2008/09
Annual Report
2008/09 Annual Report and Accounts
Aim of the Trust
“To be the specialist orthopaedic hospital of choice by providing outstanding patient care, research and education”.
Our Values
Patients first
Honesty
Respect
Excellence
Trust
Equality
1. Statement from the Chair and the Chief Executive
We are pleased to introduce the 2008/09 annual report and accounts for the Royal National Orthopaedic Hospital NHS Trust.
This has been a year of change, challenges and achievements for the Trust.
NHS London approved our Outline Business Case for the redevelopment of the Stanmore hospital site which took us a step further to providing a hospital environment which complements the excellent care that we provide our patients. The challenge remains, however, for us to find appropriate financial options to bring our plans to fruition. Progress continues on our new Outpatients’ Assessment Centre at Bolsover Street, scheduled for completion and open to patients in December 2009.
The challenges associated with the 18 week target for referral to treatment were immense for the Trust. We achieved the target in most areas, with the exception of our spinal surgery work.
Financially, the Trust remains in a strong position, achieving a surplus of £0.5million. The Trust has also repaid all of its historic debts.
Our journey continues towards becoming an NHS Foundation Trust and we reached a significant milestone of welcoming over 2,600 public and patient members to the Trust, many of whom have stated their willingness to stand for election as governors. Their support for, and interest in the Trust is welcomed and we look forward to working with our members to improve and develop our work.
Once again, we maintained our excellent record in avoiding MRSA and continued to raise awareness of infection control issues amongst staff (through regular training) as well as our patients and visitors.
We congratulate our staff for their contribution to ensuring that we do not compromise on our high standards of care whilst increasing the number of patients that we treat. Their continued commitment and professionalism ensure that we are in an excellent position to build on what we have achieved and face our challenges with confidence.
Finally, Andrew Woodhead, Chief Executive since 2004, left the Trust and Rob Hurd, previously our Director of Finance and Performance, became our Chief Executive in the autumn.
Donald Hoodless OBE Rob Hurd
Chairman Chief Executive
2. Directors’ Report
RNOH is the largest specialist orthopaedic hospital in the UK and continues to be regarded as a leader in the field of orthopaedics both in the UK and world-wide. We provide a comprehensive range of neuro-musculoskeletal healthcare, ranging from acute spinal injuries to orthopaedic medicine and specialist rehabilitation for chronic back pain sufferers. The Trust also has a well-established children’s and teenage unit. This broad range of neuro-musculoskeletal services is unique within the NHS. The Trust is based on two sites: Stanmore in Middlesex and a Central London outpatients’ facility in Bolsover Street.
The Trust is continuing to work in partnership with UCL and has agreed a Joint Academic Plan. This highlights the unique mix of clinical care, teaching and research that is undertaken at the Trust. More than 20% of all UK orthopaedic surgeons receive training here – and our patients benefit from a team of highly specialised consultants, many of whom are nationally and internationally recognised for their expertise.
2.1 Board of Directors
During the year, the following individuals served on the Royal National Orthopaedic Hospital NHS Trust Board of Directors:
Mr Donald Hoodless OBE - Chairman
Mr Andrew Woodhead - Chief Executive Officer (to 31 July 2008)
Mr Rob Hurd - Chief Executive Officer (from October 2008), previously Director of Finance and Performance (to October 2008)
Mrs Helen Farrow - Non-Executive Director (Vice Chairman)
Mr Anthony Watson - Non-Executive Director
Mr Guy Billington - Non-Executive Director
Prof Simon Shorvon -Non-Executive Director
Mr Laurence Milsted - Non-Executive Director
Mr Tim Briggs - Joint Medical Director
Dr Rhiannon Mitchell - Joint Medical Director
Mrs Sheila Puckett - Director of Operations and Service Improvement
Mr Charlie Sheldon - Director of Nursing (from October 2008)
Mrs Kathryn Corder - Acting Director of Nursing (to October 2008)
Mr Ahmet Koray - Interim Director of Finance (12 months from October 2008)
Mr Mark Vaughan - Director of Human Resources & Corporate Affairs
Professor David Marsh - Director of Research and Development (from October 2008)
Mr Mark Masters - Director of Projects, Estates and Facilities
Dr Saroj Patel - Director of Information Management and Technology
2.2 Achievements against the Trust’s 2008/09 Priorities
The Trust had a wide range of priorities and challenges for the year 2008/09 and celebrates considerable success against those priorities.
I. Financial Performance & Long Term Financial Stability
The Trust has continued to make progress in clearing its historical deficits and delivered a surplus of £483,000 for the year, achieving a risk rating score of 3 as a result. The Trust’s original business plan was to deliver a surplus of £1million, but this target was reduced after agreement was reached with NHS London on the treatment of redevelopment fees the Trust had incurred during the year.
This is the second year running the Trust has delivered a surplus and reflects the strong financial management that has developed across the organisation. A challenging cost improvement programme was implemented during the year, which yielded approximately £2.6miilion in savings. This, combined with robust income and expenditure procedures, ensured the Trust met its financial targets which, going forward, allows it to continue to build on its long-term financial stability.
Another major achievement was that all of the Trust’s loans were repaid during the year (£2.1million) as well as meeting a tough year-end cash target of £2.3million. In total, this represented a net cash increase of £3.5million for the Trust and provides the basis on which to meet our capital plans for 2009/10.
After making enquiries, the Directors have a reasonable expectation that the 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.
II. Becoming a Foundation Trust
All members of the Trust Board have collaborated on the Trust’s integrated business plan, which includes the Trust’s vision for service development, ensuring a cohesive, ambitious but achievable plan for the Trust’s future as a Foundation Trust. The Board is well placed to meet the rigorous requirements of the authorisation process.
III. Increased activity
Cumulatively, the Trust has achieved a year on year increase of approximately 5% in activity, whilst expenditure levels have only increased by 1.3% from the previous year. The plan is for a similar increase in activity in 2009/10, but more modest increases in the 2 years thereafter.
IV. Maintaining high quality of patient care
Good clinical outcomes remain a feature of patients’ experience at the Trust. This includes continued low rates of infection, in particular 0 cases of MRSA in 2008/09. Effective multi-disciplinary working is a cornerstone of the Trust’s clinical services which translates into a positive experience for patients.
The patient survey results placed the Trust fourth out of 31 acute and specialist trusts in London and thirty first out of 165 acute and specialist Trusts nationally.
V. Redeveloping both sites to enhance the patient experience and continue to provide and develop services which other hospitals cannot provide
The development of the new Bolsover Street Outpatients’ Assessment Centre has gained momentum, with expected completion by December 2009. A multi-disciplinary commissioning project team is working towards ensuring the patient journey is effective and efficient in the new state-of-the-art facility.
The Trust is keen to have early resolution of the issues surrounding the financial options for redeveloping the Stanmore site.
VI. Developing robust relationships with our strategic partners to enhance research and development in our specialist field
The Trust is pursuing a Joint Academic Plan with the Institute of Orthopaedic and Musculoskeletal Science as well as forging links with other academic centres to ensure that the Trust remains at the forefront of translational research and education in orthopaedics and musculoskeletal science.
2.3 Priorities for 2009/10
The Trust Board continues to focus on its main priorities, as described above, with particular emphasis in 2009/10 on:
Achieving Foundation Trust status
The Trust continues to develop its integrated business plan and is still aiming to apply for Foundation Trust status in 2009. Public and patient membership has grown to over 2,600, demonstrating the support and interest generated in the Trust and its future. The Trust continues to seek both public and patient members, who can apply through the Trust’s website or by completing an application form (available from the communications department).
Business Planning and Risks
In developing our plans, the Trust has taken account of certain risks and uncertainties. These include:
- The potential reconfiguration of services and PCTs across London as part of the ‘Healthcare for London’ review
- Continued development of the Trust’s information systems, costs and prices to support Trust contracts from 1 April 2010
- Delivery of the Trust cost saving programme
- Pay and other contract settlements against levels of inflation
- Delivery of capital investment schemes to time and budget
- A reduction in the demand from private patients
These risks are monitored by the Board through our governance structures and plans are in place to address them.
2.4 Partnership Working
Research and Development
The Trust continues to build on its partnership with University College London and in particular UCL’s Institute of Orthopaedic and Musculoskeletal Science which is based on the Stanmore campus. The Trust is strengthening its ties with IOMS so that the campus may evolve in the direction of an Academic Health Sciences Centre. The Trust is regarded as a centre of clinical excellence for complex neuro-musculoskeletal disease and a national tertiary referral centre. It is committed to leading clinical advancements for the benefit of patients through its partnerships and aims to move towards becoming a more integrated, translational research centre, encouraging increased involvement of clinicians in education and research. As well as continuing the relationship with IOMS, other academic centres are keen to collaborate with the Trust.
Specialist Orthopaedic Alliance
The Trust continues to play a key role in the Specialist Orthopaedic Alliance which exists to enable the Trust, along with other orthopaedic hospitals, to share best practice and address the challenges that specialist orthopaedic hospitals face to secure the future of patient services as well as research and development.
Education
The Trust continues to provide staff from the RNOH and beyond with a wide range of education and development, building on its reputation for training clinicians and non-clinical staff alike.
Information provided to Auditors
As far as the Directors are aware, there is no relevant audit information of which the auditors are unaware. They have taken all the steps that they ought to have taken as Directors in order to make themselves aware of any relevant audit information and to establish that the auditors are aware of that information.
3. Operating and Financial Review
3.1 2008/09 Operating Review
The Trust maintained its excellent track record in delivering high-quality treatment and care for patients needing complex orthopaedic surgery. Our infection rates were low (zero MRSA, 5 C-Diff cases for the year out of 10,823 inpatients, including private patients) and our results for the National Patient Survey on patient experiences were above average. However, one of the major difficulties continuing to face the RNOH, is that over 50% of the building stock is pre 1948 and in need of replacement. This has meant that we have been unable to comply with the Healthcare Commission core standards for better health in relation to the healthcare environment at the Stanmore site. The RNOH has developed an exciting, affordable and deliverable solution to replace its old buildings at Stanmore, which will ensure that future generations of NHS patients continue to get access to excellence for the treatment of complex musculoskeletal conditions. We are firmly committed to establishing a new hospital building at Stanmore and continue our discussions with NHS London about our plans and the sources of finance required to deliver the scheme.
Activity levels continued to grow. For example, a total of 9,993 NHS inpatient discharges in the year represented an 8.5% increase on the previous year (9,215 NHS inpatient discharges). This helped in making significant progress on delivering the 18 week access target. In March 2009, with a breach-sharing adjustment applied to the performance target, 88% of non-admitted patients compared to a target of 95% and 87% of admitted patients compared to a target of 90% were treated within 18 weeks. The Trust met the data completeness targets set by the Department of Health designed to support the measurement of performance against these indicators. It remains disappointing to not meet the performance targets and the Trust over the next 12 months is attempting to address its significant capacity constraints by investing in an additional theatre, clinical and support staff as well as access to independent sector providers for the provision of some non-complicated procedures that can be undertaken by our consultants on their premises.
3.2 Our Operating Resources
I. Our Staff
As at 31 March 2009, the Trust employed 1036 staff, 19 more than the previous year. This figure may be broken down in chart 1 as follows:
Staff Sickness Absence
The Trust’s sickness level for 2008/09 averaged 4% for the year. The Trust monitors very closely the extent of sickness absence across all groups of staff and the HR Department advises and collaborates with managers to reduce long term sickness.
II. Our Estate
A key priority for the Trust is the development of facilities which will enable us to continue to provide a high standard of specialist care for our patients as well as enhance the environment and provide an opportunity to increase our capacity. Work continues on developing the hospital on both sites – in Central London and Stanmore.