

Cash and cash equivalents at 01 November

5,349 Cash and cash equivalents at 31 March 23 5,861

Note 1 Accounting policies and other information

Basis of preparation

Statement of Cash Flows


Note 1 Accounting policies and other information

Basis of preparationMonitor has directed that the financial statements of NHS foundation trusts shall meet the accounting requirements of the FT ARM which shall be agreed with HM Treasury. Consequently, the following financial statements have been prepared in accordance with the FT ARM 2014/15 issued by Monitor. The accounting policies contained in that manual follow IFRS and HM Treasury’s 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.

Accounting conventionThese 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.

Going concernThese accounts have been prepared on a going concern basis.

Note 1.1 IncomeIncome 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.

Where income is received for a specific activity which is to be delivered in a subsequent financial year, that income is deferred.

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.

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 Pension’s 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.

Note 1.2 Expenditure on employee benefits

Short-term employee benefitsSalaries, 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

NHS Pension SchemePast and present employees are covered by the provisions of the NHS Pension Scheme. The scheme is an unfunded, defined benefit scheme that covers NHS employers, general practices and other bodies, allowed under the direction of Secretary of State, in England and Wales. It is not possible for the NHS foundation trust to identify its share of the underlying scheme liabilities. Therefore, the scheme is accounted for as a defined contribution scheme.Employers pension cost contributions are charged to operating expenses as and when they become due.

Additional pension liabilities arising from early retirements are not funded by the scheme except where the retirement is due to ill-health. The full amount of the liability for the additional costs is charged to the operating expenses at the time the trust commits itself to the retirement, regardless of the method of payment.

Note 1.3 Expenditure on other goods and servicesExpenditure 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.

Note 1.4 Property, plant and equipmentRecognitionProperty, 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; and• the cost of the item can be measured reliably• the item has cost more than £5,000• items are/to be issued in the community, with specific reference to Wheelchair and

Home Loans Community services, where the individual item cost is at least £250. The decision to treat these assets as PPE rather than inventory is considered to be a

critical accounting judgement.• collectively, a number of items have a cost of at least £5,000 and individually have a

cost of more than £250, where the assets are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are under single managerial control; or

• items form part of the initial equipping and setting-up cost of a new building, 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, eg, plant and equipment, then these components are treated as separate assets and depreciated over their own useful economic lives.


MeasurementValuationAll 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.

All assets are measured subsequently at fair value. Land and buildings used for the Trust’s services or for administrative purposes are stated in the statement of financial position at their revalued amounts, being the fair value at the date of revaluation less any impairment.

For equipment within Wheelchairs and Homeloans on issue the Trust has adopted a depreciated historical cost basis as a proxy for fair value in respect of these low value/short life assets.

Revaluations are performed with sufficient regularity to ensure that carrying amounts are not materially different from those that would be determined at the end of the reporting period. Fair values are determined as follows:

• Land and non-specialised buildings - market value of existing use• Specialised buildings - depreciated replacement cost

Subsequent expenditureSubsequent 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.

DepreciationItems 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 gains and lossesRevaluation 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.


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’.

ImpairmentsIn accordance with the FT ARM, impairments that arise from a clear consumption of economic benefits or of 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 that arises from a clear consumption of economic benefit or of 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-recognitionAssets 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 ie:• management are committed to a plan to sell the asset;• an active programme has begun to find a buyer and complete the sale;• the asset is being actively marketed at a reasonable price;• the sale is expected to be completed within 12 months of the date of classification as ‘held for sale’; and• 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.

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 assetsDonated 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.

Private Finance Initiative (PFI) transactionsPFI 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.

The Trust has not entered into any PFI transactions

Useful Economic lives of property, plant and equipmentUseful economic lives reflect the total life of an asset and not the remaining life of an asset. The range of useful economic lives are shown in the table below:

Finance-leased assets (including land) are depreciated over the shorter of the useful economic life or the lease term, unless the FT expects to acquire the asset at the end of the lease term in which case the assets are depreciated in the same manner as owned assets above.

Note 1.5 Intangible assetsRecognitionIntangible 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.

Min life Years Max life YearsLand - -Buildings, excluding dwellings 5 88Dwellings - -Assets under construction - -Plant & machinery 1 10Transport equipment - -Information technology 1 5 Furniture & fittings 1 5Wheelchairs/home loans equipment 1 5


Internally generated intangible assetsInternally 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.

SoftwareSoftware which is integral to the operation of hardware, eg 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, eg application software, is capitalised as an intangible asset.

MeasurementIntangible 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”.

AmortisationIntangible assets are amortised over their expected useful economic lives in a manner consistent with the consumption of economic or service delivery benefits.


Useful economic life of intangible assetsUseful economic lives reflect the total life of an asset and not the remaining life of an asset. The range of useful economic lives are shown in the table below:

Note 1.6 Revenue government and other grantsGovernment grants are grants from Government bodies other than income from commissioners or NHS trusts 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.

Note 1.7 InventoriesInventories are valued at the lower of cost and net realisable value. The cost of inventories is measured using the first -in first-out cost formula. This is considered to be a reasonable approximation to fair value due to the high turnover of stocks

Note 1.8 Financial instruments and financial liabilitiesRecognitionFinancial 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.

De-recognitionAll 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 measurementFinancial assets are categorised as “loans and receivables”. Financial liabilities are classified as “other financial liabilities”

Intangible assets - internally generated Min life Years Max life YearsInformation technology 1 5Development expenditure - -Other - -

Intangible assets - purchasedSoftware - - Licences & trademarks - - Patents - -Other - -Goodwill - -


Loans and receivablesLoans 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: cash and cash equivalents and trade and other receivables excluding non financial assets.

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.

Other financial liabilitiesAll 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.

Determination of fair valueFor financial assets and financial liabilities carried at fair value, the carrying amounts are determined from quoted market prices, independent appraisals and discounted cash flow analysis

Impairment of financial assetsAt the Statement of Financial Position date, the trust assesses whether any financial assets, other than those held at “fair value through income and expenditure” are impaired. Financial assets are impaired and impairment losses are recognised if, and only 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.

For financial assets carried at amortised cost, the amount of the impairment loss is measured as the difference between the asset’s carrying amount and the present value of the revised future cash flows discounted at the asset’s original effective interest rate. The loss is recognised in the Statement of Comprehensive Income and the carrying amount of the asset is reduced directly.


Note 1.9 Leases

Finance leasesWhere substantially all risks and rewards of ownership of a leased asset are borne by the NHS foundation trust, the asset is recorded as property, plant and equipment and a corresponding liability is recorded. The value at which both are recognised is the lower of the fair value of the asset or the present value of the minimum lease payments, discounted using the interest rate implicit in the lease.

The asset and liability are recognised at the commencement of the lease. Thereafter the asset is accounted for an item of property plant and equipment.

The annual rental is split between the repayment of the liability and a finance cost so as to achieve a constant rate of finance over the life of the lease. The annual finance cost is charged to Finance Costs in the Statement of Comprehensive Income. The lease liability, is de-recognised when the liability is discharged, cancelled or expires.

Operating leasesOther leases are regarded as operating leases and the rentals are charged to operating expenses on a straight-line basis over the term of the lease. Operating lease incentives received are added to the lease rentals and charged to operating expenses over the life of the lease.

Leases of land and buildingsWhere a lease is for land and buildings, the land component is separated from the building component and the classification for each is assessed separately.

Note 1.10 ProvisionsThe 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.

Clinical negligence costsThe NHS Litigation Authority (NHSLA) operates a risk pooling scheme under which the NHS foundation 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 NHS foundation trust. The total value of clinical negligence provisions carried by the NHSLA on behalf of the NHS foundation trust is disclosed at note 30 but is not recognised in the NHS foundation trust’s accounts.

Non-clinical risk poolingThe NHS foundation 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.

Note 1.11 ContingenciesContingent assets (that is, assets arising from past events whose existence will only be confirmed by one or more future events not wholly within the entity’s control) are not recognised as assets, but are disclosed in note 30 where an inflow of economic benefits is probable.

Contingent liabilities are not recognised, but are disclosed in note 30, unless the probability of a transfer of economic benefits is remote.

Contingent liabilities are defined as:

• possible obligations arising from past events whose existence will be confirmed only by the occurrence of one or more uncertain future events not wholly within the entity’s control; or

• present obligations arising from past events but for which it is not probable that a transfer of economic benefits will arise or for which the amount of the obligation

cannot be measured with sufficient reliability.

Note 1.12 Public dividend capitalPublic 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, and (iii) 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.

Note 1.13 Value added taxMost 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.Note 1.14 Corporation taxThe Trust has determined that it has no corporation tax liability as it does not operate any commercial activities that are not part of core health care delivery.


Note 1.15 Foreign exchangeThe functional and presentational currencies of the trust are sterling.

A transaction which is denominated in a foreign currency is translated into the functional currency at the spot exchange rate on the date of the transaction.

Where the trust has assets or liabilities denominated in a foreign currency at the Statement of Financial Position date:

• monetary items (other than financial instruments measured at “fair value through income and expenditure”) are translated at the spot exchange rate on 31 March;• non-monetary assets and liabilities measured at historical cost are translated using

the spot exchange rate at the date of the transaction; and• non-monetary assets and liabilities measured at fair value are translated using the

spot exchange rate at the date the fair value was determined.

Exchange gains or losses on monetary items (arising on settlement of the transaction or on re-translation at the Statement of Financial Position date) are recognised in income or expense in the period in which they arise.

Exchange gains or losses on non-monetary assets and liabilities are recognised in the same manner as other gains and losses on these items.

Note 1.16 Third party assetsAssets belonging to third parties (such as money held on behalf of patients) are not recognised in the accounts since the NHS foundation trust has no beneficial interest in them. However, they are disclosed in a separate note to the accounts in accordance with the requirements of HM Treasury’s FReM.

Note 1.17 Losses and special paymentsLosses 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.

Note 1.18 Transfers of functions to / from other NHS bodies / local government bodiesNo functions have been trasnferred from another NHS or local government body.


Note 1.19 Early adoption of standards, amendments and interpretationsNo new accounting standards or revisions to existing standards have been early adopted in 2014-15.

Note 1.20 Standards, amendments and interpretations in issue but not yet effective or adoptedAs required by IAS 8, foundation trusts should disclose any standards, amendments and interpretations that have been issued but are not yet effective or adopted for the public sector and an assessment subsequent application will have on the financial statements. The application of the Standards as revised would not have a material impact on the accounts for 2014-15, were they applied in that year:

IFRS 9 Financial Instruments - subject to consultation - subject to consultation IFRS 13 Fair Value Measurement - subject to consultationIFRS 15 Revenue from Contracts with Customers

Note 1.21 Critical accounting estimates and judgementsIn 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 the revision and future periods if the revision affects both current and future periods.

The following are the critical judgements, apart from those involving estimations (see below) that management has made in the process of applying the Trust’s accounting policies and that have the most significant effect on the amounts recognised in the financial statements.

Critical judgements have been made in assessing the classification of estates rental charges, between operating and finance leases.

Additionally a critical judgement has been made not to consolidate the Bridgewater element of the registered charity 5 Boroughs Partnership NHS Trust Charitable Fund (charity number 1061651). In making this judgement the Trust has made reference to the Annual Reporting Manual. The Bridgewater element of this fund is managed under an SLA with 5 Boroughs Parnership NHS Trust. Whilst Bridgewater is able to requisition expenditure from this fund within the constraints of the fund objective, corporate trusteeship of the fund remains with 5 Boroughs Partnership NHS Trust. Where a body acts as corporate trustee, there is a presumption that the body possesses ‘control’ of the fund. Therefore there is no need for Bridgewater to consolidate.


A full valuation of the Trusts estate was undertaken on 31st March 2014 by the District Valuer who is a qualified surveyor registered with the Royal Institute of Chartered Surveyors. The impact of this valuation was reflected in the accounts as at the 31st March 2014. Subsequently a desk top valuation of the Trust’s estate was obtained on 31 March 2015 and this has been the basis for the valuation as at 31st March 2015.

Note 2 Operating SegmentsBridgewater Community Healthcare NHS Foundation Trust operates in a single segment, the provision of healthcare community services. There are therefore no reportable segments.

Income from transactions with the following organisations is in excess of 10% of total income.

Page 121

A full valuation of the Trusts estate was undertaken on 31st March 2014 by the District Valuer who is a qualified surveyor registered with the Royal Institute of Chartered Surveyors. The impact of this valuation was reflected in the accounts as at the 31st March 2014. Subsequently a desk top valuation of the Trust's estate was obtained on 31 March 2015 and this has been the basis for the valuation as at 31st March 2015.

Note 2 Operating Segments

Bridgewater Community Healthcare NHS Foundation Trust operates in a single segment, the provision of healthcare community services.

There are therefore no reportable segments.

Income from transactions with the following organisations is in excess of 10% of total income.

2014-15: For the 5

months ending 31

March 2015

£000

CCGs and NHS England 53,393 Local authorities

6,769

Note 3 Operating income from patient care activities

Note 3.1 Income from patient care activities (by nature)

2014-15:

For the 5 months ending 31 March 2015

£000 Community services

Community services income from CCGs and NHS England 53,393 Community services income from other commissioners 8,652 Total income from activities 62,045

Note 3.2 Income from patient care activities (by source)

Note 3 Operating income from patient care activities

Note 3.1 Income from patient care activities (by nature)


Page 122

Income from patient care activities received from: 2014-15: For the 5 months

ending 31 March 2015

£000

CCGs and NHS England 53,393 Local authorities 6,769 Other NHS foundation trusts 151 NHS trusts 168 NHS other 519 NHS injury scheme (was RTA) 284 Non NHS: other 761 Total income from activities 62,045 Of which:

Related to continuing operations 62,045 Related to discontinued operations -

Revenue from patient care services includes income accrued for activity where data is not available at 31st March 2015. Wherever possible reference is made back to final data but estimates and assumptions are applied in order to ensure the completeness of income reported. Injury cost recovery scheme is subject to a provision for impairment of receivables of 18.9% (13/14:15.8%) to reflect expected rates of collection.

Note 4 Other operating income

2014-15: For the 5 months


£000

Research and development - Education and training 1,021 Receipt of capital grants and donations - Charitable and other contributions to expenditure - Non-patient care services to other bodies - Profit on disposal of non-current assets - Reversal of impairments - Rental revenue from operating leases - Rental revenue from finance leases - Amortisation of PFI deferred credits - Income in respect of staff costs where accounted on gross basis - Other income - Total other operating income 1,021 Of which:

Related to continuing operations 1,021 Related to discontinued operations -

Revenue from patient care services includes income accrued for activity where data is not available at 31st March 2015. Wherever possible reference is made back to final data but estimates and assumptions are applied in order to ensure the completeness of income reported.

Injury cost recovery scheme is subject to a provision for impairment of receivables of 18.9% (13/14:15.8%) to reflect expected rates of collection.

Note 4 Other operating income

Note 3.2 Income from patient care activities (by source)

Income from patient care activities received from


Page 123

Note 4.1 Income from activities arising from commissioner requested services

Under the terms of its Provider License, the trust is required to analyse the level of income from activities that has arisen from commissioner requested and non-commissioner requested services. Commissioner requested services are defined in the provider license and are services that commissioners believe would need to be protected in the event of provider failure. This information is provided in the table below:

2014-15

£000 Income from services designated (or grandfathered) as

commissioner requested services 62,045 Income from services not designated as commissioner

requested services - Total 62,045

Note 5 Operating expenses

2014-15: For the 5 months ending 31 March

2015

£000

Services from NHS foundation trusts 1,741 Services from NHS trusts 1,138 Services from CCGs and NHS England 139 Services from other NHS bodies - Purchase of healthcare from non NHS bodies 322 Purchase of social care - Employee expenses - executive directors 277 Employee expenses - non-executive directors 42 Employee expenses - staff 43,234 Supplies and services - clinical 3,436 Supplies and services - general 1,332 Establishment 998 Research and development - Transport 971 Premises 1,887 Increase/(decrease) in provision for impairment of receivables 27 Increase/(decrease) in other provisions 11 Change in provisions discount rate(s) - Inventories written down - Drug costs 687 Inventories consumed - Rentals under operating leases 4,955 Depreciation on property, plant and equipment 623




Page 123



2014-15

£000 Income from services designated (or grandfathered) as

commissioner requested services 62,045 Income from services not designated as commissioner

requested services - Total 62,045



2015

£000

Services from NHS foundation trusts 1,741 Services from NHS trusts 1,138 Services from CCGs and NHS England 139 Services from other NHS bodies - Purchase of healthcare from non NHS bodies 322 Purchase of social care - Employee expenses - executive directors 277 Employee expenses - non-executive directors 42 Employee expenses - staff 43,234 Supplies and services - clinical 3,436 Supplies and services - general 1,332 Establishment 998 Research and development - Transport 971 Premises 1,887 Increase/(decrease) in provision for impairment of receivables 27 Increase/(decrease) in other provisions 11 Change in provisions discount rate(s) - Inventories written down - Drug costs 687 Inventories consumed - Rentals under operating leases 4,955 Depreciation on property, plant and equipment 623


Page 124

Amortisation on intangible assets 20 Impairments - Audit fees payable to the external auditor

audit services- statutory audit 53 audit services- regulatory reporting (external auditor

only) - other auditor remuneration (external auditor only) -

Clinical negligence 108 Loss on disposal of non-current assets - Legal fees 125 Consultancy costs 308 Training, courses and conferences 125 Patient travel - Car parking & security - Redundancy - Early retirements - Hospitality 5 Publishing - Insurance 6 Other services, eg external payroll - Grossing up consortium arrangements - Losses, ex gratia & special payments - Other 163 Total 62,733 Of which: Related to continuing operations 62,733 Related to discontinued operations -

Operating expenses includes expenditure accrued for which no invoice has been received by 31st March 2015. In some cases it is necessary to use estimates based on knowledge of goods and services received. Wherever possible reference is made back to the value of orders but estimates and assumptions are applied in order to ensure the completeness of expenditure reported. Due to the volume of transactions adjustments are not made to prior periods unless the difference between the estimate and the actual value is material

For expenditure accruals, any variation in outcome compared to the estimates used are accounted for in the next period. These estimates and assumptions are consistent with the previous year

Directors remuneration is set out above and includes employer contributions to the NHS Pension Scheme

Note 5.1 Other auditor remuneration


2015

£000






Page 125

Other auditor remuneration paid to the external auditor: 1. Audit of accounts of any associate of the trust -

2. Audit-related assurance services - 3. Taxation compliance services - 4. All taxation advisory services not falling within item 3 above - 5. Internal audit services - 6. All assurance services not falling within items 1 to 5 - 7. Corporate finance transaction services not falling within items

1 to 6 above - 8. Other non-audit services not falling within items 2 to 7 above - Total -

Note 5.2 Limitation on auditor's liability

The limitation on auditors liability for external audit work carried out for the financial years 2014-15 is £2 million.

Note 6 Impairment of assets

There has been no impairment of assets in the reporting period

Note 7 Employee benefits


2015

Permanent

Other

Total

£000

£000

£000

Salaries and wages 34,608

84 34,692 Social security costs 2,559

140 2,699

Employer's contributions to NHS pensions 4,379

- 4,379 Pension cost - other 4

- 4

Other post-employment benefits -

- - Other employment benefits -

- -

Termination benefits -

- - Agency/contract staff -

2,338 2,338

Total gross staff costs 41,550 2,562 44,112 Recoveries in respect of seconded staff -

- -

Total staff costs 41,550 2,562 44,112 Included within: Costs capitalised as part of assets 46

555 601

Note 7.1 Average number of employees (WTE basis)

Note 5.2 Limitation on auditor’s liabilityThe limitation on auditors liability for external audit work carried out for the financial years 2014-15 is £2 million.

Note 6 Impairment of assetsThere has been no impairment of assets in the reporting period

Page 124

Amortisation on intangible assets 20 Impairments - Audit fees payable to the external auditor

audit services- statutory audit 53 audit services- regulatory reporting (external auditor

only) - other auditor remuneration (external auditor only) -

Clinical negligence 108 Loss on disposal of non-current assets - Legal fees 125 Consultancy costs 308 Training, courses and conferences 125 Patient travel - Car parking & security - Redundancy - Early retirements - Hospitality 5 Publishing - Insurance 6 Other services, eg external payroll - Grossing up consortium arrangements - Losses, ex gratia & special payments - Other 163 Total 62,733 Of which: Related to continuing operations 62,733 Related to discontinued operations -






2015

£000



Page 125

Other auditor remuneration paid to the external auditor: 1. Audit of accounts of any associate of the trust -

2. Audit-related assurance services - 3. Taxation compliance services - 4. All taxation advisory services not falling within item 3 above - 5. Internal audit services - 6. All assurance services not falling within items 1 to 5 - 7. Corporate finance transaction services not falling within items

1 to 6 above - 8. Other non-audit services not falling within items 2 to 7 above - Total -

Note 5.2 Limitation on auditor's liability

The limitation on auditors liability for external audit work carried out for the financial years 2014-15 is £2 million.

Note 6 Impairment of assets

There has been no impairment of assets in the reporting period



2015

Permanent

Other

Total

£000

£000

£000

Salaries and wages 34,608

84 34,692 Social security costs 2,559

140 2,699

Employer's contributions to NHS pensions 4,379

- 4,379 Pension cost - other 4

- 4

Other post-employment benefits -

- - Other employment benefits -

- -

Termination benefits -

- - Agency/contract staff -

2,338 2,338

Total gross staff costs 41,550 2,562 44,112 Recoveries in respect of seconded staff -

- -

Total staff costs 41,550 2,562 44,112 Included within: Costs capitalised as part of assets 46

555 601



Page 126

2014-15: For the 5 months ending 31 March 2015

Permanent

Other

Total

Number

Number

Number

Medical and dental 62

46 108 Ambulance staff -

- -

Administration and estates 669

45 714 Healthcare assistants and other support staff 276

- 276

Nursing, midwifery and health visiting staff 1,168

41 1,209 Nursing, midwifery and health visiting learners 12

- 12

Scientific, therapeutic and technical staff 438

41 479 Social care staff -

- -

Agency and contract staff -

- - Bank staff -

- -

Other -

4 4 Total average numbers 2,625 177 2,802 Of which: Number of employees (WTE) engaged on capital projects 15

8 23

Note 7.2 Retirements due to ill-health

During the period from 1st November 2014 to 31st March 2015 there was 1 early retirement from the trust agreed on the grounds of ill-health. The estimated additional pension liability of this ill-health retirement is £27k. The cost of these ill-health retirements will be borne by the NHS Business Services Authority - Pensions Division.

Note 7.3 Reporting of compensation schemes - exit packages 2014-15

There were no exit packages agreed in the period from 1st November 2014 to 31st March 2015.

Note 7.4 Exit packages: other (non-compulsory) departure payments

There were no other exit packages agreed in the reporting period.

Note 7.5 Directors' remuneration

The aggregate amounts payable to directors were:

Note 7.2 Retirements due to ill-health

During the period from 1st November 2014 to 31st March 2015 there was 1 early retirement from the trust agreed on the grounds of ill-health. The estimated additional pension liability of this ill-health retirement is £27k.


The cost of these ill-health retirements will be borne by the NHS Business Services Authority - Pensions Division.

Note 7.3 Reporting of compensation schemes - exit packages 2014-15There were no exit packages agreed in the period from 1st November 2014 to 31st March 2015.

Note 7.4 Exit packages: other (non-compulsory) departure paymentsThere were no other exit packages agreed in the reporting period.

Note 7.5 Directors’ remunerationThe aggregate amounts payable to directors were:

Page 127

2014-15: For the 5 months ending 31

March 2015

£000

Salary

349 Taxable benefits

9

Performance related bonuses

0 Employer's pension contributions

37

Total

395

Further details of directors' remuneration can be found in the remuneration report.

Note 8 Pension costs

Past and present employees are covered by the provisions of the NHS Pensions Scheme. Details of the benefits payable under these provisions can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions. The scheme is an unfunded, defined benefit scheme that covers NHS employers, GP 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 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.

The scheme is subject to a full actuarial valuation every 4 years (until 2004, every 5 years) and an accounting valuation every year. An outline of these follows:

a) Full actuarial (funding) valuation The purpose of this valuation is to assess the level of liability in respect of the benefits due under the

scheme (taking into account its recent demographic experience), and to recommend the contribution rates to be paid by employers and scheme members. The last such valuation, which determined current contribution rates was undertaken as at 31 March 2004 and covered the period from 1 April 1999 to that date. The conclusion from the 2004 valuation was that the scheme had accumulated a notional deficit of £3.3 billion against the notional assets as at 31 March 2004.

In order to defray the costs of benefits, employers pay contributions at 14% of pensionable pay and most employees had up to April 2008 paid 6%, with manual staff paying 5%. Following the full actuarial review by the Government Actuary undertaken as at 31 March 2004, and after consideration of changes to the NHS Pension Scheme taking effect from 1 April 2008, his Valuation report recommended that employer contributions could continue at the existing rate of 14% of pensionable pay, from 1 April 2008, following the introduction of employee contributions on a tiered scale from 5% up to 8.5% of their pensionable pay depending on total earnings. On advice from the scheme actuary, scheme contributions may be varied from time to time to reflect changes in the scheme’s liabilities.

Further details of directors’ remuneration can be found in the remuneration report.

Note 8 Pension costsPast and present employees are covered by the provisions of the NHS Pensions Scheme. Details of the benefits payable under these provisions can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions. The scheme is an unfunded, defined benefit scheme that covers NHS employers, GP 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 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.

The scheme is subject to a full actuarial valuation every 4 years (until 2004, every 5 years) and an accounting valuation every year. An outline of these follows:

a) Full actuarial (funding) valuationThe purpose of this valuation is to assess the level of liability in respect of the benefits due under the scheme (taking into account its recent demographic experience), and to recommend the contribution rates to be paid by employers and scheme members. The last such valuation, which determined current contribution rates was undertaken as at 31 March 2004 and covered the period from 1 April 1999 to that date. The conclusion from the 2004 valuation was that the scheme had accumulated a notional deficit of £3.3 billion against the notional assets as at 31 March 2004.


In order to defray the costs of benefits, employers pay contributions at 14% of pensionable pay and most employees had up to April 2008 paid 6%, with manual staff paying 5%.

Following the full actuarial review by the Government Actuary undertaken as at 31 March 2004, and after consideration of changes to the NHS Pension Scheme taking effect from 1 April 2008, his Valuation report recommended that employer contributions could continue at the existing rate of 14% of pensionable pay, from 1 April 2008, following the introduction of employee contributions on a tiered scale from 5% up to 8.5% of their pensionable pay depending on total earnings.

On advice from the scheme actuary, scheme contributions may be varied from time to time to reflect changes in the scheme’s liabilities. b) Accounting valuationA valuation of the scheme liability is carried out annually by the scheme actuary as at the end of the reporting period by updating the results of the full actuarial valuation.

Between the full actuarial valuations at a two-year midpoint, a full and detailed member data-set is provided to the scheme actuary. At this point the assumptions regarding the composition of the scheme membership are updated to allow the scheme liability to be valued.

The valuation of the scheme liability as at 31 March 2011, is based on detailed membership data as at 31 March 2008 (the latest midpoint) updated to 31 March 2011 with summary global member and accounting data.

The latest assessment of the liabilities of the scheme is contained in the scheme actuary report, which forms part of the annual NHS Pension Scheme (England and Wales) Resource Account, published annually. These accounts can be viewed on the NHS Pensions website. Copies can also be obtained from The Stationery Office.

c) Scheme provisionsThe NHS Pension Scheme provided defined benefits, which are summarised below. This list is an illustrative guide only, and is not intended to detail all the benefits provided by the Scheme or the specific conditions that must be met before these benefits can be obtained:

The Scheme is a “final salary” scheme. Annual pensions are normally based on 1/80th for the 1995 section and of the best of the last three years pensionable pay for each year of service, and 1/60th for the 2008 section of reckonable pay per year of membership. Members who are practitioners as defined by the Scheme Regulations have their annual pensions based upon total pensionable earnings over the relevant pensionable service.

With effect from 1 April 2008 members can choose to give up some of their annual pension for an additional tax free lump sum, up to a maximum amount permitted under HMRC rules. This new provision is known as “pension commutation”.

Annual increases are applied to pension payments at rates defined by the Pensions (Increase) Act 1971, and are based on changes in retail prices in the twelve months ending 30 September in the previous calendar year.


Early payment of a pension, with enhancement, is available to members of the scheme who are permanently incapable of fulfilling their duties effectively through illness or infirmity. A death gratuity of twice final year’s pensionable pay for death in service, and five times their annual pension for death after retirement is payable.

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 the employer.

Members can purchase additional service in the NHS Scheme and contribute to money purchase AVC’s run by the Scheme’s approved providers or by other Free Standing Additional Voluntary Contributions (FSAVC) providers.

Page 129

Note 9 Operating leases



£000

Operating lease expense

Minimum lease payments 4,955

Contingent rents -

Less sublease payments received -

Total 4,955

31 March 2015

£000

Future minimum lease payments due:

- not later than one year; 10,183

- later than one year and not later than five years; 2,052

- later than five years. 1,556

Total 13,791

Future minimum sublease payments to be received -

Bridgewater Community Healthcare has included within lease costs occupancy charges in relation to occupancy of premises owned and controlled by NHS Property Services Ltd and Community Health Partnerships. Whilst we occupy properties from CHP and NHS Property Services under arrangements which which we consider to be operating leases, we do not have agreed formal lease arrangements in place. The minimum future year lease payments disclosed above therefore only include our expected costs for these properties for 2015/16. Note 10 Finance income



£000

Interest on bank accounts 8 Total 8

Note 11 Corporation tax

There was no corporation tax due in this reporting period

Note 12 Discontinued operations

There were no discontinued operations in this reporting


Bridgewater Community Healthcare has included within lease costs occupancy charges in relation to occupancy of premises owned and controlled by NHS Property Services Ltd and Community Health Partnerships. Whilst we occupy properties from CHP and NHS Property Services under arrangements which which we consider to be operating leases, we do not have agreed formal lease arrangements in place.

The minimum future year lease payments disclosed above therefore only include our expected costs for these properties for 2015/16.

Note 10 Finance income

Page 129




£000

Operating lease expense

Minimum lease payments 4,955

Contingent rents -

Less sublease payments received -

Total 4,955

31 March 2015

£000

Future minimum lease payments due:

- not later than one year; 10,183

- later than one year and not later than five years; 2,052

- later than five years. 1,556

Total 13,791

Future minimum sublease payments to be received -

Bridgewater Community Healthcare has included within lease costs occupancy charges in relation to occupancy of premises owned and controlled by NHS Property Services Ltd and Community Health Partnerships. Whilst we occupy properties from CHP and NHS Property Services under arrangements which which we consider to be operating leases, we do not have agreed formal lease arrangements in place. The minimum future year lease payments disclosed above therefore only include our expected costs for these properties for 2015/16. Note 10 Finance income



£000

Interest on bank accounts 8 Total 8

Note 11 Corporation tax

There was no corporation tax due in this reporting period

Note 12 Discontinued operations

There were no discontinued operations in this reporting


Note 11 Corporation taxThere was no corporation tax due in this reporting period

Note 12 Discontinued operationsThere were no discontinued operations in this reporting period

Note 13 Intangible assets - 2014-15

Page 130

period

Note 13 Intangible assets - 2014-15

Internally generated information technology

£000

Valuation/gross cost at at 1 November 2014 - brought forward 177 Transfers by absorption - Additions - Impairments - Reversals of impairments - Reclassifications - Revaluations - Transfers to/ from assets held for sale - Disposals / derecognition - Gross cost at 31 March 2015 177

Amortisation at 1 November 2014 - brought forward 49 Transfers by absorption - Provided during the year 20 Impairments - Reversals of impairments - Reclassifications - Revaluations - Transfers to/ from assets held for sale - Disposals / derecognition - Amortisation at 31 March 2015 69

Net book value at 31 March 2015 108 Net book value at 1 November 2014 128


Note 13.1 Intangible assets financing 2014-15

Not

e 13

.1 In

tang

ible

ass

ets f

inan

cing

201

4-15

Soft

war

e

licen

ces

Lice

nces

&

trad

emar

ks

Pate

nts

Inte

rnal

ly

gene

rate

d in

form

atio

n te

chno

logy

De

velo

pmen

t ex

pend

iture

O

ther

Go

odw

ill

Inta

ngib

le

asse

ts

unde

r co

nstr

uctio

n To

tal

£000

£0

00

£000

£0

00

£000

£0

00

£000

£0

00

£000

N

et b

ook

valu

e at

31

Mar

ch 2

015

Pu

rcha

sed

-

- -

108

-

- -

- 10

8

Fi

nanc

e le

ased

-

- -

- -

- -

- -

Do

nate

d an

d go

vern

men

t gra

nt fu

nded

-

- -

- -

- -

- -

N

BV to

tal a

t 31

Mar

ch 2

015

- -

- 10

8

- -

- -

108

N

ote

13.2

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ngib

le a

sset

s fin

anci

ng 1

Nov

embe

r 201

4

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e

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ces

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nces

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emar

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nts

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form

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logy

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t ex

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ill

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ngib

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ts

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r co

nstr

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tal

£000

£0

00

£000

£0

00

£000

£0

00

£000

£0

00

£000

N

et b

ook

valu

e 1

Nov

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r 201

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Pu

rcha

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-

- -

128

-

- -

- 12

8

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nanc

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-

- -

- -

- -

- -

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nate

d an

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-

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- -

- -

- -

N

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t 1 N

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014

- -

- 12

8

- -

- -

128


Note 14 Property, plant and equipment - 2014-15

Note 14.1 Property, plant and equipment financing - 2014-15

Land

Buildings excluding dwellings

Plant & machinery

Information technology

Furniture & fittings Total

£000 £000 £000 £000 £000 £000

Net book value at 31 March 2015

Owned 2,388 8,988 4,565 5,866 498 22,305

Finance leased - - - - - -


Land


Plant & machinery



£000 £000 £000 £000 £000 £000

Valuation/gross cost at 1 November 2014 - brought forward 2,424 9,184 1,845 6,468 658 20,579 Opening Adjustments

2,946

2,946

Transfers by absorption - - - - - - Additions - 222 693 1,591 - 2,506 Impairments - - - - - - Reversals of impairments - - - - - - Reclassifications - - - - - - Revaluations - 360 - - - 360 Transfers to/ from assets held for sale - - - - - - Disposals / derecognition - - - - - - Valuation/gross cost at 31 March 2015 2,424 9,766 5,484 8,059 658 26,391

Accumulated depreciation at 1 November 2014 - 435 824 1,807 127 3,193 Transfers by absorption - - - - - - Provided during the year - 126 78 386 33 623 Impairments - - - - - - Reversals of impairments - - - - - - Reclassifications - - - - - - Revaluations - - - - - - Transfers to/ from assets held for sale - - - - - - Disposals/ derecognition - - - - - - Accumulated depreciation at 31 March 2015 - 561 902 2,193 160 3,816

Net book value at 31 March 2015 2,424 9,205 4,582 5,866 498 22,575 Net book value at 1 November 2014 2,424 8,749 1,021 4,661 531 17,386

The opening adjustment of £2,946k ensures consistent application of IAS1 accounting policy revised with effect from 1st November 2014.




Land


Plant & machinery



£000 £000 £000 £000 £000 £000

Net book value at 31 March 2015

Owned 2,388 8,988 4,565 5,866 498 22,305

Finance leased - - - - - -


Land


Plant & machinery



£000 £000 £000 £000 £000 £000

Valuation/gross cost at 1 November 2014 - brought forward 2,424 9,184 1,845 6,468 658 20,579 Opening Adjustments

2,946

2,946

Transfers by absorption - - - - - - Additions - 222 693 1,591 - 2,506 Impairments - - - - - - Reversals of impairments - - - - - - Reclassifications - - - - - - Revaluations - 360 - - - 360 Transfers to/ from assets held for sale - - - - - - Disposals / derecognition - - - - - - Valuation/gross cost at 31 March 2015 2,424 9,766 5,484 8,059 658 26,391

Accumulated depreciation at 1 November 2014 - 435 824 1,807 127 3,193 Transfers by absorption - - - - - - Provided during the year - 126 78 386 33 623 Impairments - - - - - - Reversals of impairments - - - - - - Reclassifications - - - - - - Revaluations - - - - - - Transfers to/ from assets held for sale - - - - - - Disposals/ derecognition - - - - - - Accumulated depreciation at 31 March 2015 - 561 902 2,193 160 3,816

Net book value at 31 March 2015 2,424 9,205 4,582 5,866 498 22,575 Net book value at 1 November 2014 2,424 8,749 1,021 4,661 531 17,386

The opening adjustment of £2,946k ensures consistent application of IAS1 accounting policy revised with effect from 1st November 2014.

Page 133

On-SoFP PFI contracts and other service concession arrangements - - - - - -

PFI residual interests - - - - - -

Government granted 36 217 - - - 253

Donated - - 17 - - 17

NBV total at 31 March 2015 2,424 9,205 4,582 5,866 498 22,575

Note 15 Revaluations of property, plant and equipment

All of the Trusts owned Land & Buildings have been revalued at 31st March 2015. The revaluation was carried out independently by:

DVS - Property Services arm of the VOA (DipSurv MRICS RICS Registered Valuer)

Crewe Valuation Office 2nd Floor Wellington House Delamere Street Crewe CW1 2LQ

The revaluation was undertaken in accordance with International Financial Reporting Standards (IFRS) as interpreted and applied by the Annual Reporting Manual. The assumption has been made that the properties valued will continue to be held for the foreseeable future having regard to the prospect and viability of the continuance of occupation. The basis of valuation is Fair Value which has been interpreted as market value for existing use.

For those properties where there is market-based evidence to support the use of ‘Existing Use Value’ (EUV) to arrive at Fair Value the comparative method of valuation has been adopted.

For those properties where there is no market based evidence to support the use of EUV to arrive at Fair Value, the Depreciated Replacement Cost (DRC) approach has been used.

Note 16 Investments - 2014-15

The Trust does not hold any investments

The Trust does not have any interests in other entities

Note 18 Inventories

31 March 2015

£000



DVS - Property Services arm of the VOA (DipSurv MRICS RICS Registered Valuer)Crewe Valuation Office2nd Floor Wellington HouseDelamere Street CreweCW1 2LQ




Note 16 Investments - 2014-15The Trust does not hold any investments



Page 133

On-SoFP PFI contracts and other service concession arrangements - - - - - -

PFI residual interests - - - - - -

Government granted 36 217 - - - 253

Donated - - 17 - - 17

NBV total at 31 March 2015 2,424 9,205 4,582 5,866 498 22,575



DVS - Property Services arm of the VOA (DipSurv MRICS RICS Registered Valuer)

Crewe Valuation Office 2nd Floor Wellington House Delamere Street Crewe CW1 2LQ




Note 16 Investments - 2014-15

The Trust does not hold any investments


Note 18 Inventories

31 March 2015

£000

Note 18 Inventories

Page 134

Drugs 39 Other - Total inventories 39

Inventories recognised in expenses for the year were £0k. Write-down of inventories recognised as expenses for the year were £0k.

Note 19 Trade receivables and other receivables

31 March 2015

£000

Current Trade receivables due from NHS bodies 5,502 Provision for impaired receivables (275) Prepayments (non-PFI) 1,299 Accrued income 724 VAT receivable 122 Other receivables 2,666 Total current trade and other receivables 10,038

Non-current Provision for impaired receivables (122) Other receivables 762 Total non-current trade and other receivables 640

Note 19.1 Provision for impairment of receivables

2014-15

£000

At 1 November 2014

370 Transfers by absorption

-

Increase in provision

27 Amounts utilised

-

Unused amounts reversed

- At 31 March 2015

397

Note 19.2 Analysis of impaired receivables

31 March 2015

Trade receivables

Other receivables

Ageing of impaired receivables £000

£000 0 - 30 days -

-




Page 134

Drugs 39 Other - Total inventories 39

Inventories recognised in expenses for the year were £0k. Write-down of inventories recognised as expenses for the year were £0k.


31 March 2015

£000

Current Trade receivables due from NHS bodies 5,502 Provision for impaired receivables (275) Prepayments (non-PFI) 1,299 Accrued income 724 VAT receivable 122 Other receivables 2,666 Total current trade and other receivables 10,038

Non-current Provision for impaired receivables (122) Other receivables 762 Total non-current trade and other receivables 640


2014-15

£000

At 1 November 2014

370 Transfers by absorption

-

Increase in provision

27 Amounts utilised

-

Unused amounts reversed

- At 31 March 2015

397


31 March 2015

Trade receivables

Other receivables

Ageing of impaired receivables £000

£000 0 - 30 days -

-

Page 135

30-60 Days -

- 60-90 days -

-

90- 180 days -

- Over 180 days 397

-

Total 397 -

Ageing of non-impaired receivables past their due date

0 - 30 days 1,523

- 30-60 Days 640

-

60-90 days 603

- 90- 180 days 1,005

-

Over 180 days 1,594

- Total 5,365 -

Note 20 Other assets

The Trust does not have other assets

Note 21 Other financial assets

The Trust does not have other financial assets

Note 22 Non-current assets for sale and assets in disposal groups

The Trust does not have any non-current assets for sale

Note 23 Cash and cash equivalents movements Cash and cash equivalents comprise cash at bank, in hand and cash

equivalents. Cash equivalents are readily convertible investments of known value which are subject to an insignificant risk of change in value.

2014-15

£000

At 1 November 2014

5,349 Transfers by absorption

-

Net change in year

512 At 31 March

5,861

Broken down into: Cash at commercial banks and in hand

29 Cash with the Government Banking Service

5,832

Deposits with the National Loan Fund

- Other current investments

-









Page 136

Total cash and cash equivalents as in SoFP

5,861 Bank overdrafts (GBS and commercial banks)

-

Drawdown in committed facility

- Total cash and cash equivalents as in SoCF

5,861

Note 23.1 Third party assets held by the NHS foundation trust

The Trust does not hold any third party assets

Note 24 Trade and other payables

31 March 2015

£000

Current NHS trade payables

4,589 Other trade payables

5,163

Capital payables

851 Social security costs

1,713

Other payables

17 Accruals

4,098

Total current trade and other payables

16,431

Non-current Receipts in advance

- NHS trade payables

-

Amounts due to other related parties

- Other trade payables

-

Capital payables

- VAT payable

-

Other taxes payable

- Other payables

-

Accruals

- Total non-current trade and other

payables

-

Note 24.1 Early retirements in NHS payables

above

There are no early retirements payables in NHS payables above

Note 25 Other financial liabilities

The Trust does not have other financial liabilities

Page 135

30-60 Days -

- 60-90 days -

-

90- 180 days -

- Over 180 days 397

-

Total 397 -

Ageing of non-impaired receivables past their due date

0 - 30 days 1,523

- 30-60 Days 640

-

60-90 days 603

- 90- 180 days 1,005

-

Over 180 days 1,594

- Total 5,365 -







Note 23 Cash and cash equivalents movements Cash and cash equivalents comprise cash at bank, in hand and cash

equivalents. Cash equivalents are readily convertible investments of known value which are subject to an insignificant risk of change in value.

2014-15

£000

At 1 November 2014

5,349 Transfers by absorption

-

Net change in year

512 At 31 March

5,861

Broken down into: Cash at commercial banks and in hand

29 Cash with the Government Banking Service

5,832

Deposits with the National Loan Fund

- Other current investments

-

Note 23 Cash and cash equivalents movements

Note 23.1 Third party assets held by the NHS foundation trustThe Trust does not hold any third party assets


Page 136

Total cash and cash equivalents as in SoFP

5,861 Bank overdrafts (GBS and commercial banks)

-

Drawdown in committed facility

- Total cash and cash equivalents as in SoCF

5,861

Note 23.1 Third party assets held by the NHS foundation trust

The Trust does not hold any third party assets


31 March 2015

£000

Current NHS trade payables

4,589 Other trade payables

5,163

Capital payables

851 Social security costs

1,713

Other payables

17 Accruals

4,098

Total current trade and other payables

16,431

Non-current Receipts in advance

- NHS trade payables

-

Amounts due to other related parties

- Other trade payables

-

Capital payables

- VAT payable

-

Other taxes payable

- Other payables

-

Accruals

- Total non-current trade and other

payables

-

Note 24.1 Early retirements in NHS payables

above

There are no early retirements payables in NHS payables above

Note 25 Other financial liabilities

The Trust does not have other financial liabilities


Note 24.1 Early retirements in NHS payables aboveThere are no early retirements payables in NHS payables above

Note 25 Other financial liabilitiesThe Trust does not have other financial liabilities

Note 26 Other liabilitiesThe Trust has no other liabilities

Note 27 BorrowingsThe Trust has no borrowingsThe Trust has access to a £13m revolving credit facility with Lloyds Banking Group.

Note 28 Finance leasesThe Trust was not a finance lessor or lessee in the reporting period

Note 29 Provisions for liabilities and charges analysis

Page 137

Note 26 Other liabilities

The Trust has no other liabilities

Note 27 Borrowings

The Trust has no borrowings

The Trust has access to a £13m revolving credit facility with Lloyds Banking Group.

Note 28 Finance leases

The Trust was not a finance lessor or lessee in the reporting period

Note 29 Provisions for liabilities and charges analysis

Other legal

claims Total

£000 £000

At 1 November 2014 47 47 Transfers by absorption - - Change in the discount rate - - Arising during the year 11 11 Utilised during the year (24) (24) Reclassified to liabilities held in disposal groups - - Reversed unused - - Unwinding of discount - - At 31 March 2015 34 34 Expected timing of cash flows:

- not later than one year; 34 34 - later than one year and not later than five years; - - - later than five years. - - Total 34 34

Legal claims provisions relate to LTPS provisions as notified by the NHS Litigation Authority. The provision reflects the probability of the cases being settled as estimated by the NHS Litigation Authority.

Note 30 Clinical negligence liabilities

Legal claims provisions relate to LTPS provisions as notified by the NHS Litigation Authority. The provision reflects the probability of the cases being settled as estimated by the NHS Litigation Authority.


Note 30 Clinical negligence liabilitiesAt 31 March 2015, £0k was included in provisions of the NHSLA in respect of clinical negligence liabilities of Bridgewater Community Healthcare NHS Foundation Trust (1 November 2014: £0k).

Note 31 Contingent assets and liabilitiesThe Trust has no contingent assets and liabilities

Note 32 Contractual capital commitmentsThe Trust has no contractual capital commitments

Interest rate riskThe Trust borrows from government for capital expenditure, subject to affordability as confirmed by the department of health. The borrowings are for 1 – 25 years, in line with the life of the associated assets, and interest is charged at the National Loans Fund rate, fixed for the life of the loan. The Trust therefore has low exposure to interest rate fluctuations.

Credit riskBecause the majority of the Trust’s revenue comes from contracts with other public sector bodies, the Trust has low exposure to credit risk. The maximum exposures as at 31st March 2015 are in receivables from customers, as disclosed in the trade and other receivables note.”

Liquidity riskThe Trust’s operating costs are incurred under contracts with other NHS bodies, which are financed from resources voted annually by Parliament . The Trust funds its capital expenditure from internally generated resources. The Trust is not, therefore, exposed to significant liquidity risks.

Note 33.2 Financial assets

Page 138

At 31 March 2015, £0k was included in provisions of the NHSLA in respect of clinical negligence liabilities of Bridgewater Community Healthcare NHS Foundation Trust (1 November 2014: £0k).

Note 31 Contingent assets and liabilities

The Trust has no contingent assets and liabilities

Note 32 Contractual capital commitments

The Trust has no contractual capital commitments

Interest rate risk

The Trust borrows from government for capital expenditure, subject to affordability as confirmed by the department of health. The borrowings are for 1 – 25 years, in line with the life of the associated assets, and interest is charged at the National Loans Fund rate, fixed for the life of the loan. The Trust therefore has low exposure to interest rate fluctuations.

Credit risk

Because the majority of the Trust’s revenue comes from contracts with other public sector bodies, the Trust has low exposure to credit risk. The maximum exposures as at 31st March 2015 are in receivables from customers, as disclosed in the trade and other receivables note."

Liquidity risk The Trust’s operating costs are incurred under contracts with other NHS bodies, which are

financed from resources voted annually by Parliament . The Trust funds its capital expenditure from internally generated resources. The Trust is not, therefore, exposed to significant liquidity risks.

Note 33.2 Financial assets

Loans and receivables

Assets at fair value

through the I&E

Held to maturity

Available-for-sale Total

£000

£000 £000

£000

£000

Assets as per SoFP as at 31 March 2015

Embedded derivatives -

-

-

-

- Trade and other receivables excluding non financial assets 8,617

-

-

-

8,617

Other investments -

-

-

-

- Other financial assets -

-

-

-

-

Cash and cash equivalents at bank and in hand 5,861

-

-

-

5,861

Total at 31 March 2015 14,478 - - - 14,478


Page 139

Note 33.3 Financial liabilities


Liabilities at fair value

through the I&E Total

£000

£000

£000

Liabilities as per SoFP as at 31 March 2015 Embedded derivatives -

- -

Borrowings excluding finance lease and PFI liabilities -

- - Obligations under finance leases -

- -

Obligations under PFI, LIFT and other service concession contracts -

- -

Trade and other payables excluding non financial liabilities 13,312

- 13,312 Other financial liabilities -

- -

Provisions under contract -

- - Total at 31 March 2015 13,312 - 13,312

Note 33.4 Maturity of financial liabilities

31 March

2015

1 November

2014

£000

£000

In one year or less 13,312

-

In more than one year but not more than two years -

-

In more than two years but not more than five years -

-

In more than five years -

-

Total

13,312

-

The fair value of financial instruments is considered to be equivalent to the transaction value.

Note 34 Losses and special payments


March 2015

Total number of

cases Total value

of cases

Number £000





Page 139



Liabilities at fair value

through the I&E Total

£000

£000

£000

Liabilities as per SoFP as at 31 March 2015 Embedded derivatives -

- -

Borrowings excluding finance lease and PFI liabilities -

- - Obligations under finance leases -

- -

Obligations under PFI, LIFT and other service concession contracts -

- -

Trade and other payables excluding non financial liabilities 13,312

- 13,312 Other financial liabilities -

- -

Provisions under contract -

- - Total at 31 March 2015 13,312 - 13,312


31 March

2015

1 November

2014

£000

£000

In one year or less 13,312

-

In more than one year but not more than two years -

-

In more than two years but not more than five years -

-

In more than five years -

-

Total

13,312

-




March 2015

Total number of

cases Total value

of cases

Number £000


Page 140

Losses Cash losses - -

Fruitless payments - - Bad debts and claims abandoned 1 5 Stores losses and damage to property - - Total losses 1 5 Special payments

Extra-contractual payments - - Extra-statutory and extra-regulatory payments - - Compensation payments - - Special severance payments - - Ex-gratia payments - - Total special payments - - Total losses and special payments 1 5 Compensation payments received

-

There have been no cases individually over £300,000.

Note 35 Events after the reporting date

There are no events after the reporting period

Note 36 Related parties During the reporting period none of the Department of Health Ministers, Trust board members or members

of the key management staff, or parties related to any of them, has undertaken any material transactions with Bridgewater Community Healthcare NHS Foundation Trust.

The Department of Health is regarded as a related party. During the reporting period Bridgewater has had a significant number of material transactions (greater than £1 million) with the Department, and with other entities for which the Department is regarded as the parent Department. For example :

Receivables

Payables

31 March 2015

1 November

2014

31 March 2015

1 November

2014

£000

£000

£000

£000

CCGs

NHS Halton CCG

406

1,494

49

46

NHS St Helens CCG

427

747

39

36

NHS Warrington CCG

1,148

1,161

-

-

NHS Wigan Borough CCG

Note 35 Events after the reporting dateThere are no events after the reporting period


Note 36 Related partiesDuring the reporting period none of the Department of Health Ministers, Trust board members or members of the key management staff, or parties related to any of them, has undertaken any material transactions with Bridgewater Community Healthcare NHS Foundation Trust.


Page 140

Losses Cash losses - -

Fruitless payments - - Bad debts and claims abandoned 1 5 Stores losses and damage to property - - Total losses 1 5 Special payments

Extra-contractual payments - - Extra-statutory and extra-regulatory payments - - Compensation payments - - Special severance payments - - Ex-gratia payments - - Total special payments - - Total losses and special payments 1 5 Compensation payments received

-

There have been no cases individually over £300,000.

Note 35 Events after the reporting date

There are no events after the reporting period

Note 36 Related parties During the reporting period none of the Department of Health Ministers, Trust board members or members

of the key management staff, or parties related to any of them, has undertaken any material transactions with Bridgewater Community Healthcare NHS Foundation Trust.


Receivables

Payables

31 March 2015

1 November

2014

31 March 2015

1 November

2014

£000

£000

£000

£000

CCGs

NHS Halton CCG

406

1,494

49

46

NHS St Helens CCG

427

747

39

36

NHS Warrington CCG

1,148

1,161

-

-

NHS Wigan Borough CCG

Page 141

251 427 1,022 -

NHS England

Cheshire, Warrington & Wirral LAT

481

-

-

-

Greater Manchester LAT

237

-

-

168

Lancashire LAT

178

-

-

-

Merseyside LAT

173

-

-

11

NHS Trusts

St Helens and Knowsley NHS Trust

544

364

1,898

770

Other NHS Bodies

NHS Pension Scheme

-

-

1,418

1,434

Health Education England

26

197

-

24

Total

3,871

4,390

4,426

2,489

Income

Expenditure

2014-15: For the 5

months ending 31

March 2015

2014-15: For the 5

months ending 31

March 2015

£000

£000 CCGs

NHS Halton CCG 6,972

2 NHS St Helens CCG 9,309

26

NHS Warrington CCG 9,486

0 NHS Wigan Borough CCG 15,456

0

NHS England

Cheshire, Warrington & Wirral LAT 2,564

0 Greater Manchester LAT 3,710

0

Lancashire LAT 1,562

0 Merseyside LAT 3,543

0

NHS Trusts

St Helens and Knowsley NHS Trust 168

1,172

Other NHS Bodies


Page 141

251 427 1,022 -

NHS England

Cheshire, Warrington & Wirral LAT

481

-

-

-

Greater Manchester LAT

237

-

-

168

Lancashire LAT

178

-

-

-

Merseyside LAT

173

-

-

11

NHS Trusts

St Helens and Knowsley NHS Trust

544

364

1,898

770

Other NHS Bodies

NHS Pension Scheme

-

-

1,418

1,434

Health Education England

26

197

-

24

Total

3,871

4,390

4,426

2,489

Income

Expenditure

2014-15: For the 5

months ending 31

March 2015

2014-15: For the 5

months ending 31

March 2015

£000

£000 CCGs

NHS Halton CCG 6,972

2 NHS St Helens CCG 9,309

26

NHS Warrington CCG 9,486

0 NHS Wigan Borough CCG 15,456

0

NHS England

Cheshire, Warrington & Wirral LAT 2,564

0 Greater Manchester LAT 3,710

0

Lancashire LAT 1,562

0 Merseyside LAT 3,543

0

NHS Trusts

St Helens and Knowsley NHS Trust 168

1,172

Other NHS Bodies

Page 142

NHS Pension Scheme 0

4,379 Health Education England 1,337

0

Total 54,107

5,579 In addition, the Trust has had a number of material transactions (greater than £1 million) with other government departments and other central and local government bodies. Most of these transactions have been with the following entities:

Receivables

Payables

31 March 2015

1 November

2014

31 March 2015

1 November

2014

£000

£000

£000

£000

Local Authorities Halton Borough Council 919

1,423

376

71

St Helens Borough Council 665

904

273

- Warrington Borough Council 741

362

286

58

Wigan Borough Council 13

771

483

137

2,338 3,460

1,418 266

Income

Expenditure

2014-15: For the 5

months ending 31

March 2015

2014-15: For the 5

months ending 31

March 2015

£000

£000 Local Authorities

Halton Borough Council 1,215

47 St Helens Borough Council 1,968

144

Warrington Borough Council 1,314

-97 Wigan Borough Council 1,515

318

6,012 412

9: Audit opinion and report

In addition, the Trust has had a number of material transactions (greater than £1 million) with other government departments and other central and local government bodies. Most of these transactions have been with the following entities:

Page 142



0

Total 54,107


Receivables

Payables

31 March 2015

1 November

2014

31 March 2015

1 November

2014

£000

£000

£000

£000


1,423

376

71


904

273


362

286

58


771

483

137

2,338 3,460

1,418 266

Income

Expenditure

2014-15: For the 5

months ending 31

March 2015

2014-15: For the 5

months ending 31

March 2015

£000




144



318

6,012 412



Page 142



0

Total 54,107


Receivables

Payables

31 March 2015

1 November

2014

31 March 2015

1 November

2014

£000

£000

£000

£000


1,423

376

71


904

273


362

286

58


771

483

137

2,338 3,460

1,418 266

Income

Expenditure

2014-15: For the 5

months ending 31

March 2015

2014-15: For the 5

months ending 31

March 2015

£000




144



318

6,012 412



Apr

May

June

July

Aug

Sept

Oct

Nov

Dec

Jan

Feb

Mar Total

Board Meeting (including both public and closed meetings)Harry Holden Chairman I I I I I I I I I I I I 12/12Karen Bliss Non-Executive Director I I I I I I I I I I I I 12/12Steve Cash Non-Executive Director I AP AP I I I I I I AP I I 9/12Kate Fallon Chief Executive I I I I I I I I I I AP I 11/12Baron Frankal Non-Executive Director

(Left Trust 31 May 2014)

I I 2/12

Sue Musson Non-Executive Director (Left Trust 31 December 2014)

AP I I I AP AP I I I 6/12

Bob Saunders Non-Executive Director I I I I I I I I I I I I 12/12Dorothy Whitaker Non-Executive Director I I I I I I I I I AP I I 11/12Christine Samosa Director of People,

Planning and Development

I I I I I I I I I I I I 12/12

Colin Scales Chief Operating Officer I I I I I AP I I I I I I 11/12Mike Treharrne

Director of FinanceI I I I AP I I I I I I I 11/12

Stephen Ward Medical Director I I AP I I I I I I AP I I 10/12Dot Keates Interim Executive

Nurse (from September 2014)

I I I I I I I I 7/12

Dorian Williams

Executive Nurse/Director of Governance (To September 2014)

I I I I I 5/12

Sally Yeoman Non-Executive Director I I I I I I I I I I I I 12/12

9. AppendicesAppendix 1

Board Attendance for year ended 31 March 2015

KeyAP - Apologies given


Appendix 2

Register of Director Attendance at Committee meetings for year ended 31 March 2015

Apr

May

June

July

Aug

Sept

Oct

Nov

Dec

Jan

Feb

Mar Total

Nominations and Remuneration Committee (Held on ad-hoc basis) Harry Holden Chairman I I I 3/3Dorothy Whitaker Non-Executive Director I I AP 2/3Bob Saunders Non-Executive Director I I I 3/3Karen Bliss Non-Executive Director I I I 3/3Steve Cash Non-Executive Director AP I AP 1/3Baron Frankal Non-Executive Director

(Left Trust 31 May 2014)

Sally Yeoman Non-Executive Director I I I 3/3

Sue Musson Non-Executive Director(Left Trust 31 December 2014)

I I

Apr

May

June

July

Aug

Sept

Oct

Nov

Dec

Jan

Feb

Mar Total

Audit CommitteeKaren Bliss Non-Executive Director

(Chair)I I I I I 5/5

Steve Cash Non-Executive Director (appointed to Committee in December 2014)

I I 2/5

Baron Frankal Non-Executive Director (Left Trust 31 May 2014)

AP 0/5

Bob Saunders Non-Executive Director I I I I I 5/5Dorothy Whitaker Non-Executive Director I I I I AP 4/5



Apr

May

June

July

Aug

Sept

Oct

Nov

Dec

Jan

Feb

2 M

ar

30 M

ar

Total

Trust Efficiency Assurance Committee Steve Cash (Chair)

Non-Executive Director

I I I AP I I AP I I 7/9

Karen Bliss Non-Executive Director

I I I I AP I I I I 8/9

Sally Yeoman Non-Executive Director

I I I I I I I I I 9/9

Kate Fallon Chief Executive AP I I AP AP I AP I AP 4/9Christine Samosa Director of

People, Planning and Development

I I I I I I I I 9/9

Colin Scales Chief Operating Officer

I I I I I I I I I 9/9

Mike Treharne Director of Finance

I I AP I I I I I I 8/9

Steve Ward Medical Director I I I I I I AP I AP 7/9

Apr

May

June

July

Aug

Sept

Oct

Nov

Dec

Jan

Feb

Mar Total

Quality and Safety Committee Bob Saunders (Chair)

Non-Executive DirectorI AP I I I I I I 7/8

Dorothy Whitaker Non-Executive Director I I I I I AP I I 7/8Karen Bliss Non-Executive Director I I I I I I I I 8/8Kate Fallon Chief Executive I I I I I I AP I 7/8Sally Yeoman Non-Executive Director AP I AP I AP I I I 5/8Dot Keates Interim Executive

Nurse (from September 2014)

I I I I I I I I 8/8

Dorian Williams Director of Governance/Executive Nurse (To September 2014)

I I I I 4/8

Steve Ward Medical Director AP I I I I I AP I 6/8Colin Scales Chief Operating Officer I I I AP AP I I I 6/8


Appendix 2

Register of Director Attendance at Committee meetings for year ended 31 March 2015 (continued)


Apr

May

June

July

Aug

Sept

Oct

Nov

Dec

Jan

Feb

Mar

Council of Governours Meetings (from the establishment of the Trust as an FT - 1 November 2014Harry Holden Chairman I I IKaren Bliss Non-Executive Director I AP APSteve Cash Non-Executive Director I AP APKate Fallon Chief Executive I I IBaron Frankal Non-Executive Director

(Left Trust 31 May 2014)Sue Musson Non-Executive Director

(Left Trust 31 December 2014)

AP AP

Bob Saunders Non-Executive Director I AP IChristine Samosa Director of People,

Planning and Development

I I I

Colin Scales Chief Operating Officer I AP IMike Treharrne Director of Finance I AP IStephen Ward Medical Director I AP APDorothy Whitaker Non-Executive Director I IDorian Williams Executive Nurse/

Director of Governance (To September 2014)

Sally Yeoman Non-Executive Director I AP IDot Keates Interim Executive Nurse

(from September 2014)I I I

John PrinceLead Governor and Public Govenour - Wigan

I I I

Irene DeakinPublic Governor- Community Dental

AP AP

Nano Nagle Hill Public Governor - Halton AP I IDiane McCormick Public Governor - Halton I AP IDave Oldham Public Governor - Halton AP AP AP

Sue IrvinePublic Governor - Rest of England

I I I

Peter ApplebyPublic Governor - St. Helens

I I I

Rita ChapmanPublic Governor - St. Helens

AP AP I

Bill HarrisonPublic Governor - St. Helens

I I

Appendix 3

Register of Director and Governor Attendance at Council of Governor meetings for year ended 31 March 2015


Apr

May

June

July

Aug

Sept

Oct

Nov

Dec

Jan

Feb

Mar

Board Meeting

Derek MaylorPublic Governor - St. Helens

AP I I

Jean Ball Public Governour - Warrington

AP AP AP

Liz Matthews Public Governour - Warrington

I I I

Derek Saunders Public Governour - Warrington

AP I I

G. Scott Baron Public Governour - Warrington

I I I

Julie Atherton Public Governour - Wigan

AP AP AP

Sylvia Cunliffe Public Governour - Wigan

I I I

James Roberts Public Governour - Wigan

I I I

Gary Young Public Governour - Wigan

I I I

Charlotte Dixon Staff Governour - Clinical Support Services

I I I

Carol Lever Staff Governour - AHP AP AP APSteven Lowe Staff Governour - AHP AP AP IAngela Akers Staff Governour -Dental I I IVikki Morris Staff Governour

-Non-Clinical SupportI I I

Corina Cassey Hardman

Staff Governour - Nursing and Midwifrey

I AP AP

Karen Worthington Staff Governour - Nursing and Midwifrey

I AP AP

Clr J PearsonPartner Governour - St. Helens

AP AP I

Janette GreyPartner Governour Higher Education

I I I

Clr Keith CunliffePartner Governour - Wigan

AP AP

Clr Peter Lloyd Jones

Partner Governour - Halton

I I I

Clr Judith GuthriePartner Governour - Warrington

I AP I

Mick TaylorPartner Governour - Voluntary Sector

AP AP I

Appendix 3

Register of Director and Governor Attendance at Council of Governor meetings for year ended 31 March 2015 (continued)

Bridgewater Quality Account 2014/15 1

Quality Account2014/15

Bridgewater Quality Account 2014/152


Contents

Part 1 - Statement on Quality from the Chief ExecutiveStatement on Quality by Chief Executive 5A bit more about us..... 7Part 2 - Priorities for Improvement and Statements of Assurance from the Board Review of Progress against 2014/15 Priorities for Improvement 8Priorities for Improvement in 2015/16 12Statements of Assurance from the Board 14Reporting against Core Indicators page 19Part 3 - Review of Quality PerformanceQuality of Services in 2014/15 25Trust Quality Measures 25Patient Experience 28Patient Story 28Patient Survey and Friends and Family Test Results 29Patient Partners 29Patient Advice and Liaison Service 30Complaints 31 Staff Engagement, Health & Wellbeing 32Staff Engagement 32NHS Staff Survey 2014 33Staff Health & Wellbeing 34Performance Development Reviews 35Staff Turnover 35Responsible Officer Compliance 36Education & Professional Development 36Mandatory Training 36Continuing Professional Development 36Competence Frameworks 37Pre-Registration 37Forward Planning 37Leadership Programme and the Bridgewater Quality Improvement 38Programme Library Strategy 38Equality, Diversity and Inclusion 39Delivering Same Sex Accommodation 40Incident reporting 40Never events 44Central Alert System 45Pressure Ulcers 45Workforce Planning 46Coroner’s Cases 46

Page


Contents

Infection Prevention and Control 47Safeguarding 53National Institute for Health and Care Excellence 54Clinical Audit 56Research 59 Care Quality Commission 59St Helens Clinical Commissioning Group Review of Newton Hospital 60Medicines Management 61Information Governance 64Emergency Preparedness, Resilience and Response 65Partnership Working 65Service Improvements 70Listening into Action 76Developing our Organisational Culture 77Quality, Innovation, Productivity and Prevention 78Clinical Strategies 79Strategy Days 79Quality Seminars 80Health Improvement Programmes 80Midwifery 81Community Dental 82Walk in Centres 83Out of Hours 83Waiting Times 84Foundation Trust Application 87Monitor Regulation 87Council of Governors 88Monitoring the Quality of Services across Bridgewater 88Quality Impact Assessment Process 89Actions taken to address Francis Report Recommendations 89Actions taken to address Freedom to Speak up Recommendations 89 Sign up to Safety 89Open and Honest Care 89NHS Safety Thermometer 90Internal Audit 91Stakeholder Involvement in the Development of our Quality Account 93 Appendices Appendix A – Children’s Immunisations for Quality Account 102Appendix B – Statement of Directors’ Responsibilities 103Appendix C – Auditors Report 104

Page


I am delighted to write this Statement on Quality for our 2014/15 Quality Account.

This has been a very positive year as the organisation became one of the first two community trusts to be awarded Foundation Trust status. This was a momentous occasion and marked the achievement of one of our strategic objectives. I would like to once again take this opportunity to thank all the staff for their hard work and dedication to delivering high quality patient care, without whom this would not have been possible. This account covers the entire financial year.

I want all colleagues to be involved in developing and implementing the plans we have; this is why we embarked on the Listening into Action programme. The Big Conversations were an opportunity for staff to talk to me about what they felt the biggest blockers to great patient care were, and what actions we should take to overcome or fix them. Staff were not backward in coming forward, with a lot of lively and passionate discussion at each event. We have been able to make some “quick wins” to address the concerns raised by staff. For example:

• A text messaging reminder service for patients has been implemented across MSK/CATS to assist in reducing the number of unutilised treatment slots as a result of

patients not turning up for their appointment• The introduction of teleconferencing facilities Trust-wide to enable staff to do their jobs

properly, help them manage their time more effectively, and reduce the amount of miles they are expected to travel. Each directorate now has its own teleconferencing line for all staff to use.

Statement on Quality by Chief Executive


We take patient feedback seriously and each month a Patient Story is presented to the Board. These stories portray a very strong message about the care we provide and we always strive to make improvements when that care is not as we would like it to be. The Trust receives relatively few complaints. However, any areas for improvement are taken very seriously by the Board, managers and all our staff and we endeavour constantly to improve the quality of care we deliver.

It is very pleasing to note that 99% of our patients expressed their overall satisfaction with their care and treatment which is up from 98% at the end of March 2014.

As Chief Executive I am confident that the Trust provides a high quality service and that this Quality Account demonstrates this. To the best of my knowledge the information in this account is accurate and fairly reflects the quality of the care we deliver.

Colin Scales


A bit more about us…

Bridgewater provides high quality community and specialist services to 855,848 people covering:

• Runcorn & Widnes (Halton) • St Helens • Warrington • Wigan Borough • Community Dental (provides services in all of the above areas plus Bolton, Tameside,

Trafford, Glossop, Stockport and Western Cheshire)

The majority of our services are delivered in patients’ homes or at locations close to where they live, such as clinics, health centres, GP practices, community centres and schools.

As a provider of both mainstream and specialist care our role is to focus on providing cost effective NHS care by keeping people out of hospital and supporting vulnerable people throughout their lives.

As a dedicated provider of community services our strategy is to bring more care closer to home – this means providing a wider range of services in community settings to keep people healthier for longer and developing more specialist services to support people to live independently at home.

We employ 3,400 staff and have an income of £140 million which comes from our commissioners; including Clinical Commissioning Groups (CCGs), NHS England and Local Authorities.

• NHS Warrington CCG represents 26 GP practices, acting on behalf of over 212,901 patients living in Warrington

• NHS Halton CCG represents 17 GP practices, acting on behalf of over 125,892 patients living in Halton

• NHS St Helens CCG represents 37 GP practices, acting on behalf of over 194,758 patients living in St Helens

• NHS Wigan CCG represents 65 GP practices, acting on behalf of over 322,297 patients living in Wigan

On an average day we care for:

• Approximately 9500 patients • 409 people in our walk-in centres • 27 people in our community hospital (Newton) • 2190 supported by our district nurses • 290 people in our community dental services


Review of Progress against 2014/15 Priorities for Improvement

Quality Improvement priorities in 2014/15

Measures ofsuccess

Ensuring we are safe

Open and Honest Care – Improve the accuracy of pressure ulcer reporting.

Safer Staffing: appropriate levels and skills of staff to ensure quality of care and patient safety. Develop a standardised caseload weighting tool that is understood and used consistently across all district nursing teams and boroughs. Effective reporting will identify the need for redeployment or additional resources.

Ensuring we are effective

To develop an innovative, evidence based, self-care approach to the treatment of atopic eczema in children.

Met

Met

Met

Monthly pressureaudit reports

Incident reports forpressure ulcers

National publicationof our pressure ulcer numbers

Met

Update and Assurance Outcome

Quarterly dashboard produced and monitored by QMG.

Reported monthly in the Integrated Performance Report (IPR) and nationally for Open and Honest Care on NHS Choices.

Reported monthly in the IPR and nationally for Open and Honest Care on NHS Choices.

Met

Quarterly safer staffing and caseload weighting reports

Monitoring of Caseload weighting

Safer staffing reports produced monthly and submitted to Board.

Standards agreed and peer audit in progress.

Measure the impact using standardised clinical assessment tools alongside parental questionnaires

Integrated Research Application System ethics was granted.The Eczema Expert pilot was delayed by 3-6 months due to issues relating to whether all the contents in the box are included in the Greater Manchester formulary/available without prescription.

Ensuring we are caring

Improving patient experience and involvement.

Increase in the number of Patient Partners involved with service redesigns

There were 170 patient partners at the end of 2013/14.There were 195 patient partners at the end of 2014/15.

Maintain or improve the overall patient experience score

At the end of 2013/14 98% of patients expressed overall satisfaction with their care and treatment.At the end of 2014/15 99% of patients expressed overall satisfaction with their care and treatment.

Understand more about the emotional and functional outcomes of care for children and young people through direct family engagement techniques. We are interviewing families and will be developing a feedback tool which

Increased understanding about what is most important to those who use our children and young people services

A parent reported outcomes and experience measure has been developed and will be routinely implemented in Warrington Borough from April 2015 to provide both assurance and feedback for services to inform continuous improvement.

Met

Met

Met

Not Met


Review of Progress against 2014/15 Priorities for Improvement (continued)


Measures ofsuccess

can capture and report on the question ‘what difference did we make?’ in relation to functional and emotional outcomes.

Engagement with patients with disabilities and their carers to work collaboratively with them to improve patient experience for patients with disabilities within community dental services.

Ensuring we are responsive

To improve the current breast feeding rates across the boroughs we serve by giving new mothers the opportunity to sign up to the Flo initiative which provides them with on-going support and motivational texts whilst they are breast feeding.

Partially

Met


Increased understanding about what is most important to patients with disabilities and their carers who use our community dental services

Measures of success have been achieved in that we have found out what is important for our patients and acted on it. However this work needs to be on-going and it is now embedded in what we do routinely.

New birth visit contacts by health visitors

6-8 week breast feeding rates

3 month breastfeeding rates (developmenttarget)

Warrington: (2013/14 – 48.3%) 2014/15 – 49.6%£Wigan: (2013/14 – 39.4%) 2014/15 – 37.9% Halton: (2013/14 – 27.99%) 2014/15 – 34.58% £St Helens: (2013/14 – 30.85%) 2014/15 – 42.77%£

Warrington: (2013/14 – 36.6%) 2014/15 – 37.3%£Wigan: (2013/14 – 31.2%) 2014/15 – 28.4% Halton: (2013/14 – 21.71%) 2014/15 – 20.72% St Helens: (2013/14 – 21.79%) 2014/15 – 21.01%

The 3 month breast feeding rates are not currently collated.The current emphasis is on improving the initial and 6-8 week breast feeding rates.

IV therapy delivered in Warrington, Halton, St Helens and Knowsley. Early supported discharges (ESDs) Q1 Early discharges = 107 Q2 Early discharges = 123 Q3 Early discharges = 110Q4 Early discharges = 133PART (Paediatric Acute Response Team) have also facilitated 5 ESDs since the service commenced in May 2014.

IV therapy delivered in Warrington, Halton, St Helens and Knowsley .Number of admissions avoided Q1 Admissions avoided = 82Q2 Admissions avoided = 93 Q3 Admissions avoided = 97Q4 Admissions avoided = 121

All patients received into custody are requested to attend an annual health check.

Developing out of hospital services to deliver intravenous therapy (IV) in the community.

Reduced length of stay in hospital

Number of hospital admissions avoided

To implement a comprehensive annual health check across all three prison sites for offenders who have a learning disability.

Nationally agreed health check requirements will be implemented

Met

Met

Met

Not Met

Partially££

£

£


Review of Progress against 2014/15 Priorities for Improvement (continued)


Measures ofsuccess

To ensure processes are in place to provide on-ward referral, sign-posting and advice to patients identified as potentially having dementia, and their carers, within our community nursing and in-patient services.

Met


Number of annual health checks carried out

Questions from the Six Item Cognitive Impairment Tool (6CIT) (nationally recognised cognitive impairment test) to be incorporated into initial screening assessment to ensure all patients are screened

Devise borough specific information packs regarding local services to support patients and carers

Develop a passion for supporting people with dementia by identifying and utilising “dementia champions” to lead the project

Develop tiered levels of dementia awareness by working with learning and development to establish a baseline of work-force current training and awareness levels and establish a training needs analysis and training plan, as appropriate

Our risk descriptions will be the same as our incident descriptions

More accurately documented risk assessments and consequently a potential reduction in harm caused

Audit completed and all the required health checks have been carried out as required.

6CIT contained within all community nursing assessment documentation across Bridgewater.

E-directory of services and voluntary agencies available by borough to support patients and carers developed on intranet.Resource links are available as part of the training.

Dementia champions identified at service level within community nursing. There are between 2-4 champions in each borough.Dementia friend identified within in-patient services. The champions are a resource for staff if required.The dementia friendly training has now been superseded by the e-learning.

Dementia training is on the community nursing workforce training needs analysis and levels of training are monitored by the Learning and Development Team.Bridgewater dementia training figures returned to NHS North West are Q1 = 585, Q2 = 226, Q3 = 392 and Q4 178 Total = 1381

Risk management training delivered on a monthly basis which has more accurately identified patient safety incidents. All incident cause groups (used for aggregate reporting) have been re-described during 2014/15 but implemented in April 2015 with the risk types being updated in line with these during April 2015.

Risk management training delivered on a monthly basis. Met

Not MetPrevent the risk of future incidents by improving the way in which we monitor risks by more closely aligning our risk and incident data.

Ensuring we are well-led

Met

Met

Met

Met


The priorities for 2014/15 have been monitored throughout the year. As we move into 2015/16 the Trust will ensure that these areas continue to be monitored as part of the Trust quality monitoring processes. The three areas not completed will continue to be monitored and reported on in next year’s account.

Quality Improvement CommentOutcome

To develop an innovative evidence base, self-care approach to the treatment of atopic eczema in children

Prevent the risk of future incidents by improving the way in which we monitor risks by more closely aligning our risk and incident data

To improve the current breast feeding rates across the boroughs we serve by giving new mothers the opportunity to sign up to the Flo initiative which provides them with on-going support and motivational texts whilst they are breast feeding

This development will continue into 2015/16 and the Trust is working partnership with the Clinical Commissioning Group to develop the way forward for the benefit of the children.

This was not completed by the end of 2014/15. The new incident cause groups will be in place from April 2015/16.

In light of the 2014/15 data we are working with the commissioners to develop enhanced service specifications for infant feeding.

Not Met

Not Met

Partially Met


Priorities for Improvement in 2015/16During 2015/16 the Trust is committed to further develop the culture in line with our mission: to improve local health and promote wellbeing in the communities with serve.

As we start 2015/16 the Trust is entering a new exciting phase of its journey and the existing Quality Strategy will be reviewed and refreshed to meet the changing environment of community care in line with the Five Year Forward Plan, and national initiatives that have identified improvement in quality of care and the developments in the organisational structure. The new Quality Strategy will cover the next three years. The Board will review and approve this new strategy in August 2015.

To continue our quality journey we will build on the positive culture where quality of care can develop. The Trust will ensure through our revised strategy that we:

• Have clearly aligned goals and objectives at every level• Identify shared values and behaviours across the Trust• Provide a learning and improvement environment

This strategy will be further developed and defined during 2015/16 in consultation with patients, governors and partner organisations. The Trust will have an implementation plan for our Quality Strategy. The Quality and Safety Committee will receive quarterly reports on the implementation of this plan via the Quality Management Group. Our progress on delivering the priorities will be reported in next year’s Quality Account.

Quality Priority 1 - Sign up to Safety‘Sign up to Safety’ aims to deliver harm free care for every patient, every time, everywhere. It champions openness and honesty and supports everyone to improve the safety of patients.

We have developed our patient safety improvement plan for 2015/16 based on the ‘Sign up to Safety’ actions and we have committed to the following five ‘Sign up to Safety’ pledges:

1. Putting safety first: commit to reduce avoidable harm in the NHS by half and make public the goals and plans developed locally

2. Continually learn: make our organisation more resilient to risks, by acting on patient feedback and by constantly measuring and monitoring how safe our services are 3. Being honest: be transparent with people about our progress to tackle patient safety issues and support staff to be candid with patients and their families if something

goes wrong 4. Collaborating: take a lead role in supporting local collaborative learning so that improvements are made across all of the local services that patients use5. Being supportive: help our people understand why things go wrong and how to put them

right. Give them the time and support to improve and celebrate the progress


Quality Priority 2 - Improvement in the handling of serious and untoward incidentsFollowing publication of NHS England’s revised framework for the handling of serious and untoward incidents, the Risk Team and Senior Managers agreed a programme of work for 2015/16. This programme of work will assist in the implementation of the new framework and address the:

• Late submission of Root Cause Analysis (RCA) documents during 2014/15 • Quality of data on the Strategic Executive Information System (STEIS)• Internal quality control of the “sign off “ of completed SUI investigations

The programme of work has been discussed with each of our Clinical Commissioning Groups.

Quality Priority 3 – NHS Safety Thermometer improvements in careThe Trust performs well against aspects of the NHS Safety Thermometer in comparison to other NHS community services. Nevertheless, we strive to continuously improve care against these key areas. During 2015/16, we will further develop clinical delivery and training in the following areas:

• Pressure ulcer management: • To continue the reporting of the pressure ulcer monitoring tool and analysis of the

data • To reduce the incidents of avoidable pressure ulcers in line with the new national

framework• To continue to work in partnership with local health providers to improve the health

economy pathway • Falls management in in-patient bed areas:

• To roll out the FallSafe programme to all in-patient and intermediate care units • To monitor the effectiveness of the programme and reduction in the number of

falls incidents • Undertake regular audits on falls during the 2015/16

• Medication safety: • Robust monitoring of omitted or late doses of medication by improved incident

reporting, ensuring lessons learnt are embed into practice and policy and training put in place

• Increase the reporting of medication near misses in order to identify lessons learnt and thus reduce medication incidents

• Improve the uniformity of medication incident data reported via the Trusts electronic incident reporting system in order to improve the analysis of incidents

Quality Priority 4 - Newton Hospital Vision and StrategyFollowing a review by the CQC and St Helens CCG, the Trust is developing a vision and strategy working in liaison with the CCG; due for presentation at the Trust Board in Quarter 2.


How were they chosen? Patient safety is a top priority for the Trust. We have signed up to the ‘Sign up to Safety’ initiative, which is designed to help realise the ambition of making the NHS the safest healthcare system in the world.

Quality priorities 2 and 3 have been identified following discussions with a range of staff at a Management Away Day and they are in line with our top three reported incidents. The Clinical Commissioning Groups (CCGs) have identified these areas as priorities.

With respect to quality priority 4, the Trust is working with St Helens CCG to determine the strategic direction of Newton Hospital with the aim of improving patient pathways and partnership working with the wider health economy.

Statements of Assurance from the BoardReview of ServicesDuring 2014/15 Bridgewater Community Healthcare NHS Foundation Trust provided and/or sub-contracted 129 relevant health services.

Bridgewater Community Healthcare NHS Foundation Trust has reviewed all the data available to them on the quality of care in 100% of these relevant health services. The income generated by the relevant health services reviewed in 2014/15 represents 93.5% of the total income generated from the provision of relevant health services by Bridgewater Community Healthcare NHS Foundation Trust for 2014/15.

AuditDuring 2014/15, one national clinical audit and one national confidential enquiry covered relevant health services that Bridgewater Community Healthcare NHS Foundation Trust provides.

During that period Bridgewater Community Healthcare NHS Foundation Trust participated in 100% national clinical audits and 100% national confidential enquires of the national clinical audits and national confidential enquires it was eligible to participate in.

The national clinical audits and national confidential enquires that Bridgewater Community Healthcare NHS Foundation Trust was eligible to participate in during 2014/15 are as follows:

No national clinical audit reports published during 2014/15 were relevant to the services that Bridgewater Community Healthcare NHS Foundation Trust provides and therefore none were eligible to be reviewed.

Title Audit RequirementsThe National Audit of Intermediate Care Services distributed a service user questionnaire. This

phase of the audit did not require cases to be submittedThe National Confidential Enquiry – Sepsis Study organisational questionnaire

This study was an organisational questionnaire and did not require cases to be submitted


The reports of 30 local clinical audits were reviewed by the provider in 2014/15 and Bridgewater Community Healthcare NHS Foundation Trust intends to take the following actions to improve the quality of healthcare provided:

Title of Audit Key Findings ActionsAudit of Catheter Care (joint audit with Wrightington, Wigan and Leigh NHS Foundation Trust)

11 standards in the audit. 8/11 achieved compliance levels of 80% or more.

The remaining 3 standards that achieved less than 80% are:1. samples followed up within 3 days 2. wound swab if signs of infection 3. supra-pubic catheters not to be

changed in first 6 weeks

The patient feedback aspect of the audit supports the audit findings except that the patient health records show 80% of patients were given catheter passports, whereas patient feedback figure is 50%. This difference may be due to the fact that not all patients returned the questionnaire.

Improve use of standard forms such as CCP11 (care plan form) to ensure comprehensive documentation and prompts.

Minor redesign of catheter passport as suggested by patient feedback.

Re-audit with clarification around two questions that results indicate may have been misinterpreted by auditors.

Audit of In-patient Falls Prevention (Newton Community Hospital)

Falls and fall-related injuries are a common and serious problem for older people. People aged 65 and older have the highest risk of falling, with 30% of people older than 65 and 50% of people older than 80 falling at least once a year.(NICE 2013)Patient health records were assessed using NICE standards for inpatient falls:• 100% of patients had a falls

assessment within 6 hours of admission

• All patients had an agreed care plan that had been reviewed. However only 40% were

multifactorial with timescales • 88% of patient and their carers

received verbal advice on the ward on falls prevention techniques

• 79% of patients received further verbal advice before discharge on falls prevention strategies

Audit results reflect a lot of improvement work undertaken prior to audit; however the audit has shown some areas for improvement.The RCP FallSafe initiative with pathway and care bundles is being adapted and will be launched within the next 6 months across all bed-based services provided by Bridgewater. This will provide a more robust process for both patients and staff. A further audit will be undertaken 3 months after implementation of FallSafe to ensure that all NICE standards have been achieved.


Title of Audit Key Findings Actions• Only 1 person had evidence of

being offered and referred to a falls prevention service

• Only 19% of patients had a lying and standing blood pressure taken (local & RCN standard)

• 81% had a home assessment documented in the notes. Patient feedback showed this to be 100%

Further patient feedback:• 100% of patient said they were

treated with dignity and respect at all times

• All patients rated the care as very good or excellent

Out of the 30 audits, 19 have action plans for development and 11 achieved the standards of care. It should be noted that a good clinical audit programme will focus on areas identified for potential improvement. This means that most of the topics being audited for the first time are expected to have action plans for improvement. A portion of the clinical audit programme will consist of re-audits that have been through cycles of improvements and been re-audited until standards are met. Some examples of audits that have met the standards are:

Title of Audit Key Findings

Audit of assessment of dementia at Newton Community Hospital (cycle 2)

Significant improvements from initial audit as shown below.

100% assessed using evidence based tool (6CIT), of these 84% within 6 hours of admission. An increase of 61% from previous audit. The service added the recording the time of the 6CIT assessment which provided the evidence that 84% were being assessed within 6 hours. The previous audit highlighted that the time was not recorded and there was only evidence of ‘assessment within 6 hours’ in 39% of cases.

91% of patients had the outcome of the 6CIT assessment acted upon. In the previous audit this was 80%.

The initial audit findings showed that only 17% had information regarding the assessment contained within the GP letter, within this audit cycle this had increased to 96%.

This re-audit shows that standards audited are now all within an acceptable level.

Audit of Insulin Safety in Community Nursing

This audit was piloted in the Wigan borough and then repeated across all areas of Bridgewater. As the clinical standards of care were met, there is no need to re-audit but on-going monitoring will be undertaken through incident reporting.

There were four parts to this audit. Three parts were undertaken during a home visit to administer insulin to patients.


Participation in Clinical Research The number of patients receiving relevant health services provided or subcontracted by Bridgewater Community Healthcare NHS Foundation Trust in 2014/15 that were recruited during that period to participate in research approved by a research ethics committee was 87.

Goals agreed with Commissioners - Use of the Commissioning for Quality and Innovation (CQUIN) Payment FrameworkA proportion of Bridgewater Community Healthcare NHS Foundation Trust income in 2014/15 was conditional on achieving quality improvement and innovation goals agreed between Bridgewater Community Healthcare NHS Foundation Trust and any person or body they entered into a contract, agreement or arrangement with for the provision of relevant health services, through the CQUIN payment framework.

The Trust developed Commissioning for Quality and Innovation schemes with each of the four main boroughs, Halton, St Helens, Warrington and Wigan Clinical Commissioning Group payment framework. Targets were also agreed separately with Specialised Commissioning for our Offender Heath services.

The framework aims to embed quality within commissioner-provider discussions and to create a culture of continuous quality improvement, with goals that are agreed as part of annual contracts.

Title of Audit Key FindingsThe fourth part related to staff training.

1. Nurses were observed: all patients were noted to have their blood glucose checked or were known to be stable prior to the administration of the insulin. All staff were observed administering the insulin in a safe manner.

2. Patient health records were audited which showed that all patients had an

insulin care plan. All prescription sheets met record keeping standards for:- Dose in units (not abbreviated)- Frequency- Drug name- Batch and expiry

3. The patient was asked whether they had been offered or taught to administer the insulin, either self-administer or a family member/carer.

The patient was also asked whether it was easy enough to get insulin medication from their own GP.- In 16% of patients, it is not known whether they had been taught or offered

self -monitoring or self -administration skills. The auditor either did not ask the patient or did not complete the audit form properly during the visit.

- A small number of patients (6%) said that it was not easy enough to get insulin medication; they blamed the pharmacy or their own GP.

4. 47% of staff said they had not received training on insulin. The largest number of staff saying they had received training was at Wigan (62%), and the lowest at Halton (4%). The disparity of training is a known issue across the service and is already under review.


Further details regarding the agreed goals for 2014/15 and for the following 12 month period is available electronically at www.bridgewater.nhs.uk/aboutus/foi/cquin/

During 2014/15 the Trust attracted 2.5% of our contract value as CQUIN payments. The total payment available within the CQUIN framework during the period was £2907k.

The monetary total for the associated payment in 2013/14 was £2948k.

What others say about the Provider - Statements from the CQCBridgewater Community Healthcare NHS Foundation Trust is required to register with the Care Quality Commission and its current registration status is full and unconditional registration.

The Care Quality Commission has not taken enforcement action against Bridgewater Community Healthcare NHS Foundation Trust during 2014/15.

Bridgewater Community Healthcare NHS Foundation Trust has not participated in any special reviews or investigations by the CQC during the reporting period.

NHS Number and General Medical Practice Code ValidityBridgewater Community Healthcare NHS Foundation Trust submitted records during 2014/15 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:

• 99.9% for outpatient care• 98.5% for accident and emergency care

The percentage of records in the published data which included the patient’s valid General Medical Practice code was:

• 97.4% for outpatient care • 98.5% for accident and emergency care

Information Governance Toolkit Attainment LevelsThe Information Governance Toolkit (IGT) provides an overall measure of the data quality systems, standards and processes. The score a trust receives is therefore indicative of how well that trust has followed guidance and good practice. An audit was conducted by Mersey Internal Audit Agency (MIAA) during January/February 2015 to evaluate and validate the Trust’s self-assessed scores. The final report from MIAA granted the Trust ‘significant assurance’.

Bridgewater Community Healthcare NHS Foundation Trust Information Governance Assessment Report overall score for 2014/15 was 66% and was graded green and validated as satisfactory.


Clinical Coding Error RateBridgewater Community Healthcare NHS Foundation Trust was not subject to the payment by results clinical coding audit during 2014/15 by the Audit Commission.

Statement on Relevance of Data Quality and your actions to improve your Data QualityBridgewater Community Healthcare NHS Foundation Trust will be taking the following action to improve data quality.

The Trust recognises the need to ensure that all Trust and clinical decisions are based on sound data and has a number of controls in place to support the process of ensuring high quality data.

The Trust has used MIAA to audit performance reporting since May 2011. The overall objective of the audits is to provide assurance that the Trust has an effective process-controlled system for performance reporting.

The Trust has implemented its data consistency programme that aims to ensure a consistent One Bridgewater approach to recording data across all its boroughs.

A data consistency implementation group is chaired by the Medical Director, who oversees data consistency progress aligned with service redesign and SystmOne roll-out across the Trust.

Reporting against Core IndicatorsSince 2012/13, NHS Foundation Trusts have been required to report performance against a core set of indicators. Bridgewater Community Healthcare NHS Foundation Trust is able to provide data related to the following relevant indicators.

Core Indicator 2014/15 2013/14The percentage of patients aged 16 or over, that were readmitted to a hospital which forms part of the Trust within 28 days of being discharged from a hospital which forms part of the Trust during the reporting.

2%

There were 343 discharges and 7 readmissions within 28 days

0.3%

There were 367 discharges and 1 readmission within 28 days

NB – The above figures relate to Newton Community Hospital which is an intermediate care facility and only admits patients aged 18 or over. Therefore, direct comparison with the national comparative data below is not possible.

The National average for Emergency 28 day Readmissions for patients over 16 years of age for the 2011/12 reporting period (latest available data) is 11.08% and the North West average is 13.02%.


Bridgewater Community Healthcare NHS Foundation Trust considers that this data is as described for the following reasons;

Reason Days to readmission back into Newton Community Hospital

1 x Fall 16Reduced mobility 1Chest infection 5Patient unable to cope at home 1Chest Pain 23Reduced Mobility 4Reduced Mobility 22

Bridgewater Community Healthcare NHS Foundation Trust has taken the following actions to improve this number, and so the quality of its services, by:

• Continuation of the two week Outreach Service to provide support to patients in their own homes

• Commencement of daily Multidisciplinary (MDT) Team Planning Meetings• Commencement of three x weekly MDT ward rounds• Commencement of local team analysis of readmissions to enable learning and improvement

Core Indicator Bridgewater 2013

Bridgewater 2014

National Average for Community

Trusts

Highest Community

Trust

Lowest Community

Trust

% of staff that would recommend the Trust to friends and family in need of treatment. (Q12d NHS Staff Survey)

65% 70% 70% 83% 62%

% of staff that would recommend the Trust to friends and family as a place to work. (Q12c NHS Staff Survey)

47% 49% 53% 73% 41%

The Bridgewater Community Healthcare NHS Foundation Trust considers that this data is as described for the following reasons:

• There have been major organisational changes affecting staff during 2013 and 2014. It is recognised that change of this nature and scale can affect staff morale and their perceptions of the organisation. Work has been on-going during 2014 to try to

improve this and there has been a slight improvement in the score to reflect this.


The Bridgewater Community Healthcare NHS Foundation Trust intends to take the following actions to improve this score, and so the quality of its services by:

• Recognising that there is a slight improvement in this result and continuing to work towards improving this score by proactively monitoring the staff survey action plans

that will be developed with staff involvement and focusing on the results of the quarterly family and friends survey results.

• Various initiatives have been put into place to work further on staff engagement and these include: updating the intranet site, Director Walkabouts, Professional Forums, Chief Executives Blog, Team Brief and Trust Bulletin, Star of the Month, Annual Staff Awards and “you said, we did…..are doing” cascades.

Core Indicator 2014/15 2013/14Percentage of patients who were admitted to hospital (Newton Hospital only) and who were risk assessed for venous thromboembolism during the reporting period.

98.75% 99.46%

VTE Screening Performance Average % of VTE Patients Screened Lowest Performance % Highest Performance %

Bridgewater Average Full Year 99.64% 94.40% 100%National Average All Trust (April 2014 - Jan 2015)

96.09% 87.42% 100%

Greater Area Manchester Team(April 2014 - Jan 2015)

96.17% 93.68% 100%

Community Trust All (April 2014 - Jan 2015)

98.53% 95.14% 100%

(NB – the data in the above table from UNIFY2 relates to both Newton Hospital and our intermediate care service in Padgate House. Therefore a direct comparison is not possible. The table has been added to provide indicative data regarding the national average and the highest and lowest scores for this core indicator).

Bridgewater Community Healthcare NHS Foundation Trust considers that this data is as described for the following reasons;

• Four patients were not risk assessed;• Three patients were readmitted into the acute hospital within 24 hours• One patient died within 24 hours of admission.


Bridgewater Community Healthcare NHS Foundation Trust has taken the following actions to improve this percentage, and so the quality of its services, by ensuring that all patients are risk assessed and appropriate actions/treatment for all patients within 24 hours of admission are completed where their length of stay is longer than 24 hours.

Core Indicator 2014/15 2013/14

The number and, where available, rate of patient safety incidents reported within the trust during 2014/15, and the number and percentage of such patient safety incidents that resulted in severe harm or death

The number and, where available, rate of patient safety incidents reported within the trust during 2014/15

3963 incidents reported of which 1323 (33%) were submitted to the NRLS as patient safety incidents

4655 incidents reported of which 1088 (23%) were submitted to the NRLS as patient safety incidents

The number and percentage of such patient safety incidents that resulted in severe harm or death

There were 24 incidents resulting in severe harm or death, 13 (0.98%) of which met the criteria for a patient safety incident

There were 16 incidents resulting in severe harm or death, 7 (0.64%) of which met the criteria for a patient safety incident

Please see additional information provided in the incident reporting section of this account regarding the national average, highest and lowest comparative figures from the National Reporting and Learning Service (NRLS).

The Trust considers that this data is as described for the following reasons, compared to 2013/14: -

• Incident reporting volumes have decreased by 716 (15%) due to a correction in the reporting of non-patient safety incidents during 2014/15, please see the Incident Reporting section for further detail

• The volume of patient safety incidents has increased by 151 (13%) due to closer scrutiny and more accurate reporting, of these,

• The ratio of No Harm incidents (near miss, insignificant outcomes) increased by 195 (49%) through better recording

• There was an increase of 26 (48%) serious untoward incidents identified

The Trust has maintained or initiated the following actions to improve the collection and accuracy of this data and indicators, and so the quality of its services, by: • Increased staff training in root cause analysis documentation and techniques, incident

management and risk assessment

• Routine scrutiny of incidents on a daily and weekly basis by the risk team and senior clinicians that increases data quality and accuracy

• Increasing the timeliness of risk and incident reported to the Quality Management Group to discuss and agree service change

• Improving internal incident reports for the re-structured clinical directorates


Monitor Compliance / Monitor Risk Assessment Framework Due to Bridgewater achieving Foundation Trust status on 1st November 2014, the on-going Trust Development Agency Oversight self-certification and monthly declarations ceased in September 2014.

Monitor expects NHS Foundation Trusts to establish and effectively implement systems and processes to ensure that they can meet national standards for access to health care services. Monitor incorporated performance against a number of these standards in their assessment of the overall governance of Bridgewater going forward as a Foundation Trust.

Performance against the relevant indicators and performance thresholds is set out on next page.


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Quality of Services in 2014/15Trust Quality MeasuresDuring 2014/15 the following Quality Measures were agreed.The measures were chosen to reflect patient safety, patient experience and clinical effectiveness, and to demonstrate the quality of care provided by a broad range of our services.

Indicator to be measured

Change compared to previous year



2012/13 full year position Comments

Number of pressure ulcers which developed whilst patients were under our care £ 38% 33% 34%

Volume of reported incidents decreased overall, and the % ratio of these types of incidents increased by comparison

Number of serious unto-ward incidents (SUIs)

£ 80 54 57

The volume of reported SUIs increased by 26 (48%) with a significant increase in non-pressure ulcer SUIs i.e. information governance breaches and falls

Proportion of incidents with outcome of “No Harm “

£ 45% 34% 51%

Reported patient safety incidents increased by 2%,and “No Harm” (near miss, insignificant) outcomes increased by 11%NB – the figures published in last year’s account included minor harm

Number of reported cases of Clostridium difficile £

2 4 2

For further information please see Clostridium difficile section

Number of reported cases of MRSA

0 0 3

Ratio of patient falls (in-patient facilities)

£ 5% 3% 3%

The overall number of reported incidents decreased, and the ratio of falls increased by 2%

Percentage of patient facing staff that have been vaccinated against flu

ALW £Warrington£

Halton & St Helens£

Dental£Total£

60%48%45%

47%53%

56%46%36%

36%45%

51%59%58%

32%52%

National average across all trusts - 54.9%A vaccination and immunisation lead post is to be appointed to lead the delivery of and operationally manage the flu immunisation programme

£

£


Indicator to be measuredChange

compared to previous year

2014/15 full year

position



Staff who would recommend our services to friends and family

£ 3.553.48

(reported last year as 3.47)

3.58

The minimum score is 1 and the maximum score is 5. For further information please see section on Statutory Quality Indicators and Statements

Percentage of patients indicating they had a good overall experience £ 99% 98%

Figure not collected in

2012/13

For further information please refer to patient survey and Friends and Family Test results sections of this account

Number of complaints £ 91 88 125

End of life – Percentage of patients being cared for in their Preferred Place of Care (PPC)

Warrington£

ALW £

Halton

St Helens

97%

87%

81%

95%

95%

86%

97%

Not available

Ashton Leigh Wigan data on PPC was not routinely collated prior to 13/14. During 2013/14 Halton & St Helens jointly monitored whether a PPC assessment had been completed (93.5%).During 2014/15 a standardised approach has been introduced to monitoring clinical standards in end of life care delivery in all boroughs. Within Halton and St Helens this process has been introduced from September 2014 and we are working towards embedding this within teams to ensure the quality of the data. During 2015/16 we will begin to evaluate the data to highlight areas we can develop and improve.


Indicator to be measuredChange

compared to previous year

2014/15 full year

position



Percentage of immunisations delivered on schedule for children reaching their 2nd birthday

DiphtheriaTetanus

Whooping coughpolioHib

Meningitis CPneumococcal

MMR

Please see appendix A

Percentage of admitted patients that have been risk assessed for VTE (Newton Hospital)

£

98.75% 99.46%Figures not collected in

2012/13

Four patients were not risk assessed;

• three patients were readmitted into the acute hospital within 24 hours

• one patient died within 24 hours of admission.

Number of patients re-entering the service within 30 days (Newton Hospital only)

£ 7 1 Figures not collected in

2012/13

Of the 7 patients readmitted within 28 days to Newton 1 patient had a fall, 2 had a decline in medical condition, 1 not coping at home and 3 patients mobility deteriorated further following discharge. They were readmitted back into Newton Community Hospital which avoided admission into an acute hospital bed


Patient ExperienceThe Trust recognises that eliciting, measuring and acting upon patient feedback is a key driver of quality and service improvement. The Trust has a Patient Charter outlining what people should expect from Bridgewater services and who to contact if they do not meet those standards. The Trust uses a range of methods to seek patient feedback including the use of patient stories, patient surveys, which include the Friends and Family question and the use of Patient Partners, as a way of involving the people who actually use the services. All feedback is closely monitored with any lessons learned identified and cascaded across the organisation.

Patient StoryA patient story is presented to the Board each month. This is a compelling way of illustrating the patient’s experience and enables the Board to gain a meaningful understanding of how people feel about using our services.

Lessons learned from each story are identified and action plans are developed and monitored monthly to ensure that quality and service experience issues are acted on and lessons learned across the whole Trust.

Some examples of patient stories during the year include:

• Adult Continence Service

How the service supported a patient to use a range of products and equipment which fitted-in with their life style and has given them confidence when on holidays abroad, using trains, and going to the theatre.

• Adult Learning Disability Service

How the service supported a patient living alone with a history of diabetes, no social care provision and who had not attended for a check-up at his GP surgery for over 3 years. Patient was unable to read letters from healthcare providers and therefore was not able to access appropriate services. The service supported him to identify and understand his needs and ensured information was accessible in easy read/pictorial letters.

• Health Visiting Service

How a mother was involved in the service as a Parent Partner to share her experience of the service in order to ensure the service was continually improving and meeting the needs of patients.

• Augmentative and Alternative Communication Network

A remarkable story about a patient with cerebral palsy, who helped develop a communication tool to enable them to communicate.

The patient uses Alternative and Augmentative Communication (A.A.C.) and would like to be a role model for new users and anxious parents.


Patient Survey and Friends and Family Test ResultBridgewater has developed a ‘Talk to Us…’ form to seek patient feedback. This includes the Friends and Family Test (FFT), which became mandatory for all Community Trusts from January 2015, as well as a number of questions which aim to ascertain how people feel about accessing Bridgewater services.

The FFT is based on a simple question “How likely are you to recommend our service to friends and family if they needed similar care or treatment?” with answers on a scale of extremely likely to extremely unlikely.

Although the FFT only became mandatory for all Trusts from January 2015, this has been implemented across Bridgewater since 2013 and during the year, a total of 22,613 people responded to the FFT question. The way the FFT is reported has changed during the year and the results are now shown as a percentage of people who would recommend the service and those who would not. The results from October 2014, when the new system of analysing the results was introduced, are shown below.

Quarter 3 Quarter 4Borough/Service Number of

ResponsesWould

RecommendWould NOT Recommend

Number of Responses

Would Recommend

Would NOT Recommend

Dental Services 493 99% 1.1% 454 99% 0.5%Halton 1526 97% 0.5% 1226 98% 0.6%St Helens 1371 97% 1% 2482 96% 0.3%Warrington 819 98% 0.5% 1342 98% 0.3%Wigan 1997 96% 0.4% 3506 96% 0.8%

The survey results from the follow up questions show that 24,820 people have responded to the questionnaires since April 2014 and 99% have expressed overall satisfaction with their care and treatment.

Patient PartnersPatient Partners is a Bridgewater initiative to showcase how to actively involve patients and carers to work with staff to identify areas for improvement in quality of care and service delivery.

Over 190 Patient Partners are actively involved in working with the services to identify and implement service improvements. The services working with Patient Partners include:

• Adult Speech and Language Therapy (Halton).

• Changes include the development of a ‘Loud treatment group’ to be set up to support intensive, evidence based therapy for speech difficulties for people with Parkinson’s Disease.

• Dermatology (Wigan)

• Eczema Expert - Patient Partners within focus groups supported the development of a Top Tips sheet for emollient and steroid use within the Eczema Expert pack and continue to provide feedback to support development.


• Heart Failure Nurse Specialist Healthy Heart Service (Halton and St Helens)

• Capturing patient stories on their journey through the service, including ease of access to the service, the quality of the information provided and what we could

do to improve the service.

• School Health (Warrington)

• Capturing the views of children and young people who have asthma, about their experiences and how the services could help them understand and manage their condition.

Patient Advice and Liaison ServiceWe recognise that when people have issues or concerns with our services we should aim to resolve these as quickly as possible. Bridgewater provides a single free phone number for people to contact for advice and information or to help resolve their issues and concerns.

During 2014/15 we received 1440 contacts across Bridgewater, as summarised below.

Corporate Dental Halton St Helens Warrington Wigan Willaston Total

Quarter 1 2 11 48 50 94 151 0 356

Quarter 2 0 12 64 46 95 164 1 382

Quarter 3 3 8 48 45 95 122 0 321

Quarter 4 4 14 56 50 101 153 3 381

Total 9 45 216 191 385 590 4 1440

Around 51% of the contacts were requests for advice and information, including signposting to other organisations.

Almost 49% of the contacts resulted in the department liaising between the enquirer and the service to resolve issues and concerns. Examples of the issues raised include appointment delay/cancellation and staff attitudes.

Only 8 of the 1440 contacts went on to become formal complaints.


ComplaintsWe aim to learn from complaints as part of improving our patients’ experience.

During 2014/15 we received 91 complaints compared to 88 during the previous year. These are summarised on a Borough/Service basis below:

Dental Halton St Helens Warrington Wigan Willaston Total

Number of Complaints

5 19 18 21 25 3 91

The complaints were divided across a range of issues. The themes are summarised in the table below:

Theme of complaint NumberAspects of clinical treatment 62

Attitude of staff 13

Aids and appliances, equipment, premises 5

Appointments, delay/cancellation (outpatient) 4

Failure to follow agreed procedures 4

Admissions, discharge and transfer arrangements 2

Patients’ privacy and dignity 1

Total 91

Every complaint received is investigated to understand fully what has happened and to seek out the lessons that can be learned. All lessons learned are discussed with the service leads at the lessons learned group and cascaded via Team Brief.

Some examples of lessons learned include:

• Ear Care Service – All ear care patients to be provided with written information outlining potential side effects. This will be recorded on SystmOne when the information leaflet has been posted with appointment.• Walk-in Centre (WIC) – a concern was raised as to whether it is normal policy to

refuse treatment based on the fact the night had been busy, the conduct of the nurse who saw the child and the notes that were put on her clinical records.• Closing procedure for WIC to be reviewed to ensure it supports the decision making process for patients attending at the end of the day.• Customer Care training initiated for all patient facing staff.

• Dental Services – Following a complaint about staff attitude and the lack of care and treatment received from a particular dentist in one of our community dental services. • E-learning package purchased from the National Autistic Society to enable dental

staff to understand the effects of autism in dental health and treatment. • The package will be shared with the Learning and Development Team to be accessible to all services.


Staff Engagement, Health & Wellbeing Our key priorities for 2014/15 were to:

• Improve on the national NHS Staff Survey results• Improve the national NHS Staff Survey ‘Engagement‘ score• Improve the national NHS Staff Survey score for Staff recommending the Trust as a place to work and receive treatment• Increase the Personal Development Review rate (Staff appraisal) • Reduce sickness absence rates against a Trust target of 3.78%• Achieve Trust target of a rolling 8% for staff turnover.

Staff EngagementThe Trust promotes effective employee engagement to create a motivated and valued workforce which ultimately leads to better patient care and service experience. Engagement, consultation and ensuring effective communications with our staff is of paramount importance. During the past 12 months we have continued to improved our methods of communication, involvement and engagement with staff to enable them to understand the aims and objectives of the Trust, its mission, vision and values.

The key performance indicators have helped the Trust to measure, and will continue to help measure the quality of staff experience. Data relating to workforce indicators are reported to the Trust Board as are the annual national NHS staff survey results.

We enjoy effective partnership working with our Trade Unions and Staff-side colleagues and believe this is critical to our success.

We have various information and communication channels, engagement systems, programmes and initiatives which include, but are not limited to:

• A monthly Team Brief cascade led by the Chief Executive and Executive Team. The Brief is cascaded by managers across the whole organisation within seven days

• A weekly Trust Bulletin which provides staff with information as to what is happening within the Trust, patient stories, the events that they can attend, seminars, workshops and forums they can engage in. Staff are able to contribute to the content of the Bulletin, put questions to the Trust’s communications team and partake in research programmes and promote the good work of their services as per its regular ‘Spotlight on Services’ feature

• A “Star of the Month Award” whereby staff can nominate colleagues who have gone over and above their role, living up to the Trust’s values and demonstrating ‘star’

qualities. Awards are presented by the Chief Executive and publicised in the Bridgewater Bulletin, Trust Intranet and website• Trust wide Staff Awards were held in March 2015. There were six Awards categories:

• Clinical Employee of the Year• Non-Clinical Employee of the Year• Team of the Year• Outstanding Contribution to Innovation• Patient Choice Award – nominated by our Patients/Members• Chairman’s Award for Lifetime Achievement


• The Chief Executive’s Blog is featured in the Trust Bulletin and also accessible to staff via the Trust’s Intranet

• The Trust Intranet keeps staff updated with current information on the organisation; what is happening within the Trust, its services, organisational change, developments, initiatives, innovation and improvements

• Director Walk-abouts enable staff to meet members the executive team to discuss the quality of services they delivery and listen to their views, ideas and what it is like to work for the Trust

• Professional Forums, which are made up of clinical staff, include presentations and workshops on national, regional and local issues and initiatives, best practice and networking opportunities

• The Productive Community Services Programme enables staff to share their experiences of service improvements and developments. Staff have and are adjusting

to new ways of working. Staff who have undergone modules have reported much improved working environments, increased face-to-face contact time with patients

and less time spent on administration tasks due to system and process improvements, enabling more time to deliver patient care.

NHS Staff Survey 2014Working with staff to understand key messages from the staff survey

The Trust takes part in the national annual NHS staff survey. As well as providing us with feedback on how we are doing and how staff are feeling in relation to 29 ‘Key Findings’, we are provided with a national ‘staff engagement’ score. Our 2014 score slightly improved in comparison to 2013 from 3.61 to 3.67. The scoring system is a scale of 1 to 5 with 1 being ‘strongly disagree’ and 5 ‘strongly agree’.

The overall indicator of staff engagement is calculated using the following ‘Key Findings’ questions:

• KF22: Staff ability to contribute towards improvement in work• KF24: Staff recommendation of the Trust as a place to work or receive treatment• KF25: Staff motivation at work

To ensure that we continue to listen to our staff and acknowledge the important feedback we get from our survey, we develop action plans to inform us of our key priorities and areas for further developments and continuous improvements. The action plan is and will continue to be managed through formal management meetings where performance reviews take place. Action plans and progress against the same are shared with our Staff-side colleagues at our partnership working groups.

As part of our response to the staff survey to enable staff to see how we are responding to their feedback, we have developed the “Listening to You” approach…”You said, we did…are doing” cascades. Year on year we ensure that we measure the changes identified in the staff survey as it provides a structured, evidence based way for us to engage with staff and respond to their feedback. We have also introduced ‘Chris’ Clinic’ which gives direct access to the Trust’s Director of People, Planning and Development on a weekly basis, enabling an opportunity for staff to ask questions or raise issues on an individual basis.


We have a quarterly staff friends and family test which is focussed on areas of the national staff survey, enabling us to monitor our progress throughout the year.

The staff survey results provide us with our top five and bottom five ranking scores:

Top 5 Ranking Scores - The five areas for which the Trust compares most favourably with other Community Trusts in England are:

• KF17: Percentage of staff experiencing physical violence from staff in last 12 months• KF27: Percentage of staff believing the trust provides equal opportunities for career

progression or promotion• KF19: Percentage of staff experiencing harassment, bullying or abuse from staff in last

12 months• KF16: Percentage of staff experiencing physical violence from patients, relatives or the

public in the last 12 months• KF12: Percentage of staff witnessing potentially harmful errors, near misses or incidents in last month.

Bottom 5 Ranking Scores - The five areas for which the Trust compares least favourably with other Community Trusts in England are:

• KF2: Percentage of staff agreeing that their role makes a difference to patients• KF29: Percentage of staff agreeing that feedback from patients / service users is used

to make informed decisions in their directorate / department• KF8: Percentage of staff having well-structured appraisals in last 12 months• KF21: Percentage of staff reporting good communication between senior management and staff• KF15: Percentage of staff agreeing that they would feel secure raising concerns about

unsafe clinical practice

Although we saw a deterioration in 11 of our ‘Key Findings’ in comparison to the 2013 with the exception of KF7: Percentage of staff appraised in the last 12 months, staff survey results were not statistically significant. There has also been an improvement in scores on 16 of the Key Findings from 2013 to 2014. None of the scores in which there has been an improvement are statistically significant. This was welcoming for the Trust in light of the major organisational changes affecting staff. Improving on the staff survey results will remain a key priority through our action plans and focus groups.

Staff Health & WellbeingWe continue in our commitment to reduce sickness absence through effective management and support from Occupational Health and the Trust’s Human Resources team. A healthy motivated workforce is integral to achieving better care for our patients. We have an occupational health service which provides staff with:

• Telephone and face to face counselling services• Physiotherapy services• Occupational health referral and assessment services, including speedy referrals for

mental health and muscular-skeletal disorders.


Our Occupational Health Service provides us with information that helps us identify areas of staff health and wellbeing that may require more attention, such as issues of personal and workplace stress. The introduction of online occupational health referrals has enabled more timely referrals and feedback on medical assessments / opinions.

The Trust recognises that any adverse impact on staff that affects their ability to function at their best in the workplace needs active steps to provide support and take a preventative stance where possible. The Trust will be recruiting a member of staff to support the managing and handling of staff health and wellbeing.

The Trust’s sickness absence target is 3.78%. The absence rate at the end of March 2015 was 5.68% in comparison to 4.90% at the end of March 2014.

Management are provided with monthly absence reports which enable them to monitor absence in line with the Trust’s policies and procedures. Absence rates are monitored monthly by the Trust Board.

Personal Development Reviews (PDRs) We continue to provide opportunities for our staff to develop via a ‘values’ driven personal development review to ensure they can continue to meet the needs of our aims, objectives and patients.

The Trust’s focus on PDRs has been captured within the 2014 NHS Staff Survey in which 85% of respondents confirmed that they had been appraised in the last 12 months. This is the survey’s ‘Key Findings’ for which the Trust has had a significant reduction since 2013 when 94% of staff confirmed they had been appraised.

Directorate Percentage of Staff ComplianceAdult Services 96.99%

Children’s Services 91.32%

Corporate Service 49.66%

Specialist Services 96.71%

BRIDGEWATER 91.15% Concerted efforts will be focused into ensuring that staff have an annual PDR. Managers now complete and return monthly compliance reports which enable senior managers to review PDR take up, compliance and non-compliance by way of individual staff members within their Teams. To ensure PDRs are meaningful, we will be focussing on improving our bottom five ranking staff survey scores.

Staff TurnoverThe rolling staff turnover for the Trust as at 31 March 2015 was 14.07%. This is above the Trust target of 8% however during a time of organisational change and continuing cost improvement programmes this is not necessarily unexpected or a cause for concern. Work is on-going around staff engagement and any particular issues should be identified during this stream of work.


Responsible Officer ComplianceThe introduction of Medical Revalidation in December 2012 has reinforced the interdependent responsibilities of healthcare organisations and individual professionals around patient safety and good medical practice. Medical revalidation has placed new statutory duties on organisations and individuals, to ensure that doctors are practising in well structured, managed and governed systems.

Through utilising PREM IT electronic appraisal system, Bridgewater is supporting the evaluation of our doctors’ fitness to practise in a fair and consistent way. Currently we are 100% compliant with our appraisals returns. The next step is to establish a reporting process that will not only evidence our compliance, but also provide assurance at Board Level that our medical professionals are operating safely and providing good medical care.

Education & Professional DevelopmentThe primary aim of the Education and Professional Development (EPD) Service is to support all health care staff within Bridgewater to have up to date, evidence based knowledge, skills and abilities in order to ensure that they can provide safe, effective and compassionate care.

Mandatory TrainingDuring 2014/15 substantial work has been undertaken to review the mandatory training and induction programmes. This has involved consideration of a new eLearning platform and alignment to national and local agendas.

Continuing Professional DevelopmentContinuing Professional Development (CPD) is fundamental to the advancement of all staff and is the mechanism through which high quality care is identified and maintained (DH 2014). The EPD service has continued to support all staff to further develop their knowledge, skills, practical experience and competencies. This is achieved by completion of an annual Training Needs Analysis which is based on both individual learning and development needs, identified through Personal Development Review, and the Commissioned Service delivery. This ensures that staff have the right skills to deliver a high quality service to meet the identified needs of the population they serve. In 2014/15 training has been provided on a variety of topics including:

• Clinical skills

• Coaching and Mentoring

• Communication and Difficult Conversations

• Leadership and Management

• Record Keeping

In addition, we continue to support and fund staff to attend external learning and development opportunities and to access academic modules on a wide range of subjects for example:


• Advanced Clinical Skills

• Apprenticeship frameworks, vocational qualifications and cadet programmes

• Public Health

• Prevention and Early Intervention

• Research

Educational Governance and internal Quality Assurance processes are in place and aligned to the Education Outcomes Framework (DH 2013). This guarantees continual improvement of the training provided and that it matches the expectations of the public, staff, employers, healthcare professional bodies and, if appropriate, statutory requirements.

Competence FrameworksA Competence Development Group was established in early 2014 to support the development of competence frameworks for all grades of patient facing staff. These are currently being piloted within several of our services and will be evaluated prior to Trust wide implementation. This will support continuous assessment and on-going development of staff and provide assurance on the skills, competence, attitudes and behaviours of our staff.

The Trust has also taken an active role as a member of the North West Steering Group in the development and testing of the Care Certificate Framework; in response to the recommendations of the 2013 Cavendish Report. The Care Certificate covers 15 standards that set out the learning outcomes, competences and standards of behaviour expected of all healthcare support workers to ensure that they are caring, compassionate and provide quality care. As a result of the feedback received from the Trusts involved in the development and testing, the Care Certificate was formally launched in April 2015 and is currently being implemented by all health and social care organisations in England.

Pre-RegistrationThe development of future healthcare professionals is at the very heart of our education and professional development offer. A dedicated team of practice education facilitators work in partnership with our clinical staff and services and with our partner universities to ensure the maintenance of high quality educational placements and positive learning experiences. The team also supports practice education through the on-going development and maintenance of our qualified mentors and educators. The Trust is able to offer students the opportunity to undertake placements in a diverse range of clinical services and in integrated health and social care settings. This prepares our future practitioners to respond to the needs of our current and future population as health and social care continues to transform and develop.

Forward PlanningIn 2015/16, we will continue to develop the Professional Development Support Framework to underpin education provision with a particular focus on revalidation to include accountability, clinical supervision and action learning sets. In addition, we plan to further affirm our commitment to the development of our future workforce through wider access to work experience programmes and through the development of placements to support undergraduate medical students.


Leadership Programme and the Bridgewater Quality Improvement Programme Bridgewater’s Quality Improvement Programme has been established to support the culture of continual improvement within the Trust. Bridgewater has worked in close collaboration with the Advancing Quality Alliance (AQuA) to research, design and deliver a bespoke improvement course. Course participants focus on improving clinical outcomes for our patients through increasing capability and flexibility within the workforce.

The first cohort of band 6-8 staff commenced in January 2014, the second programme commenced in September 2014 and the third programme is due to commence in May 2015. The style of learning is interactive and uses the knowledge and expertise of the course participants throughout the three modules, which cover an introduction to quality improvement and quality improvement tools, an introduction to Lean and the human dimensions of change.

The tools and techniques used throughout include the latest principles from both industry and healthcare.

The modules are designed to equip participants with transferable knowledge and to be able to share their learning within the workplace.

The course requires completion of a work based project and examples of the projects are included below:

• How we best utilise the skills of therapy assistants (redesign of role to increase capacity and skill mix capability in the team).

• Speech and Language Therapy – social marketing – understand the needs of local schools and what will improve our relationships.

• FallSafe programme with ward staff to reduce incidence of inappropriate falls for bed based services.

• Review inappropriate referrals with integrated community discharge planning team, collaboration between community and acute trust.

• Review and redesign role of health care assistant to become more involved in the care of patients at the Walk in Centres.

Library StrategyBridgewater Library and Knowledge Service (LKS) has continued to develop in line with its strategic plans for 2012-15. As a result we scored 87% in the 2014-15 annual quality assurance process (LQAF), which measures NHS libraries’ performance nationally. This is a further improvement on previous scores and brings us in line with other Trusts in the Northwest.

In February 2015, a new national strategy for NHS Library and Knowledge Services was published. Entitled “Knowledge for Healthcare: a framework for NHS library and knowledge services in England 2015 – 2020”, the national strategy sets out the strategic intentions for all


NHS library services up to 2020. The Bridgewater LKS response has been to revise and update our local strategy in line with national expectations. The Bridgewater strategy for 2015-18 focusses on the consolidation of achievements to-date and ensures that LKS services are equally available to Bridgewater staff irrespective of their location. As a community trust with a wide geographic spread, we rely heavily on information technology to deliver evidence in electronic form. In 2014-15, Bridgewater staff and students logged in to databases 1571 times using OpenAthens authentication. This is an increase from 785 accesses in 2013-14.

Equality, Diversity and InclusionThe reduction of health inequalities is a fundamental part of the framework within which all NHS organisations operate. The Health and Social Care Act 2012, the NHS Constitution, the NHS Outcomes Framework and the Five Year Forward View all set out the commitment to reduce health inequalities and improve healthy life expectancy. The first two CQC Fundamental Standards, (Person Centred Care and Dignity and Respect), also reiterate the commitment nationally to provide a healthcare service that is equitable in access and outcomes for all members of our society. These national strategies, the Equality Act 2010 and the Human Rights Act 1998 provide the legal framework within which the Trust operates its equality governance.

In order to demonstrate compliance with the Equality Act the Trust uses the national NHS Equality Delivery System (EDS2) to assess and grade performance on 18 outcomes across four goals – two patient centred and two staff and management centred. Using the information gathered in the completion of the annual Public Sector Equality Duty report, the EDS2 process and the equality analysis of services the Trust determines actions for the coming year(s).

At Board level, responsibility for equality diversity and inclusion sits with the Director of People, Planning and Development. The Head of Health Inequalities and Inclusion ensures that the Trust is meeting its legal responsibilities and provides strategic direction in relation to equality and health inclusion. The Equality and Human Rights Project Officer works with services to provide guidance and support on equality and diversity issues. The Trust’s Equality Statement sets out the commitment to equality and inclusion and is supported by an Equality and Health Inequalities Action Plan. Board assurance on the fulfilment of equality goals and objectives is provided by the Quality and Safety Committee who review the actions of the Health Inequalities and Inclusion Team and report on a six monthly basis. In addition, regular updates are provided to the Trust’s commissioners by the team.

The Trust has a network of over 100 personal fair diverse champions who receive regular updates to cascade to their staff; updates in the last year have included child sexual exploitation, autism friendly Christmas and stroke awareness.

As a health care provider the Trust requires all services to have a completed an equality analysis.

The Health Inequalities and Inclusion Team plans for 2015/16 include the signing of British Deaf Association BSL Charter, the production of reasonable adjustments guidance for Trust staff, the production of religion and belief guidance for staff, the start of a rolling programme of access audits of Trust services, a review of language interpretation and translation


provision, further awareness raising through the personal fair diverse Trust champions and submission to Stonewall Workplace Equality Index. In addition the Trust will be reporting on the key indicators in the new NHS Workforce Race Equality Standard.

Detailed Trust equality information such as our Public Sector Equality Duty reports, our EDS (and EDS2) grading results and service equality analysis are published on our website http://www.bridgewater.nhs.uk

Delivering Same Sex Accommodation (DSSA) (Halton, St Helens and Warrington Boroughs)Newton HospitalEvery patient has the right to receive high quality care that is safe, effective and respects their privacy and dignity. Newton Community Hospital (our only inpatient facility) is committed to providing every patient with same sex accommodation as it helps to safeguard their privacy and dignity when they are often at their most vulnerable. Other than in exceptional circumstances, patients admitted to Newton Community Hospital can expect to find the following standards for the provision of same sex accommodation:

• the room where their bed is will only have patients of the same sex• the toilet and bathroom will be just for one gender and will be close to the bed area• patients may share some communal space, such as day rooms or dining rooms

Occasionally, it may not be possible to care for patients in a same sex environment, e.g. in the case of an emergency or specialist care situation. The clinical (medical) need will take priority over keeping the patient apart from other patients of the opposite sex.

We can confirm for the period of April 2014 until March 2015 there were no breaches to the same sex accommodation.

Padgate HousePadgate House is a 35 bedded intermediate care unit based in Warrington. The building is owned and managed by Warrington Borough Council. The Trust is responsible for the provision of clinical services. The home has 35 single bedded rooms which are not en-suite. This ensures that patients never share a bedded area. The building has 14 bathrooms which are shared by all residents meaning that males and females will share the same facilities however there are clear engaged signs on doors and doors are lockable from the inside to maintain patient privacy. Staff are able to unlock doors from the outside should the need arise to ensure patient safety and were necessary staff will accompany and assist patients whilst using bathrooms. As Padgate House is not a hospital they are not considered to breach under the mixed sex accommodation requirements for use of communal bathroom facilities.

Incident ReportingThe Trust utilised the web-based Ulysses Safeguard Risk Management System for reporting all actual incidents and near misses, where clinical service delivery or patient safety may have been compromised.


There was a decrease in 2014/15 reporting compared to 2013/14 due to more accurate reporting and changes in service structures during 2014/15. Increasing accuracy of incident reporting is a positive indication of an open and honest culture that encourages staff to report incidents.

Commissioning Borough 2013/14 2014/15 VarianceALW 1304 1173 -131 -10%

Cheshire* 8 +8

Halton 829 766 -63 -8%

St Helens 1234 1031 -203 -16%

Trafford 30 1 -29 -97%

Warrington 930 761 -169 -18%

Prisons (NHS England) 85 80 -5 -6%

Dental (NHS England) 233 134 -99 -42%

Corporate 34 9 -25 -74%

Total 4679 3963 -716 -15%

*Cheshire Commissioners came online with the introduction of the Willaston Primary Care Service in July 2014.

Due to weekly and monthly incident data reviews by senior clinicians and managers, introduced during 2013/14 and maintained during 2014/15, the quality and accuracy of data has continued to improve during 2014/15. Along with daily checks undertaken by members of the risk team, this process also ensures that any serious incidents are identified early and escalated as quickly as possible for management attention.

The ‘Care Indicator Tool for Pressure Ulcers’ demonstrated quarterly improvements in pressure ulcer management by clinicians and continues to be utilised during 2014/15 to the benefit of patient outcomes. The added value of this data resulted in improved investigations and identified gaps for service change, notably, the frequency of review of patient’s pressure ulcers.

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10131131

1041 1143993

1127916


There were 13 (0.98%) patient safety incidents reported that resulted in major or catastrophic outcomes. Staff reported 3963 incidents during 2014/15, 1323 (33%) of which were categorised as incidents or near misses effecting patient safety. These are submitted to the National Reporting and Learning Service (NRLS), from which the CQC nationally monitors all Trusts’ patient safety incidents. The following table represents the number of patient safety incidents reported to the NRLS by level of actual impact.

Patient Safety Incidents by Actual Impact 2013/14** 2014/15 2014/15

Near Miss 114 10% 203 15% +89 +6%

Insignificant 285 24% 391 30% +106 +5%

Minor 636 54% 546 41% -90 -13%

Moderate 128 11% 170 13% +42 +2%

Major 5 0.43% 4 0.30% -1 -0.12%

Catastrophic 4 0.34% 9 0.68% +5 +0.34%

1172 1323 +151

**Compared to the 2013/14 Quality Account, the incident data has increased due to retrospective data input and update after data was extracted for that report

Although the overall volume of reported incidents (3963) has decreased compared to last year by 716 (15%), the volume of patient safety incidents (1323) increased by 151 (13%) compared to 2013/14. An increasing volume of reported patient safety incidents and more serious incidents offers assurance that staff continue to honestly and openly report issues relevant to the safety of patients and where increased actual harm has occurred. The ratio of ‘No Harm’ patient safety incidents increased by 195 (49%); near misses and insignificant outcomes each increased by 89 (6%) and 106 (5%) respectively compared to 2013/14.

Moderate, 114, 10.5%

Other, 7, 0.6%

Near Miss (no harm), 97, 8.9%

Insigni�cant, (no harm) 261, 24.0%

Minor, 609, 56.0%

Major, 4, 0.4%

Catastropic, 3, 0.3%

Patient Safety Incidents by Actual Levels of impact


The Children and Family Services Directorate confirmed that, compared to 2013/14, the reduction in reported incidents confirms a correction in reporting more accurately rather than any reporting downturn.

Similarly, in the previous division-based structure, services in the ALW division reported high numbers of demand and capacity concerns via the incident reporting system rather than incidents that directly impacted on service delivery or patient care. The managers have now documented these issues on the Operational Risk Register and are monitoring these directly with clinical managers. A number of actions have been put in place to address these concerns:

• Procurement of capacity planning tool in ALW Health Visiting and School Nursing services with the involvement of staff

• Involvement of teams in service planning via the clinical reference groups

• Profession-specific leadership as a result of the ALW operational management and team restructure

• Improved timescales for completion of vacancy control forms so staff can see the recruitment process progressing

• Team leader and professional meetings set up to improve communication and aid solution focused thinking

All incidents were routinely investigated and, in some cases, these may have been escalated into a full root cause analysis based on a consistent national methodology. The Trust maintained a pool of over 40 staff (clinical and non-clinical) specifically trained in root cause analysis techniques thus ensuring that incidents are thoroughly investigated and lessons are learned to prevent recurrence.

Non-PSI

PSI

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Patient Safety Incidents reported to the National Reporting and Learning Service (NRLS) April 2014 to September 2014 by NRLS Degree of Harm

Ave from similar organisations*

Reported from similar organisations

Total % N % Lowest Highest

None 327 45% 929 52% 230 1492

Low 296 27% 618 34% 94 1585

Moderate 96 41% 227 13% 87 537

Severe 3 0.41% 15 0.82% 0 89

Death 7 0.96% 3 0.19% 0 15

729 1792

* National figures obtained from the NRLS April 2015 report. Please note that:

• The averages include Bridgewater data,

• This national data covers patient safety incidents reported from April 14 to September 2014 (October 14 to March 2015 data is available later in 2015), however,

• The NRLS advises that not all organisations apply the national coding of Degree of Harm in a consistent way, which can make comparison of harm profiles of

organisations difficult, also

• Most other providers are not solely Community Trusts as Bridgewater is i.e. they have some mental health or acute functions; as a result, of the 19 Trusts that the NRLS has

compared Bridgewater to, there is only one other Community Trust with a service profile similar to Bridgewater and against which the Trust remains comparable

The following initiatives were undertaken during 2014/15 to improve our management of incidents:

• Automated weekly incident reports to senior managers every Monday morning of the previous seven days incident details to identify any concerns

• An increased pool of trained root cause analysis investigators during the final quarter• Automatic notification of all pressure ulcers to all the tissue viability nurses immediately on submission• Improving rates of pressure ulcer photographs attached electronically to incidents in

order that the tissue viability nurses can provide early advice remotely.

Never EventsNever events are serious, largely preventable patient safety incidents that may result in death or permanent harm, that should not occur if the available preventative measures have been implemented. The Department of Health reviews a list of these each year and there are 25 different events that all Trusts continually monitor. If they occur, we are required to report directly to the Care Quality Commission and our commissioners. There were no such events occurring during 2014/15.


Central Alert SystemUsing incident data from across England, the NHS develops national initiatives and training programmes to reduce incidents and encourage safer practice. Alerts are released through a single “Central Alerting System” (CAS) to NHS organisations which are then required to indicate their compliance with these safe practice alerts. They cover urgent regional or national matters concerning faulty medical devices, medication, estates issues and other patient safety issues. The Trust received 101 clinical alerts, and 59 non-clinical alerts, which were then cascaded to each directorate and onto service leads to assess the action required for each alert. All alerts relevant to patient safety in the community sector were assessed within the required timescales and action plans for improvement put in place where they were applicable to community healthcare.

At the end of 2014/15 the Trust was assessing the relevance of three alerts to meet any recommendations within the expected completion dates set later in 2015/16.

Pressure Ulcers Pressure ulcers can range from redness of the skin, to a small graze to a cavity. All patients with pressure ulcers are regularly reviewed to identify where, how and why they developed. In particular any pressure ulcer that develops or deteriorates whilst in our care has to be investigated to identify the cause and any areas where we could have improved our care. More serious pressure ulcers are reported to the GP, commissioners and the NHS Area Teams. The Trust is then monitored to ensure that we have identified the reasons for the development of pressure ulcers and any actions we need to undertake to improve future care.

A system for reporting all pressure ulcers is in place. During 2014/15 a total of 1153 pressure ulcer incidents were reported by staff of which 716 (62%) developed before our involvement in their care, 437 (38%) developed or deteriorated whilst the patient was under the care of the Trust. The Trust actively encourages all reported incidents and near misses are shared with patients and their relatives/carers. However, where an incident carries an impact score of 3 (moderate) or above sharing this information is now compulsory and this Trust monitors adherence to this through its Quality Management Group.

Many patients who develop or experience a deterioration to an existing pressure ulcer may have infrequent visits from district nursing, for example four times a year. Therefore, it is important that we work closely with patients and their carers to support them to care for their pressure areas. We have developed a patient information leaflet on what good pressure relief looks like, demonstrating pressure relieving techniques and provision of pressure relieving equipment where appropriate. District nurses actively encourage and rely on feedback from patients and their carers regarding any changes to the patient’s condition that requires a district nurse to check.

A training programme is delivered by our tissue viability team to all staff. This includes both taught sessions and workbooks for staff to complete. Within each team there are dedicated link nurses, who are registered nurses with additional training. Link nurses are then responsible for supporting staff to complete their competence in pressure ulcer care. Link nurses then act as a point of contact for any further guidance needed in relation to specific patients working closely with the tissue viability nurse’s when required.


The Trust also has a pressure ulcer working group which monitors the pressure ulcer action plan, which was developed to ensure all the right organisational systems and processes were in place to support staff who were caring for patients with pressure ulcers or who were at risk of developing them. The information leaflet and training programme came out of this work.

Building on this work from last year we have now implemented a process to monitor our performance against the new processes and national standards. Achievement against the standards can be evaluated at team, neighbourhood or borough level and is reported quarterly to our Quality Management Group. In the event the standard has not been fully achieved, an individual or team performance plan is developed to guide the necessary improvements.

Workforce Planning – Staff in the right place at the right time with the right skillsThrough the delivery of the Trust’s service transformation and cost improvement programmes, we have become much better at understanding what patients and the public want and need. It is important that we have a workforce that is flexible, mobile and is being continually developed around patient need.

Managers undertake workforce planning in line with an agreed model.

From April 2014, we have been required nationally to publish our staffing levels set within the guidance and context of ‘Safer Staffing Levels’. As a Community Trust we only have to report Safe Staffing for our Community Hospital inpatient unit. This information has been submitted monthly and in 2014/15 the Board have received monthly reports. The information is also shared on NHS Choices and our web site.

http://www.bridgewater.nhs.uk/saferstaffing/

Coroner’s CasesThe Trust received a Regulation 28 ‘prevention of future deaths’ report in December 2014 following the inquest into the death of an infant in April 2014. The death occurred the morning after he had been seen and examined by the GP Out of Hours Service in Warrington.

The coroner raised four matters of concern with the Trust and stated that ‘there is a very clear training need identified here in relation to the appreciation of this type of occurrence with very young children’.

The Trust has addressed the concerns raised in the report and has responded to the Coroner and the patient’s family in a timely manner. The Chief Executive met with the Coroner to investigate how we as a trust can assist the Coroner’s Office with processes to ensure we are always able to represent our view and to assure both him and the family of the actions we have taken within the Trust.


Infection Prevention and ControlSafe, effective and systematic infection prevention and control measures are an important component in health care. The prevention of infection is the primary goal when providing care to patients and to ensure risk is reduced to healthcare staff. Much has been done to reduce the risks of healthcare associated infections (HCAIs) in both the hospital and community over the past years, and it is therefore essential that Bridgewater continues to ensure ‘infection prevention’ continues to be seen as a priority.

Hygiene CodeThe Trust is responsible for meeting the standards within Hygiene Code (Health and Social Care Act 2008). We therefore believe that we are able to assure the Care Quality Commission (CQC) that we can supply evidence of best practice which indicates how we are maintaining a reduction in HCAI’s and supporting measures to improve environmental hygiene.

Dental health care and practice is monitored by ensuring care is managed against the standards within the ‘HTM01-05: Decontamination in Primary Care Dental Practices Guidance’.

As a Trust, we continue to support a philosophy of a ‘zero tolerance’ to avoidable HCAI. In the past year to help us achieve this we have:

• Continued a programme of peer audit of hand hygiene in all staff with face to face hands on contact.

• Achieved a second year with no MRSA bacteraemia infections• Assisted in the reduction of avoidable Clostridium difficile infections• Continued to provide education, audit and training regarding ‘Essential Steps to Safe

Clean Care’, the national programme of healthcare practice which helps staff to work in a systematic manner to prevent infection. In particular using ‘Aseptic Non Touch Technique’ (ANTT), for high risk procedures

• Worked across the health economy sharing best practice in infection prevention.• Had a small improvement in staff flu vaccine uptake, but realise more needs to be

done• Undertaken a programme of quality walk-round visits• Responded to the risks from suspected Ebola infection.

Infection, Prevention and Control TeamAt the beginning of 2014, the Infection, Prevention and Control (IPC) Team divided into two distinct teams to ensure that clear lines of accountability were distinguished between the commissioner and provider roles. The commissioner role is not covered in this report. The Trust IPC team structure and lines of accountability can be seen below. The IPC service reports directly to the Executive Nurse who is the Director of Infection, Prevention and Control.

Two full-time IPC nurses are currently managing the provider service and a decision to employ a third nurse is currently under review. The Trust IPC team has the responsibility for providing advice, training and on-going support on infection, prevention and control to all directorates and their services as well as other partner agencies, i.e. intermediate care facilities jointly managed/utilised by the Trust.


Infection, Prevention and Control Programme of WorkThe annual Infection, Prevention and Control Programme of Work is developed and monitored throughout the year. The work programme has a primary focus on policy development, education and training, which outlines the structures required to share information across the Trust from the Chief Executive to staff in the community and vice versa.

All actions set within the work programme are developed to support the Trust in providing evidence of meeting the criteria within the Health and Social care Act 2008. The last year has been a challenging year for the IPC team, with a change to their management structure and having to meet new priorities such as managing the staff flu programme and responding to the Ebola outbreak. This is also the first year that the two infection prevention control nurses have been responsible for supporting the management of IPC across the whole footprint, which is extensive. Whilst most actions set were met, some goals were not, due to increasing workload and changes to roles, these were:

• Ensuring there is a Trust wide Infection, Prevention and Control Group • IPC Team to provide face-to-face update sessions to all teams

It is expected that both of these actions will remain in the 2015/16 plan and will be met as a priority.

Internal Reporting Arrangements The Quality and Safety Committee, that provides assurance to the Board, receives a quarterly report and verbal update from the Lead Nurse infection, prevention and control and the Director of Infection, Prevention and Control (DIPC).The Trust’s compliance against the Health and Social Care Act, and key actions to meet best practice are noted at this committee. This group has been made aware of the challenges encountered by the IPC team and of the recommendations requested by the IPC team to support an effective service.

Executive Nurse/Director of Governance

Director of Infection, Prevention and Control

(DIPC)

Trust Board

Quality and

Safety

Committee

General Managers and

Services

Infection, Prevention and Control Lead Nurse

(band 8b)

Infection, Prevention and Control Infection,

Prevention and Control (band 7)

IPC Nurse (vacant)

IPC Structure and Lines of Communication/Accountability


Reporting to Clinical Commissioning GroupsThe Trust reports its compliance against the Health and Social Care Act to a number of Clinical Commissioning Groups. Again the annual programme of infection, prevention and control is the basis of this reporting mechanism, and any findings from outbreaks or single cases of infection are discussed at this group. Action plans are scrutinised and clear dates for response and completion of actions are set out.

Healthcare Associated Infection (HCAI)The risk of obtaining a HCAI will always be a concern for patients receiving treatment across the NHS. We have worked closely with our commissioners to monitor HCAI, and where a lapse in care is thought to have occurred during the care we have provided, a full root cause analysis (RCA) is always undertaken. At present we as a Trust participate in the national mandatory surveillance programme for MRSA and Clostridium difficile infection. The diagram below indicates infections attributed to the Trust.

Methicillin Resistant Staphylococcus Aureus (MRSA)The Infection Prevention and Control Team review all notifications of MRSA bacteraemia (blood poisoning) infection, using a recognised Post Infection Review (PIR) tool. This helps to fully investigate the patient’s journey, exploring the key contacts patients have had with health care staff and their practices. No MRSA bacteraemia cases were attributed to the Trust during 2014/15, this is the second year a nil return has been submitted and indicates a continued effort by Trust staff to prevent infection MRSA bacteraemia in practice.

To ensure the Trust maintains a continued zero MRSA bacteraemia, staff are audited and provide evidence of good hand hygiene in practice, undertake infection prevention precautions such as aseptic technique and are supported by the infection, prevention and control team.

0

1

Apri

l 14

May

14

June

14

July

14

Augu

st 1

4

Sept

embe

r 14

Octo

ber

14

Nove

mbe

r 14

Dece

mbe

r 14

Janu

ary

15

Febr

uary

15

Mar

ch 1

5

HCAI Bridgewater Community Healthcare NHSFoundation Trust 2014-15

Number of cases of Community acquired MRSA cases attributed to Bridgewater within month

Number of cases of Community acquired C. difficile cases attributed to Bridgewater within month


Clostridium DifficileClostridium difficile (also known as ‘ C. difficile’ or ‘C. diff’) is a bacterium that can be found in people’s intestines (their digestive tract or gut). It causes either diarrhoea (mild to severe) or in some cases a life-threatening inflammation of the intestines. A person can become infected with Clostridium difficile if he/she ingests the bacterium and this can be made worse if they have taken a number of antibiotics which can disturb the normal bacteria in their gut. The most effective way we can reduce Clostridium difficile infection is to reduce antibiotic prescribing where possible, target infections with specific antibiotics, and ensure that when antibiotics are prescribed, the full course is taken by patients. Good hand hygiene with soap and water and environmental hygiene are also key in the fight against this infection.

As a community trust we do not have a target for reduction of Clostridium difficile but we are expected to support acute trusts and commissioning organisations in meeting their goals. Only one of the four Clinical Commissioning Groups we work with have set a threshold (see the table below).

Clinical Commissioning Group Threshold ActualAshton, Leigh and Wigan No threshold set 0

Warrington 4 0

Halton No threshold set 0

St Helens No threshold set 2

Over 2014/15, a number of cases of Clostridium difficile infection were investigated and two of these were attributed to the Trust (please note that ‘attributed to the Trust’ signifies in these cases that some care we provided could be improved rather than the Trust being directly responsible for the infection). These two cases of Clostridium difficile infection had been admitted to the Trust inpatient facilities and commenced with diarrhoea soon after admission. The cases could have been avoided if use of aperients (laxatives) had been reviewed and in the second case all staff involved had noted that this was a relapse of an earlier Clostridium Difficile infection, rather than a new case and the patient treated accordingly. Learning from these two cases have been noted and action plans completed to reduce future risk to patients.

EbolaAll NHS Trust were asked to ensure that they have robust systems in place to educate the public and healthcare staff in the management of patients suspected as having this infection. For the Trust this has meant reviewing where patients are most likely to attend for advice, and this we believed would be our out of hours services and walk in centres. The IPC team distributed posters and information provided by Public Health England, ensuring this information was visible as people attend our premises. Education sessions were then provided by the IPC team to ensure staff were aware of the latest guidance and of how to manage suspected cases, ensuring these staff were aware of key contacts. We have not been involved in the management of any confirmed cases. The Trust IPC team will continue to address any staff educational and support needs until the outbreak is declared over.


OutbreaksOutbreaks of infection usually occur when people and patients come together. The Trust is responsible for two inpatient facilities and we encountered a number of diarrhoea and vomiting infections during the winter months, affecting both residents and staff. This seems to have reflected the levels of diarrheal infection in the community at large which have caused problems for our hospitals. The outbreaks were all found to be due to norovirus infection. This is a particularly virulent (contagious) infection, which spreads easily between staff and patients as it can be spread via both the bowel when suffering diarrhoea and aerosols from the mouth when those affected vomit. During outbreaks of this kind it is important is to keep patients hydrated and comfortable, maintain strict adherence to hand hygiene and other infection, prevention and control practices, ensure staff stay away from work whilst affected, close to admissions until the outbreak is declared over and to undertake a thorough environmental ‘deep clean’ before reopening. These outbreaks have tested our practices, policies and procedures and we have reviewed these in the light of the findings. Action plans were set to ensure lessons were learned and these actions have been implemented to reduce the risk of further outbreaks and to help us better manage those we cannot avoid.

Environmental CleanlinessInfection control audits are undertaken in a cross section of clinics at least annually and following each audit an action plan is written with recommendations for implementation. Overall the audits indicate that the majority of our clinics demonstrate very good compliance with national standards and satisfaction with our clinical services. Where issues were found action plans were set to improve standards, often the issues were regarding clutter and helping staff to manage their environment better. All of our cleaning contractors meet the national cleaning standards and use a colour coding system to reduce the risk of cross contamination and infection.

Quality walk-roundsPatient safety walk-rounds were historically a way of ensuring that executives were informed first hand, regarding the safety concerns of frontline staff. They are also a way of demonstrating visible commitment by listening to and supporting staff when issues of safety are raised.

Over the past year quality walk-rounds have been undertaken across the Trust footprint involving a number of our adult, children and complex services. The process allows us the opportunity to speak to staff and service users and for them to speak directly to senior staff. Each visiting team includes a senior manager, non-executive directors (NEDs), IPC nurses, estates and a patient representative. Each team member has a crib sheet of quality based questions which help collect data on the service provided, highlight the successes and where action is needed to improve the care we give. Any actions highlighted from the visits are fed back to the executive team, staff groups and services to improve future practice. The process has proved popular with our NEDs and patient representatives but requires review to ensure that appropriate administration and support when organising the visits is in place. A key element of the walk-rounds is to ensure that areas for improvement are identified and actions set to improve care provided. These actions can be checked to ensure they have been completed in the next round of quality visits.


Influenza Vaccination for staffThe Trust’s Lead Nurse for Infection, Prevention and Control along with colleagues from communications ran a staff influenza campaign between September 2014 and February 2015 to encourage the take-up of the seasonal flu vaccine among staff and in particular frontline staff.

The objectives of the 2014/15 seasonal flu campaign were:

• To meet the Department of Health, Public England target of 75% of frontline staff employed by Bridgewater being immunised against seasonal flu• To inform all staff employed by Bridgewater of the list of locations, times and dates

where they can have a free flu vaccination• To inform all staff employed by Bridgewater about the benefits of having a flu vaccination and address any questions they may have.

To meet these objectives a flu plan was devised and was structured to ensure that key members of staff including those at director level, were aware that key to the success of this programme was their individual and collective involvement. Over 100 staff vaccination sessions were undertaken in clinics, at team meetings and ‘drop ins’, to ensure staff had better access. A staff questionnaire was completed and this indicated that 71% believed that there were enough flu sessions. Recommendations to improve uptake for 2015/16 are given at the end of this section, however as it has now been widely reported that the vaccine this year was not as effective to the strain that was circulating, fears are that this many have an effect on flu uptake across the NHS.

The Trust campaign was run from the first week of September 2014 until the end of February 2015. In total 53% (n=1240) of frontline staff across Bridgewater were vaccinated during this period. This is an increase of 8% on the previous Bridgewater 2013/14 flu season. Results by service and borough can be seen below. Over 386 corporate non-clinical staff were also vaccinated and whilst these staff are not counted in the official frontline figures, the Trust supports them as they often encourage their clinical colleagues to be vaccinated.

Flu vaccine uptake by directorate Total frontline staff Total vaccinated % Adult 1153 614 53

Children 711 422 59

Specialist 483 204 42

Total 2347 1240 53%

Flu vaccine uptake by Borough % Ashton, Leigh & Wigan 60

Halton 45

St Helens 47

Warrington 48

To improve flu uptake in the coming year the IPC team have highlighted a number of issues. An improvement plan will be in place and monitored through directorate and quality management groups.


Safeguarding The Trust has systems in place to ensure that patients and the public are safe. Safeguarding assurance is provided through the Safeguarding Assurance Group which reports to the Quality and Safety Committee of the Trust. The Safeguarding Assurance Group monitors training, incidents, risks and supports the partnership working in relation to safeguarding children and vulnerable adults. The group provides challenge to internal and external processes and is chaired by the Trust executive lead for safeguarding. A recent audit by Mersey Internal Audit showed that the systems and processes in place provided significant assurance that people are safe in our care.

Safeguarding assurance is also provided to commissioners through the safeguarding audit tool which is completed annually with quarterly reviews of performance by the commissioners.

The Trust is represented on each of the local safeguarding boards and the staff involved in safeguarding issues have good working relationships with local authorities, social services, police and safeguarding teams. Multi Agency Safeguarding Hubs are providing integrated safeguarding teams, promoting information sharing, shared assessments and targeted delivery of services to families and young people.

The Trust follows national statutory guidance and local recommended practice for safeguarding.

Safeguarding children and vulnerable adults is the key focus for our service.

The Safeguarding service provides:

• Advice, support, and training for Trust staff and external agencies • Services for children in care – ensuring their health needs are identified and health

care plans are monitored • Clinical and safeguarding supervision for staff within the Trust to provide support, management and education to practitioners to improve practice for safeguarding children and adults.

The organisation participates in multi-agency safeguarding inspections working with services within local authority boundaries e.g. St Helens, Halton, Warrington, Wigan and Trafford. A recent Ofsted inspection in Halton recommended that Care Leavers were aware of their right to access health information about themselves and to be provide with a “health Passport”. All Care Leavers are currently provided with this information before they leave care. The outcome of a recent Ofsted inspection in Warrington is awaited.

In the last year the Trust has participated in several Serious Case Reviews for children, local case reviews for adults and domestic homicide reviews; these are all on-going and the learning from the reviews has been used to inform best practice in the organisation and in partnership working.


Some of the learning which has been implemented into practice includes:

• A guideline for bruising and physical injuries in children has been developed and communicated

• Improved communication processes in district nursing services; daily handover process • Shared risk assessments for non-concordant care • Assessment of self-neglect • Promotion and awareness raising of the escalation policy across partner agencies • Multi-agency case file audits to recognise the impact of services working together to

affect change and improve outcomes for children• Improved information sharing with GP practices and flagging of vulnerable children on

the computer records has been achieved• We have reviewed Out of Hours GP information sharing processes and are developing standard operating procedures for sharing of information with the universal caseload holder when a child attends the OOH GP service on three separate occasions in a given period (six months for pre-school children and 12

months for school age children)• We have implemented safeguarding supervision for the Out of Hours GP service• We have developed more robust IT processes with the acute Trust for the sharing of

information when children attend the emergency department or are discharged from hospital

• The voice of the child is being heard, recorded and acted upon on a more consistent basis

The Looked after Children service has now been incorporated into the Safeguarding Children Team across all boroughs. Developments in this area have resulted in improved attendance of children and young people for initial and review health assessments. Health needs are being addressed sooner with an expectation of better health outcomes for children. Care leaver passports have been developed to provide young people with a summary of their health since birth, incorporating immunisations dates and relevant family history. Guidance is given to educate young people regarding access to health care i.e. GP, dentist, sexual health services.

National Institute for Health and Care Excellence (NICE) Every month NICE publishes guidance that sets the standards for high quality healthcare and encourages healthy living.

The Trust is committed to continually improving the quality of our services and the health of our patients. By adopting a robust approach to implementing NICE guidelines service users can be assured that their care and treatment is safe, up to date, and evidence based.

All newly published NICE guidance is distributed to services throughout the Trust to ensure that services are compliant with NICE recommendations. Services evaluate each piece of guidance and determine whether it is relevant to their service and if so, the service is required to undertake a baseline assessment to state whether they are fully compliant, partially compliant or non-compliant.


Services are given four weeks to undertake baseline assessments following publication of guidance and a further four weeks if compliance is partial and an action plan needs to be developed. Partial compliance means that there is one or more recommendation that the service is not adhering to at present. This is to be expected in relation to newly published NICE guidance. However, an action plan must be devised in order to bring the service into full compliance.

In the year April 2014 to March 2015, NICE published 109 pieces of guidance, excluding NICE Quality Standards, most of which related to care provided in acute hospitals. There were 23 pieces of guidance applicable to services that the Trust provides. We were fully compliant with 11 and action plans were put in place to bring us into full compliance with the remaining 12.

Total applicable to Trust services

Fully compliant Partially compliant with action plan to bring into full compliance

Not compliant

23 11 12 0

Compliance with NICE guidance is reported through the Quality and Safety Committee of the Trust Board. Clinical audits of NICE guidance are included in the annual clinical audit plan. Below is an example of an audit that was completed to check compliance with NICE guidance.

Audit of Nocturnal Enuresis (NICE CG 111 “Nocturnal Enuresis: the management of bedwetting in children and young people.” The audit was undertaken in the Children Continence Service provided in the Halton and St Helens area. It revealed good practice in comparison to NICE recommendations but highlighted a couple of areas where improvements could be made. In particular, standard 1 – see table below. All 21 items had to be documented for the standard to be met and in 59% of cases, they were all there. The service is moving paper health records to an electronic patient record and has reviewed the electronic system to ensure that all of these assessment questions are included. This will act as a prompt to ensure that specific questions are not omitted. A further audit will be undertaken in 2015 to ensure that this compliance percentage has improved as anticipated.

Compliance

1Assessment and Investigation – this standard contained 21 individual items relating to bedwetting history, daytime symptoms and toileting patterns. If even one of these 21 items was omitted, the standard was recorded as not met.

59%

2 The clinician should assess whether the child or young person has any comorbidities or there are other factors to consider 94%

3 An alarm should be offered as the first-line treatment to children or young people with bedwetting. 82%

4 The response to an alarm should be assessed by 4 weeks. 100%

5Alarm treatment should be continued in children or young people with bedwetting who are showing signs of response until a minimum of 2 weeks’ uninterrupted dry nights has been achieved.

100%

6 The appropriateness of continuing with alarm treatment should be assessed if complete dryness is not achieved after 3 months. 100%


NICE Quality StandardsNICE Quality Standards are a different type of publication to be used by providers and commissioners in the design and delivery of services. NICE Quality Standards are to be used to engender quality improvements and, unlike other NICE guidance, are not for compliance purposes.

A two pronged approach was implemented from 2014/15 so that the Trust can keep up with new Quality Standards published each month while at the same time address NICE Quality Standards that had previously been published.

By the end of March 2015, there were a total of 83 NICE Quality Standards. 73% of these are applicable to care provided by one or more of our services. A phased prioritised approach is underway to gather evidence against each one, so that plans for improvement to service delivery can be made.

Clinical Audit Clinical audit is a quality improvement process that seeks to improve patient care. This means the care that patients receive is reviewed against standards which are proven to be best practice (evidence based care). This is carefully evaluated and where required, changes are made to improve care. We believe that it is our responsibility to provide our patients with good quality, safe and effective care in order to achieve the best outcomes.

We need to identify areas that can be improved and address those as a matter of priority. The clinical audit plan is presented to and overseen by the Quality and Safety Committee. Progress is reported on a quarterly basis and includes key findings from individual audit projects along with the main priorities in the associated action plans.

Topics included in the clinical audit plan are identified from:

• National priorities for example an NHS England national audit or NICE guidelines • Local priorities, for example an incident report, a patient complaint or a concern from

any other source. • Commissioner priorities.

The example below is an audit which reflected one of our commissioner’s priorities.

Audit of Efficacy of the Growth and Nutrition ServiceThe Child Growth and Nutrition Service is a specialist nurse led clinic for obese children, established in St Helens in 2004. It was expanded to cover the Halton area in 2011. Children aged 4-16 years who meet the referral criteria are eligible to attend. The aim of children’s weight management, for the majority of children, is to maintain their weight whilst they continue to grow in height until their height and weight is in proportion and their BMI is within the healthy range. In extreme obesity or once a child reaches puberty the aim would be a small weight loss of 0.5-1kg per month until their height and weight is in proportion and their BMI is within the healthy range.


The standards used to measure the care are contained within:

• NICE 43 (2006) - Obesity: Guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children

• SIGN 115 (2010) - Management of Obesity• Bridgewater clinical guidance: Child Growth and Nutrition Service for Clinically Obese

School Age Children (4-16 years) (2011), HStHCL284. Last updated 2014

The service has undertaken clinical audit over several years previous to this final one. Earlier cycles of audit have focussed on whether the service met the needs of the families referred, behaviour change and effect on BMI. Later audits focussed on clinical care, specifically the identification and management of obesity related co-morbidities. Over all of the cycles of audit, the percentage of children in the extreme obese category has reduced from 13.33% to 1.11%.

The results as detailed in the table below show 100% compliance with 10 out of 11 standards. One out of the five elements in Standard 9 does not achieve 100% and that is the urine sample tested for the presence of glucose and protein. Patients were being asked to bring a urine sample to clinic. In the cases where the test was not done, it is noted that a specimen was not provided. The service has already changed practice and now asks for the urine specimen to be provided in clinic rather than brought along to clinic.

At the review appointment the BMI score improved or was maintained in 63% of children. Reasons were documented in relation to the remaining 37% such as not achieving the required exercise levels, family situations such as holidays, family breakdown, emotional difficulties, comfort eating. These reasons illustrate some of the challenges the service must address and the range of support needed by families and children.

In addition to the information provided in the table below, parents and children were asked via questionnaire for their feedback which shows that:

• 93% of parents reported attending the clinic helps to support the family with behaviour change

• 100% of parents reported having an agreed action plan with realistic goals. A number of parents said they did not have a written copy but would have liked one. In

response to this, the service is now offering a written action plan whilst in clinic. This will result in improved communication with parents and children thereby ensuring patient safety and patient involvement in care

• 93% of parents reported that their child was involved in decisions about their care• Children were asked how they felt about more exercise, changes in diet and attending

clinic. They were also asked what changes they had made. Their feedback shows that they are making the recommended changes although they are not always happy to do so

• When asked 86% of the children said if a friend needed the same kind of help they should come to this clinic. The remaining 14% of the children said maybe.


Standard1 Referral criteria must be met in all cases (includes aged 4-16 and BMI ≥98th Centile) 100%2 On receipt of referral an appointment is to be offered within 8 weeks from referral 97%

3

At initial assessment an holistic assessment which will include:• Birth history• Past medical history • Current medical concerns • Medication• Allergies• Immunisation status• Environmental factors and Social and family factors• Assess family history of obesity and comorbidities

93%

4

Medical Examination• Height weight and calculation of BMI• Waist measurement and abdominal girth• Respiratory, cardiac, abdominal examinations• Pubertal development, signs of acanthosis nigricans, hirsuitism or cushings syndrome• Signs and symptoms suggestive of type 2 diabetes• Routine urinalysis

92%

5If clinically indicated, children should be signposted to Tier 2/3 Primary Mental Health Service as required for appropriate support. Emotional and wellbeing assessment done via strengths, difficulties and short moods and feelings questionnaire.

100%

6“Physical activity levels” should be discussed with child and parent and documented within the patient record. 100%

7 “Dietary intake” was discussed with child and parent and documented within notes 100%

8All children to have an agreed care plan with achievable goals and timescales with letter of discussion sent to parent, GP, school nurse and any other professional. 100%

9

Clinical investigations• Urine sample tested for the presence of glucose and protein• Children are referred to the paediatric day unit /phlebotomy for a fasting serum glucose

level if they present with any of the following:- a family history of Type 2 diabetes or maternal gestational diabetes- acanthosis nigricans- BMI >99.6th centile

• Children are referred to the paediatric day unit/phlebotomy for a fasting lipid profile if they present with any of the following:- a family history of dyslipidemia- a family history of ischaemic heart disease- BMI >99.6th centile

• Children are referred to the paediatric day unit for a glucose tolerance test if the child presented with appearance of Acanthosis Nigricans

• Thyroid function (TSH) will be checked if the child is short for height and there is a family history of auto-immune disorder e.g. coeliac disease, hypothyroidism or type 1 diabetes

88%

10 All children must be seen within 6 to 12 months following the first assessment and reviewed 100%

11

All children discharged from services are to have at least one of the following:• BMI<98th Centile• Parent/ child choice• Child reached 16th birthday and will transfer over to adult pathway• Transferred out of area • Non-attendance at clinic following one DNA unless the staff member is aware of any exceptional mitigating circumstances or following two consecutive cancelled appointments

100%


ResearchDuring 2014/15, The Trust has expanded its research portfolio and is now participating in dental research and studies relating to prison healthcare. In addition, eligible Trust patients have been able to participate in a number of important national studies into areas such as rehabilitation following stroke, autism and ADHD, heart failure in older patients, and a Down’s Syndrome feeding study.

The Trust has received recognition from the Health Services Journal and National Institute for Health Research (NIHR) for the contribution we have made to promote clinical research in the Trust; one important aspect of which is providing our patients with opportunities to participate in research. To this end, the Trust has participated in the Department of Health’s ‘OK to Ask’ about clinical research and international clinical trials campaigns.

Bridgewater clinicians continue to use research evidence to inform their clinical practice. The number of research active staff continues to increase, via assisting the identification and recruitment of patients into studies, initiating research, and registering for higher research degrees, such as doctorates or NIHR Clinical Masters in Research. During 2014/15, Trust staff have also published their work in books and journals, and presented at conferences. Examples of this research has considered screening for cardiovascular risk factors in patients with psoriasis, implementing NICE guidelines for childhood eczema, and incorporating Yoga into physiotherapy practice as an extension of therapeutic exercise.

Care Quality Commission – Essential Standards for Patient Safety and Quality Throughout 2014/15 the Trust has continued to declare full compliance with the essential standards and remains registered, without conditions, with the CQC.

Quarterly reports on compliance across the Trust have been submitted to both the Quality Management Group and the Quality and Safety Committee.

To facilitate the reporting of compliance from service level up to the above committees we have continued to utilise our CQC Monitoring Framework. This framework sets out the expectation that our clinical services are accountable and responsible for monitoring and reporting compliance with the essential standards. Compliance is reported up through the directorate management structures and where necessary appropriate actions are undertaken to address any identified areas for improvement.

In order to check compliance at service level we have continued to carry out our own internal CQC Service Reviews. During 2014/15 there were 24 reviews undertaken. The review panels consist of a member of the governance team and a service manager. The panel discuss compliance against all the outcomes with the relevant clinical manager. The reviews take approximately 2.5 hours and whilst they cannot be seen as “deep dives” into each service they do facilitate an increased awareness of “what good looks like”. Following a review, the service is provided with an action plan identifying areas for improvement. All the action plans are monitored within the relevant directorate structure and via the quarterly reports through to completion.


Care Quality Commission InspectionsIn February 2014 the Trust was the first community health service to be inspected in the North as part of the Wave 1 pilot inspections of NHS community health providers.

Overall, the CQC inspection found that the Trust provided safe and effective community health services which were well-led with a clear focus on quality. However, the regulator found some weaknesses in risk and quality reporting and action taken following the identification of risks at Newton Community Hospital.

The final CQC inspection report published on 17th April 2014 included one compliance action as follows:

Regulation 10 HSCA 2008 (Regulated Activities)Regulations 2010 Assessing and monitoring the quality of service provision.The provider has not protected people by means of an effective operation of systems to identify, assess and manage risks relating to the health, welfare and safety of service users at Newton Community Hospital.Regulation 10(1)(b) and 10(2)(c)(i)

As expected, the report also identified some specific areas where we needed to make improvements to systems and processes. An action plan was submitted to CQC to address CQC’s Areas for Improvement (“Must do’s, Should do’s and Could do’s”). This action plan was monitored by both the Quality Management Group and the Quality and Safety Committee to ensure all the required actions were undertaken.

CQC identified two “must do’s”;

• Develop effective reporting mechanisms to ensure that the board are fully sighted on activity and performance at Newton Community Hospital.• As a result a Quality Dashboard was developed which is submitted as part of the Integrated Performance Report to the Quality and Safety Committee.

• Develop effective systems to identify, assess and manage of risks at Newton Community Hospital.

• All Newton Hospital specific risks are recorded on Ulysses (the organisations electronic risk management system) and discussed with staff at the weekly multidisciplinary team meetings.

The Trust declared compliance against the above compliance action in March 2015.

St Helens Clinical Commissioning Group Review of Newton HospitalThe CQC inspection of the Trust in February 2014 found some gaps in risk and quality reporting at Newton Community Hospital. Consequently, St Helens Clinical Commissioning Group (CCG) made a request to carry out an inspection visit of the inpatient ward at Newton to provide them with assurance that any issues identified by the CQC had been addressed.

The visit took place on the 5th November 2014. The inspection team included several members of the CCG along with two Healthwatch representatives.


All the members of the team were provided with information prior to the visit so that they could spend the time on the ward with patients and staff.

The ward was busy but the team found the staff very accommodating, friendly and welcoming. The patients that the inspectors spoke to were very positive about the quality of their care and the team saw staff treating patients with compassion, dignity and respect.

Areas for improvement included the need to develop the environment to be more dementia friendly and to make patient documentation simpler and clearer, both of which are being taken forward. As a result of the visit the ward team are now producing a vision for Newton Hospital which will identify goals for the ward team to achieve which will be monitored by the Bridgewater executive board and at the St Helens quality meeting with the CCG.

Medicines Management IncidentsThe Bridgewater Medicines Management Team continues to work closely with healthcare professionals to ensure patient safety and quality care with respect to medicines use. The Trust supports an open culture encouraging the reporting of medication incidents and also interventions made to avoid possible errors.

The detailed review and analysis of reported medication incidents is a fundamental aspect of the work of the Medicines Management Team, supported by the Risk Management Team. Following an initial detailed analysis and classification of incidents, by the Medication Incident Panel, incidents are discussed at the Medicines Management Groups (both internal Bridgewater meetings and interface meetings involving pharmacist representatives from the local CCGs) and the Quality Management Group to identify themes and review the lessons learned measures put in place to minimise incidents.

In 2014/15, 250 medication related incidents were reported by the Trust staff including 28 involving controlled drugs. They include ‘third party’ incidents which Bridgewater staff identified but originated from other healthcare providers e.g. hospitals, community pharmacies, GPs, care agencies or individuals. The reporting of these third party incidents demonstrates continued vigilance by Bridgewater staff regarding the safety of medicines within the community.

The graphs below summarise the total medication incidents and the controlled drug incidents reported by severity, respectively.


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Third party incidents and administration of medications are the main types of incident reported. It is well known that medication issues are most frequent when a patient moves from one place of care to another and often due to lack of communication e.g. breakdown in communication on transfer of patients between organisations. The Trust’s Medicine Management team has established closer links in 2014/15 with local trusts to report relevant third party incidents for appropriate investigation and to facilitate lessons learnt being shared across the health economy.

As a result of the medicines management review of medication incidents the Trust is able to review procedures and policies to ensure any changes are implemented. Incidents are dealt with on a case by case basis with staff involved undergoing a review and assessment of their practice using the medicines competency framework. Non-Medical PrescribingA Non-Medical Prescriber (NMP) is a registered healthcare professional who has specialist knowledge and skills and who has undertaken additional training to become a qualified prescriber. The Trust currently has ~450 non-medical prescribers who work to ensure patients have timely and appropriate access to medication and have individualised evidence based care.


The North West Non-Medical Prescribing Leads Network commission an annual audit and NHS healthcare organisations across the north west are invited to take part in this regional clinician’s online audit for non-medical prescribers. The standards set for this audit were developed at the inception of the audit in 2009 and were linked to the Care Quality Commission Outcome 9 (Medicines Management) and 16 (Assessing and monitoring the quality of service provision). The main aims of taking part in the audit are to provide a source of evidence that helps to identify areas requiring improvement and to demonstrate the importance of having prescribers who can deliver care where and when it is needed thus enabling them to complete the episode of care.

Within Bridgewater, 51% of non-medical prescribers took part in the 2014 on-line clinician’s audit. Participants were asked to complete each audit as soon as possible after seeing a patient (consultation).

229 (51%) non-medical prescribers took part in the audit compared with 26% in 2012 (there was no audit in 2013 due to updating of the audit tool and national organisational changes).

The following information indicated how non-medical prescribers are key in the delivery of care at the point of contact:

• 38% contacts prevented a GP surgery appointment

• 26% contacts prevented a GP home visit

• 10% prevented follow up to another healthcare professional

• 6% prevented re-admission

• 5% prevented attendance at A&E

• 4% prevented of new referral to another healthcare professional

• 3% prevented of admission (hospital or hospice)

• 2% prevented of walk in centre visit

• 2% prevented of follow up by consultant (or team)

• 1% prevented of visit to minor injuries centre

• 1% prevented of new referral to consultant.

The results of the audit have been shared with all of the prescribers and individuals have access to their own prescribing report to allow them to review any areas of their prescribing practice where improvement can be made. The impact/outcome of consultation results highlight the value of non-medical prescribing in practice within Bridgewater and for their patients. This approach enables health professionals and patients to utilise their time more effectively and reduce the number of appointments patients may otherwise need to attend.


Information Governance The Trust understands our service users provide their personal information to us on the understanding we will treat it confidentially and keep it secure.

Information governance (IG) provides a framework to bring together all the legal rules, guidance and best practice that apply to the handling of information, allowing:

• Implementation of central advice and guidance• Compliance with the law• Year on year improvement plans• Best practices in handling and dealing with information• Safeguards for, and appropriate use of, patient, staff and business information.

The Trust has an on-going, rolling IG assurance programme, dealing with all aspects of confidentiality, integrity and the security of information. As a core part of this, IG training is mandatory for all staff, which ensures that everyone is aware of their responsibility for managing information in the correct way.

The Trust has carried out significant work in developing an overarching IG agenda. This incorporates the Quality and Safety Committee which has responsibility for overseeing IG at a strategic level with the Information Governance Subgroup assigned responsibility at an operational level.

In 2014 the Trust had three data breaches, including loss of patient identifiable data. Security of patient and staff information is considered to be of paramount importance to the Trust. The three data breaches were thoroughly investigated and as a result of the investigations, processes and procedures were reviewed, and all staff were asked to undertake the ‘Secure Transfer of Personal Data’ eLearning module. Lessons learned following the investigation were communicated to all staff via monthly Team Briefs and staff meetings. The data breaches were reported to the Information Commissioners Office (ICO) via the Information Governance Toolkit, as ‘Serious Incidents Requiring Investigation’ (SIRI). The Information Commissioner’s Office (ICO) conducted a thorough investigation into all three incidents and was satisfied that the Trust had taken the necessary measures to minimise the risk of any further data breaches, and concluded that the three incidents did not meet the criteria set out in their Data Protection Regulatory Action Policy necessitating further action.

In 2014, the Health and Social Care Information Centre (HSCIC) set up a Caldicott2 Implementation Monitoring Group (CIMG) team in response to Dame Fiona Caldicott’s review and the Government report, Information: To Share or Not to Share in 2013. The Trust fully supports the CIMG to ensure the recommendations in the report are acted upon by submitting an assurance report to the CIMG on a quarterly basis.

The Trust is proactive in information sharing for care purposes with the local health economy across the entire Bridgewater patch. The Trust has in place documented protocols to ensure information sharing has a secure legal basis, is ethical and secure and most importantly, staff involved in the process of information sharing understand the process and are confident in ensuring all sharing is in the best interests of the patient.


Emergency Preparedness, Resilience and Response (EPRR)As a provider of NHS-funded healthcare, the Trust has defined roles and responsibilities under the Civil Contingencies Act 2004, the Health & Social Care Act 2012, NHS England Emergency Planning Framework 2013, NHS England Core Standards for EPRR 2014 and other associated guidance. All NHS-funded organisations must identify a Board-level Accountable Emergency Officer (AEO) who is responsible for ensuring they comply with legal and policy EPRR requirements. The Trust’s AEO is the Chief Operating Officer, who is supported in discharging these duties by the Head of EPRR.

We have an Emergency Planning Steering Group to coordinate and oversee the EPRR function and ensure that we have major incident, business continuity and other emergency plans which are regularly reviewed and tested. This group also monitors the action plans we have in place to address any areas for development which have been identified.

For further information relating to EPRR please see the 2014/15 Annual Report.

Partnership Working Health and Wellbeing BoardsThe Trust is delighted that we are invited to attend the Health and Wellbeing Boards in each of the towns we serve.

This is not universally the case in England, but it is extremely helpful for providers to be present when Health and Wellbeing Boards are setting priorities for their populations and to be able to contribute to their conversations about what is feasible, what is desirable and how best to work together to achieve their aims.

Each borough has asked for a local as well as a “global” breakdown of our quality performance reports and we discuss quality at a borough–level with each CCG quality lead regularly, throughout the year.

Work with Halton’s Children Trust PartnershipBridgewater have been working with local council colleagues in the Halton Borough to develop a more joined up service for families, children and young people who have more complex needs that require services from a number of agencies.

A time limited working group, including parents, children centres, family support, early years schools, Common Assessment Framework support and health services was set up to look at what would be best for Halton families’, children and young people. A service manager from the Bridgewater children’s services team led the redesign work. The result has been the creation of three newly organised 0-19 early intervention teams, which started to work together in September 2014. The service is available to children, young people and families in Halton. This is the first step towards integration of health, education and social care teams. Development continues to be led by the Children Trust Partnership to make sure that services are easy to access and delivered in a way that helps children, young people and families.


Warrington Children’s Community Respiratory Team (CCresT)During 2014/15, Bridgewater and Warrington and Halton Hospitals Trust collaborated to develop a new service to help the youngsters of Warrington who are troubled by recurrent wheeze or diagnosed with asthma. CCResT, which opened its doors in April 2015, aims to keep care close to home, reduce the number of interactions with secondary care and improve self-management of the condition. Through detailed assessment and a personalised education plan, these children will be enabled to lead as normal a life as possible and reduce the number of exacerbations of their disease. Assessment and education will be delivered by staff experienced in the care of respiratory disease, having previously delivered a similar service based at Warrington Hospital. The care will be provided by both paediatric respiratory nurses and physiotherapists who are passionate in delivering high quality care. Following a detailed initial assessment, further consultations will be offered to evaluate the impact of changes in care. Once improvement has been confirmed the children will be referred back to their GP for further review and management. In certain circumstances CCResT will be able to refer directly onto paediatric consultants if this is felt to be necessary.

Warrington GP Extended Hours Service “Access, demand and capacity” is one of the ten priority areas established by the GP membership for the Warrington CCG Primary Care Strategy. As part of the Prime Minister Challenge Fund (PMCF) initiative, Warrington Health Plus Community Interest Company (CIC) is working in partnership with Bridgewater to establish a service that helps meet this priority. In November 2014, together we successfully established the GP Extended Hours Service, as a pilot from our Bath St Health and Wellbeing Centre. This pilot provides access to GP appointments outside core practice hours, seven days a week.

Through this pilot we have learnt how best to work with GP practices on providing a non-urgent appointment service, particularly the process that allows a safe and effective patient journey. Through this work, we have identified demand and capacity issues that every GP practice is facing in core hours, as many patients are requesting same day appointments. As a result, Bridgewater is currently working in partnership with Warrington Health Plus team to support the implementation of the second stage of this project, which will address the demand for same day GP appointments.

Wigan District Nurse Liaison Team The District Nurse Liaison team are based within Wigan Hospital. The role of the team is to aid in providing a seamless discharge from hospital to their own homes or future home (e.g. care homes etc). This is carried out by attending the wards on a daily basis and discussing referrals into the community with the ward staff and assisting in liaising with the district nursing teams when planning discharges.

The nurses are experienced former community nurses with a wealth of knowledge and experience and provide education and links to the ward staff thus facilitating efficient discharges.


Care Home Support TeamThe Warrington Care Home Support Team work in partnership with care home managers, other professionals from within Bridgewater, GPs, colleagues from Warrington Hospital, and social services.

The team undertake rapid specialist assessment of patients within residential and nursing homes that have acute/unstable conditions who are referred to the team as an alternative to a GP visit or hospital admission. They also make recommendations for the nursing management of patients in care homes ensuring best practice and a high standard of nursing care is delivered. This involves communicating with patients, relatives, agencies and the multidisciplinary team, regarding patient care and acting as an advocate for individual management of patients.

To ensure care plans are met and patients have access to specialist services they work as part of the multidisciplinary team, working with other healthcare professionals and Social Services as required.

The team also provide education and support to staff within the care homes to enable them to provide quality care to the care home patients.

The team raise any concerns with the safeguarding team and attend relevant safeguarding/best interest meetings alongside partners in social care.

One of the care home support team is a Care Home Discharge Facilitator based in Warrington Hospital. They review those clients that have been admitted to hospital to ensure that discharge planning is commenced appropriately, avoiding delays to the discharge. They will also assist in arranging any specific equipment or training if the client’s needs have changed during the hospital stay to ensure they can safely return home.

Introduction of the Northwest Ambulance Service (NWAS) Pathfinder Service (Wigan)As part of a successful winter pressures bid, Leigh Walk-In Centre (WIC) introduced the NWAS pathfinder service in November 2014. The introduction of a doctor within the service has aided A&E avoidance schemes and provided an alternative destination for NWAS staff to bring their patients. During February 2015 Leigh WIC were able to divert 53 out of 54 patients (98%) referred to them by NWAS away from A&E.

In addition, referral rates to A&E from Leigh WIC have reduced; in October 2014 Leigh saw 3437 patients and referred 147 (4.2%) to A&E. In January 2015 they saw 3490 patients and referred only 86 (2.40%). The rate of referral has remained 2.2 - 2.4% since November 2014.

Intravenous (IV) Therapy Teams (Warrington, St Helens, Halton and Knowsley)IV Therapy Teams provide acute care, previously only available in a hospital setting in patients own homes and local clinics.

The benefits of a community IV Therapy service according to Chapman et al (2011) include:

• Admission avoidance and reduced length of stay in hospital (with resulting increases in inpatient capacity and significant cost savings compared with inpatient

care)


• Reduction in risk of healthcare-associated infection • Improved patient choice and satisfaction.

The service actively in-reaches into local acute trust wards to promote the service and help identify patients suitable for home treatment which facilitates discharge.

The service has no waiting lists, first visit community doses can be administered the same day once the referral document is received. Once the patient returns home and contacts the team, a venous access device can be inserted and the first community dose can be administered within the comfort of the patients own home.

Initially, when the IV service was set up the majority of referrals were received from an acute setting. Medically stable patients were referred to the service and their lengths of stay as an inpatient reduced. Conditions treated include osteomyelitis, infected joints, endocarditis, abscesses and meningitis etc.

However, as the service has grown an increasing number of patients are being referred directly to the service by their GP, community matron and outpatient clinic settings. This avoids a hospital admission. Conditions treated include skin and soft tissue infections, bronchiectasis, urinary tract infections, acute dehydration and hyperemesis gravidarum etc.

Patient feedback on the IV Therapy Service:

• “The service was invaluable to my husband and without it he would not have realised his final wish to spend his last days at home”

• “This service is great, without it I would have had to stay in hospital for two weeks solely for intravenous antibiotics. All the staff I have met have been very professional and pleasant”

• “I didn’t have to go the hospital. I had the treatment in the warmth and comfort of my own home”.

Specialist Community Rehabilitation Service Hub and Spoke Model Historically, in Cheshire and Merseyside, patients with complex rehabilitation needs requiring community rehabilitation following discharge from a specialist unit or acute trust, experienced prolonged waiting times for community generic or neurological therapy services, as well as significant variations in access and quality of care. Limited provision impacted on patients’ clinical outcomes resulting in longer term recovery, reduced opportunity for independence and increasing potential for readmissions to acute hospital.

Following the implementation of the Cheshire and Merseyside Major Trauma Collaborative, a rehabilitation pathway was developed to address the increased demand for rehabilitation requiring a specialist multidisciplinary approach across inpatient, outpatient and community services.

Bridgewater Community Specialist Rehabilitation Services (BCSRS) are managed as part of a co-ordinated whole system model of care which includes the following levels of specialist rehabilitation services and partner organisations:

• Hub Hyper Acute Rehabilitation Unit and Complex Rehabilitation Unit (The Walton Centre Foundation Trust);


• The Phoenix Specialist Rehabilitation Spoke Unit (The Royal Liverpool and Broadgreen NHS Hospital Trust); • Elyn Lodge Specialist Spoke Rehabilitation Unit (St Helens and Knowsley NHS Hospital Foundation Trust); • Oak Vale Extended Specialist Rehabilitation Unit (Health and Social Care Partnerships); • Community Specialist Rehabilitation Services (Bridgewater NHS Foundation Trust,• Merseycare NHS Trust • Liverpool Neuro.

The service is commissioned for patients with highly complex rehabilitation needs who require specialist multidisciplinary intervention following traumatic injury and illness within their own homes for a period of up to 12 months. Whilst the service was commissioned in April 2013, the team has evolved to reflect the needs of the patient group. The multidisciplinary team includes occupational therapists, physiotherapists, neuropsychology and clinical psychology, rehabilitation assistants and a case manager.

The team focuses on individual goals for the patient which extend beyond activities of daily living. They encompass returning to work, education and management of social and leisure time.

This pathway is unique. No other national pathway encompasses a number of providers who focus on delivering seamless care and rehabilitation from the acute episode through intensive rehabilitation in the hub/spoke inpatient units through to extended and community rehabilitation.

Implementation of Community Care Plans in Halton and St Helens In Halton and St Helens there were two new CQUINs for community nursing this year. An integrated care one for long term conditions for patients under 65 and a frailty CQUIN for patients over 75.

They have resulted in the services working closely with the North West Ambulance service on the development and implementation of community care plans, for those patients who frequently call emergency services in crisis situations.

Individualised care plans have been developed with the patients and carers detailing the patient’s condition, what changes to look out for, and rescue steps if the patient needs help. The care plans are also shared with GPs. The aim of the care plans is to prevent the patient being transported to hospital during crisis situations. The care plans are uploaded onto an electronic system so services can access the information and a copy is left with the patient ensuring the ambulance service has all the necessary information and a rescue plan when they are called out.

Traditional care planning no longer meets the needs of complex patients. The community matron team have developed self-care plans for patients with long term conditions and all the patients are involved in identifying their needs and developing their care plan. The “I” statement enables the patient, carers and clinicians to detail what aspects of the plan they can do and what aspects require support from others. The I care plans have resulted in clear understanding for patients of the care that will be provided and it provides them with control over their health and well-being.


Patient survey results have shown that patients are showing an increase in confidence in managing their own care.

Service Improvements (including new or significantly revised services)New Urgent Care Centre During 2014/15 Bridgewater has been working very closely with other local healthcare providers and commissioners to improve urgent care services offered in the Widnes area.

As a result of this collaboration the new Widnes NHS Urgent Care Centre (UCC) will open in late summer 2015 in the Health Care Resource Centre, Oaks Place Widnes and will be open 7am – 10pm, 365 days of the year. UCCs are community-based primary care facilities which provide access to urgent care for a local population. The aims of the UCC include making care easier to access closer to home and helping people avoid making unnecessary visits to A&E. There will be increased numbers of doctors, nurses and other practitioners working within the UCC and they will have access to X-ray, ultrasound and other diagnostic services; enabling them to treat a wider range of conditions and injuries in an effective and timely manner and meet the needs of our population.

Work to reduce falls in Newton HospitalIn the last twelve months Newton Hospital in-patient unit has been working hard to support patients who are assessed as being high risk of having a fall.

The ward has undertaken weekly audits for the past eight months and established that 96% of patients have been assessed as high risk of falls.

Patients are admitted to the ward often due to falling in the community or following orthopaedic surgery following a fall, the aim of the ward is to maximise patient’s independence and functional ability so that where possible patients can return safely to their own homes.

In the past twelve months the ward has reviewed practice and implemented the following to support falls prevention;

• Offering patients falls prevention slipper socks• Purchasing falls monitors• Where possible placing patients who are high risk of falls in a more visible area• Weekly audits of falls assessment forms• Increase staffing when patient demand requires it• Development of patient information leaflets• Daily multidisciplinary meetings which discusses every patient on the ward• Three times a week multidisciplinary ward rounds• Undertaken a priority audit assessing falls prevention processes against NICE Guidance• Currently participating in developing ‘FallSafe’ Care bundles which provides falls prevention and management guidance approved by the Royal College of Physicians


The chart below demonstrates the number of falls over the past twelve months on the ward. This shows there has been an overall reduction.

NB this data includes all falls activity including near misses and lowering to the floor.

Willaston GP PracticeOn 1st July 2014, Bridgewater took over the management of the Willaston Surgery in Wirral. Willaston has a well-established team and offers a full range of primary care services. Since July 2014, it has been our objective to maintain and strengthen the team and the work they do. This can be evidenced with the continued high levels of satisfaction outlined in the bi-annual GP patient survey.

From the outset we have committed to exploring ways of working more closely with the team to help them deal with their workload and respond to changing patient needs. For example, the practice has introduced an early visiting service, with the aim to undertake home visits in the morning and if possible avoid hospital admissions. If a hospital admission is required, there is a better chance of an earlier discharge.

Building on the well-respected patient participation group, Bridgewater has continued with the ongoing positive patient engagement via the patient participation group.

This involves continually seeking their views on the delivery of the services offered to the patients of Willaston. This commenced with a village meet and greet on 1st August 2014 at which the senior Bridgewater team met with local people and their representatives. This proved to be a positive event, providing the opportunity for patients to ask questions of Bridgewater. This commitment has continued with well attended patient participation group meetings that take place every six months.

Speech & Language Therapy in HaltonThe Speech and Language Therapy (SLT) Department in Halton have been actively involved in seeking feedback from their service users, and using this feedback to improve service delivery. They have developed a series of pathways which illustrate how this is achieved.

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The main streams of feedback sought include:

1. Service specific feedback received following discharge from the service. This is sought from service users and/or their carers/staff depending on who has been

involved in setting and achieving the goals for intervention2. Randomised telephone feedback for service users on active caseloads3. Verbal feedback obtained on a voluntary basis from service users, carers and other

professionals. “Verbal” is a term loosely applied in this context, as feedback is accepted that has been communicated effectively via any means of communication4. Focus group feedback – Service users and patient partners are invited to comment

on aspects of service delivery to inform change5. GP/referrer feedback – feedback is sought alongside reports to seek feedback on

our input and how we have communicated the outcome of our intervention.

Feedback received is documented by staff and in accordance with the feedback codes (which relate to diagnosis and type of SLT input received).

The number sent compared to the number received is monitored to ascertain how representative the feedback is of caseloads and to inform whether further changes to methods of collection for feedback are indicated.

Every month, feedback is shared with the team at the team meeting.

The SLT manager and/or the therapist:

• Generates an action plan in response to the feedback • Shares feedback and any action plans with the Customer Care Team

The SLT team are open to any feedback on service delivery or suggested changes to be made at all times. When spontaneous feedback is shared, the recipient informs the person giving feedback that this will be shared with the team and action plans made accordingly as appropriate.

Focus groups are arranged in order to involve service users in consideration of any service delivery issues or changes.

Feedback received is used to improve service delivery, and is recorded and processed as for all other feedback received.


The Continence Service in Wigan won a National Award The Wigan Continence Care Service, provided jointly by Bridgewater in partnership with Wrightington, Wigan and Leigh NHS Foundation Trust (WWL), received the Continence Care Team award at the inaugural National Continence Care Awards in London. The service received the award for being “a multi-professional continence team which effectively delivers improvements in the patient experience and quality of life”.

St Helens Health Improvement Team launches “It’s Time to Talk…” In May 2014, the Health Improvement Team St Helens launched “it’s Time to Talk…” campaign in St Helens.

As part of the Healthy in St Helens event, the team offered information and tips on how the public can start a conversation with a friend, relative, colleague or neighbour. The campaign links closely with the national Time to Change campaign, which aims to end mental health discrimination. Since its launch in 2007, evidence shows that there has been significant improvement in public attitudes towards mental health.

As part of the launch, the team encouraged people to make a pledge to do something small, but meaningful for a friend whether it was a walk, a call, a text or a chat over a cuppa.

HSJ Awards Winner: Managing Long Term ConditionsThe Integrated Neighbourhood teams in Wigan won the ‘Managing Long Term Conditions’ award at the national HSJ Awards 2014 in London.

The awards are the largest celebration of healthcare excellence in the UK, highlighting the most innovative and successful people and projects in the sector.


The creation of Wigan’s integrated neighbourhood teams has helped create more than 1,000 case management plans for the highest risk patients at Wigan’s practices since April 2013. This has contributed significantly to a 43% drop in A&E visits and a fall of 48% in emergency admissions. Outpatient attendance was also down by 17% by January 2014.

A standard operating procedure, dedicated clinical facilitators and admin support, investment in new technology, patient meetings to agree care goals, and the overall simplicity of the system were other measures behind the success.

After a review by esteemed judging panels, made up of senior and influential figures from the health sector, Bridgewater won in recognition of its outstanding work. The judges said “The winner is providing system change driving whole person care - a step by step approach which is engaging along the way”.

Supporting Patients and their Families at the End of Life Healthcare organisations across Wigan and Leigh worked together to ensure that care for people approaching the end of life continued to be focused on meeting individual needs and wishes in line with the Priorities of Care as outlined in the document “One Chance to get it Right: Improving people’s experiences of care in the last few days and hours of life”.

The Priorities of Care supersede the Liverpool Care Pathway and maintain a focus on continuing to provide compassionate care while moving away from protocols and processes.

The priorities recognise that personalised end of life care plans should be created and communication with patients and those close to them is fundamental.

The partnership of organisations across Wigan Borough were committed to applying the five Priorities of Care in order to ensure high quality end of life care is delivered in every healthcare setting - hospitals, the community and hospices.

A rolling programme of education and training was implemented to ensure understanding and full use of the priorities across the borough.

In order to meet the five priorities a plan of care was developed for those approaching the end of life and agreed with each patient and those close to them.

Special Educational Needs and Disabilities AgendaAs a result of the Children and Families Act 2014 parents should now have a stronger voice in determining how their children’s special needs are addressed. Our services have been working more closely with our colleagues in the borough councils to develop child friendly Education Health and Care Plans. This is leading services to work closely together in a different way. In order to best meet the needs of children and families who access our services we need to ensure we have all the skills required for working in new and integrated ways. To do this we are reviewing all our skill mix and redesigning our services to meet the needs of the population going forward.


Warrington Communication Project is Commissioned on a Permanent Basis The Children and Family Services Directorate was delighted when a needs analysis project, focusing on the communication needs of vulnerable children with communication disorders and autism or learning disabilities, was so successful that it has been commissioned on a permanent basis in secondary schools in Warrington.

Paediatric speech and language therapy staff worked with teaching staff in five secondary schools with students with autism and learning difficulties. Teaching staff were coached to deliver specialist social skills support for these vulnerable young people. Views on outcomes from parents and schools were extremely positive with adults saying that:

• Students talk to each other more and have fewer fallouts. There is less need for staff interventions to sort out problems at break and lunch times.

• Students are forming more successful relationships with pupils within the mainstream school.

• Some students are more integrated into classes and need less support. Two pupils who had significant social interaction difficulties are now almost independent in class and are developing mainstream friendship groups.

• Mainstream subject teachers have commented that these students are more active learners and that their classroom behaviour is more appropriate than some of their peers.

• They participate more in class discussions. • One school introduced the ‘Going for Gold’ reward scheme. This rewards achievement against their goals and around positive learning behaviour. The students

in the project are among the higher achievers for this award within their mainstream year groups.

• Academic improvements in English are a result of improved oral language skills.

Teaching staff have been able to take the young people out on community visits, which is unlikely to have happened before the project. In all cases staff and the public have commented on their social skills. Students could ask for information and hold a brief and appropriate conversation with staff at the local leisure centre, the library etc.

As a result of the success of the project it has now been offered to these schools on a permanent basis.

Paediatric Continence Service gains Makaton accreditation The Paediatric Continence Service in Halton and St Helens gained Makaton accreditation and are now a certified member of the ‘Makaton friendly Scheme’. This was awarded in recognition of the team’s efforts during the intensive training and on-going assessment of four modules by a Makaton examiner, to ensure that people, including children, feel welcome and able to use our services.

Makaton is a language programme using signs and symbols to help people communicate. Makaton can take away frustration of struggling to be understood and enables individuals to connect with other people and the world around them.


The Family Nurse PartnershipThe Family Nurse Partnership (FNP) is a free and voluntary programme for first time expectant mothers who are under 20 years of age. The FNP has been established in Wigan since 2011. In 2014 it was expanded to include Halton and St Helens boroughs. The programme was signed off by the FNP National Unit and began to work with young families from November 2014. The Warrington team was established in February 2015 and was signed off by the FNP National Unit in March 2015.

The FNP offers intensive and structured home visiting, delivered by specially trained nurses from early pregnancy until the child is two years old.

We know from research that a healthy pregnancy gives babies the best possible start in life. A mothers and fathers relationship with their baby right from their start is crucial for their future health and happiness.

The specially trained family nurse will help parents understand about pregnancy and how mothers can care well for themselves and their babies.

Information provided will support parents to make decisions which

• Increase the chances of mums having a healthy pregnancy• Help them to manage their labour• Improve their child’s development• Build a positive relationship with their baby and other people• Help parents plan for their future• Enable parents to make healthy lifestyle choices• Enable parents to achieve their aspirations (such as finding a job or returning to education)

We have received some very positive feedback from families;

Mum • “I’m more independent and prepared for being a mum”• “Family Nurse Partnership made the difficult times easier. I can put my child first but

still do things for myself in the future”Dad

• “can’t wait to get stuck in, this is really helping us to develop as parents, step by step”Gran

• “it must be working, I can see she’s changed so much”

Listening into Action (LiA) Listening into Action (LiA) is a new and innovative way of working, aimed at:

• Removing barriers that get in the way of providing the best care to patients and their families• Improving the patient experience • Enabling out frontline teams to do their jobs more effectively


Bridgewater staff know what needs to be done to improve our services, and LiA puts them at the centre of change – using their knowledge, ideas and experience to make changes that have a big impact.

Bridgewater’s LiA journey started in October 2014 with the Pulse Check staff survey, designed to assess staff motivation and engagement. The results highlighted the need to improve staff morale, so work began on the Chief Executive’s “Big Conversation” events. Nearly 400 staff contributed to the eight events held across the boroughs and through the intranet page.

Staff were asked to feedback on what gets in the way of them delivering the very best care for our patients, and what changes they think would make the biggest impact. All suggestions were documented and key themes emerged, including IT, morale and culture, and recruitment.

A number of “quick wins” were also highlighted and acted upon, including the introduction of teleconferencing phone lines, WiFi access at Newton Hospital, and a dedicated phone-in session with the Director for People, Planning and Development.

The LiA Sponsor Group identified 13 key themes, and oversaw the creation of new dedicated staff-led working groups. These groups have spread the LiA ethos throughout Bridgewater by holding “smaller conversations” within their teams, striving to make improvements to their work stream through to the “Pass it On” events in June 2015. Bridgewater’s Chief Executive will continue to chair the bi-weekly Sponsor Group Meetings.

Developing our Organisational CultureOver the past year the Trust has made a commitment to achieve a culture change across the organisation. This is to create a culture that truly engages with and empowers our staff to enable them to provide the highest standard of care for patients, service users and an environment that promotes a culture of wellbeing for staff.

A series of workshops have been held with all levels of staff during the year to shape the culture framework for the Trust. The framework will be launched in 2015/16.


Quality, Innovation, Productivity and Prevention (QIPP)QIPP is an approach to how services can be delivered against a backdrop of increasing pressure on NHS budgets nationally. The QIPP approach is that through reviewing how we currently deliver services we can find new and innovative ways of delivering a better service at a lower cost. QIPP is also about identifying new services that will improve quality and outcomes for patients but save money elsewhere in the NHS. This means that more money can be spent in the community, keeping people more independent in their own homes.

Last year we described our planning for a new fracture liaison service (FLS) in Wigan. This went live on 1st April 2014 and is already demonstrating a significant impact on the care we provide for patients. The following table shows the performance at the end of March 2015:

Quality Standards Performance 2014/151. 90% of referrals are seen within 6 weeks 96.2%

2. 100% of referrals are seen within 18 weeks 100%

3. 100% of referrals are made to the FLS within 7 days of being seen (originating provider dependant)

100%

4. 100% of patients are followed up for medication optimisation within one month of being assessed by the service

100%

5. 100% of patients are followed up for medication optimisation within 12 months of being assessed by the service

Not yet available

The service has received 1347 referrals and completed 1081 contacts during the year, the majority of whom had been referred from fracture clinic. Patients are prescribed a bone sparing drug called bisphosphonate which helps to strengthen bone density and so prevent fractures and lifestyle advice. The fewer the number of fractures the less demand there is on A&E, emergency theatres and medical beds, demonstrating how an initiative in the community improves outcomes for patients and reduces demand for hospital care.

Bridgewater also led a whole system initiative in Wigan called Integrated Neighbourhood Teams or INTs. These are multidisciplinary teams in the community (Bridgewater, Wrightington Wigan and Leigh, 5 Boroughs Partnership Trust, Wigan Council) who meet with GPs to discuss and agree care plans for patients who have been frequently admitted to hospital. By meeting in this way and sharing information, the patient’s care can be better co-ordinated and they can be supported to remain independent in their own home. As with the fracture liaison service patient outcomes and experience has improved as well as creating an overall reduction in demand for hospital services. In November 2014, Integrated Neighbourhood Teams won the prestigious HSJ Award for managing long term conditions. During the last year Bridgewater has been working together with health and social care partners in Wigan to develop an integrated Community Nursing and Therapies (ICNT) service which will radically change the way services are delivered. Based around locality integrated hubs, services will be co-located (children’s, health improvement, mental health, social care, community and long term conditions management). The re-designed service will improve the management of both higher risk patients (the INTs will be core to the new delivery model) but also focus on patients who have a lower risk score to support self-management and independence.


Clinical Strategies The Clinical Services Strategies set out the intentions for the delivery and development of services over the next five years. They include what we do, why and how to ensure that our services are in the strongest position to deliver high quality care and promote health and wellbeing in our communities.

Internally, the Trust’s mission, core values and quality strategy were integral to the development of the clinical strategies and support delivery of the ambitions set out in the strategies.

Externally, national and local policy guidance and commissioning intentions along with professional and expert group guidance also informed our thinking.

The insight our frontline staff have into their work underlines the importance of their role in clinical service development and innovation. They have the advantage of being able to combine their practical experience of delivering services with national, professional, clinical and policy guidance and locally determined requirements from our commissioners. The Trust has responded strongly to staff involvement in the co-production of strategies via a range of quality seminars held with front line staff.

Examples of the positive impact of our strategy on our population can be found throughout this document.

Strategy DaysTwo strategy days were held in 2014/15 to enable the senior management team and clinical leaders to focus on the Trusts strategy particularly considering the five year forward view, commissioning intentions of the CCGs and meeting the future needs of the borough populations.

The strategy day in December 2014 focused on the five year forward view and taking stock of where we were at that point in time Borough by Borough. The strengths, weaknesses, opportunities and threats were mapped for each health economy. This gave the opportunity for the challenges below to be considered specific to each boroughs local needs and context.

Workshops were held to look at some key challenges for us and to consider:

• How we may become a multi-specialty community provider • What our role is in urgent and emergency care • What our primary care strategy should be

Following discussion next steps and plans were agreed for each of the work groups.

The strategy day held in March 2015 was an opportunity to look at the progress of the LiA, culture and quality improvement work programmes across the Trust, the potential barriers and what could be done to remove them. There was opportunity to revisit the work undertaken at the December strategy day looking at the “Five Year Forward View” and forming multi-speciality providers and at the Trusts “Living by Our Mission” strategy and how to make it a reality .

The senior management team then looked at the challenges falling out of the discussions above and how we could meet them by doing things differently.


Quality Seminars The Trust held three Quality Seminars in 2014/15. The aim of the seminars was to encourage staff to think differently about how they work and by doing things differently continually improve the quality of care provided.

The first seminar was held in May 2014 and an external speaker Steve Head gave a very engaging presentation centred around everyone making a 1% difference. Staff considered what a gold standard service would look like and then what small things they could all do to improve the quality of care they deliver.

They were asked to consider what they could stop doing that was not adding value to the service, patients or helping colleagues and then what could they start doing that would. They were asked to consider how they would deliver these changes and what the milestones would be to success.

There were some excellent suggestions from staff and each member of staff made a pledge to make one change that would improve the quality of care they provide and agreed to review these pledges in three months’ time. The objective was to ensure that the outcome of the seminar were real practical changes that made a positive difference to patient care and experience. All the quality seminars focused on considering existing practice, processes and systems and challenging the way we currently provide care to encourage staff to think how they could implement both immediate small practical changes and innovative transformation to improve quality.

Health Improvement ProgrammesThroughout 2014/15, Bridgewater has provided a comprehensive range of Health Improvement services in ALW, Halton and St Helens. These services are provided by teams which have diverse and specialist skills, and they work in close partnership with local communities, voluntary and third sector organisations. The teams have a remit to enable clients to improve their own health. Using motivational interviewing techniques, the health improvement teams support clients to stop smoking, adopt healthier eating, reduce their alcohol intake and engage more in their local community. Clients can self-refer to the services but they are often signposted by other health professionals such as GPs, practice nurses, Health Care Assistants and Bridgewater partners. The pathway through the service may be directly attributed to a health check.

The services are delivered in many venues across the boroughs including GP surgeries, LIFT buildings, libraries, Job Centres, community centres and workplaces ensuring easy access for service users.

Examples of how these teams improve individual health are highlighted in the ‘Be clear on cancer’ work streams (where awareness is raised about risks of developing cancer and how to access services and support as soon as possible if people have signs and symptoms) and weight management work streams (where teams support people to lose weight through improved choices about diet, exercise and cooking, as well as working on motivation and self-esteem). The teams work in novel ways to reach out to local communities – one example


being a drama workshop to improve awareness of mental health issues is St Helens College. Through drama, students were made aware of their own emotions and feelings, and how to seek support without stigma. Feedback from students included comments that ‘It made me realise I had felt like that’ and ‘It made me want help others’. The success of the project was far reaching, such that consideration is being given to roll this out to local schools.

Midwifery (Halton)Halton Midwifery Service continues to be the only midwifery service nationally based within a community trust. The service delivers the full remit of pregnancy and postnatal care and a home birth facility. In the past year we have booked 1,576 women for care during their pregnancy, cared for approximately 1,600 women and their babies in the postnatal period. There were 12 successful planned home births and the service responded and provided care to 10 un-booked home births. The service provides care 365 days per year and has an on call facility from 5pm-9am also across 365 days.

The pilot of the digital pens and electronic women held records finished in March and the system went live in April 2014. All women booking with the service now have their personal, clinical and midwifery information stored within a bespoke system which links with SystmOne. There have been some teething problems which are addressed as they arise but overall the system has been beneficial to the service, the woman, and the capture of clinical data across the maternity episode.

Postnatally, babies details and clinical care is also recorded electronically which adds to the capture of quality data available for the baby from birth which can be shared with other health professionals providing continuing care e.g. health visitors and form the basis of a lifelong medical record for the child in question.

Alongside the internal maternity dashboard, April 2014 saw the introduction of the external Clinical Commissioning Group ‘maternity dashboard’ into the service. The purpose of both dashboards is to monitor clinical effectiveness, safe staffing and patient experience across the service. Data is inputted monthly and RAG rated (red, amber, and green) so that trends can be monitored and action plans produced. There are plans to amalgamate both dashboards in the forthcoming year and a change will be made to the smoking data with all women who smoke being referred to the smoking cessation service rather than the present opt in referral. This is in line with the forthcoming care bundle for reducing stillbirths nationally.

User feedback is collected using the ‘friends and family’ criteria at the antenatal and postnatal touch points. A service specific user questionnaire was distributed in June 2014 and we received 399 completed questionnaires over a four week period from 500 distributed. Women were asked to answer 13 questions including two demographic questions and were asked for comments at the end of the questionnaire.

99.74% of respondents felt:• They had continuity of care • The information given was delivered in a professional manner• They had a chance to ask questions and• That their questions were addressed satisfactorily.


Comments such as ‘found all staff helpful and approachable’ and ‘very good professional care very impressed’ were warmly received by the staff. The exercise will be repeated again in June 2015.

Local Supervising Midwifery Report (Halton and St Helens Division)The annual Local Supervising Audit was carried out in October 2014 and once again all the standards were met. There were some recommendations from the visit which have been incorporated into an action plan which is reviewed at the six weekly supervisor of midwife meetings and both the plan and the progress will be presented at the next audit visit in November 2015.

Alongside the trust mandatory training, midwives must complete specific midwifery updates on a yearly basis and this training is delivered within the service with input from transfusion services and midwifery lectures at Edge Hill. A bespoke community based emergency skills and drills package is accessed annually by each midwife within the service to maintain competency in emergency situations.

Community Dental The Community Dental Service (CDS) in Bridgewater is commissioned to provide a range of dental care in Greater Manchester, Merseyside and Cheshire as well as some public health activity in conjunction with a number of local authorities. The key performance indicator dictates that 95% of referrals to the service are seen within 20 working days. The service continues to meet this target.

One of the key roles of the CDS is to provide dental care for people with severe disabilities. Over the past year the CDS has prioritised gaining feedback from patients with disabilities and their carers in order to provide a dental service which meets their specific needs. The CDS now has a member of staff who has volunteered to be a ‘Disability Champion’ in each area. They are tasked with making contact with local disability groups to seek their views on what the ideal dental service for people with disabilities should look like.

As a result of the information gained by the Disability Champions sensory toys have been purchased for children to play with in the waiting room and projectors to project images onto the ceiling to distract patients during treatment. Large changing mats are now available in all dental clinics for patients who require them.

Feedback from carers of patients with autism has resulted in staff accessing an e-learning package from the National Autistic Society and a presentation about the effects of autism on dental health and dental care is being rolled out to all staff. Visual communication aids have been developed to assist communication between patients who have autism and the dental staff.

Feedback from dental network staff revealed they needed more training on general aspects of disability. Training sessions on person centred care for people with disabilities are now being rolled out to dental staff.


Walk-in Centres The Department of Health‘s (DH) Operating Framework sets out the national clinical quality indicators for Accident and Emergency Departments (A&E) including walk-in centres.

The Trust has three walk-in centres in Leigh, St Helens and Widnes which provide treatments for minor ailments.

Walk In Centre

Indicator Target BW Leigh St Helens WidnesPercentage of patients seen in less than 4 hours

<=95% 99.77% 99.56% 99.91% 99.76%

Time to treatment decision (median value) <=60 mins 00:19:34 00:19:26 00:20:44 00:18:02

Unplanned re-attendance % <=5% 0.2% 0.7% 0.0% 0.1%

Left without being seen % <=5% 0.7% 0.3% 0.7% 1.1%

The Trust and three centres have achieved their targets throughout 2014/15.

Out of HoursThe Out of Hours Services provide medical assistance by offering telephone advice from GPs and from nurses along with face to face consultations either at home or in a primary care centre. The Trust has two Out of Hours services, one in Wigan and one in Warrington.

From 1st January 2005, all providers of GP Out of Hours (OOH) Services are required to comply with the National Quality Requirements (NQR) first published in October 2004.

The services report quality standards dependent on their agreed service specification and performance.

This year’s data shows an improvement in compliance for both services.

It should be noted, that due to the low numbers reported in some quality requirements individual breaches can make a significant difference to compliance levels.

Actions are in place to further strengthen performance and create greater resilience within the service. The service is constantly reviewing and amending the service model to better meet demand performance and quality to improve the patient experience.

Out of Hours Services are required to be compliant against a set of national targets. The Trust has gradually improved its performance against the targets throughout 2014/15, however the cumulative position is described in the table below:


Quality Requirements description Targets Wigan Warrington

QR01 Regularly reporting of Quality Standards Compliant Compliant Compliant

QR02 Clinical details sent before 8;00 100% 97.91% 96.18%

QR03 Patients with defined needs Compliant N/A Compliant

QR4 Clinical Audit complete 100% N/A 100%

QR5 Patient Experience 1% N/A Compliant

QR8a Engaged Calls 0.10% N/A 0.00%

QR8b Abandoned Calls 5% N/A 2.30%

QR8c Answered with 50 seconds 100% N/A 94.76%

QR9a Emergency Care Requiring Ambulance 100% N/A 100%

QR9b Urgent Care requiring call within 20 minutes 100% N/A 89.83%

QR9c Routine Care requiring call within 60 minutes 100% N/A 90.28%

QR12a PCC Emergency Appointment within 60 minutes 100% 100% 100%

QR12b PCC Urgent appointment within 120 minutes 100% 93.02% 91.38%

QR12c PCC Routine appointment within 360 minutes 100% 99.42% 98.43%

QR12a Visit Emergency appointment within 60 minutes 100% N/A 90.00%

QR12b Visit Urgent appointment within 120 minutes 100% 89.51% 88.59%

QR12c Visit Routine appointment within 360 minutes 100% 97.85% 96.26%

QR12a Telephone Emergency appointment within 60 minutes 100% 98.80% N/A

QR12b Telephone Urgent appointment within 120 minutes 100% 99.41% N/A

QR12c Telephone Routine appointment within 360 minutes 100% 99.94% N/A

QR13 Interpretation Services within 15 minutes of initial contact Compliant Compliant Compliant

Waiting TimesThe Trust monitors and reports on the length of time between a patient’s referral to one of our services and when the treatment is received by the patient.

Waiting Times - Consultant Led ServicesConsultant-led services are those where a consultant retains overall responsibility for the clinical care of the patient.

The completed Referral to Treatment (RTT) pathway is a true indicator of the length of time between referral and the start of treatment.

Compliant

Non Compliant

Not applicable

Partially Compliant


At the end of 2014/15 the Trust had a total of 782 patients waiting for consultant-led services.

Waiting Times - All ServicesThe Trust measures the time that has elapsed between receipt of referral to the start of treatment and applies the national target of 18 weeks to all its services. Below are patient waiting times reported at the end of each month for all Bridgewater services (2014/15).

At the end of 2014/15 the Trust had a total of 10,769 patients waiting for all services. Of these 9,827 (91.25%) were waiting under 11 weeks.

0

100

200

300

400

500

600

700

800900

1000

Apr-14 May-14 Jun-14 Jul-14 Aug-13 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar15

> 18 weeks< 11 weeks 11-17 weeks

Num

ber

of

wai

ters

Bridgewater Consultant-led Services Referral to Treatment Times

April 2014 to March 2015

0

2000

4000

6000

8000

10000

12000

14000

Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar15

All Bridgewater Services with Waiting Lists Waiting Times April 2014 to March 2015

> 18 weeks< 11 weeks 11 - 17 weeks

Num

ber

of

wai

ters


Cancer ServicesThe Trust delivers community based cancer services to patients living in the Warrington area which is commissioned by Warrington CCG.

The table below demonstrates that the Trust has been meeting and overachieving against the Referral to Treatment and cancer targets throughout 2014/15

Waiting Times Thresholds Full Year 14/15 Achieved?All cancers: 31-day wait for second or subsequent treatment (Surgery) 94% 100.00% P

All Cancers: 62-day wait for first treatment (From urgent GP referral to treatment) 85% 98.65% P

All cancers: 31-day wait (From diagnosis to first treatment) 96% 98.36% P

All cancers: 2 weeks wait from referrals to date first seen 93% 99.52% P

Compliance against TargetsReferral To Treatment time is the length of time between a patient’s referral to one of our services to the start of their treatment.

The NHS Constitution gives patients the right to:

• Start your consultant led treatment within a maximum of 18 weeks from referral for non-urgent conditions

• The Trust also aspires to meeting the 18 week pledge for all other services• Be seen by a cancer specialist within a maximum of two weeks from GP referral for

urgent referrals where cancer is suspected• Start your AHP led treatment within a maximum of 18 weeks from referral for non-urgent conditions.

The Trust achieved all its quarterly monitored national targets for waiting times during 2014/15.

Performance against Referral to Treatment (RTT) waiting time targets

As part of the national requirements the Trust is required to report on the length of time between referral to a Consultant-Led service and the start of treatment being received. The following table demonstrates our compliance against the 18 week RTT target of 95% for completed pathways.

Consultant-Led Services Referral To Treatment

(completed pathways) Thresholds Full Year 14/15 Achieved?

Referral to treatment 18 week compliance (95th percentile) Full year <18.3 15.83P

Referral to treatment 18 week compliance (% under 18 weeks) Full year 95% 97.0%

Within 2014/15 the Trust met and exceeded the 95% threshold set.


Foundation Trust Application The Trust has now completed Monitor’s foundation trust (FT) application process. Following the findings of the Care Quality Commission’s (CQC) inspection carried out in February 2014, the Trust was able to progress to the final stage of the FT application process, and re-engaged with Monitor in June 2014.

During this final stage, Monitor’s assessment team visited the Trust to conduct on-site interviews with the Board of Directors, clinical staff, our Governors and partner agencies.

Following this rigorous process, the Trust Board met with Monitor’s Board in London on 9th September 2014 and on 1st November, Bridgewater was one of the first two community trusts to be awarded an FT licence.

Monitor RegulationNow that the Trust has attained FT status, it is subject to the routine annual planning and reporting requirements set out by Monitor, as part of their on-going regulation of foundation trusts.

Each year, Monitor sets out the annual planning and reporting cycle that details the actions and submissions that the Trust must make to maintain its FT licence. The required submissions include detailed information on finance and activity, contracts and performance, and a comprehensive operational plan that sets out the Trusts intentions for the coming financial year.

Performance against the Risk Assessment Framework is set out below.

Risk Assessment Framework 2014/15 Q1 Q2 Q3 Q4

Continuity of Service Rating

n/a n/a 4 4

Governance Rating

n/a n/a Green Green

Continuity of Service Rating score of 4 - Monitor will generally take no action beyond continuing to monitor the licence holder. Governance Rating of Green – No governance concern is evident or where Monitor are not currently undertaking a formal investigation.


Council of Governors The Trust has a Council of Governors which consists of both elected and appointed governors. Throughout this first year of operation as a foundation trust, the Council of Governors’ role has been developing. Governors have provided a valuable input to quality visits to a number of services this year, bringing their ‘lay’ perspective to bear in improving service delivery. They have undertaken considerable outreach to local communities, increasing the membership and promoting the work of the Trust. More formally, the governors were engaged in the stakeholders sessions as part of the appointment of a new Chief Executive Officer, and have commenced the process of recruiting new non-executive directors.

The Trust was already operating a Council of Governors in shadow form, following elections in September 2013, in preparation for becoming a foundation trust. Following authorisation, formal Council of Governor meetings were held in November 2014, December 2014 and March 2015.

The Council of Governors comprises a total of 33 Governor seats, of which 18 are elected Public Governors, nine are elected Staff Governors and six are appointed Partner Governors. The Council is chaired by the Trust’s Chairman and the Lead Governor.

Monitoring the Quality of Services across Bridgewater Board and Sub-CommitteesThe Board and Sub-Committee structure of the Trust is illustrated below.

BOARDAuditCommittee

InvestmentCommittee

Quality andSafety

Committee

Nominationsand

Renumerations

LocalNegotiatingCommittee

Trust EffieciencyAssurance Committee

During 2014/15 the Quality Management Group, as a sub-group of the Quality and Safety Committee (QSC), was established as an operational group to facilitate discussion on all quality related issues e.g. incidents, risks, CQC compliance, new national initiatives e.g. Sign up to Safety and presentations from the directorates regarding key service delivery and staffing priorities. This group includes key senior managers to ensure that any identified barriers to the provision of quality care are addressed in a timely manner and escalated to the QSC as appropriate. This group has enabled the Trust to proactively manage and challenge the quality agenda.


Quality Impact Assessment ProcessQuality Impact Assessments (QIA) are carried out to review all cost improvement programme (CIP) schemes, to ensure there are no negative impacts to the quality of services.

The QIA panel has been established to oversee the Trust’s QIA process. It provides assurance that there is a robust QIA process for all CIP schemes. It reports internally to both the Quality and Safety Committee quarterly and the Trust Efficiency Assurance Committee (TEAC) on a monthly basis and externally to the Clinical Commissioning Groups.

Action taken to Address Francis Report Recommendations The Trust undertook an assessment of the 290 recommendations in the Francis 2 report which were then categorised into 26 objectives for the Trust in 2014/15. The Trust has monitored this action plan with regular updates to the Board and the four Clinical Commissioning Groups. This is now normal business of the Trust and the Quality Strategy will provide further framework to embed quality into the Trust culture.

Action taken to Address Freedom to Speak Up Recommendations The Trust has undertaken a gap analysis against the Freedom to Speak Up – Review of whistleblowing in the NHS, which during 2015/16 will be developed into an action plan and will be monitored by the Quality and Safety Committee.

Sign up to Safety Sign up to Safety is designed to help realise the ambition of making the NHS the safest healthcare system in the world by creating a system devoted to continuous learning and improvement. This ambition is bigger than any individual or organisation and achieving it requires us all to unite behind this common purpose. We need to give patients confidence that we are doing all we can to ensure that the care they receive will be safe and effective at all times.

Sign up to Safety aims to deliver harm free care for every patient, every time, everywhere. It champions openness and honesty and supports everyone to improve the safety of patients.

Patient safety is a top priority at Bridgewater Community Healthcare Foundation Trust. We have signed up to the ‘Sign up to Safety’ initiative, which is designed to help realise the ambition of making the NHS the safest healthcare system in the world. We have developedour patient safety improvement plan for 2015/16 based on the Sign up to Safety actions and we have committed to the five Sign up to Safety pledges (please see Priorities for Improvement in 2015/16 section for further details).

Open and Honest Care (previously known as the Transparency Project)From April 2014 the Trust was the only Community Trust to publish Open and Honest data. The data published relates to pressure ulcer data as collected as part of the NHS Safety Thermometer. We also publish data relating to staff and patient experience, including patient stories submitted to the Board and lessons learnt by the Trust. It is envisaged that it will


support patient choice, enhance staff knowledge and lead to changes in both clinical practice and organisational culture which is seen as fundamental to good patient care.

The Trust has worked with the national team to further develop the work and look at how further areas of care can be reported on.

NHS Safety Thermometer The NHS Safety Thermometer is a national improvement tool for measuring, monitoring and analysing patient care and “harm free” care. It provides a quick and simple method for surveying patient harms and analysing results so that we can measure and monitor local improvement and harm free care over time.

The Trust has been compliant with submission of this data during 2014/15.

Bridgewater Sample SizeThis table illustrates the size of the population that contributed to the point prevalence monthly monitoring.

Bridgewater Sample Size

March-14

April-14

May-14

June-14

Jul-14

Aug-14

Sep-14

Oct-14

Nov-14

Dec-14

Jan-15

Feb-15

Mar-15

1025 940 981 1197 951 970 1134 1044 981 1085 966 1050 964

Percentage of Harms (New)This table demonstrates that for 11 months of 2014/15, the Trust reported a below national average position for new harm caused by the Trust during a patient’s episode of care.

Percentageof harms (New)

Mar-14

Apr-14

May-14

Jun-14

Jul-14

Aug-14

Sep-14

Oct-14

Nov-14

Dec-14

Jan-15

Feb-15

Mar-15

National 2.57% 2.53% 2.51% 2.46% 2.34% 2.47% 2.42% 2.42% 2.32% 2.26% 2.40% 2.36% 2.32%

Bridgewater CommunityNHSFoundation TrustTrust

3.02% 2.02% 1.12% 2.34% 0.95% 1.96% 1.94% 1.15% 1.73% 2.12% 1.66% 1.81% 1.04%

Percentage of Harm FreeThis table demonstrates that for 12 months of 2014/15, the Trust reported an above national average position for patients who had received harm free care during their episode of care.

Percentageof harms (New)

Mar-14

Apr-14

May-14

Jun-14

Jul-14

Aug-14

Sep-14

Oct-14

Nov-14

Dec-14

Jan-15

Feb-15

Mar-15

National 93.62% 93.56% 93.50% 93.59% 93.82% 93.66% 93.72% 93.87% 93.88% 94.07% 93.82% 93.72% 93.96%

Bridgewater CommunityNHSFoundation TrustTrust

94.44% 95.21% 96.02% 95.82% 96.42% 94.95% 95.41% 96.46% 95.11% 96.13% 94.51% 94.95% 95.02%


Internal Audit During the past year our internal auditors (Mersey Internal Audit Agency) have undertaken a series of reviews of various aspects of services. Below is a table indicating the reviews undertaken and the assurance levels given.

High Assurance - Some low impact control weaknesses found which, if addressed would improve overall control. However, these weaknesses do not affect key controls and are unlikely to impair the achievement of the objectives of the system.

Significant Assurance - There are some weaknesses in the design and/or operation of controls which could impair the achievement of the objectives of the system, function or process. However, either their impact would be minimal or they would be unlikely to occur.

Limited Assurance - There are weaknesses in the design and / or operation of controls which could have a significant impact on the achievement of the key system, function or process objectives but should not have a significant impact on the achievement of organisational objectives.

REVIEW TITLE ASSURANCE LEVEL

Emergency Preparedness Review Objective: To review and evaluate the arrangements in place within the Trust in relation to Emergency Preparedness systems and procedures.

Significant

General Ledger Objective: The financial ledger records all financial transactions of the organisation and ensures their completeness and integrity, with the aim of providing the basic data from which management accounts, financial accounts and statutory returns can be prepared.

Significant

Income & Debtors Objective: All income due to the organisation is properly identified, collected and accounted for under management control and management receives timely and adequate information to control this.

Significant

Non Pay Expenditure Objective: All goods and services are ordered promptly by authorised officers, are available when required are of an appropriate quality, and the correct payment is made to the correct payee at the most appropriate time and is properly accounted for in the organisation’s records.

Significant

Treasury Management Objective: Ensuring that the financial stability of the organisation is attained and then constantly monitored and maintained to enable the organisation to meet its business plan.

Significant

SystmOne & IG Governance Arrangements Objective: To provide an opinion on the adequacy of the governance framework implemented around the SystmOne application with reference to the best practice standards such as the NHS Information Governance Toolkit.

Significant

Recruitment Processes Follow Up Objective: To provide an update against the position reported to the April 2014 Audit Committee meeting on the progress of recommendations made in respect of the 2013/14 review of Recruitment Processes.

Significant

Serious Untoward Incidents (SUIs) Follow Up Objective: To provide an update on the progress of implementation of recommendations made in the 2013/14 SUI review and provide an analysis of the level of agreement with the recommendations made.

Significant


REVIEW TITLE ASSURANCE LEVELNew Domain Review Objective: To provide an opinion on the design, effectiveness and coverage of the arrangements in place to protect and manage the new Microsoft Domain and the system, data and user resources under its control.

Significant

Information Governance (IG) Toolkit Objective: To provide an opinion on the adequacy of policies, systems and operational activities to complete, approve and submit the IG Toolkit scores. We also provided an opinion on the validity of the scores based on the evidence available.

Significant

Safeguarding Follow Up Review Objective: To provide an update against the position reported to the February 2015 Audit Committee meeting on the progress of recommendations made in respect of the 2014/15 review of Safeguarding.

Significant

Telephony (VOIP) Review Objective: To provide an assessment of the effectiveness of the control framework being exercised by management over the telephone systems and highlight improvements where appropriate.

Limited

Safeguarding Review (Superseded by Follow Up) Objective: To The overall objective of the review was to assess the systems and processes in place across the organisation to ensure compliance with safeguarding statutory requirements and guidance.

Limited

Data Consistency Phase I Review Objective: To ensure that the Trust has robust systems and processes in place for collecting and recording activity data to support the complete and accurate reporting of activity data to Trust Board in accordance with national definitions and requirements.

Limited

Network Infrastructure Review Objective: To provide an assessment of the risks associated with the adequacy and effectiveness of the network infrastructure (such as distributed cabling, switches, routers, firewalls and monitoring tools) and associated control framework, that provides responsive and resilient connectivity between users, key systems and data storage across the Trust’s managed estate as well as external connections.

Limited

Financial Systems Technical Security Review Objective: To provide an assessment on the effectiveness of the technical security control framework being exercised by management over Financial Systems including Excel spreadsheets created in-house and highlighting opportunities for improvement, where appropriate.

Limited

School Nursing Service Review Objective: To provide an opinion on the controls and systems in place at a local level, focus-ing upon the School Nursing Service.

Limited

20 Working Day Dental Target Objective: To ensure there are adequate systems and controls in place to deliver the 20 day dental target.

Limited

Specialised Services Governance Arrangements Review Objective: To provide assurance that the governance arrangements in place and operating within the Specialised Services directorate are in line with the Trust’s accountability framework.

Limited

ESR (HR / Payroll) Review Objective: To provide an assessment of the effectiveness of the systems of control operating at the Trust to ensure that only employees of the organisation are paid, and only for work that they perform on behalf of the organisation.

Limited


Detailed action plans have been developed in response to all recommendations from the MIAA reports, regardless of the overall level of assurance, and will be monitored by the Audit Committee and the Quality and Safety Committee with follow up visits planned by MIAA during 2015/16 to receive updates and assurance that these have been addressed.

The Audit Committee was in receipt of full reports and progress reports on all of the audits and recommendations during 2014/15.

Stakeholder Involvement in the Development of our Quality AccountOpportunity to Shape the Content of our Quality AccountPrior to our quality account being drafted our Chief Executive wrote to our Clinical Commissioning Group’s and Local Authorities requesting their input into the content of the account. A number of suggestions were received regarding content and our 2015/16 quality improvement priorities which have been addressed during the development of the account.

Stakeholder feedbackWe sent out our draft Quality Account to our stakeholders inviting them to comment on whether or not they considered the document to be accurate in relation to services provided.

All of the responses have been included in our account.

Healthwatch Wigan Stakeholder FeedbackHealthwatch Wigan (HWW) welcome this Quality Account for 2014/15 and would like to congratulate the Trust and all the staff at Bridgewater on becoming one of only two Community Trusts to achieve Foundation status. HWW would also like to acknowledge the hard work of staff at all levels of the Trust in maintaining and, in many areas, improving the services delivered to the people of Wigan.

HWW recognises the work done by the Board in the past year to improve staff engagement and improve staff morale and we look forward to seeing this work continuing to enable further improvement to the services being delivered by Bridgewater. HWW would like to encourage the Trust to continue to use ‘Patient Stories’ as a way of illustrating the patient experience to the Board but would like to see a negative story used occasionally, one where perhaps services were not up to the standards required by the Trust. We feel that these will help the Board to understand the patient experience even better. HWW would like to see included in the 1st Priority a statement about the Trust having a ’no blame culture’ in order for staff to feel able to report all incidents and admit mistakes regardless of fault and to learn from them.

HWW would like to see some explanation in the report of some of the results recorded e.g.:• Why the Breast feeding rates at 6-8 weeks have fallen

Wigan


• Why the take up of Personal Development Reviews amongst Corporate Staff was only 50%

• Whilst HWW recognises the work the Trust is doing to stop patients going to A&E by the introduction of the Northwest Ambulance Service (NWAS) Pathfinder Service which has diverted patients to the Leigh Walk-in Centre, we would like to see a breakdown of patient outcomes when using the Out of Hours Service in Wigan.

HWW would like to see a report included in the account about the work, if any, the Trust is doing with the Voluntary Sector in Wigan to enhance the patient experience.Finally HWW would like to congratulate the Wigan Continence Care Service on receiving the Continence Care Team award at the inaugural National Continence Care Awards in London and the Wigan District Nurse Liaison Team on the work they are doing to improve the ‘discharge experience’ for patients at the Royal Albert Edward Infirmary.

Martin BroomDirector, Healthwatch Wigan


Wigan Borough Clinical Commissioning Group Response to Bridgewater Community Healthcare NHS Foundation Trust Quality Account 2014/2015 Wigan Borough Clinical Commissioning Group (the CCG) appreciates the opportunity to comment on the Annual Quality Account for Bridgewater Community Healthcare NHS Foundation Trust. Firstly the CCG would like to congratulate the Trust on being one of the first two NHS Community Trusts to have been awarded Foundation Trust status. The CCG also welcomes and recognises the progress that the Trust has made in respect of their 2014/2015 quality priorities. Notable successes have included for example; the work undertaken on developing the ‘Open and Honest Care’ programme with Patient Stories presented to the Trust Board on a monthly basis and the related work to improve the accuracy of Pressure Ulcer reporting across the Trust. The CCG also recognises the improvement in the Patient Experience scores from 98% at the end of 2013/2014 to 99% at 2014/2015. However there are areas where further improvement is required; and the CCG requests that the Trust seeks to improve its governance arrangements in relation to the investigation and learning from Serious Incidents (SIs). In addition the Trust should also actively seek to improve their reporting of Patient Safety Incidents (PSIs) with no or low harm as a consequence to the National Reporting and Learning System (NHS NRLS). This will assist to provide assurance that the Trust is a learning organisation. The quality priorities for 2015/2016 inclusive of engagement with; the National Campaign ‘Sign up to Safety’ and the NHS Safety Thermometer Improvements in Care will assist to shape and support the future improvements to improve the quality, safety and experience of the care provided by the Trust services. The CCG will also support the Trust to deliver safer, effective and caring healthcare through the agreed Commissioning for Quality and Innovation (CQUIN) Schemes for 2015/2016 to incentivise quality improvements for example; in Frail Elderly Care; Out of Hours Antibiotic Stewardship and Patient Safety. The CCG looks forward to continuing to work with the Trust during the coming year, to build on the progress made and to provide continued support to the planned initiatives that will seek to improve the quality of care and outcomes for the resident population of the Wigan Borough. Dr Tim Dalton, Chairman, Wigan Borough Clinical Commissioning Group May 2015


Communities Directorate Runcorn Town Hall, Heath Road, Runcorn, Cheshire WA7 5TD Tel: 0151 907 8300

Dear Kate, Quality Accounts 2015 Further to receiving a copy of your draft Quality Accounts and the Joint Quality Accounts event held on 13th May that your colleague Dot Keates attended to present a summary of your Quality Accounts, I am writing with the Health Policy and Performance Board comments. The Health Policy and Performance Board particularly noted the following key areas: During the year 2014/15 the Trust identified a number of priorities to be achieved during this year. The Board were pleased to note that the majority of the targets for this year were achieved which is extremely good. The three areas that were not achieved, have been put against the priorities for this year and the Board look forward to also seeing improvements in these quality areas. The Board noted that the staff survey on recommending the Trust as a place to work or receive treatment was below the national average, but slightly improved on the previous year. The Board understand that the large organisational changes that have taken place will affect people’s morale and perceptions, and hopefully this will improve over time. The Board are pleased to see the action plan that has been implemented to make improvements in this area, in particular the professionals forum, monthly team brief and “you said, we did” cascades. The Board are pleased to note the additional Improvement Priorities for 2015 – 2016:

‘Sign up to Safety’ – the Board noted that the Trust aims to deliver harm free care for every patient, every time, everywhere and to champion openness and honesty to improve the safety of patients.

Improvement in the handling of serious and untoward incidents

Kate Fallon Chief Executive Bridgewater Community Healthcare NHS Trust Bevan House Smithy Brook Road Pemberton Wigan, WN3 6PR

Our Ref EST

If you telephone please ask for

Emma Sutton-Thompson

Your ref Date 20th May 2015

E-mail address Emma.Sutton-Thompson @halton.gov.uk


NHS Safety Thermometer improvements in care – the Board are particularly interested to see a reduction in avoidable pressure ulcers in the coming year.

The Board note that the priorities for next year were all centred around safety and felt that other areas to be considered were effectiveness and lessons learnt. The Board would like to thank Bridgewater Community Healthcare NHS Trust for the opportunity to comment on these Quality Accounts. Yours sincerely, Councillor Joan Lowe Chair, Health Policy and Performance Board


Dear Kate, Quality Accounts 2015 Further to receiving a copy of your draft Quality Accounts and the Joint Quality Accounts event held on 13th May that your colleague Dot Keates attended to present a summary of your Quality Accounts, I am writing with the Health Policy and Performance Board comments. The Health Policy and Performance Board particularly noted the following key areas: During the year 2014/15 the Trust identified a number of priorities to be achieved during this year. The Board were pleased to note that the majority of the targets for this year were achieved which is extremely good. The three areas that were not achieved, have been put against the priorities for this year and the Board look forward to also seeing improvements in these quality areas. The Board noted that the staff survey on recommending the Trust as a place to work or receive treatment was below the national average, but slightly improved on the previous year. The Board understand that the large organisational changes that have taken place will affect people’s morale and perceptions, and hopefully this will improve over time. The Board are pleased to see the action plan that has been implemented to make improvements in this area, in particular the professionals forum, monthly team brief and “you said, we did” cascades. The Board are pleased to note the additional Improvement Priorities for 2015 – 2016:

‘Sign up to Safety’ – the Board noted that the Trust aims to deliver harm free care for every patient, every time, everywhere and to champion openness and honesty to improve the safety of patients.

Improvement in the handling of serious and untoward incidents

Kate Fallon Chief Executive Bridgewater Community Healthcare NHS Trust Bevan House Smithy Brook Road Pemberton Wigan, WN3 6PR

Our Ref EST

If you telephone please ask for

Emma Sutton-Thompson

Your ref Date 20th May 2015

E-mail address Emma.Sutton-Thompson @halton.gov.uk


First Floor Runcorn Town Hall

Heath Road Runcorn Cheshire

WA7 5TD

Tel: 01928 593479 www.haltonccg.nhs.uk

needs or who are looked after through local CQUIN programmes. The outcomes from these programmes has been excellent and your staff have worked hard to deliver the improvements in care planning and management for patients locally. NHS Halton CCG would like to congratulate the organisation on achievement of foundation trust status the process for which we understand is both challenging and robust. NHS Halton CCG recognises the challenges for all providers in the coming year but we look forward to working with the Trust during 2015-2016 to deliver continued improvement in service quality and patient experience and also on the partnership work as we move forward with our One Halton model of service delivery. Yours sincerely

Jan Snoddon Chief Nurse/Quality Lead NHS Halton CCG Email [email protected]



WA7 5TD


Esther Kirby Director of Nursing and Quality Bridgewater Community NHS Foundation Trust 28th May 2015 Re: QA Bridgewater 14-15 JS Dear Esther Re Quality Account 2014-2015 Many thanks for the submission of the Quality Account for 2014-2015 and for the presentation to local stakeholders on 13th May 2015. This letter provides the response from NHS Halton Clinical Commissioning Group to the Quality Account 2014-2015. NHS Halton CCG understands the pressures and challenges for trust and the local health economy in the last year and would like to congratulate and thanks the Trust for the level of partnership working and support with NHS Halton CCG in this year in relation to the Urgent Care centre developments. We also note the excellent collaborative work with your staff and managers in relation to the review of community nursing services in Halton and the support given by both your staff and the local manager in the development of a new specification for these services for 2015-2016. The work has enabled a high level of engagement with your staff locally and has without doubt enabled greater integration across the health economy in particular with General Practice and Local authority social care. As you are aware NHS Halton CCG worked closely during 2014-2015 with the co commissioners NHS St Helen CCG for Contracting and Quality arrangements through which all indicators and CQUINs schemes were reviewed and monitored. The arrangements for 2015/2016 contract year will be slightly different with Halton leading on its own contract but we will continue to have close links with other commissioners of your services in an effort to standardise expectations and ways of workings. This year the trust has made excellent progress in the delivery of quality improvements with some excellent work in relation to improvements in pressure ulcer prevention and management which are now being fully embedded in the trust. NHS Halton CCG would like to congratulate the trust on the hard work of its staff and their commitment to the care of the people of Halton. In this year we have seen significant improvements in integrated care to frail elderly patients, those with long term conditions and children with complex



WA7 5TD


Esther Kirby Director of Nursing and Quality Bridgewater Community NHS Foundation Trust 28th May 2015 Re: QA Bridgewater 14-15 JS Dear Esther Re Quality Account 2014-2015 Many thanks for the submission of the Quality Account for 2014-2015 and for the presentation to local stakeholders on 13th May 2015. This letter provides the response from NHS Halton Clinical Commissioning Group to the Quality Account 2014-2015. NHS Halton CCG understands the pressures and challenges for trust and the local health economy in the last year and would like to congratulate and thanks the Trust for the level of partnership working and support with NHS Halton CCG in this year in relation to the Urgent Care centre developments. We also note the excellent collaborative work with your staff and managers in relation to the review of community nursing services in Halton and the support given by both your staff and the local manager in the development of a new specification for these services for 2015-2016. The work has enabled a high level of engagement with your staff locally and has without doubt enabled greater integration across the health economy in particular with General Practice and Local authority social care. As you are aware NHS Halton CCG worked closely during 2014-2015 with the co commissioners NHS St Helen CCG for Contracting and Quality arrangements through which all indicators and CQUINs schemes were reviewed and monitored. The arrangements for 2015/2016 contract year will be slightly different with Halton leading on its own contract but we will continue to have close links with other commissioners of your services in an effort to standardise expectations and ways of workings. This year the trust has made excellent progress in the delivery of quality improvements with some excellent work in relation to improvements in pressure ulcer prevention and management which are now being fully embedded in the trust. NHS Halton CCG would like to congratulate the trust on the hard work of its staff and their commitment to the care of the people of Halton. In this year we have seen significant improvements in integrated care to frail elderly patients, those with long term conditions and children with complex


Public and Environmental Health Department Policy & Resources Directorate Runcorn Town Hall, Heath Road, Runcorn, Cheshire, WA7 5TD www.halton.gov.uk

Public Health Comments on Quality Accounts – May 2015 Bridgewater Breastfeeding- More needs to be done across Halton to improve breastfeeding rates.

It was disappointing to note that the 6-8 week breastfeeding rates had got worse since the previous year. However, it is encouraging to note that the Trust will continue to focus on this issue over the coming year.

Dementia- Good to see that dementia targets for 14/15 were met.

Encouraging to note that falls management will form part of Quality Priority 3 for 2015/16. Halton has identified reducing the number of falls in the over 65s as part of its Health and Wellbeing Strategy given the high rates of falls locally.

Health Inequalities and Inclusion Team- It is encouraging to note that the trust is continuing to work on the issue of health inequalities locally. Given the increasing health inequalities issue it is important to ensure that we continue to monitor services to ensure they are accessible to all.

Encouraged to note the work that continues within the trust on Healthcare Acquired Infections and the positive results this has achieved. It is also positive to note the work that is continuing on outbreak control and steps that have been taken by the Trust on Ebola.

Influenza vaccination for staff- it was disappointing to see that Halton had the lowest vaccine uptake across Trust areas (45%). This is some way off the recommended target of 75% set by the Department of Health. It would be good to see improvement strategies in place to address this.

NICE Guidance Compliance- The report notes that in 2014/15, 25 pieces of NICE guidance were published, however, the Trust is only fully compliant on 13. We do however accept that action plans are in place to increase full compliance in all areas.

Audit of Growth and Nutrition Service- Whilst it is encouraging to note the decrease in the number of children in the extreme obese category, the results show the need to continue to focus on this important area, especially since Halton suffers from particularly challenging rates of childhood obesity.

Childhood Immunisations- Whilst it is encouraging to see that vaccine uptake remains high in Halton, there has been a slight reduction in a number of areas. Most of these are very small, however, MMR uptake in 2014/15 has reduced by 2.5% from the previous year. Whilst this still represents a modest reduction, it is still an area that needs to be monitored to ensure it does not decrease further. Similarly, the uptake for the Pneumococcal booster also reduced by 2.2% since last year.


Clinical Chief Officer : Dr Andrew Davies MB ChB

Esther Kirby Executive Nurse Bridgewater Community Healthcare NHS Trust Bevan House, 17 Beecham Court, Smithy Brook Road, Pemberton, Wigan. WN3 6PR. Dear Esther Re: Quality Account 2014-2015 Many thanks for the submission of the Quality Account for 2014-2015, and for the presentation to local stakeholders and the Local Area Team. This letter provides the response from Warrington CCG to your Quality Account. The account affirms the work that is being carried out by the trust and which is regularly discussed through the mechanisms which we have in place; contract monitoring, the established strong focus on quality and the rigorous SUI process are all contributory factors to ensure that both commissioner and provider are working collaboratively to improve care and agree appropriate actions and monitoring when the patient experience has not been to the standard we all aspire too. I believe that these forums continue to build on our relationship and cemented our united approach to delivering high standards of health care to the local population. Warrington CCG welcomes the work delivered by the Trust in relation to improving patient care for the local population and wishes to continue the healthy relationship that we have for future planning of health care delivery. We also wish to congratulate you for the impressive work which you have carried out, particularly the intravenous therapy service which has impacted on reducing the length of stay and avoiding admissions for Warrington residents. The CCG acknowledges the work undertaken to reduce pressure ulcers the year end position of 38% is an increase on the last two years, although it’s difficult to see what is attributable to Warrington and understand the true impact of the work that has taken place this last year. Warrington CCG also share your disappointment at not meeting your improvement target regarding the prevention of the risk of future incidents, however acknowledges that this work will continue and be built upon in your quality priorities for 2015/2016.

01925 843636 Please Ask For: John Wharton E-mail: [email protected] Date: 26th May 2015

Arpley House

110 Birchwood Boulevard Arpley House

Birchwood Warrington WA3 7QH

www.warringtonccg.nhs.uk




Arpley House







Arpley House





Warrington CCG welcomes the feedback which you received from your Care Quality Commission (CQC) and are pleased to see the trust declared compliance against the identified compliance action. The inclusion of your planned Quality Priorities for 2015/16, particularly r sign up to safety and the continued focus on improving the handling of serious and untoward incidents is also most welcome. I conclude by informing you that we are looking forward to working with the Trust throughout 2015/16, helping to improve the quality and delivery of services for the local population and ensuring that the provider is working towards delivering the three key domains of the CCG’S quality strategy safety, effectiveness and experience remain at the heart of health care provision. I believe that this is an accurate and honest account of your organisation and wish to congratulate you on your work. Yours sincerely

John Wharton Chief Nurse & Quality Lead Warrington Clinical Commissioning Group


Working in partnership with and

T: 01744 624265F: 01744 624188

Our Ref: SC/JB / SC1211

2 June 2015

St Helens Chamber Salisbury StreetOff Chalon WaySt HelensWA10 1FY

Emailed: [email protected]

Colin ScalesChief ExecutiveBridgewater Community Healthcare NHS Foundation TrustBevan House17 Beecham CourtSmithy Brook RoadWigan WN3 6PR

Dear Colin

Bridgewater Quality Accounts.

Following the recent Quality Accounts presentation, which unfortunately I was unable to attend, the following observations / comments were made by Sarah O’Brien which I would like to formally feedback to yourselves. The presentation a good presentation, open and honest.

1. We were pleased to note that you had included Newton Hospital as a Quality priority for 2015-16 and look forward to working with them on this.

2. Quality priority 2 for 2015-16 is relating to improvement in management of serious incidents. We recognise that Bridgewater have already made a lot of improvements this year and would like to see more emphasis in 2015-16 on learning lessons.

3. All 3 quality priorities for 2015-16 are very safety focused and it would be good to see some plans relating to experience and effectiveness.

4. The Listening to action work you have a commenced is excellent.

5. Joe Banat fed back that the work Bridgewater have carried out to date to improve access to Open Minds and outcomes and this should be included in the quality account.

6. We suggested there could have been a bit more included in the document about safeguarding and staffing and what Bridgewater are carrying out in these areas

Yours sincerely,

Dr Stephen CoxClinical Chief ExecutiveNHS St Helens CCGcc S O’Brien

L Spooner

Working in partnership with and

T: 01744 624265F: 01744 624188


2 June 2015




Dear Colin









Yours sincerely,


L SpoonerWorking in partnership with and

T: 01744 624265F: 01744 624188


2 June 2015




Dear Colin









Yours sincerely,


L Spooner


Appendix A

Children’s Immunisations for Quality Account

Bridgewater

Percentage of immunisations delivered on schedule for

children reaching their 2nd birthday

Primary 13/14 14/15

Diphtheria 97.8% 97.7%

Tetanus 97.8% 97.7%

Pertussis (Whooping Cough) 97.8% 97.7%

Polio 97.8% 97.7%

Haemophilus Influenzae B 97.8% 97.4%

Meningitis C 97.6% 98.3%

Pneumococcal Booster 95.8% 94.7%

MMR 95.6% 94.2%

Ashton, Leigh and Wigan



Primary 13/14 14/15


Tetanus 97.6% 97.8%


Polio 97.6% 97.8%




MMR 95.3% 94.5%


Appendix A (continued)

Children’s Immunisations for Quality Account

Halton and St. Helens



Primary 13/14 14/15


Tetanus 97.7% 97.4%


Polio 97.7% 97.4%




MMR 96.3% 93.8%

Warrington



Primary 13/14 14/15


Tetanus 98.3% 98.1%


Polio 98.3% 97.9%




MMR 94.8% 94.4%

Statement of Directors’ Responsibilities The directors are required under the Health Act 2009 and the National Health Service (Quality Accounts) Regulations 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 NHS 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 2014/15 and supporting guidance • The content of the Quality Report is not inconsistent with internal and external sources

of information including: • Board minutes and papers for the period April 2014 to May 2015 • Papers relating to Quality reported to the board over the period April 2014 to May

2015 • Feedback from commissioners dated May 2015 • Feedback from governors dated May 2015 • Feedback from local Healthwatch organisations dated May 2015 • Feedback from Overview and Scrutiny Committee dated May 2015 • The trust’s complaints report published under regulation 18 of the Local Authority

Social Services and NHS Complaints Regulations 2009.• The national patient survey – not applicable to community healthcare providers• The national staff survey 24/02/2015 • The Head of Internal Audit’s annual opinion over the trust’s control environment

dated March 2015• CQC Intelligent Monitoring Report – not applicable to community healthcare providers

• 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.gov.uk/annualreportingmanual) as well as the standards to

support data quality for the preparation of the Quality Report (available at www.monitor.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.

By order of the board

..............................Date.............................................................Chairman

..............................Date.............................................................Chief Executive

29/5/15

29/5/15


Bridgewater Community Healthcare NHS Foundation TrustBevan House17 Beecham CourtSmithy Brook RoadWiganWN3 6PR

Tel: 01942 482630 | Fax 01942 482662

Email: [email protected] | www.bridgewater.nhs.uk

www.facebook.com/BridgewaterNHS

www.twitter.com/Bridgewater_NHS


10. Useful Contacts

Your views

We welcome your comments and feedback on our Annual Report and Accounts and Quality Account.

Please contact 01942 482655 or email [email protected] if you:

• have any further questions or need help understanding any aspect of this document• would like to view this document in another language or format such as Braille or audio• would like us to send you a printed copy of this document or parts of this document

Giving feedback on our services

If you wish to tell us about your experience of our services please contact Patient Services:Email: [email protected]: 0800 587 0562

Membership

If you would like to have a say and help us to develop our services to meet local needs, thenplease consider becoming a member. Membership is open to anyone aged 14 years or over who lives in England. Please contact us to find out more.

Email: [email protected]: 01942 482672

Want to know more about us?

You can:

• find out more about us on our website: www.bridgewater.nhs.uk• follow us on Twitter: www.twitter.com/Bridgewater_NHS• “like” us on Facebook www.facebook.com/BridgewaterNHS• contact our Headquarters:

Bevan House 17 Beecham Court Smithy Brook Road Wigan WN3 6PR.

Telephone: 01942 482630 or Email: [email protected]

Acknowledgements

Thank you to all the staff and teams who contributed to this document.


Bridgewater Annual Report 2014/15 157 157 Bridgewater Annual Report 2014/15


Bridgewater Community Healthcare NHS Foundation TrustBevan House17 Beecham CourtSmithy Brook RoadWiganWN3 6PR

Tel: 01942 482630 | Fax 01942 482662

Email: [email protected] | www.bridgewater.nhs.uk

www.facebook.com/BridgewaterNHS

www.twitter.com/Bridgewater_NHS

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