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Public laser CoK booking form

Url: /Media/UHS-website-2019/Docs/Medical-physics/Public-laser-CoK-booking-form.docx

Latest instalment of award winning comic book series aimed at supporting young people with type 1 diabetes

Description: The latest instalment in a series of comics aimed at supporting young people living with diabetes and raising awareness around th
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Good health care for all

Description: Good health care for all What can I expect from the NHS? Alison Giraud-Saunders February 2012 1 Who helped with
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Annual-report-24-25-final

Description: 2024/25 Incorporating the quality account University Hospital Southampton NHS Foundation Trust Annual Report and Accounts 2024/25 Presented to Parliament pursuant to Schedule 7, paragraph 25(4)(a) of the National Health Service Act 2006 © 2025 University Hospital Southampton NHS Foundation Trust Contents Welcome from our Chair and Chief Executive 7 Performance report 9 Introduction from the Chief Executive 10 Overview 11 Principal risks to our strategy and objectives 16 Performance overview 17 Performance analysis 22 Quality priorities 29 Financial performance 33 Sustainability 33 Social, community, anti-bribery and human rights issues 34 Events since the end of the financial year 35 Overseas operations 35 Equality in service delivery 35 Going concern 41 Accountability report 42 Directors’ report 43 Remuneration report 69 Staff report 82 Counter fraud 98 Code of governance for NHS provider trusts 98 NHS System Oversight Framework 99 Statement of the chief executive officer’s responsibilities as the accounting officer of UHS 100 Annual Governance Statement 102 Scope of responsibility 102 The purpose of the system of internal control 102 Risk management and control within the Trust 102 Review of economy, efficiency and effectiveness of the use of resources 116 Quality account 119 Part 1: Statement on quality from the Chief Executive 120 Part 2: Priorities for improvement and statements of assurance from the Board 122 Part 3: Other information 194 5 Annual accounts 241 Statement from the Chief Financial Officer 242 Auditor’s report including certificate 244 Foreword to the accounts 251 Statement of Comprehensive Income 252 Statement of Financial Position 253 Statement of Changes in Taxpayers’ Equity 254 Statement of Cash Flows 256 Notes to the accounts 257 6 Welcome from the Chair and Chief Executive Officer University Hospital Southampton NHS Foundation Trust (‘UHS’ or the ‘Trust’) has experienced another challenging year, with increased demand for the Trust’s services, a more restrictive financial environment, and changes in terms of the organisation of the NHS in England. Despite the challenges faced by the Trust during 2024/25, we can feel incredibly proud of the achievements of our 13,000 staff, who went above and beyond to deliver for our patients and the communities we serve. Particular highlights include: • In the top 15 in the country against government targets for elective recovery performance with 127% of activity compared with 2019/20. • Top-quartile performance against most performance metrics compared to similar sized teaching hospitals, including long-waiting patients on referral to treatment pathways, diagnostics and cancer performance. • Delivery of £85.3m of savings through our cost improvement programme – the highest ever amount by the Trust. We continue to be one of the best performing trusts in England in many areas. The Trust’s elective recovery performance places it as one of the best performing trusts in England. As a result, we have seen the number of long-waiting patients fall to one patient waiting over 78 weeks and to 21 patients waiting over 65 weeks – in many instances these delays were due to a national lack of corneal transplant tissue. This is despite an increase in the number of patients being referred to the Trust for treatment. Our performance against key cancer metrics has seen an improvement in commencing treatment of cancer within 62 days to 81% by March 2025, against the NHS England average for 2024/25 of 70.5%. Similarly, the Trust performed in the range of 88%-96% during the year against the target of patients commencing treatment within 31 days of diagnosis. There has been significant demand for non-elective care throughout the year, which has placed significant demands on the Trust’s emergency department. There were frequently more than 400 attendances per day and the Trust saw an average of 13,100 patients per month (2023/24: 12,700). As a result of this increased demand, coupled with issues with flow through the hospital and a high incidence of seasonal illnesses during the winter, UHS’s performance against the four-hour emergency department target has steadily declined over the course of 2024/25. The Trust also recorded a lower than expected death rate via the Summary Hospital-level Mortality Indicator (SHMI) and was one of 12 trusts in England out of 119 with lower than expected death outcomes. The Trust reported a deficit of £7m at year-end, which represents a significant achievement given the financial pressures we have experienced, such as significant demand for services above block contract levels, pay award pressures, and inflation. The Trust also saw its productivity improve during the year and delivered its highest ever performance under its cost improvement programme. 7 Despite the introduction of strict controls in early 2024, the Trust exceeded its target for workforce numbers during 2024/25 by 373 whole-time-equivalents. However, a significant proportion of this number was due to assumed reductions in the number of staff required to manage patients with no clinical criteria to reside in the hospital and patients with a primary mental health need not materialising. Instead, the number of both categories of patient continued to rise during the year, placing additional strain on the Trust’s capacity and reducing flow through the hospital as patients are unable to move in a timely way from the emergency department, to wards and then to discharge due to lack of capacity. Higher levels of staff absence during the winter months coupled with high levels of seasonal illness and consequent demand on the emergency department also necessitated the opening and staffing of surge capacity. Indeed, demand on the emergency department was so great during the year that surge capacity was required even outside of the typically busier winter period. Our people remain our greatest asset. Without our staff, the Trust would not be able to deliver for the communities we serve. We were pleased to see the results from the 2024 Staff Survey, which placed UHS above the benchmarking group across all the key people themes. In particular, there have been improvements in relation to satisfaction with immediate managers, flexible working opportunities, and staff recommending UHS as a place to work. UHS has also continued with its staff room refurbishment programme and made significant improvements to the prayer facilities for Muslim staff, patients, students and community members in our chapel, all funded by Southampton Hospitals Charity. We expect 2025/26 to be even more challenging than 2024/25. The Trust has already had to take some difficult decisions in terms of its workforce numbers, prioritisation for capital expenditure, and services. We will be expected to continue to maintain quality of patient care and experience and to deliver the required levels of performance whilst at the same time having to make significant reductions in its expenditure to deliver a balanced budget. Many of the challenges faced by the Trust – in common with other providers – can only be addressed by working in partnership with wider local partners, such as other healthcare providers, local authorities and charities to deliver system-wide solutions. At the same time, we recognise that there is more that we can do internally to ensure that our internal processes deliver in the most effective and efficient manner. We would like to express our heartfelt thanks to our amazing staff, who have gone and continue to go above and beyond to put our patients first and deliver world class care. Jenni Douglas-Todd Chair David French Chief Executive Officer 8 PERFORMANCE REPORT OVERVIEW AND PERFORMANCE Performance report Introduction from the Chief Executive Officer This was another challenging year for the Trust, continuing the trend seen in previous years of increasing demand which must be balanced with the need to deliver quality patient care whilst maintaining a sustainable financial position. The Trust saw even higher demand for non-elective care than in recent years with attendances at the emergency department being as high as 400 per day and the Trust having to open and staff surge capacity for a significant proportion of the year, including outside of the typically more strained winter period. The trend of increasing numbers of patients having no clinical criteria to reside in hospital, but unable to be discharged due to a lack of funded care in a more appropriate venue, continued, as did the increasing number of patients presenting with a primary mental health need. This placed significant pressure on the Trust’s resources due to the impact on flow through the hospital and the need to engage additional members of staff to manage these patients – in some instances this requires as many as four members of staff, usually via a specialist agency, for each patient as well as, potentially, additional security resource. Despite the challenges, the Trust continued to perform well when compared to other comparable organisations, achieving some of the best elective recovery performance in England at 127% compared to 2019/20 levels. The Trust implemented spending and recruitment controls in early 2024, which it continued to operate under during 2024/25, in order to manage its difficult financial position. However, the Trust ended the year above its plan in terms of workforce numbers, although a significant proportion of this amount was due to the increasing number of patients having no criteria to reside and mental health patients. The Trust achieved its highest ever delivery on its cost improvement programme with £85.3m of savings, and achieved an overall end of year deficit of £7m. 10 OVERVIEW AND PERFORMANCE Overview About the Trust Our services University Hospital Southampton NHS Foundation Trust is one of the largest acute teaching trusts in England with a turnover of £1.5 billion in 2024/25. It is based on the coast in southeast England and provides services to people living in Southampton and south Hampshire and specialist services, including neurosciences, respiratory medicine, cancer care, cardiovascular, obstetrics and specialist children’s services, to nearly four million people in central southern England and the Channel Islands. The Trust is also a designated major trauma centre, one of only two places in the south of England to offer adults and children full major trauma care provision. As a leading centre for teaching and research, the Trust has close working relationships with the University of Southampton, the Medical Research Council, National Institute for Health and Care Research (NIHR), Wellcome Trust and Cancer Research UK. The Trust is consistently one of the UK’s highest recruiting trusts of patients to clinical trials and one of the top nationally for research study volumes as ranked by the NIHR Clinical Research Network. Every year the Trust: treats around 166,000 inpatients and day patients, including about 75,000 emergency admissions sees over 770,000 people at outpatient appointments deals with around 155,000 cases in its emergency department The Trust provides most of its services from the following locations: • Southampton General Hospital – the Trust’s largest location, where a great number of specialist services are based alongside emergency and critical care, and which includes Southampton Children’s Hospital. • Princess Anne Hospital – located across the road from Southampton General Hospital and providing maternity care and specialist care for women with medical problems during pregnancy and babies who need extra care around birth. • Royal South Hants Hospital – although the Trust does not operate this site near the centre of Southampton, it provides a smaller number of services from this location. • New Forest Birth Centre – located at Ashurst on the edge of the New Forest and run by experienced midwives and support staff, it acts as a community midwifery hub. • Lymington New Forest Hospital – a community hospital located in Lymington managed by Hampshire and Isle of Wight Healthcare NHS Foundation Trust. UHS manages surgical services at the hospital. The services provided by the Trust are commissioned and paid for by the Hampshire and Isle of Wight Integrated Care System (ICS) and, in the case of more specialised services (such as treatments for rare conditions), by NHS England. 11 OVERVIEW AND PERFORMANCE Trust services are supported by clinical income, of which 53% is paid for by NHS England and 44% by integrated care boards, predominantly the Hampshire and Isle of Wight Integrated Care Board (ICB). These are provided under a standard NHS contract, which incorporates ongoing monitoring of the Trust and the quality of the services provided. Our structure UHS gained foundation trust status on 1 October 2011. A foundation trust is a public benefit corporation providing NHS services in line with the core NHS principles: that care should be universal, comprehensive and free at the point of need. The Trust is licensed as a foundation trust to provide these services by NHS England and the healthcare services we provide are regulated by the Care Quality Commission. Since 1 July 2022, the Trust has been part of the Hampshire and Isle of Wight Integrated Care System when this was established through the Health and Social Care Act 2022. Each ICS has two statutory elements: an integrated care partnership (ICP) and an integrated care board. The ICP is a statutory committee jointly formed between the NHS integrated care board and all upper-tier local authorities that fall within the ICS area. The ICP brings together a broad alliance of partners concerned with improving the care, health, and wellbeing of the population, with membership determined locally. The ICP is responsible for producing an integrated care strategy on how to meet the health and wellbeing needs of the population in the ICS area. The ICB is a statutory NHS organisation responsible for developing a plan for meeting the health needs of the population, managing the NHS budget and arranging for the provision of health services in the ICS area. The Trust has been a university teaching hospital since 1971. The diagram below provides an overview of the overall organisational structure of the Trust. Public and foundation trust members Council of Governors Board of Directors Executive Directors Division A Surgery Critical Care Ophthalmology Theatres and Anaesthetics Division B Cancer Care Emergency Medicine Helicopter Emergency Medical Services Medicine and Medicine for Older People Pathology Specialist Medicine Division C Women and Newborn Maternity Child Health Clinical Support 12 Division D Cardiovascular and Thoracic Neurosciences Trauma and Orthopaedics Radiology Trust headquarters division OVERVIEW AND PERFORMANCE Our values The Trust’s values describe how things are done at UHS and act as a guide to all staff working with colleagues to deliver high quality patient care and a great patient experience every day. These values are: Patients, their families and carers are at the heart of what we do. Their experience of our services will be our measure of success. Partnership between clinicians, patients and carers is critical to achieving our vision, both within hospital teams and extending across organisational boundaries in the NHS, social care and the third sector. We will ensure we are always improving services for patients through research, education, clinical effectiveness and quality improvement. We will continue to incorporate new ideas, technologies and create greater efficiencies in the services we provide. 13 OVERVIEW AND PERFORMANCE Our strategy 2021-25 The Trust’s strategy was updated during 2020/21 to take account of everything its staff had experienced during the COVID-19 pandemic and what had been learnt from this. The vision for UHS is to become an organisation of world class people delivering world class care. The Trust’s strategy is organised around five themes and for each of these it describes a number of ambitions UHS aims to achieve by 2025. Theme Ambitions Outstanding patient outcomes, • experience and safety By 2025 we will strengthen our national reputation for outstanding • patient outcomes, experience and safety, providing high quality care • and treatment across an extensive range of services from foetal medicine, through all life stages and conditions, to end-of-life care. Pioneering research and • innovation We will continue to be a leading • teaching hospital with a growing, reputable and innovative research • and development portfolio that attracts the best staff and efficiently delivers the best possible treatments and care for our patients. World class people • Supporting and nurturing our people through a culture that values • diversity and builds knowledge and skills to ensure everyone reaches their full potential. We must provide • rewarding career paths within empowered, compassionate, and motivated teams. Integrated networks and • collaboration We will deliver our services with • partners through clinical networks, collaboration and integration across geographical and organisational • boundaries. • We will monitor clinical outcomes, safety and experience of our patients regularly to ensure they are amongst the best in the UK and the world. We will reduce harm, learning from all incidents through our proactive patient safety culture. We will ensure all patients and relatives have a positive experience of our care, as a result of the environment created by our people and our facilities. We will recruit and enable people to deliver pioneering research in Southampton. We will optimise access to clinical research studies for our patients. We will enable innovation in everything we do, and ensure that ‘cutting edge’ investigations and treatments are delivered in Southampton. We will recruit and develop enough people with the right knowledge and skills to meet the needs of our patients. We will provide satisfying and fulfilling roles, growing our talent through development and opportunity for progression. We will empower our people, embracing diversity and embedding compassion, inclusion and equity of opportunity. We will work in partnership with key stakeholders across the Hampshire and Isle of Wight integrated Care System. We will strengthen our acute clinical networks across the region, centralising when necessary and supporting local care when appropriate. We will foster local integration with primary and community care as well as mental health and social care services for seamless delivery across boundaries. We will build on our successful partnership with University of Southampton (UoS), growing our reputation as a national leading university teaching hospital. 14 OVERVIEW AND PERFORMANCE Foundations for the future • We will deliver best value to the taxpayer as a financially Making our enabling infrastructure efficient and sustainable organisation. (finance, digital, estate) fit for • We will support patient self-management and seamless the future to support a leading care across organisational boundaries through our university teaching hospital in the ambitious digital programme, including real time data 21st century and recognising our reporting, to inform our care. responsibility as a major employer • We will expand and improve our estate, increasing in the community of Southampton capacity where needed and providing modern facilities and our role in broader for our patients and our people. environmental sustainability. • We will strengthen our role in the community as an employer of choice, a partner in delivery of services to our population and by leading the Greener NHS agenda locally. During each year of the strategy the Trust sets out a more detailed series of objectives to achieve and progress towards the delivery of its ambitions. In 2024/25 these objectives included: Outstanding patient Establishing an integrated approach to quality management. outcomes, experience Treating patients according to need but aiming to meet the target of zero and safety 65-week waiters by the end of September 2024, and continued reduction of longer waiters. Reducing length of stay across elective and non-elective pathways. Improving patient experience and outcomes through continued implementation of the Fundamentals of Care programme. Pioneering research and innovation Delivering year four of the research and innovation investment plan. Delivering year two of the five-year research and development strategy implementation plan for research for impact. World class people Delivering a workforce plan for the Trust for 2024/25 which is safe, sustainable and affordable. Delivering targeted improvements in staff experience, engagement and culture. Sustaining turnover at less than 13% and maintaining sickness absence at under 4%. Integrated networks In partnership with acute trusts working directly with priority areas to and collaboration progress joint network strategies. Working with the local delivery system on vertical integration to reduce the number of patients without criteria to reside. Foundations for the future Delivering a stretching financial plan for 2024/25, including identifying what needs to be true to recover a sustainable financial position and exit the Recovery Support Programme. Engaging the organisation in the challenge to manage demand so that capacity and demand are in equilibrium. Delivering the aims of the 2024/25 transformation programmes and always improving strategic priorities. Delivering the prioritised 2024/25 capital programme and setting a prioritised capital programme for 2025/26. Completing year two of the Public Sector Decarbonisation Scheme. 15 OVERVIEW AND PERFORMANCE Performance against these objectives was monitored and reported to the Trust’s Board on a quarterly basis. At the end of 2024/25, the Trust had met the objectives set as follows: Corporate Ambition Number of Green Amber Red objectives Outstanding patient outcomes, 4 3 1 0 safety and experience Pioneering research and innovation 2 2 0 0 World class people 3 2 0 0 Integrated networks and collaboration 2 0 2 0 Foundations for the future 5 2 2 1 Totals 16 8 6 2 Note: Green: achieved in full Amber: partially achieved Red: not achieved Particular areas to highlight where the Trust has achieved strong delivery during the year include: • Reduction in the number of patients waiting over 65 weeks, with only 21 waiting over 65 weeks. • Reduction in the length of stay by 5.25% through successful delivery of the inpatient flow transformation programme. • Implementation of the Fundamentals of Care programme. • Successful delivery of year four of the research and innovation investment plan. • Reducing staff turnover to 10.1% at year end and achieving a staff absence rate below 4%. • Progress in developing the identified priority clinical networks. • Successful delivery of the Trust’s 2024/25 capital programme. Principal risks to our strategy and objectives The Board has identified and manages the principal risks to the delivery of its strategy and objectives through its board assurance framework. The principal risks to the delivery of its strategy and objectives identified by the Trust during 2024/25 were that: • There would be a lack of capacity to appropriately respond to emergency demand, manage the increasing waiting lists for elective demand, and provide timely diagnostics, that results in avoidable harm to patients. • Due to the current challenges, the Trust fails to provide patients and their families or carers with a high-quality experience of care and positive patient outcomes. • The Trust would not effectively plan for and implement infection prevention and control measures that reduce the number of hospital-acquired infections and limit the number of nosocomial outbreaks of infection. • The Trust does not take full advantage of its position as a leading university teaching hospital with a growing, reputable and innovative research and development portfolio, attracting the best 16 OVERVIEW AND PERFORMANCE staff and efficiently delivering the best possible treatments and care for its patients. • The Trust is unable to meet current and planned service requirements due to unavailability of staff to fulfil key roles. • The Trust fails to develop a diverse, compassionate and inclusive workforce, providing a more positive experience for all staff. • The Trust fails to create a sustainable and innovative education and development response to meet the current and future workforce needs identified in the Trust’s longer-term workforce plan. • The Trust does not implement effective models to deliver integrated and networked care, resulting in sub-optimal patient experience and outcomes, increased numbers of admissions and increases in patients’ length of stay. • The Trust is unable to deliver a financial breakeven position, resulting in: inability to move out of the NHS England Recovery Support Programme; NHS England imposing additional controls/ undertakings; and a reducing cash balance, impacting the Trust’s ability to invest in line with its capital plan, estates and digital strategies and in transformation initiatives. • The Trust does not adequately maintain, improve and develop its estate to deliver its clinical services and increase capacity. • The Trust fails to introduce and implement new technology and expand the use of existing technology to transform its delivery of care through the funding and delivery of the digital strategy. • The Trust fails to prioritise green initiatives to deliver a trajectory that will reduce its direct and indirect carbon footprint by 80% by 2028-2032 (compared with a 1990 baseline) and reach net zero direct carbon emissions by 2040 and net zero indirect carbon emissions by 2045. As in previous years, demand for services continued to increase, especially for emergency (nonelective) care. The winter months in particular saw both high levels of demand and above average levels of staff absence due to seasonal illnesses. The Trust consistently experienced high numbers of patients having no clinical criteria to reside in hospital, but who could not be discharged due to a lack of appropriate care packages. This results in a lack of flow through the hospital and also requires additional staff to be engaged due to the need to open surge capacity. In addition, the Trust continued to experience significant challenges from patients with a primary mental health care need for whom there were insufficient spaces available in a more suitable alternative setting. Performance overview The Trust monitors a broad range of key performance indicators within its departments, divisions, directorates and through Trust executive committees. On a monthly basis, the Board and executive committee receives a performance report containing a variety of indicators intended to provide assurance in respect of the Trust’s strategy and that the care provided is safe, caring, effective, responsive, and well-led. This report also includes the Trust’s performance against the national targets set by NHS England. The performance reports include a ‘spotlight’ section, which provides more detailed analysis of a particular area. Typically, this is one of either the national targets or the Trust’s performance against the expectations set out in the NHS Constitution. 17 OVERVIEW AND PERFORMANCE The monthly performance report is also published on the Trust’s website. The Chief Executive Officer provides a regular report on performance to the Council of Governors, which includes a range of non-financial and financial performance information. Capacity The Trust experienced high demand for its services, continuing the trend from previous years. Demand in the emergency department in particular was significant, with attendances growing by 3.2% compared to 2023/24. This situation has resulted in a gradual decline in the Trust’s performance against the target of 95% patients spending less than four hours in the main emergency department. The number of patients having no clinical criteria to reside continued to impact flow within the hospital. The number of patients having no clinical criteria to reside was frequently above 250 at any one time during the year. The Trust experienced an increase in the number of referrals with the number of patients on a waiting list under the 18-week referral to treatment pathway rising from approximately 59,000 to 62,000 by the end of the year. Quality and compliance The Trust’s elective recovery performance was one of the best in England at 127% compared to 2019/20. The Trust continued to monitor the quality of care delivered throughout 2024/25 through a number of established quality assurance programmes. Clinical leaders monitored key quality, safety and patient experience indicators such as falls, pressure ulcers and venous thromboembolisms. The roll out of the Trust’s Fundamentals of Care initiative continued. High-quality peer reviews were consistently conducted, with a key focus on weekly matron-led quality walkabouts – both during and outside of standard hours – centred around the five CQC domains: safe, effective, responsive, caring, and well-led. Additionally, focused matron walkabouts were introduced to address specific themes related to patient safety and Fundamentals of Care standards, such as medication safety and infection prevention. These initiatives have been instrumental in identifying areas for improvement and promoting the sharing of best practices across teams. The Trust’s clinical accreditation scheme (CAS) builds on this intelligence, with clinical areas completing self-assessments of performance and review teams completing on-site visits. The clinical areas were supported by the CAS team from an initial contact meeting and walkabout through to outcome panel. Patient representatives were included in these review teams. CAS paperwork was reviewed to reflect the learning points from themed Matron’s walkabouts, aligning it to the CQC single assessment framework and the UHS Fundamentals of Care programme to ensure a robust ward accreditation. Learning was shared at the clinical leaders’ group and via reports. 18 OVERVIEW AND PERFORMANCE A framework was developed to govern Mortality and Morbidity meetings at the Trust, setting expectations for the content and format of these meetings. In addition, further work was carried out to ensure that the output from these meetings was shared more widely and that there is a clear escalation process. The Trust opened a patient and family support hub, repurposing the Macmillan Centre into a generic non-disease specific facility. The Trust worked with system partners to develop a unified and standardised approach to volunteer recruitment using a passporting system. The Trust commenced its implementation of the National Safety Standards for Invasive Procedures 2 (NatSSIPs 2). Violence, abuse and aggression against staff continued to rise. The Trust took action over the course of the year to support its teams, including through roll out of de-escalation training. This has had a positive impact and has reduced the requirement for physical restraint and has reduced the number of incidences of physical violence against staff. However, the level of violence and aggression directed at staff by patients and other members of the public continues to be an area of concern for the Trust. The Trust continued to build its always improving culture and drive on quality improvement by training over 1,000 staff, remaining 3% above the NHS average for all improvement focussed staff survey questions and winning an award for patient involvement in improvement and safety. This enabled improvements across theatre, inpatient flow and outpatient programmes. In 2024/25, average length of stay was reduced by 5.25%, an additional 1,230 patients were treated in theatres, and 7% of patients were placed onto patient initiated follow up (PIFU) outpatient pathways. Partnerships Further information can be found in the quality account. The Trust works within the Hampshire and Isle of Wight Integrated Care System and is an active member of a number of partner groups including the Acute Provider Collaborative Board and the Health and Wellbeing Board. The Trust develops and agrees its annual financial plans with the Integrated Care Board. The Trust is a member of a number of specific partnership groups for particular services, including the Central and South Genomics Medicine Service, the Children’s Hospital Alliance and the Southern Counties Pathology Network. The Trust works actively as a partner with other provider organisations around clinical networks, particularly with acute Trusts within the Integrated Care System and others closely located geographically. The Trust also links closely with the University of Southampton on a number of topics including research, commercial development and education and has a developed meeting structure to oversee this. 19 OVERVIEW AND PERFORMANCE Workforce The Trust’s key area of focus during 2024/25 was to maintain a flat workforce level in order to meet the Trust’s 2024/25 workforce plan. In addition, the Trust sought to reduce reliance on bank and agency staff. The Trust ended the year above its workforce plan by 373 whole-timeequivalents. A significant proportion of the expected reduction in staff numbers had been linked to expected delivery of reductions in the number of patients having no criteria to reside and mental health patients through system-wide transformation programmes. However, these reductions did not materialise. In addition, due to the significant demand on the Trust’s services, it was necessary to open and staff surge capacity. This was exacerbated by high levels of staff absence due to illness during the winter months. The Trust was successful in reducing staff turnover to 10.1%, achieving the local target of 75% of staff in each area has received training, including neonatal medical team. • Trolley dashes. • Train the trainer. Progress metrics Audit of compliance: • Has it been undertaken for the appropriate babies? • Was the frequency of observation undertaken correctly? • Was the score accurately calculated? • Did escalation take place if required? • Was the response to escalation appropriate? 157 QUALITY ACCOUNT Quality Improvement Priority Four: Implementation of the National Safety Standards for Invasive Procedures (NatSSIPs) 2 at UHS Core dimension Patient safety Rationale of selection The new National Safety Standards for Invasive Procedures (NatSSIPs 2) represent the progression of the original NatSSIPs. The key aim to standardise, harmonise and educate (SHE) across organisations and procedural teams remains central to the NatSSIPs purpose. Critical changes include bolstered organisational standards and proportionate checks that recognise different levels of risk during major and minor invasive procedures, and the adaptions to processes that may be necessary in lifethreatening situations. This standardisation, harmonisation and education goals are set out in the table below. Standardise Harmonise Educate Organisational Sequential (‘The NatSSIPs Eight’) Safety behaviours, processs, policies, insight, involvement and performance measures across organisations and specialities. Expected behaviour, safety standards, checklists and format across invasive specialities. Across groups of hospitals. Across IT systems. Reduce variation across specialities. Commit to safety education, human factors expertise and systems thinking. Create a safety infrastructure, leadership understanding and training in cultural change. Teach and train in team behaviours, human factors, systems thinking learning / co-production with patients. Investigations into the increase of never events in 2023 and 2024 has identified that the majority of these had contributing factors related to stop points for safety. The key learning identified: Thematic analysis of never events Surgical mark not visible/clear Not listening to patient concerns Change in surgical plan and lack of documentaion Lack of time out if concerns are raised Lack of triangulated checks Ability to speak up concerns Swab, sharp and instrument count process Implant checks not triangulating patent details Inexperienced staff with lack of familiarity of processs Lack of induction training in stop points Distractions during stop point checks 158 QUALITY ACCOUNT All these factors will be addressed through NatSSIPs2 implementation. Safer invasive procedures is to be included as a local quality indicator by the ICB within the 2025/26 national contract. Key aims • Establish a NatSSIPs oversight committee. • Set up an invasive procedures committee. • Establish the following workstreams: o Audit of stops point for safety in theatres and for minor procedures in outpatient and ward areas o Multi-disciplinary safety walkabouts o VLE and induction workstream • Education: recruitment of medical education led to set up simulation-based MDT training. • Patient involvement. • NatSSIPs eight and communications. • Stop points for safety staff resources. Progress metrics • Increase in the completion of VLE stop points training. • Develop and implement a programme to deliver non-technical skills to the MDT. • All areas with a never event in the last two years have an up to date audit and action plan for compliance with NatSSIPs2. 159 QUALITY ACCOUNT Quality Improvement Priority Five: Fundamentals of Care Core dimension Patient safety Rationale of selection The term Fundamentals of Care (FoC) describes the eight standards that staff across the Trust have committed to in collaboration with the patient, to support the physical and emotional needs of patients’, relatives, and carers. This is not a new concept, it underpins the core values of what it means to be a healthcare professional, to truly ‘care’ and will build upon our achievements in year one. Operational challenges have led the workforce to become more task-focused and less personfocused, taking away from that personalised care experience but we are committed to changing that culture, following our Trust value, patients first. The FoC exemplifies how the interdisciplinary team connects and builds relationships with our patients, getting to know them and what matters to them as a person, not just as a patient, supporting and encouraging independence and rehabilitation from the beginning of their hospital stay. These activities are the essentials of our daily living such as personal hygiene, skin care, oral hygiene, toileting, eating and drinking, and mobilising. Communication is also essential and includes both listening and hearing patients, understanding what is important to them using communication tools they need, coming to shared decisions with patients about their care and recognising the diversity of our population, embracing accessibility for those with people with learning disabilities, sight/hearing loss or other disabilities, or if English may not be their primary language. In addition, the FoC encourages us as healthcare professionals to consider the whole person, support cultural, spiritual, mental health, emotional wellbeing and dignity needs of people we care for and those that matter to them. We know here at UHS that not everyone experiences this level of care, but we acknowledge the need to change the rhetoric from ‘we are busy’ to ‘we are never too busy to care’ empowering and educating our staff at all levels to challenge the ‘we have not got time’ rhetoric and ensure fundamental care is at the heart of what we do at UHS. Thus improving, patient care and experience. Key aims We will grow the multi-disciplinary engagement and involvement in workstreams that embrace the FoC and encourage person centred to care. We will continue to pursue the digitalisation of the Friends and Family Test (FFT), using this data and the national inpatient and urgent and emergency care survey as a baseline, while linking with involved patients where required with to encourage feedback on the FoC. We will listen to the voice of our patients, their relatives, and carers to make sure their stories and experiences are heard by our workforce to encourage the organisation wide change. We will ensure the FoC will has clear and measurable improvement metrics as part of a live clinical quality dashboard that will afford ward managers and senior leaders, the opportunity to monitor, review and report on to FoC in their areas. 160 QUALITY ACCOUNT We will embed the FoC into the matron walkabout and CAS processes, supported by consistent evaluation metrics that ask the patients about their experiences and encourage clinical areas to continually assess and evaluate the FoC in their areas through a self-assessment tool. We will enhance the availability of existing resources on our virtual learning environment (VLE) in collaboration with our patient partners for all staff groups and embed the FoC into training across the organisation, to improve the knowledge, skills and awareness ensuring the delivery of quality care. We will continue to test and evaluate the What Matters To Me project, growing our volunteer role to support staff in finding out what is important to the patient and using their personalised board to remind staff of the ‘person’ they are caring for. We will continue to establish project links in child health, maternity and outpatients to ensure a bespoke, but collaborative roll out of FoC, considering how these different care environments may impact care. Progress metrics • Patient hygiene: we will see an improvement in the number of patients who report having their personal care needs met, particularly within their first 24 hours coming through emergency admission routes. • Skin integrity: we will support the reduction in incidences of avoidable pressure ulcers across the organisation. • Communication: we see an increase in the number of people accessing our interpreting services and a reduction in complaints related to interpretation. • Pain: we will see an improvement in patients reporting that their pain was well controlled when coming through the emergency department. • Mouthcare: we will see a positive uptake in the implementation of the new mouthcare assessment tool and an improvement in patients reporting that their oral hygiene needs have been met. • Nutrition and hydration: we will see an increase in patients reporting they are being offered adequate food and drink provisions throughout their hospital stay, including access to equipment for those with conditions or disabilities that impact their ability to do so independently. • Bowel and bladder care: we will see improved assessment of bowel and bladder habits through increased documentation using the Inpatient Noting system. • Enhancing safe movement: we will support a reduction in the incidence of high harm falls and high harm falls that have preventable causes. • Infection prevention: we will see a reduction in nosocomial infections through increased hand hygiene standards and more effective cleaning of equipment. 161 QUALITY ACCOUNT Quality Improvement Priority Six: Develop the Trusts’ approach to reducing the impact of health inequalities (HIs) (year two) Core dimension Clinical effectiveness Rationale of selection Tackling health inequalities is a key priority for the NHS. At UHS we have been working to have an impact on health inequalities for several years. In 2024/25 we formalised these efforts with a governing board, chaired by our chief medical officer and with a clear programme of improvement based on recognised priorities. This formed the basis of our quality priority in 2024/25. This year’s quality priority is a continuation of the work that started in 2024/25. We intend to continue to grow our understanding and actions as an organisation, improving the equity of access, outcomes and experience of our services across our community. Key aims We are continuing our health inequalities board, with focus on five priorities: enabling our organisation, data and measurement, clinical service priorities, communication and engagement and strategy and approach. Each of these priorities have aligned directors to oversee improvement and a detailed delivery plan. Key priorities and expected outcomes from each of these are listed below: Enabling the organisation • Developing supporting structures: set up governance so that teams who identify health inequality related issues know where they can go for help, so that we can understand frequently arising challenges and notice when a problem raised might be affecting other of the hospital too. This will aid improvement, learning from issues identified and escalation of issues that cannot be resolved locally • Capability building: develop training for our staff to understand health inequalities, identify them within services and access tools to make improvement. • Delivery of the health inequalities officer role: grow knowledge of the health inequalities officer role across the organisation and utilise this role to share knowledge, training and support improvements. Data and measurement • Continue to develop our understanding of inequalities in access across outpatients and diagnostics, inpatients, theatres and the emergency department. • Enable the measurement of improvement in areas recognised as clinical priorities. • Enable completion of national reporting. Clinical priorities • Improve services and support for patients and staff with obesity (children and adults). • Improve identification and control of hypertension. • Improve services and support for patients and staff who smoke. 162 QUALITY ACCOUNT Communication and engagement • Adopt health inequalities into leadership and decision making. • Learning from our communities and our staff. • Communicating improvements internally and externally. • Staff support campaign. Strategy and approach • Overseeing and agreeing UHS approach and strategy for HIs. • Overseeing annual delivery against priorities. • Aligning programme resource. • Maintaining collaborative working with public health and Integrated care board teams and other local healthcare providers. • Keeping up to date with national recommendations and expectations, sharing this knowledge with our organisation. • Overseeing trust-wide improvement and health inequalities maturity. Progress metrics • Increasing numbers of staff trained. • Numbers of health inequalities issues reported (expected to increase through understanding before reducing due to improvement work). • Case studies shared of successful improvement projects. • Increased involvement and collaboration with patients and public on improvement. • Increased use of QEIA templates in decision making. • Demonstration of improved access to care for obesity, tobacco dependency and hypertension. 163 QUALITY ACCOUNT 2.3 Statements of assurance from the Board This section includes mandatory statements about the quality of services that we provide relating to the financial year 2024/25. This information is common to all quality accounts and can be used to compare our performance with that of other organisations. The statements are designed to provide assurance that the board of directors has reviewed and engaged in crosscutting initiatives which link strongly to quality improvement. 2.3.1 Review of services During 2024/25 UHS provided and/or sub-contracted 118 relevant health services (from total Trust activity by specialty cumulative 2024/25 contractual report). UHS has reviewed all the data available to them on the quality of care in all these relevant health services. The income generated by the relevant health services reviewed in 2024/25 represents 100% of the total income generated from the provision of relevant health services by UHS for 2024/25. 2.3.2 Participation in national clinical audits and confidential enquiries The UHS clinical audit programme was developed in support of the Trust’s vision by putting patients first, working together and always improving. This leads on to a specific strategy for clinical outcomes, to ensure robust and measurable processes are in place to plan locally and participate strategically. Healthcare Quality Improvement Partnership (HQIP) produces a National Clinical Audit & Enquiries Directory which identifies those national audits which are included in the NHS England Quality Account List 2024/25, those audits which are part of National Clinical Audit and Patient Outcomes Programme (NCAPOP). NCAPOP audits are commissioned and managed on behalf of NHS England by HQIP. These collect and analyse data supplied by local clinicians to provide a national picture of care standards for that specific condition. On a local level, NCAPOP audits provide local trusts with individual benchmarked reports on their compliance and performance, feeding back comparative findings to help participants identify necessary improvements for patients. The audits listed on the NCAPOP are ‘must-do’ national audits. The quality accounts national clinical audit list includes audits which we regard as ‘best practice’ to participate in (in addition to those from the NCAPOP) and for that reason we always include these in our corporate audit plans as a priority where they are relevant to our Trust. UHS has a strong history for completing clinical audits. The clinical effectiveness team has a robust approach to governing and supporting the completion. We’ve opened discussions with senior clinical leadership within Hampshire and Isle of Wight Integrated Care Board regarding the current challenges with contributing to and using the outputs of national audits. Benchmarked data resulting from national audits provides strong guidance on areas of excellence and improvement, however completion can be challenging in its compl
Url: /Media/UHS-website-2019/Docs/About-the-Trust/Annual-reports-and-quality-accounts/Annual-report-24-25-final.pdf

Radiology department contact details for patient referrals

Description: Radiology Department Revised Contact Details for Patient Referrals For advice and guidance contact radiology via the eRs advice and guidance pathway: Radiology- (advice and guidance)-Southampton-UHSFT-RHM. Department Email Phone Cardiothoracic Radiology booking team Children's Radiology uhs.cardiothoracicradiology@nhs.net uhs.childrensradiology@nhs.net 0238120 4833 0238120 4191 CT booking team uhs.ctbookingsteam@nhs.net 0238120 6881 MRI booking team uhs.mribookings@nhs.net 0238120 6588 Ultrasound & Main X-ray booking teams Nuclear Medicine booking team uhs.mainradiologybooking@nhs.net uhs.nuclearmedicinereferrals@nhs.net 0238120 4015 0238120 4321 PACS uhs.pacssupport@nhs.net 0238120 4390 IR booking team uhs.irbookingteam@nhs.net 0238120 6199 IR Secretaries PET suh-tr.nuclearmedicine@nhs.net Nuclear Medicine Brain Reporting HHFT uhs.nuclearmedicinebrainreporting@nhs.n et uhs.nm-referral-uhs@nhs.net
Url: /Media/UHS-website-2019/Docs/Services/Radiology/Radiology-department-contact-details-for-patient-referrals.pdf

Papers Trust Board - 27 July 2023

Description: Date Time Location Chair Agenda Trust Board – Open Session 27/07/2023 9:00 - 13:15 Conference Room, Heartbeat/Microsoft Teams
Url: /Media/UHS-website-2019/Docs/About-the-Trust/Trust-governance-and-corporate-docs/2023-Trust-documents/Papers-Trust-Board-27-July-2023.pdf

UHS AR 23-24 Final

Description: 2023/24 Incorporating the quality account University Hospital Southampton NHS Foundation Trust Annual Report and Accounts 2023/24 Presented to Parliament pursuant to Schedule 7, paragraph 25(4)(a) of the National Health Service Act 2006 © 2024 University Hospital Southampton NHS Foundation Trust Contents Welcome from our chair and chief executive 6 Overview and performance 8 Performance report 9 Overview 10 Accountability report 37 Directors’ report 38 Remuneration report 62 Staff report 75 Annual governance statement 95 Quality account 111 Statement on quality from the chief executive 112 Priorities for improvement and statements of assurance from the board 115 Other information 180 Annual accounts 207 Statement from the chief financial officer 208 Auditor’s report 210 Foreword to the accounts 217 Statement of Comprehensive Income 218 Statement of Financial Position 219 Statement of Changes in Taxpayers’ Equity 220 Statement of Cash Flows 221 Notes to the accounts 222 5 Welcome from the Chair and Chief Executive Officer This has been another busy and undoubtedly challenging year across the NHS and UK health and social care system, and much of what has impacted the national picture has been reflected in the operational focuses and patient and people priorities for University Hospital Southampton NHS Foundation Trust (‘UHS’ or the ‘Trust’) over the last year. Meeting and continuing to overcome the challenges we have faced has required an organisation-wide team effort, and looking back at the successes we feel incredibly proud of the achievements of our 13,000 staff. Particular highlights include: • In the top ten in the country (7th) against government targets for elective recovery performance with 118% of activity compared with 2019. • Top-quartile performance against most performance metrics compared to similar sized teaching hospitals, including Emergency Department access, long-waiting patients on Referral to Treatment pathways, Diagnostics and Cancer performance. • Significant investment in new capacity through building new wards and theatres and refurbishing existing areas of the hospital. • Delivery of our highest ever Cost Improvement Programme saving. These achievements place us among the best performing trusts in England in several areas and are even more remarkable against a backdrop of continued periods of industrial action and increasing demand for our services, with many people coming to us with higher levels of acuity than ever before. The Trust’s performance in terms of elective recovery places it as one of the best-performing trusts in England and demonstrates the impact of the Trust’s decision to invest in additional capacity in prior years by building new wards and theatres. The Trust’s Emergency Department performance in respect of its four-hour waiting target at the end of March 2024 has attracted additional capital funding as part of an incentive scheme. Some of this funding will be used to increase the department’s same-day emergency care capacity during 2024/25. From a financial perspective, balancing the complexities of today’s challenges alongside the need to protect and ensure the long-term stability and quality of our service provision, has required the Board to take a number of considered and crucial efficiency improvement actions this year. Whilst challenging, the Trust has seen significant progress in delivering on both its forecasted finance position for 2023/24 and productivity targets. Achieving long-term financial stability is key to us continuing to invest in much needed upgrades and improvements to the parts of our estate that are ageing, and to developing new state-of-the-art facilities and infrastructure that increases our capabilities and capacity into the future. In the last year parts of the hospital have been transformed, with the opening of new wards, theatres and a skybridge to link the estate. Construction of a sterile services and aseptics facility has begun at Adanac Park and the expansion of our neonatal department, where we treat and care for some of our most vulnerable babies and their families, is underway. The development of a new aseptic facility at Adanac Park will have capacity to serve other hospitals within the region and is a significant opportunity for improved system-wide working. 6 We have also worked with our people to design spaces where they can rest, relax and recharge - including a new wellbeing hub and rooftop garden on the Princess Anne Hospital site. In addition, 40 staff rooms across the site have been refurbished thanks to funding from Southampton Hospitals Charity. During the year, the Trust worked to establish the Southampton Hospitals Charity as a separate charitable company to improve its ability to both raise and spend funds. This process completed on 1 April 2024. Work was carried out to refurbish a children’s ward during the year in partnership with the charity. Our people are our greatest asset, and we are pleased to see improvements from the annual staff survey in several areas - such as how people can work more flexibly, access to learning and development and improved satisfaction in support from line managers. We recognise the pressures and demands that come with working in this environment and will continue to ensure everyone working here feels heard, encouraged and supported when raising concerns. At UHS, every opportunity is taken to recognise and celebrate the incredible things our people do here every day, including the return of our in-person annual awards ceremony, monthly staff recognition events and the first ever ‘We Are UHS Week’. These occasions are an important reminder that, even when faced with challenges, there is so much to be proud of and celebrate across the whole Trust. Working together, both within the Trust and across organisational boundaries, remains one of our core values. The partnership between UHS and the University of Southampton is as strong as it has ever been, with more than 250,000 individuals having now taken part in research studies in Southampton. As the lead partner member for Acute Hospital Services on the Hampshire and Isle of Wight Integrated Care Board, we are proactively working with other trusts and healthcare providers in the region to improve the health of the community we serve. In addition, the Trust has continued to work in partnership with other providers across the system to build a shared elective orthopaedic hub in Winchester. It is anticipated that the health and social care system will continue to be a challenging environment in 2024/25. We recognise that many of the big challenges we face can only be solved in partnership with wider local partners, and we are committed to actively playing our part in delivering system-wide solutions. Equally, we will continue to focus on improving whatever is within our internal control, and to work collaboratively with our people to ensure our patients’ experience, safety and outcomes remain central to our decision-making and the actions of everyone at UHS. Jenni Douglas-Todd Chair 19 July 2024 David French Chief Executive Officer 19 July 2024 7 PERFORMANCE REPORT Performance report Introduction from the Chief Executive Officer As with 2022/23, this was another challenging year with continued increasing demand for the Trust’s resources and the need to balance this with the need to deliver quality patient care and at the same time maintain a sustainable financial position. Demand for non-elective care continued to increase with an average of 375 attendances per day to our main Emergency Department. In addition, the number of patients on the 18-week Referral to Treatment pathway rose to 58,000. Patients having no clinical criteria to reside in hospital, but unable to be discharged due to the lack of funded care in a more suitable location, posed and continues to pose a significant challenge for the Trust. The number of patients within this category was as high as 270 at times and was consistently higher throughout the year when compared to 2022/23. Despite this the Trust continued to perform well when compared to other comparable organisations, achieving some of the best Emergency Department and elective recovery fund performance in England. The Trust’s financial position continued to be difficult, which required some difficult decisions in respect of spending controls and controls on recruitment. The Trust focused in particular on controlling spending on temporary and agency staff, but in view of the overall workforce numbers compared to the 2023/24 plan, further controls were implemented in respect of substantive recruitment. Due to the additional controls and the Trust’s best delivery to date on its Cost Improvement Programme (£63.4m), the Trust achieved an end of year deficit of £4.5m, compared to the deficit of £26m anticipated in its 2023/24 plan. 9 Overview About the Trust Our services University Hospital Southampton NHS Foundation Trust is one of the largest acute teaching trusts in England with a turnover of more than £1.3 billion in 2023/24. It is based on the coast in south east England and provides services to over 1.9 million people living in Southampton and south Hampshire and specialist services, including neurosciences, respiratory medicine, cancer care, cardiovascular, obstetrics and specialist children’s services, to nearly four million people in central southern England and the Channel Islands. The Trust is also a designated major trauma centre, one of only two places in the south of England to offer adults and children full major trauma care provision. As a leading centre for teaching and research, the Trust has close working relationships with the University of Southampton, the Medical Research Council, National Institute for Health and Care Research (NIHR), Wellcome Trust and Cancer Research UK. The Trust is consistently one of the UK’s highest recruiting trusts of patients to clinical trials and one of the top nationally for research study volumes as ranked by the NIHR Clinical Research Network. Every year the Trust: treats around 155,000 inpatients and day patients, including about 70,000 emergency admissions sees over 750,000 people at outpatient appointments deals with around 150,000 cases in our emergency department The Trust provides most of its services from the following locations: • Southampton General Hospital – the Trust’s largest location, where a great number of specialist services are based alongside emergency and critical care and which includes Southampton Children’s Hospital. • Princess Anne Hospital – located across the road from Southampton General Hospital and providing maternity care and specialist care for women with medical problems during pregnancy and babies who need extra care around birth across the region. • Royal South Hants Hospital – although the Trust does not operate this site near the centre of Southampton it provides a smaller number of services from this location. • New Forest Birth Centre – located at Ashurst on the edge of the New Forest and run by experienced midwives and support staff it acts as a community midwifery hub. The services provided by the Trust are commissioned and paid for by the Hampshire and Isle of Wight Integrated Care System (ICS) and, in the case of more specialised services (such as treatments for rare conditions), by NHS England. Trust services are supported by clinical income, of which 54% is paid for by NHS England and 43% by integrated care boards, predominantly the Hampshire and Isle of Wight Integrated Care Board (ICB). These are provided under a standard NHS contract, which incorporates ongoing monitoring of the Trust and the quality of the services provided. 10 Our structure UHS gained foundation trust status on 1 October 2011. A foundation trust is a public benefit corporation providing NHS services in line with the core NHS principles: that care should be universal, comprehensive and free at the point of need. The Trust is licensed as a foundation trust to provide these services by NHS England and the healthcare services we provide are regulated by the Care Quality Commission. Since 1 July 2022, the Trust has been part of the Hampshire and Isle of Wight Integrated Care System when this was established through the Health and Social Care Act 2022. Each ICS has two statutory elements: an integrated care partnership (ICP) and an integrated care board. The ICP is a statutory committee jointly formed between the NHS integrated care board and all upper-tier local authorities that fall within the ICS area. The ICP brings together a broad alliance of partners concerned with improving the care, health and wellbeing of the population, with membership determined locally. The ICP is responsible for producing an integrated care strategy on how to meet the health and wellbeing needs of the population in the ICS area. The ICB is a statutory NHS organisation responsible for developing a plan for meeting the health needs of the population, managing the NHS budget and arranging for the provision of health services in the ICS area. The Trust has been a university teaching hospital since 1971. The diagram below provides an overview of the overall organisational structure of the Trust. Public and foundation trust members Council of Governors Board of Directors Executive Directors Division A Division B Division C Division D Surgery Critical Care Opthalmology Theatres and Anaesthetics Cancer Care Emergency Medicine Helicopter Emergency Medical Services Medicine and Medicine for Older People Pathology Specialist Medicine Women and Newborn Maternity Child Health Clinical Support Cardiovascular and Thoracic Neurosciences Trauma and Orthopaedics Radiology Trust Headquarters Division 11 Our values The Trust’s values describe how things are done at UHS and act as a guide to all staff working with colleagues to deliver high quality patient care and a great patient experience every day. These values are: Patients, their families and carers are at the heart of what we do. Their experience of our services will be our measure of success. Partnership between clinicians, patients and carers is critical to achieving our vision, both within hospital teams and extending across organisational boundaries in the NHS, social care and the third sector. We will ensure we are always improving services for patients through research, education, clinical effectiveness and quality improvement. We will continue to incorporate new ideas, technologies and create greater efficiencies in the services we provide. 12 Our strategy 2021-25 The Trust’s strategy was updated during 2020/21 to take account of everything its staff had experienced during the COVID-19 pandemic and what had been learnt from this. The vision for UHS is to become an organisation of world class people delivering world class care. The Trust’s strategy is organised around five themes and for each of these it describes a number of ambitions UHS aims to achieve by 2025. Theme Ambitions Outstanding patient outcomes, • We will monitor clinical outcomes, safety and experience of our experience and safety patients regularly to ensure they are amongst the best in the UK By 2025 we will strengthen our and the world. national reputation for outstanding • We will reduce harm, learning from all incidents through our patient outcomes, experience and proactive patient safety culture. safety, providing high quality care • We will ensure all patients and relatives have a positive experience and treatment across an extensive of our care, as a result of the environment created by our people range of services from foetal and our facilities. medicine, through all life stages and conditions, to end-of-life care. Pioneering research • We will recruit and enable people to deliver pioneering research in and innovation Southampton. We will continue to be a leading teaching hospital with a growing, reputable and innovative research and development portfolio • We will optimise access to clinical research studies for our patients. • We will enable innovation in everything we do, and ensure that ‘cutting edge’ investigations and treatments are delivered in Southampton. that attracts the best staff and efficiently delivers the best possible treatments and care for our patients. World class people • We will recruit and develop enough people with the right Supporting and nurturing our knowledge and skills to meet the needs of our patients. people through a culture that values • We will provide satisfying and fulfilling roles, growing our talent diversity and builds knowledge and through development and opportunity for progression. skills to ensure everyone reaches • We will empower our people, embracing diversity and embedding their full potential. We must provide compassion, inclusion and equity of opportunity. rewarding career paths within empowered, compassionate, and motivated teams. Integrated networks and collaboration We will deliver our services with partners through clinical networks, collaboration and integration across geographical and organisational boundaries. • We will work in partnership with key stakeholders across the Hampshire and Isle of Wight integrated care system. • We will strengthen our acute clinical networks across the region, centralising when necessary and supporting local care when appropriate. • We will foster local integration with primary and community care as well as mental health and social care services for seamless delivery across boundaries. • We will build on our successful partnership with University of Southampton (UoS), growing our reputation as a national leading university teaching hospital. 13 Theme Foundations for the future Making our enabling infrastructure (finance, digital, estate) fit for the future to support a leading university teaching hospital in the 21st century and recognising our responsibility as a major employer in the community of Southampton and our role in broader environmental sustainability. Ambitions • We will deliver best value to the taxpayer as a financially efficient and sustainable organisation. • We will support patient self-management and seamless care across organisational boundaries through our ambitious digital programme, including real time data reporting, to inform our care. • We will expand and improve our estate, increasing capacity where needed and providing modern facilities for our patients and our people. • We will strengthen our role in the community as an employer of choice, a partner in delivery of services to our population and by leading the Greener NHS agenda locally. During each year of the strategy the Trust sets out a more detailed series of objectives to achieve and progress towards the delivery of its ambitions. In 2023/24 these objectives included: Outstanding patient outcomes, experience and safety Pioneering research and innovation World class people Integrated networks and collaboration Foundations for the future • Increasing the number of reported Shared Decision-Making conversations. • Increasing the number of specialities reporting outcomes that matter to patients. • Rolling out the Patient Safety Incident Reporting Framework across the Trust. • Working with patients as partners to improve patient satisfaction. • Treating patients according to need but aiming for no patient to wait, other than through patient choice, more than 65 weeks for treatment. • Delivering national metrics for site set-up time to target for clinical research studies. • Improving the Trust’s position against peers. • Delivering year three of the Trust’s research and innovation investment plan. • Developing the five-year research and development strategy implementation plan and delivery of the first year. • Strengthening and broadening the partnership between the Trust and the University of Southampton. • Supporting delivery of the Trust’s workforce plan for 2023/24. • Reducing turnover and sickness absence rates. • Increasing overall participation in the NHS staff survey and maintaining overall staff engagement score. • Increasing the proportion of appraisals completed. • Delivering the first year objectives of the Inclusion and Belonging strategy. • Working in partnership with acute trusts to agree and implement the acute services strategy. • Producing and embedding an internal framework for network development. • Working with the local delivery system on vertical integration to reduce the number of patients without criteria to reside. • Working with system partners to open a surgical elective hub. • For the Trust to be seen as an ‘anchor institution’ in the local area. • Delivering the Trust’s financial plan for 2023/24. • Engaging the organisation in the challenge to manage demand so that capacity and demand are in equilibrium. • Delivery of the Always Improving strategy priorities. • Delivering the Trust’s capital programme in full. • Entering into a new energy performance contract and delivering the first year of the Public Sector Decarbonisation Scheme. Performance against these objectives was monitored and reported to the Trust’s Board on a quarterly basis. 14 At the end of 2023/24, the Trust had met the objectives set as follows: Corporate Ambition Outstanding patient outcomes, safety and experience Pioneering research and innovation World class people Integrated networks and collaboration Foundations for the future Totals Number of Objectives 5 5 5 5 5 25 Achieved in full 4 3 2 3 2 14 Partially achieved 1 2 2 1 3 9 Not achieved 0 0 1 1 0 2 Particular areas to highlight where the Trust has achieved strong delivery during the year include: • Delivery of quality priorities in Shared Decision-Making and the roll out of the Patient Safety Incident Response Framework. • Achieving the Trust’s 65-week waiter glide path. • Successful delivery of a number of research and development priorities, including work with the University of Southampton. • Maintaining sickness absence and turnover well below the targets set at the beginning of the year, and successfully delivering the first year of the Trust’s Inclusion and Belonging strategy. • Delivery of the Trust’s full available capital budget and completion of the first year of the Trust’s decarbonisation scheme. 15 Principal risks to our strategy and objectives The Board has identified and manages the principal risks to the delivery of its strategy and objectives through its board assurance framework. The principal risks to the delivery of its strategy and objectives identified by the Trust during 2023/24 were that: • There would be a lack of capacity to appropriately respond to emergency demand, manage the increasing waiting lists for elective demand, and provide timely diagnostics, that results in avoidable harm to patients. • Due to the current challenges, the Trust fails to provide patients and their families or carers with a highquality experience of care and positive patient outcomes. • The Trust would not effectively plan for and implement infection prevention and control measures that reduce the number of hospital-acquired infections and limit the number of nosocomial outbreaks of infection. • The Trust does not take full advantage of its position as a leading university teaching hospital with a growing, reputable and innovative research and development portfolio, attracting the best staff and efficiently delivering the best possible treatments and care for its patients. • The Trust is unable to meet current and planned service requirements due to unavailability of qualified staff to fulfil key roles. • The Trust fails to develop a diverse, compassionate and inclusive workforce, providing a more positive experience for all staff. • The Trust fails to create a sustainable and innovative education and development response to meet the current and future workforce needs identified in the Trust’s longer-term workforce plan. • The Trust does not implement effective models to deliver integrated and networked care, resulting in sub-optimal patient experience and outcomes, increased numbers of admissions and increases in patients’ length of stay. • The Trust is unable to deliver a financial breakeven position, resulting in: inability to move out of the NHS England Recovery Support Programme; NHS England imposing additional controls/undertakings; and a reducing cash balance, impacting the Trust’s ability to invest in line with its capital plan, estates and digital strategies and in transformation initiatives. • The Trust does not adequately maintain, improve and develop its estate to deliver its clinical services and increase capacity. • The Trust fails to introduce and implement new technology and expand the use of existing technology to transform its delivery of care through the funding and delivery of the digital strategy. • The Trust fails to prioritise green initiatives to deliver a trajectory that will reduce its direct and indirect carbon footprint by 80% by 2028-2032 (compared with a 1990 baseline) and reach net zero direct carbon emissions by 2040 and net zero indirect carbon emissions by 2045. During 2023/24, the Trust saw continued increased demand for its services, particularly in the Emergency Department In addition, the number of patients having no clinical criteria to reside in hospital, but unable to be discharged due to a lack of appropriate care packages was higher than anticipated and spiked during winter, which significantly impacted patient flow through the hospital and required the Trust to engage additional temporary staff. The number of patients in this category peaked at 270 during the winter. There were particular challenges in respect of those patients with a primary mental health care need who would be better cared for in a more suitable alternative setting. 16 Performance overview The Trust monitors a broad range of key performance indicators within its departments, divisions, directorates and through Trust executive committees. On a monthly basis, the Board and executive committee receives a performance report containing a variety of indicators intended to provide assurance in respect of the Trust’s strategy and that the care provided is safe, caring, effective, responsive and well-led. This report also includes the Trust’s performance against the national targets set by NHS England. The performance reports include a ‘spotlight’ section, which provides more detailed analysis of a particular area. Typically, this is one of either the national targets or the Trust’s performance against the expectations set out in the NHS Constitution. The monthly performance report is also published on the Trust’s website. The Chief Executive Officer provides a regular report on performance to the Council of Governors, which includes a range of non-financial and financial performance information. Capacity The Trust continued to experience high demand for its services, especially in the Emergency Department, with average demand during the year being around 375 patients presenting per day in the main adult and children’s emergency department. In addition, the Trust experienced a significant impact on flow within the hospital due to a high number of patients having no clinical criteria to reside in hospital but unable to be discharged. This number was as high as 270 at times during winter: an increase of around 50 patients when compared to the prior year. The Trust also saw an increase in the number of referrals with the number of patients on a waiting list under the 18-week Referral to Treatment pathway rising from approximately 55,000 to 58,000 by the end of the year. In common with other trusts, the ongoing industrial action also impacted the Trust’s ability to provide urgent care and deliver on its elective recovery programme. Quality and compliance Despite the challenges, the Trust’s Emergency Department performance was one of the highest in England in March 2024, which resulted in additional capital funding being awarded. In addition, the Trust’s elective recovery performance was one of the best in England at 118% compared to 2019. The Trust continued to monitor the quality of care delivered throughout 2023/24 through a number of established quality assurance programmes. Clinical leaders monitored key quality, safety and patient experience indicators such as falls, pressure ulcers and venous thromboembolisms. Quality peer reviews were carried out, most significantly through Matron-led Quality Walkabouts every week in and out of hours focusing on the five key CQC questions – safe, effective, responsive, caring, and well-led. The Trust’s Clinical Accreditation Scheme builds on this intelligence, with clinical areas completing self-assessments of performance and review teams completing onsite visits. Patient representatives were included in these review teams. Learning was shared at the Clinical Leaders’ Group and via quarterly reports. The Trust was an active partner in a South-East accreditation network, offering advice and a steer to providers who are just setting up or looking to develop their own scheme, and extended that advice and support to other providers in England. 17 On 15 May 2023, the CQC inspected the maternity and midwifery service at Princess Anne Hospital as part of their national maternity inspection programme. The inspection report was published 11 August 2023, and the Trust retained its overall rating of ‘good’. This year UHS introduced its Fundamentals of Care (FOC) initiative. Whilst this is not a new concept, there were concerns that missed fundamental care had been amplified during the COVID- 19 pandemic. This initiative aims to empower and educate staff at all levels to ensure fundamental care is at the heart of what the Trust does. The Trust completed its transition to the Patient Safety Incident Response Framework (PSIRF) and collaborated with the ICB to develop a PSIRF plan and policy to underpin the change. The Trust implemented the requirements in respect of ‘Martha’s Rule’ where patients, relatives and carers have a legal right to a rapid review by a critical care outreach team during an acute deterioration episode in and out of hours. The Trust continued its focus on infection prevention and control, responding rapidly to rises in infection over the winter, and successfully flexing initiatives and innovations to achieve successful management in a responsive manner. The Trust progressed its Always Improving strategy and successfully supported the identification and implementation of further quality improvement projects. This included improvements across theatres, inpatient flow and outpatient programmes. During the year, average length of stay was reduced by 1.64%, day theatre cancellations were reduced by 200, and 42,350 patients were placed onto Patient Initiated Follow Up (PIFU) pathways. Further information can be found in the Quality Account. Partnerships The Trust works within the Hampshire and Isle of Wight Integrated Care System, and is an active member of a number of partner groups including the Acute Provider Collaborative Board and the Health and Wellbeing Board. The Trust develops and agrees its annual financial plans with the Integrated Care Board. The Trust is a member of a number of specific partnership groups for particular services, including the Central and South Genomics Medicine Service, the Children’s Hospital Alliance and the Southern Counties Pathology Network. The Trust works actively as a partner with other provider organisations around clinical networks, particularly with acute Trusts within the Integrated Care System and others closely located geographically. The Trust also links closely with the University of Southampton on a number of topics including research, commercial development and education and has a developed meeting structure to oversee this. 18 Workforce The Trust’s key areas of focus during 2023/24 were in respect of increasing the substantive workforce whilst also reducing reliance on bank and agency usage, and reducing staff turnover and sickness. Although the Trust was successful in recruiting to substantive posts, the expected reduction in reliance on bank and agency staff did not materialise, which meant that the Trust was 331 whole-time equivalents above its plan for 2023/24. The Trust was successful in reducing staff turnover from 13.5% in 2022/23 to 11.4%, achieving the local target of . Cancer Waiting Times - 2 Week Wait Performance Cancer Waiting Times - 2 Week Wait Performance 100% 90% 80% 70% 60% 50% 40% Apr-23 May-23 Jun-23 Jul-23 Aug-23 Sep-23 Oct-23 Nov-23 Dec-23 Jan-24 Feb-24 Mar-24 Performance % standard met The national target was for 96% of patients to commence treatment within 31 days of diagnosis. In March 2024, the Trust achieved 92% and performed in the range of 86%-94% throughout the year. The Trust has continued to make progress against the target for treatment of cancer within 62 days of an urgent GP referral, improving performance from 64% in April 2023 to 76% in March 2024 (NHS average: 69%). First definitive treatment for cancer within 31 days of a decision to treat % standard met Cancer waiting times 31 day RTT performanceUHS vs. NHSE average Cancer waiting times 31 day RTT performance UHS vs. NHSE average 96% 94% 92% 90% 88% 86% 84% 82% 80% 78% 76% Apr-23 May-23 Jun-2 3 Jul-2 3 Aug-23 Sep-2 3 Oct-23 Nov-2 3 Dec-23 Jan-24 Feb-2 4 Mar-24 Performance NHS Average 27 Treatment for Cancer within 62 days of an urgent GP referral to hospital Cancer Waiting Times 62 Day RTT Performance UHS vs NHSE Average Cancer Waiting Times 62 Day RTT Performance UHS vs NHSE Average % standard met 1 00% 80% 60% 40% 20% 0% Apr-23 May-23 Jun-23 Jul-23 Aug-23 Sep-23 Oct-23 Nov-23 Dec-23 Jan-24 Feb-24 Mar-24 Performance NHS Average 28 Quality priorities Priorities for improvement 2023/24 Last year the Trust continued its ambition to deliver the highest quality care shaped by a range of national, regional, local, and Trust-wide factors. During the year the Trust continued to experience unprecedented demand on its services, with flow, capacity, infection prevention and safety all presenting challenges. However, the Trust was confident in its ability to keep a focus on its quality priorities, and its teams worked hard to achieve their goals even in these difficult circumstances. Priorities are aligned to the three core dimensions of quality: • Patient experience – how patients experience the care they receive. • Patient safety – keeping patients safe from harm. • Clinical effectiveness – how successful is the care provided? Out of the six priories set, the Trust achieved five and partially achieved one. Overview of success Quality Priority One Improving care for people with learning disabilities and autistic (LDA) people across the Trust. Supporting staff delivering this care. Outcome against goals: achieved Key achievements: • LDA working group reestablished. • Development of an improvement plan using the NHS Learning Disability Improvement standards. • The LDA team has moved to the virtual enhanced care group in Division B where operational and governance support, leadership, and peer support/learning opportunities has been strengthened. • Sensory Boxes have been introduced for all clinical areas, funded by the Hampshire and Isle of Wight (HIOW) Integrated care board (ICB). These boxes include noise cancelling headphones, fidget toys, communication books and visual cards to support patients and wards. • Recruited additional Learning Disability Champions. • Established links with the parent carer forum (PCF) for the local area and are now attending regular events. A representative from the PCF sits on the LDA working group. The LDA team are working with the Trust lead for patient experience to develop this aspect of the LDA workplan over the next year. Quality Priority Two Supporting patients, service users and staff to overcome their tobacco dependence via a smoking cessation programme. Outcome against goals: achieved Key achievements: • Package of support available to patients who may be smokers and who need to be supported not to smoke during their treatment. • Fully trained team of tobacco advisors working in the hospital and an advisor working in the outpatient setting supporting the patients once they have returned home. • Devised the IT changes the Trust would like to implement to improve its service and referral process. • Recruited 30 smoke-free champions. • Successfully supported 1,131 patients with a self-confirmed quit rate of 45.6% at 28 days. • Supported 109 outpatients who have successfully achieved a 60% quit rate. • On track to achieve the goal to go smoke-free by April 2024 including the removal of smoking shelters. 29 Quality Priority Three Ensure carers are fully supported, involved, and valued across all our services by developing the carers support service across the Trust in partnership with Southampton Hospitals. Outcome against goals: partially achieved Key achievements: • Carers now have a more comprehensive package of concessions and vouchers to help support their cared-for person (e.g. free parking available onsite for blue badge owners is now available). • Listening events were held to put patients at the centre of transforming the way we deliver care is delivered, enabling their voices to improve the quality of care and outcomes for all. • Developed joint working with local partners (e.g. Children’s Society and No Limits to support young carers). Not yet achieved: • The ‘pathway to support, has not yet been developed. Work is ongoing to develop a new strategy. • A charity-funded carers’ support worker has not yet been appointed. • The carers’ training package has not yet been relaunched. Quality Priority Four Put patients at the centre of transforming the way care is delivered, enabling their voices to improve the quality of care and outcomes for all. Outcome against goals: achieved Key achievements: • Work has continued to work across corporate and divisional services to embed patients and carers into quality and service improvement, creating new patient groups (e.g. Mesh Support Group). • Successfully developed our engagement with various local communities, working to ensure that a range of care experiences are considered ( e.g. there is now a Gypsy, Roma, and Irish Traveller community health liaison officer to ensure that these communities are engaged with and brought into work to improve the inclusivity of our services). • Attending multiple public engagement opportunities (Young Carers’ Festival, Mela, University Freshers’ Fayres, Carers’ Listening Lunch, Hoglands Park Play Day, visits to local temples and ‘Love Where You Live’). • Youth and Young Adult Ambassador involvement has increased, including attendance toat meetings of the Council of Governors, and supporting hospital projects. • A Celebration of Carers Week and Volunteers Week were run. • The Trust has analysed its reported outcome measures to identify health inequalities in its services. This information has been used to set a new quality priority for 2024/25. • An SMS friends and family test text survey has been introduced to improve the response rate on patient feedback from the Emergency Department. In the first three months following the survey launch, responses increased from 24 to 424. 30 Quality Priority Five To develop the Trust’s clinical effectiveness process, connecting to the Trust’s Always Improving approach to measuring, understanding, and using outcomes to improve patient care. Outcome against goals: achieved Key achievements: • The Trust has developed its clinical effectiveness process across the Trust with involvement of informatics, governance and management teams, clinical effectiveness leads as well as reporting committees. • Patient representation onhas been included in the clinical assurance meeting for effectiveness and outcomes (CAMEO) to ensure conversations focus on what matters to patients. • The CAMEO template has been changed to focus discussions on areas the specialty is proud of (strong or improving outcomes), areas for improvement (poorly benchmarked or worsening outcomes) and planned actions. • The Trust encourages the use of run and/or statistical process control charts along with benchmarking where available. • Details of NICE and quality standards and national and regional reviews are included to cover breadth of clinical effectiveness. • How the clinical effectiveness team works has been reorganised, aligning each of them to each division giving a named link which helps to deepen understanding and improve links with governance and improvement activities locally. • Working with informatics to establish a core set of clinical outcome measures which are meaningful to patients, which can be reported centrally (starting with surgical specialities). • Starting to develop an education strategy and platform to support staff with a number of tools used in clinical effectiveness as well as clarity on where and how to record and evidence audit and service improvement. • A revised strategy has been drafted. Quality Priority Six Developing a culture where all clinical staff have a basic knowledge of diabetes. Outcome against goals: achieved Key achievements: • Launch of the ‘Start with the Diabasics’ Initiative, designed to help give diabetes visibility across UHS. • Delivered an extensive education programme to clinical staff across the professions and bands, including the introduction of some e-learning and a Diabasics introductory video has been shown at all trust staff inductions since July 2023. • Supported the development of 45 diabetes link nurses, resulting in all ward areas now having a named diabetes link nurse. • Improved triage for referrals. • Established processes for ‘lessons learned’. • Developed IT solutions to improvingimprove alerts and guidance. • A ‘Ketone Wednesdays’ initiative has been created in response to overuse of blood ketone testing (estimated waste cost of £100,000 per year). • The Trust’s lead diabetes specialist nurse and the Diabasics Initiative were both shortlisted for National Quality in the Care Diabetes Awards (October 2023). • The Diabasics Initiative was mentioned as a case study on the Diabetes UK charity website as an example of good practice that could be reproduced elsewhere. More information can be found about how the Trust delivered and measured its quality priorities, including feedback from patients and staff and improvement aims and quality priorities for 2024/25, in the Trust’s Quality Account for 2023/24. 31 Financial performance The Trust delivered a deficit of £4.5m from a revenue position of over £1.3bn, following receipt of £24.6m one-off cash support from NHS England. UHS started the year with an underlying deficit as a result of a number of cost pressures, notably demand for services being above block contract levels and the cost of national pay awards being above funded levels. The Trust has also continued to face a number of pressures, including high numbers of patients who no longer meet the criteria to reside in the hospital, and high demand for patients with a primary mental health need. In 2023/24, the Trust delivered a record savings level of £63.4m (5%) across a range of programmes. Trust operating income rose by £107m from the previous financial year, most notably funding the NHS pay award, as well as additional elective recovery funding. Trust operating expenses rose by £89m, incorporating funded inflationary costs as well as costs relating to the cost pressures outlined above. The Trust has also continued its reinvestment of surplus cash into infrastructure for the Trust, with capital investment of over £75m, including investment in new wards, theatres, decarbonisation, digital infrastructure, neonatal expansion and backlog maintenance. Trust cash and cash equivalents finished the year at £79m, a reduction of £24m from the previous year due to the operating loss and capital investment outlined above. Whilst liquidity remained strong in 2023/24 supported by NHS England cash support, the underlying financial deficit means it is likely to decline further in 2024/25. The Trust is continuing to monitor its cash position closely and is considering whether additional cash support may be required in 2024/25. Sustainability The Trust recognises that everyone has a part to play in responding to the climate crisis. In March 2022, the Trust agreed its own green plan in response to the challenge of the NHS becoming the world’s first health service to reach carbon net zero. Now in its third year, the plan identifies the Trust’s key areas of focus and its ambitions and has seen progress across all areas of the plan. The plan sets out the scale of the challenge, the Trust’s commitment to reducing the impact on the environment and the steps to be taken across the following categories: • Estates and facilities • Clinical and medicines • Digital transformation • Supply chain and procurement • Travel and transport • Waste and resources • Food and nutrition • Adaptation • Biodiversity • Wider sustainability The Trust continues to progress through its green plan and has completed the ‘Greener NHS’ reporting tool for several quarters, which has demonstrated good progress. In addition, the Trust is planning to launch its ‘Our Sustainable UHS’ app for staff, which will give tips on sustainability and create personalised travel plans, including identifying potential contacts for car sharing. In addition, the Trust is considering proposals to implement additional solar power, smart metering and expanding the use of LED lighting. 32 In 2022/23, the Trust was successful in bidding for £29.4m of funding through the Public Sector DeCarbonisation Fund, which will be used to fund green initiatives as part of the Trust’s capital programme. During the year the Trust successfully bid for £823k in National Energy Efficiency Funding which has been used to upgrade the lighting at Princess Anne Hospital. Social, community, anti-bribery and human rights issues The Trust recognises its responsibilities under the European Convention on Human Rights (included in the Human Rights Act 1998 in the UK). These rights include: • right to life • right not to be subjected to inhuman or degrading treatment or punishment • right to liberty and freedom • right to respect for privacy and family life. These are reflected in the duty, set out in the NHS Constitution, to each and every individual that the NHS serves, to respect their human rights and the individual’s right to be treated with dignity and respect. The Trust is committed to ensuring it fully takes into account all aspects of human rights in its work. An equality impact assessment is completed for each Trust policy. For patients, the Trust’s safeguarding policies protect and support the right to live in safety, free from abuse and neglect and other policies and standards are designed to optimise privacy and dignity in all aspects of patient care. Feedback from patients and the review of complaints, concerns, claims, incidents and audit help to monitor how the Trust is achieving these objectives. The Trust’s green plan, approved by the board of directors in March 2022, recognises the Trust’s broader role and responsibility to address the issues of climate change, air pollution, waste and environmental decline present to the city of Southampton and the impact that these issues have on the health and wellbeing of the local population served. Although the Modern Slavery Act 2015 does not apply to the Trust, its green plan sets out an ambition to stop modern slavery. The Trust is also committed to maintaining an honest and open culture within the Trust; ensuring all concerns involving potential fraud, bribery and corruption are identified and rigorously investigated. The Trust has a Fraud, Bribery and Corruption Policy, a Standards of Business Conduct Policy and a Raising Concerns (Whistleblowing) Policy. These apply to all staff and to individuals and organisations who act on behalf of UHS. Anti-bribery is part of the Trust’s work to counter fraud. This work is overseen by the Audit and Risk Committee, which receives regular reports from the local counter fraud specialist on the effectiveness of these policies through its monitoring and reviews, providing recommendations for improvement, as well as an annual report from the freedom to speak up guardian. You can read more about the work of the Audit and Risk Committee and the Trust’s approach to counter fraud in the Accountability Report. Events since the end of the financial year There have been no important events since the end of the financial year affecting the Trust. Overseas operations The Trust does not have any overseas operations. 33 Equality in service delivery NHS trusts have an essential role in tackling health inequalities, both as part of the services they provide, but also through work with the wider system. By working with those in integrated care systems, local authorities and third sector organisations, the Trust can have a significant impact on the health of the local population. The national focus on health inequalities is growing. This comes with new legal duties around reporting information and expectations to report on improvement programmes. In September 2023, a health inequalities steering group was initiated, under the leadership of the Chief Medical Officer, with representation from clinical, operational, transformation, patient experience, research, organisational development and culture, informatics, public health and the Integrated Care Board. The group focused on scoping future priorities aligned to national guidelines, contractual obligations and priorities, regional priorities, feedback from clinical teams and patients, understanding where action is already being taken, and what the data is showing. Overall, the group
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Description: Originally uploaded to http://cdn.flamehaus.com/Valve_Handbook_LowRes.pdf Handbook courtesy of Valve HANDBOOK FOR NEW EMPLOYEES ============================================================ HANDBOOK FOR NEW EMPLOYEES ======================================================== A fearless adventure in knowing what to do when no one’s there telling you what to do FIRST EDITION 2012 Dedicated to the families of all Valve employees. Thank you for helping us make such an incredible place. Table of Contents Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii How to Use This Book . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii Part 1: Welcome to Valve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Your First Day Valve Facts That Matter Welcome to Flatland Part 2: Settling In . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Your First Month What to Work On Why do I need to pick my own projects?, But how do I decide which things to work on?, How do I find out what projects are under way?, Short-term vs. long term goals, What about all the things that I’m not getting done?, How does Valve decide what to work on? Can I be included the next time Valve is deciding X? Teams, Hours, and the Office Cabals, Team leads, Structure happens, Hours, The office Risks What if I screw up?, But what if we ALL screw up? Part 3: How Am I Doing? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Your Peers and Your Performance Peer reviews, Stack ranking (and compensation) Part 4: Choose Your Own Adventure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Your First Six Months Roles, Advancement vs. growth, Putting more tools in your toolbox Part 5: Valve Is Growing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Your Most Important Role Hiring, Why is hiring well so important at Valve?, How do we choose the right people to hire?, We value “T-shaped” people, We’re looking for people stronger than ourselves, Hiring is fundamentally the same across all disciplines Part 6: Epilogue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 What Is Valve Not Good At? What Happens When All This Stuff Doesn’t Work? Where Will You Take Us? Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 © 2012 Valve Corporation. All Rights Reserved. Printed in the United States of America. This handbook does not constitute an employment contract or binding policy and is subject to change at any time. Either Valve or an employee can terminate the employment relationship at any time, with or without cause, with or without notice. Employment with Valve is at-will, and nothing in this handbook will alter that status. First edition: March 2012 Valve Corporation Bellevue, Washington USA www.valvesoftware.com Designed by Valve Typeface: ITC New Baskerville 10 9 8 7 6 5 4 3 2 1 Preface In 1996, we set out to make great games, but we knew back then that we had to first create a place that was designed to foster that greatness. A place where incredibly talented individuals are empowered to put their best work into the hands of millions of people, with very little in their way. This book is an abbreviated encapsulation of our guiding principles. As Valve continues to grow, we hope that these principles will serve each new person joining our ranks. If you are new to Valve, welcome. Although the goals in this book are important, it’s really your ideas, talent, and energy that will keep Valve shining in the years ahead. Thanks for being here. Let’s make great things. – vii – VALVE: HANDBOOK FOR NEW EMPLOYEEs How to Use This Book This book isn’t about fringe benefits or how to set up your workstation or where to find source code. Valve works in ways that might seem counterintuitive at first. This handbook is about the choices you’re going to be making and how to think about them. Mainly, it’s about how not to freak out now that you’re here. ================================================== For more nuts-and-bolts information, there’s an official Valve intranet (http://intranet). Look for stuff there like how to build a Steam depot or whether eyeglasses are covered by your Flex Spending plan. This book is on the intranet, so you can edit it. Once you’ve read it, help us make it better for other new people. Suggest new sections, or change the existing ones. Add to the Glossary. Or if you’re not all that comfortable editing it, annotate it: make comments and suggestions. We’ll collectively review the changes and fold them into future revisions. ================================================== 1 Welcome to Valve – viii – VALVE: HANDBOOK FOR NEW EMPLOYEEs Your First Day WELCOME TO VALVE Valve Facts That Matter Fig. 1-1 So you’ve gone through the interview process, you’ve signed the contracts, and you’re finally here at Valve. Congratulations, and welcome. Valve has an incredibly unique way of doing things that will make this the greatest professional experience of your life, but it can take some getting used to. This book was written by people who’ve been where you are now, and who want to make your first few months here as easy as possible. –2– Fig. 1-2 Valve is self-funded. We haven’t ever brought in outside financing. Since our earliest days this has been incredibly important in providing freedom to shape the company and its business practices. Valve owns its intellectual property. This is far from the norm, in our industry or at most entertainment contentproducing companies. We didn’t always own it all. But thanks to some legal wrangling with our first publisher after Half-Life shipped, we now do. This has freed us to make our own decisions about our products. Valve is more than a game company. We started our existence as a pretty traditional game company. And we’re still one, but with a hugely expanded focus. Which is great, because we get to make better games as a result, –3– VALVE: HANDBOOK FOR NEW EMPLOYEES and we’ve also been able to diversify. We’re an entertainment company. A software company. A platform company. But mostly, a company full of passionate people who love the products we create. Welcome to Flatland Hierarchy is great for maintaining predictability and repeatability. It simplifies planning and makes it easier to control a large group of people from the top down, which is why military organizations rely on it so heavily. But when you’re an entertainment company that’s spent the last decade going out of its way to recruit the most intelligent, innovative, talented people on Earth, telling them to sit at a desk and do what they’re told obliterates 99 percent of their value. We want innovators, and that means maintaining an environment where they’ll flourish. That’s why Valve is flat. It’s our shorthand way of saying that we don’t have any management, and nobody “reports to” anybody else. We do have a founder/president, but even he isn’t your manager. This company is yours to steer—toward opportunities and away from risks. You have the power to green-light projects. You have the power to ship products. A flat structure removes every organizational barrier –4– Fig. 1-3 VALVE: HANDBOOK FOR NEW EMPLOYEEs between your work and the customer enjoying that work. Every company will tell you that “the customer is boss,” but here that statement has weight. There’s no red tape stopping you from figuring out for yourself what our customers want, and then giving it to them. If you’re thinking to yourself, “Wow, that sounds like a lot of responsibility,” you’re right. And that’s why hiring is the single most important thing you will ever do at Valve (see “Hiring ,” on page 43). Any time you interview a potential hire, you need to ask yourself not only if they’re talented or collaborative but also if they’re capable of literally running this company, because they will be. ================================================== Why does your desk have wheels? Think of those wheels as a symbolic reminder that you should always be considering where you could move yourself to be more valuable. But also think of those wheels as literal wheels, because that’s what they are, and you’ll be able to actually move your desk with them. You’ll notice people moving frequently; often whole teams will move their desks to be closer to each other. There is no organizational structure keeping you from being in close proximity to the people who you’d help or be helped by most. The fact that everyone is always moving around within the company makes people hard to find. That’s why we have http://user—check it out. We know where you are based on where your machine is plugged in, so use this site to see a map of where everyone is right now. ================================================== –6– 2 Settling In VALVE: HANDBOOK FOR NEW EMPLOYEEs Your First Month So you’ve decided where you put your desk. You know where the coffee machine is. You’re even pretty sure you know what that one guy’s name is. You’re not freaking out anymore. In fact, you’re ready to show up to work this morning, sharpen those pencils, turn on your computer, and then what? This next section walks you through figuring out what to work on. You’ll learn about how projects work, how cabals work, and how products get out the door at Valve. What to Work On Why do I need to pick my own projects? We’ve heard that other companies have people allocate a percentage of their time to self-directed projects. At Valve, that percentage is 100. Since Valve is flat, people don’t join projects because they’re told to. Instead, you’ll decide what to work on after asking yourself the right questions (more on that later). Employees vote on projects with their feet (or desk wheels). Strong projects are ones in which people can see demonstrated value; they staff up easily. This means there are any number of internal recruiting efforts constantly under way. –8– S ettling in If you’re working here, that means you’re good at your job. People are going to want you to work with them on their projects, and they’ll try hard to get you to do so. But the decision is going to be up to you. (In fact, at times you’re going to wish for the luxury of having just one person telling you what they think you should do, rather than hundreds.) But how do I decide which things to work on? Deciding what to work on can be the hardest part of your job at Valve. This is because, as you’ve found out by now, you were not hired to fill a specific job description. You were hired to constantly be looking around for the most valuable work you could be doing. At the end of a project, you may end up well outside what you thought was your core area of expertise. There’s no rule book for choosing a project or task at Valve. But it’s useful to answer questions like these: • Of all the projects currently under way, what’s the most valuable thing I can be working on? • Which project will have the highest direct impact on our customers? How much will the work I ship benefit them? • Is Valve not doing something that it should be doing? • What’s interesting? What’s rewarding? What leverages my individual strengths the most? –9– VALVE: HANDBOOK FOR NEW EMPLOYEEs How do I find out what projects are under way? There are lists of stuff, like current projects, but by far the best way to find out is to ask people. Anyone, really. When you do, you’ll find out what’s going on around the company and your peers will also find out about you. Lots of people at Valve want and need to know what you care about, what you’re good at, what you’re worried about, what you’ve got experience with, and so on. And the way to get the word out is to start telling people all of those things. So, while you’re getting the lay of the land by learning about projects, you’re also broadcasting your own status to a relevant group of people. Got an idea for how Valve could change how we internally broadcast project/company status? Great. Do it. In the meantime, the chair next to anyone’s desk is always open, so plant yourself in it often. Short-term vs. long-term goals Because we all are responsible for prioritizing our own work, and because we are conscientious and anxious to be valuable, as individuals we tend to gravitate toward projects that have a high, measurable, and predictable return for the company. So when there’s a clear opportunity on the table to succeed at a near-term business goal with a clear return, we all want to take it. And, when we’re faced with a – 10 – S ettling in problem or a threat, and it’s one with a clear cost, it’s hard not to address it immediately. This sounds like a good thing, and it often is, but it has some downsides that are worth keeping in mind. Specifically, if we’re not careful, these traits can cause us to race back and forth between short-term opportunities and threats, being responsive rather than proactive. So our lack of a traditional structure comes with an important responsibility. It’s up to all of us to spend effort focusing on what we think the long-term goals of the company should be. Someone told me to (or not to) work on X. And they’ve been here a long time! Well, the correct response to this is to keep thinking about whether or not your colleagues are right. Broaden the conversation. Hold on to your goals if you’re convinced they’re correct. Check your assumptions. Pull more people in. Listen. Don’t believe that anyone holds authority over the decision you’re trying to make. They don’t; but they probably have valuable experience to draw from, or information/data that you don’t have, or insight that’s new. When considering the outcome, don’t believe that anyone but you is the “stakeholder”. You’re it. And Valve’s customers are who you’re serving. Do what’s right for them. – 11 – VALVE: HANDBOOK FOR NEW EMPLOYEEs ================================================== There are lots of stories about how Gabe has made important decisions by himself, e.g., hiring the whole Portal 1 team on the spot after only half of a meeting. Although there are examples, like that one, where this kind of decision making has been successful, it’s not the norm for Valve. If it were, we’d be only as smart as Gabe or management types, and they’d make our important decisions for us. Gabe is the first to say that he can’t be right nearly often enough for us to operate that way. His decisions and requests are subject to just as much scrutiny and skepticism as anyone else’s. (So if he tells you to put a favorite custom knife design into Counter-Strike, you can just say no.) ================================================== Whatever group you’re in, whether you’re building Steam servers, translating support articles, or making the tenthousandth hat for Team Fortress 2, this applies to you. It’s crucial that you believe it, so we’ll repeat it a few more times in this book. What about all the things that I’m not getting done? It’s natural in this kind of environment to constantly feel like you’re failing because for every one task you decide to work on, there will be dozens that aren’t getting your attention. Trust us, this is normal. Nobody expects you to devote time to every opportunity that comes your way. Instead, we want you to learn how to choose the most important work to do. – 12 – S ettling in How does Valve decide what to work on? The same way we make other decisions: by waiting for someone to decide that it’s the right thing to do, and then letting them recruit other people to work on it with them. We believe in each other to make these decisions, and this faith has proven to be well-founded over and over again. But rather than simply trusting each other to just be smart, we also constantly test our own decisions. Whenever we move into unknown territory, our findings defy our own predictions far more often than we would like to admit. We’ve found it vitally important to, whenever possible, not operate by using assumptions, unproven theories, or folk wisdom. This kind of testing takes place across our business, from game development to hiring, to selling games on Steam. Luckily, Steam is a fantastic platform for business learning. It exists to be an entertainment/service platform for our customers, and as such it also is a conduit for constant communication between us and them. Accepted truisms about sales, marketing, regionality, seasonality, the Internet, purchasing behavior, game design, economics, and recruiting, etc., have proven wrong surprisingly often. So we have learned that when we take nearly any action, it’s best to do so in a way that we can measure, predict outcomes, and analyze results. – 13 – VALVE: HANDBOOK FOR NEW EMPLOYEEs Recruiting can be a difficult process to instrument and measure. Although we have always tried to be highly rational about how we hire people, we’ve found much room for improvement in our approach over the years. We have made significant strides toward bringing more predictability, measurement, and analysis to recruiting. A process that many assume must be treated only as a “soft” art because it has to do with humans, personalities, language, and nuance, actually has ample room for a healthy dose of science. We’re not turning the whole thing over to robots just yet though(see “Hiring ,” on page 43). Can I be included the next time Valve is deciding X? Yes. There’s no secret decision-making cabal. No matter what project, you’re already invited. All you have to do is either (1) Start working on it, or (2) Start talking to all the people who you think might be working on it already and find out how to best be valuable. You will be welcomed— there is no approval process or red tape involved. Quite the opposite—it’s your job to insert yourself wherever you think you should be. – 14 – S ettling in Teams, Hours, and the Office Cabals Fig. 2-1 Cabals are really just multidisciplinary project teams. We’ve self-organized into these largely temporary groups since the early days of Valve. They exist to get a product or large feature shipped. Like any other group or effort at the company, they form organically. People decide to join the group based on their own belief that the group’s work is important enough for them to work on. ================================================== For reference, read the article on cabals by Ken Birdwell. It describes where cabals came from and what they meant to us early on: http://tinyurl.com/ygam86p. ================================================== – 15 – VALVE: HANDBOOK FOR NEW EMPLOYEEs Team leads Often, someone will emerge as the “lead” for a project. This person’s role is not a traditional managerial one. Most often, they’re primarily a clearinghouse of information. They’re keeping the whole project in their head at once so that people can use them as a resource to check decisions against. The leads serve the team, while acting as centers for the teams. Structure happens Project teams often have an internal structure that forms temporarily to suit the group’s needs. Although people at Valve don’t have fixed job descriptions or limitations on the scope of their responsibility, they can and often do have clarity around the definition of their “job” on any given day. They, along with their peers, effectively create a job description that fits the group’s goals. That description changes as requirements change, but the temporary structure provides a shared understanding of what to expect from each other. If someone moves to a different group or a team shifts its priorities, each person can take on a completely different role according to the new requirements. Valve is not averse to all organizational structure—it crops up in many forms all the time, temporarily. But problems show up when hierarchy or codified divisions of – 16 – S ettling in labor either haven’t been created by the group’s members or when those structures persist for long periods of time. We believe those structures inevitably begin to serve their own needs rather than those of Valve’s customers. The hierarchy will begin to reinforce its own structure by hiring people who fit its shape, adding people to fill subordinate support roles. Its members are also incented to engage in rent-seeking behaviors that take advantage of the power structure rather than focusing on simply delivering value to customers. Hours While people occasionally choose to push themselves to work some extra hours at times when something big is going out the door, for the most part working overtime for extended periods indicates a fundamental failure in planning or communication. If this happens at Valve, it’s a sign that something needs to be reevaluated and corrected. If you’re looking around wondering why people aren’t in “crunch mode,” the answer’s pretty simple. The thing we work hardest at is hiring good people, so we want them to stick around and have a good balance between work and family and the rest of the important stuff in life. If you find yourself working long hours, or just generally feel like that balance is out of whack, be sure to raise the (cont’d on page 19) – 17 – Fig. 2-2 Method to move your desk 1. 2. 3. 4. step 1. Unplug cords from wall step 2. Move your desk step 3. Plug cords back into wall step 4. Get back to work VALVE METHOD DIAG. 1 A Timeline of Valve’s History 1996 1997 Valve is formed in Kirkland, WA, by Gabe Newell and Mike Harrington. Formation papers are signed on the same day as Gabe’s wedding. Quake engine license is acquired from id Software. Production commences on the game soon to be known as Half-Life (HL). Production commences on Valve’s second game, Prospero. Valve recruits and hires two game teams, including the ﬁrst international employee from the UK. Gabe promises that if HL becomes the #1- selling game, the company will take everyone on vacation. After internal review, HL deemed not good enough to ship. HL team returns to the drawing board and essentially starts over. Prospero permanently shelved. – 19 – HFNE:96:97::01 VALVE 19 9 8 Half-Life: Day One OEM demo is released. Released as a demo bundled with the Voodoo Banshee graphics card, the OEM release circulates far beyond its original intended audience. Valve realizes the level of anticipation for the full game. Half-Life is released. Following a certain Black Mesa Incident, the world is never the same again. TeamFortress Software Pty. Ltd. is acquired. Creators of Team Fortress (TF) join Valve and commence work on Team Fortress Classic. Valve’s ﬁrst company vacation to Cabo San Lucas, Mexico. # of employees: 30 # of children: 0 VALVE HFNE:98::02 1999 2000 2001 Valve establishes a pattern of supporting the best mods and occasionally acquiring them. Mike Harrington amicably dissolves his partnership with Gabe Newell, leaving Newell as the sole head of Valve Corporation. Half-Life: Opposing Force is released. Expansion pack follows events in Black Mesa from the viewpoint of an invading soldier. Counter-Strike (CS) is released. CS soon becomes the world’s #1 premier online action game. Team Fortress Classic is released. Ricochet is released. Robin Walker demonstrates to the mod community how a game can be created quickly and easily with Valve’s SDK. Half-Life: Deathmatch Classic is released. Half-Life: Blue Shift is released. HFNE:99:00:01::03 VALVE 2002 2003 Valve outgrows its original Kirkland ofﬁce space and moves to downtown Bellevue, WA. Steam is announced at GDC. Valve’s Steam offers to third parties its new suite of tools and services, which it had originally built to service its own games like HL and CS. Valve Anti-Cheat (VAC) is released. In a ﬁeld where rampant online cheating ruins the experience for many customers, Valve aggressively addresses the issue. Half-Life 2 (HL2) source code is stolen. A thief inﬁltrates Valve’s network to steal and disperse the code base for the still-in-production HL2. Years of speculation regarding the Borealis and Kraken Base begin… Steam is released. CS is released as Valve’s first Xbox title. Day of Defeat is released. A popular mod gets full Valve support, becoming one of its stalwart products. VALVE HFNE:02:03::04 2004 Source engine is unveiled. Half-Life 2 (HL2) is released. The world’s ﬁrst (legal) look at the Source engine, along with the game it powers: HL2. HL2 appears as the ﬁrst game available both through Steam and in retail locations. HL2 also becomes Valve’s second Xbox title. Counter-Strike: Source (CSS) is released. Years of work on Valve’s new Source engine technology ﬁnally come to light. Counter-Strike: Condition Zero is released. Half-Life: Source is released. The original HL gets a visual upgrade. HFNE:04::05 VALVE 2005 2006 2007 First third-party games are released on Steam. A landmark in digital distribution, Steam gives PC developers an alternative to retail for their games. Half-Life 2: Episode One is released. Valve’s ﬁrst experiment in episodic storytelling. The Orange Box is released with two previously-released titles and three new products: Half-Life 2: Lost Coast tech demo is released. Supported by the ﬁrst version of Valve’s popular developer commentary. Day of Defeat: Source is released. Valve hires six students from DigiPen Institute of Technology after seeing their demo of the game, Narbacular Drop. Half-Life Deathmatch: Source is released. Team Fortress 2 (TF2), the long-awaited sequel to the classic multiplayer game. Half Life 2: Episode Two— raising the bar for emotional storytelling. Portal—hailed worldwide as an instant classic. Steam Community is released with the first wave of features designed to help friends connect and socialize via the Steam platform. Steam reaches 15 million active users, playing over 200 games. VALVE HFNE:05:06:07::06 2008 Left 4 Dead is released. 2009 LEFT 4 DEAD 2 is released. Presale numbers are the biggest yet for a Valve game. Steamworks is unveiled, making the business and technical tools of the Steam platform available to thirdparty developers free of charge. Steam hits over 20 million users and over 500 games. TF2 gets major class updates for Medic, Pyro, and Heavy characters. These updates are delivered via Steam to all TF2 customers. Steam ships its ﬁrst downloadable content update for indie game The Maw. Steam Cloud is released, offering seamless online storage of any ﬁle types, including saved games, conﬁguration ﬁles, etc. Steam hits over 25 million users and over 1,000 games. TF2 releases The Sniper vs Spy Update, followed by outright WAR! After this release, the TF2 updates increase rapidly: more than 280 have shipped in total. TF2 ships its ﬁrst hat. HFNE:08:09::07 VALVE 2010 2011 2012 Portal 2 debuts on multiple platforms to critical acclaim. Valve’s 44th international hire clears immigration—this time from Germany. Valve moves to a more expansive location in Bellevue, WA. Valve announces that Steam and Source will be available for Macintosh. Dota 2 premieres at Gamescom in Cologne, Germany, with the first annual Dota 2 championship. In 2012, Valve heads to the Big Island of Hawaii for its 10th company vacation. # of employees: 293 # of children: 185 Valve announces Portal 2 is launching in 2011. Valve begins development of Dota 2. VALVE HFNE:10:11:12::08 Q1: New employee handbook rolls off press. What’s next? You tell us… S ettling in issue with whomever you feel would help. Dina loves to force people to take vacations, so you can make her your first stop. The office Sometimes things around the office can seem a little too good to be true. If you find yourself walking down the hall one morning with a bowl of fresh fruit and Stumptown-roasted espresso, dropping off your laundry to be washed, and heading into one of the massage rooms, don’t freak out. All these things are here for you to actually use. And don’t worry that somebody’s going to judge you for taking advantage of it—relax! And if you stop on the way back from your massage to play darts or work out in the Valve gym or whatever, it’s not a sign that this place is going to come crumbling down like some 1999-era dot-com startup. If we ever institute caviar-catered lunches, though, then maybe something’s wrong. Definitely panic if there’s caviar. – 19 – VALVE: HANDBOOK FOR NEW EMPLOYEEs Risks What if I screw up? Nobody has ever been fired at Valve for making a mistake. It wouldn’t make sense for us to operate that way. Providing the freedom to fail is an important trait of the company— we couldn’t expect so much of individuals if we also penalized people for errors. Even expensive mistakes, or ones which result in a very public failure, are genuinely looked at as opportunities to learn. We can always repair the mistake or make up for it. Screwing up is a great way to find out that your assumptions were wrong or that your model of the world was a little bit off. As long as you update your model and move forward with a better picture, you’re doing it right. Look for ways to test your beliefs. Never be afraid to run an experiment or to collect more data. It helps to make predictions and anticipate nasty outcomes. Ask yourself “what would I expect to see if I’m right?” Ask yourself “what would I expect to see if I’m wrong?” Then ask yourself “what do I see?” If something totally unexpected happens, try to figure out why. There are still some bad ways to fail. Repeating the same mistake over and over is one. Not listening to customers or peers before or after a failure is another. Never ignore the evidence; particularly when it says you’re wrong. – 20 – S ettling in Fig. 2-3 – 21 – Fig. 2-4 Methods to find out what’s going on 1. 2. S ettling in But what if we ALL screw up? 3. 4. step 1. Talk to someone in a meeting step 2. Talk to someone in the elevator step 3. Talk to someone in the kitchen step 4. Talk to someone in the bathroom VALVE METHOD DIAG. 2 Fig. 2-5 So if every employee is autonomously making his or her own decisions, how is that not chaos? How does Valve make sure that the company is heading in the right direction? When everyone is sharing the steering wheel, it seems natural to fear that one of us is going to veer Valve’s car off the road. Over time, we have learned that our collective ability to meet challenges, take advantage of opportunity, and respond to threats is far greater when the responsibility for doing so is distributed as widely as possible. Namely, to every individual at the company. We are all stewards of our long-term relationship with our customers. They watch us, sometimes very publicly, – 23 – VALVE: HANDBOOK FOR NEW EMPLOYEEs make mistakes. Sometimes they get angry with us. But because we always have their best interests at heart, there’s faith that we’re going to make things better, and that if we’ve screwed up today, it wasn’t because we were trying to take advantage of anyone. 3 How Am I Doing? – 24 – VALVE: HANDBOOK FOR NEW EMPLOYEES Your Peers and Your Performance We have two formalized methods of evaluating each other: peer reviews and stack ranking. Peer reviews are done in order to give each other useful feedback on how to best grow as individual contributors. Stack ranking is done primarily as a method of adjusting compensation. Both processes are driven by information gathered from each other—your peers. Peer reviews We all need feedback about our performance—in order to improve, and in order to know we’re not failing. Once a year we all give each other feedback about our work. Outside of these formalized peer reviews, the expectation is that we’ll just pull feedback from those around us whenever we need to. There is a framework for how we give this feedback to each other. A set of people (the set changes each time) interviews everyone in the whole company, asking who each person has worked with since the last round of peer reviews and how the experience of working with each person was. The purpose of the feedback is to provide people with information that will help them grow. That means that the best quality feedback is directive and – 26 – H ow am I doing ? prescriptive, and designed to be put to use by the person you’re talking about. The feedback is then gathered, collated, anonymized, and delivered to each reviewee. Making the feedback anonymous definitely has pros and cons, but we think it’s the best way to get the most useful information to each person. There’s no reason to keep your feedback about someone to yourself until peer review time if you’d like to deliver it sooner. In fact, it’s much better if you do so often, and outside the constraints of official peer reviews. When delivering peer review feedback, it’s useful to keep in mind the same categories used in stack ranking because they concretely measure how valuable we think someone is. Stack ranking (and compensation) The other evaluation we do annually is to rank each other against our peers. Unlike peer reviews, which generate information for each individual, stack ranking is done in order to gain insight into who’s providing the most value at the company and to thereby adjust each person’s compensation to be commensurate with his or her actual value. Valve pays people very well compared to industry norms. Our profitability per employee is higher than that of Google or Amazon or Microsoft, and we believe strongly that the right thing to do in that case is to put a maximum – 27 – Fig. 3-1 Method to working without a boss 1. 2. 3. 4. step 1. Come up with a bright idea step 2. Tell a coworker about it step 3. Work on it together step 4. Ship it! VALVE METHOD DIAG. 3 H ow am I doing ? amount of money back into each employee’s pocket. Valve does not win if you’re paid less than the value you create. And people who work here ultimately don’t win if they get paid more than the value they create. So Valve’s goal is to get your compensation to be “correct.” We tend to be very flexible when new employees are joining the company, listening to their salary requirements and doing what we can for them. Over time, compensation gets adjusted to fit an employee’s internal peer-driven valuation. That’s what we mean by “correct”—paying someone what they’re worth (as best we can tell using the opinions of peers). ================================================== If you think your compensation isn’t right for the work you do, then you should raise the issue. At Valve, these conversations are surprisingly easy and straightforward. Adjustments to compensation usually occur within the process described here. But talking about it is always the right thing if there’s any issue. Fretting about your level of compensation without any outside information about how it got set is expensive for you and for Valve. ================================================== The removal of bias is of the utmost importance to Valve in this process. We believe that our peers are the best judges of our value as individuals. Our flat structure eliminates some of the bias that would be present in a peer-ranking system elsewhere. The design of our stack-ranking process is meant to eliminate as much as possible of the remainder. – 29 – VALVE: HANDBOOK FOR NEW EMPLOYEEs Each project/product group is asked to rank its own members. (People are not asked to rank themselves, so we split groups into parts, and then each part ranks people other than themselves.) The ranking itself is based on the following four metrics: 1. Skill Level/Technical Ability How difficult and valuable are the kinds of problems you solve? How important/critical of a problem can you be given? Are you uniquely capable (in the company? industry?) of solving a certain class of problem, delivering a certain type of art asset, contributing to design, writing, or music, etc.? 2. Productivity/Output How much shippable (not necessarily shipped to outside customers), valuable, finished work did you get done? Working a lot of hours is generally not related to productivity and, after a certain point, indicates inefficiency. It is more valuable if you are able to maintain a sensible work/life balance and use your time in the office efficiently, rather than working around the clock. – 30 – Fig. 3-2 VALVE: HANDBOOK FOR NEW EMPLOYEEs 3. Group Contribution How much do you contribute to studio process, hiring, integrating people into the team, improving workflow, amplifying your colleagues, or writing tools used by others? Generally, being a group contributor means that you are making a tradeoff versus an individual contribution. Stepping up and acting in a leadership role can be good for your group contribution score, but being a leader does not impart or guarantee a higher stack rank. It is just a role that people adopt from time to time. 4. Product Contribution How much do you contribute at a larger scope than your core skill? How much of your work matters to the product? How much did you influence correct prioritization of work or resource trade-offs by others? Are you good at predicting how customers are going to react to decisions we’re making? Things like being a good playtester or bug finder during the shipping cycle would fall into this category. – 32 – H ow am I doing ? By choosing these categories and basing the stack ranking on them, the company is explicitly stating, “This is what is valuable.” We think that these categories offer a broad range of ways you can contribute value to the company. Once the intra-group ranking is done, the information gets pooled to be company-wide. We won’t go into that methodology here. There is a wiki page about peer feedback and stack ranking with some more detail on each process. – 33 – Fig. 3-3 Method to taking the company trip 1. 2. 3. 4. step 1. Find someone to watch your cats step 2. Board our chartered flight step 3. Relax by the pool step 4. Relax by the pool some more VALVE METHOD DIAG. 4 4 Choose Your Own Adventure VALVE: HANDBOOK FOR NEW EMPLOYEEs Your First Six Months You’ve solved the nuts-and-bolts issues. Now you’re moving beyond wanting to just be productive day to day—you’re ready to help shape your future, and Valve’s. Your own professional development and Valve’s growth are both now under your control. Here are some thoughts on steering both toward success. Roles Fig. 4-1 By now it’s obvious that roles at Valve are fluid. Traditionally at Valve, nobody has an actual title. This is by design, to remove organizational constraints. Instead we have things we call ourselves, for convenience. In particular, people – 36 – CHOOSE YOUR OWN ADVENTURE who interact with others outside the company call themselves by various titles because doing so makes it easier to get their jobs done. Inside the company, though, we all take on the role that suits the work in front of us. Everyone is a designer. Everyone can question each other’s work. Anyone can recruit someone onto his or her project. Everyone has to function as a “strategist,” which really means figuring out how to do what’s right for our customers. We all engage in analysis, measurement, predictions, evaluations. One outward expression of these ideals is the list of credits that we put in our games—it’s simply a long list of names, sorted alphabetically. That’s it. This was intentional when we shipped Half-Life, and we’re proud to continue the tradition today. Advancement vs. growth Because Valve doesn’t have a traditional hierarchical structure, it can be confusing to figure out how Valve fits into your career plans. “Before Valve, I was an assistant technical second animation director in Hollywood. I had planned to be a director in five years. How am I supposed to keep moving forward here?” Working at Valve provides an opportunity for extremely efficient and, in many cases, very accelerated, career – 37 – VALVE: HANDBOOK FOR NEW EMPLOYEEs growth. In particular, it provides an opportunity to broaden one’s skill set well outside of the narrow constraints that careers can have at most other companies. So the “growth ladder” is tailored to you. It operates exactly as fast as you can manage to grow. You’re in charge Fig. 4-2 of your track, and you can elicit help with it anytime from those around you. F Y I , we usually don’t do any formalized employee “development” (course work, mentor assignment), because for senior people it’s mostly not effective. We believe that high-performance people are generally self-improving. – 38 – CHOOSE YOUR OWN ADVENTURE Most people who fit well at Valve will be betterpositioned after their time spent here than they could have been if they’d spent their time pretty much anywhere else. Putting more tools in your toolbox The most successful people at Valve are both (1) highly skilled at a broad set of things and (2) world-class experts within a more narrow discipline. (See “T-shaped” people on page 46.) Because of the talent diversity here at Valve, it’s often easier to become stronger at things that aren’t your core skill set. Engineers: code is only the beginning If you were hired as a software engineer, you’re now surrounded by a multidisciplinary group of experts in all kinds of fields—creative, legal, financial, even psychological. Many of these people are probably sitting in the same room as you every day, so the opportunities for learning are huge. Take advantage of this fact whenever possible: the more you can learn about the mechanics, vocabulary, and analysis within other disciplines, the more valuable you become. Non-Engineers: program or be programmed Valve’s core competency is making software. Obviously, – 39 – VALVE: HANDBOOK FOR NEW EMPLOYEES different disciplines are part of making our products, but we’re still an engineering-centric company. That’s because the core of the software-building process is engineering. As in, writing code. If your expertise is not in writing code, then every bit of energy you put into understanding the code-writing part of making software is to your (and Valve’s) benefit. You don’t need to become an engineer, and there’s nothing that says an engineer is more valuable than you. But broadening your awareness in a highly technical direction is never a bad thing. It’ll either increase the quality or quantity of bits you can put “into boxes,” which means affecting customers more, which means you’re valuable. 5 Valve Is Growing – 40 – VALVE: HANDBOOK FOR NEW EMPLOYEEs Your Most Important Role Concepts discussed in this book sound like they might work well at a tiny start-up, but not at a hundreds-of-people-plusbillions-in-revenue company. The big question is: Does all this stuff scale? Well, so far, yes. And we believe that if we’re careful, it will work better and better the larger we get. This might seem counterintuitive, but it’s a direct consequence of hiring great, accomplished, capable people. Getting this to work right is a tricky proposition, though, and depends highly on our continued vigilance in recruiting/hiring. If we start adding people to the company who aren’t as capable as we are at operating as high-powered, selfdirected, senior decision makers, then lots of the stuff discussed in this book will stop working. One thing that’s changing as we grow is that we’re not great at disseminating information to everyone anymore (see “What is Valve not good at?,” on page 52). On the positive side, our profitability per employee is going up, so by that measure, we’re certainly scaling correctly. Our rate of hiring growth hovered between 10 and 15 percent per year, for years. In 2010, we sped up, but only to about 20 percent per year. 2011 kept up this new pace, largely due to a wave of hiring in Support. – 42 – Valve is growing We do not have a growth goal. We intend to continue hiring the best people as fast as we can, and to continue scaling up our business as fast as we can, given our existing staff. Fortunately, we don’t have to make growth decisions based on any external pressures—only our own business goals. And we’re always free to temper those goals with the long-term vision for our success as a company. Ultimately, we win by keeping the hiring bar very high. Hiring Fig. 5-1 – 43 – VALVE: HANDBOOK FOR NEW EMPLOYEEs Hiring well is the most important thing in the universe. Nothing else comes close. It’s more important than breathing. So when you’re working on hiring—participating in an interview loop or innovating in the general area of recruiting—everything else you could be doing is stupid and should be ignored! When you’re new to Valve, it’s super valuable to start being involved in the interview process. Ride shotgun with people who’ve been doing it a long time. In some ways, our interview process is similar to those of other companies, but we have our own take on the process that requires practice to learn. We won’t go into all the nuts and bolts in this book—ask others for details, and start being included in interview loops. Why is hiring well so important at Valve? At Valve, adding individuals to the organization can influence our success far more than it does at other companies —either in a positive or negative direction. Since there’s no organizational compartmentalization of people here, ================================================== Bring your friends. One of the most valuable things you can do as a new employee is tell us who else you think we should hire. Assuming that you agree with us that Valve is the best place to work on Earth, then tell us about who the best people are on Earth, so we can bring them here. If you don’t agree yet, then wait six months and ask yourself this question again. ================================================== – 44 – Valve is growing adding a great person can create value across the whole company. Missing out on hiring that great person is likely the most expensive kind of mistake we can make. Usually, it’s immediately obvious whether or not we’ve done a great job hiring someone. However, we don’t have the usual checks and balances that come with having managers, so occasionally it can take a while to understand whether a new person is fitting in. This is one downside of the organic design of the company—a poor hiring decision can cause lots of damage, and can sometimes go unchecked for too long. Ultimately, people who cause damage always get weeded out, but the harm they do can still be significant. How do we choose the right people to hire? An exhaustive how-to on hiring would be a handbook of its own. Probably one worth writing. It’d be tough for us to capture because we feel like we’re constantly learning really important things about how we hire people. In the meantime, here are some questions we always ask ourselves when evaluating candidates: • Would I want this person to be my boss? • Would I learn a significant amount from him or her? • What if this person went to work for our competition? Across the board, we value highly collaborative people. That means people who are skilled in all the things that are – 45 – VALVE: HANDBOOK FOR NEW EMPLOYEEs integral to high-bandwidth collaboration—people who can deconstruct problems on the fly, and talk to others as they do so, simultaneously being inventive, iterative, creative, talkative, and reactive. These things actually matter far more than deep domain-specific knowledge or highly developed skills in narrow areas. This is why we’ll often pass on candidates who, narrowly defined, are the “best” at their chosen discipline. Of course it’s not quite enough to say that a candidate should collaborate well—we also refer to the same four metrics that we rely on when evaluating each other to evaluate potential employees (See “Stack ranking,” on page 27). We value “T-shaped” people. That is, people who are both generalists (highly skilled at a broad set of valuable things—the top of the T) and also experts (among the best in their field within a narrow discipline—the vertical leg of the T). This recipe is important for success at Valve. We often have to pass on people who are very strong generalists without expertise, or vice versa. An expert who is too narrow has difficulty collaborating. A generalist who doesn’t go deep enough in a single area ends up on the margins, not really contributing as an individual. – 46 – Valve is growing Fig. 5-2 We’re looking for people stronger than ourselves. When unchecked, people have a tendency to hire others who are lower-powered than themselves. The questions listed above are designed to help ensure that we don’t start hiring people who are useful but not as powerful as we are. We should hire people more capable than ourselves, not less. In some ways, hiring lower-powered people is a natural response to having so much work to get done. In these conditions, hiring someone who is at least capable seems (in the short term) to be smarter than not hiring anyone at all. But that’s actually a huge mistake. We can always bring – 47 – VALVE: HANDBOOK FOR NEW EMPLOYEES on temporary/contract help to get us through tough spots, but we should never lower the hiring bar. The other reason people start to hire “downhill” is a political one. At most organizations, it’s beneficial to have an army of people doing your bidding. At Valve, though, it’s not. You’d damage the company and saddle yourself with a broken organization. Good times! Hiring is fundamentally the same across all disciplines. There are not different sets of rules or criteria for engineers, artists, animators, and accountants. Some details are different—like, artists and writers show us some of their work before coming in for an interview. But the actual interview process is fundamentally the same no matter who we’re talking to. “With the bar this high, would I be hired today?” That’s a good question. The answer might be no, but that’s actually aw
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Description: Private Patient Policy Trust reference Description FIN002 Version number 2 This policy provides guidance on how to administer and account for patients undertaking to pay for hospital treatment. Level and type of document Target audience Level 1: applicable across the Trust All staff that have any interactions with private patients at the Trust. List related documents/policies Complaints Policy and Procedure Standards of Business Conduct Policy Being Open – A duty to be candid policy and associated guidance Consultant and career grade doctor job planning policy Disciplinary Policy Standards of Business Conduct Policy Trusts Standing Financial Instructions policy Author Charlotte McCaskie, Head of Private Patients and Overseas Visitor Services Policy sponsor Na’el Clarke Commercial Director This is a controlled document. Whilst this document may be printed, the electronic version posted on Staffnet is the controlled copy. Any printed copies of this document are not controlled. As a controlled document, this document should not be saved onto local or network drives but should always be accessed from Staffnet. 1 Date Dec 2021 Version control Author(s) Charlotte McCaskie Version created V2 Approval committee Quality Governance Steering Group Date of approval Oct 2021 Date next review due Oct 2022 Key changes made to document A comprehensive rewrite of the whole document. 1 Version control .................................................................................................................... 1 2 Introduction ......................................................................................................................... 3 3 Scope and purpose ............................................................................................................. 3 4 Definitions ........................................................................................................................... 3 5 Staff Roles and Responsibilities .......................................................................................... 5 6 Indemnity ...........................................................................................................................10 7 Principles of Private Patient Practice..................................................................................10 8 Private patient facility charges and payment ......................................................................10 9 Identification of private patients..........................................................................................11 10 Treating a private patient ................................................................................................11 11 Change of administrative Patient Category.....................................................................11 12 Top up drugs ..................................................................................................................13 13 Overseas Private Patient ................................................................................................14 14 Category II patients ........................................................................................................15 15 Repatriation of private patients .......................................................................................15 16 Complaints .....................................................................................................................16 17 NHS time owing..............................................................................................................16 18 Training ..........................................................................................................................16 19 Private Practising Privileges at UHS ...............................................................................17 20 Use of NHS and Trust Brand Logo .................................................................................18 21 Incident and Serious Incident Reporting .........................................................................18 22 The Bribery Act 2010......................................................................................................19 23 Communication and training plans..................................................................................19 24 Equality impact assessment (for all policies only) ...........................................................19 25 Document review............................................................................................................19 26 Process for monitoring compliance .................................................................................20 27 Appendices ....................................................................................................................21 Appendix A Private Patient referral process and responsibilities ...............................................22 Appendix B Private Practising Privileges Application form ........................................................23 Appendix C Private Patients Complaints Procedure..................................................................25 Appendix D Secretarial Service, expression of interest form .....................................................27 Appendix E Notification in change of Patient Category Form ....................................................28 Appendix F NHS time owing .....................................................................................................29 Appendix G Consultant Rules for extension of NHS Theatre Lists ............................................30 28 References.....................................................................................................................31 29 Useful links .....................................................................................................................31 2 2.1 2.1.1 2.1.2 Introduction Summary This policy is issued by University Hospital Southampton NHS Foundation Trust (the Trust) to provide guidance on how to administer and account for patients undertaking to pay for hospital treatment. The Trust welcomes private patients and re-invests the income generated from private patient activity for the benefit of all patients and services within the Trust. The objectives of this policy are to ensure that: • All private patients receiving treatment at the Trust are identified. • Staff are undertaking work when it is permissible to undertake it and the terms under which treatment is provided are clear. • There is clarity on issues around charges and tariffs. • There are provisions for changing the Patient Category of a patient from private to NHS. • Private patients are able to pay for their treatment. • There is guidance to the private patient team, Consultants, clinical teams and administrative staff for their roles in administering private patient services. 3 Scope and purpose 3.1 This policy has been developed to provide clear information to all staff regarding the provision and management of private patient activity within the Trust. The Private Patient Policy is required to clarify the Trust’s position on patients transferring between NHS and private Patient Category, to ensure that all staff are aware of the necessary procedures to effectively manage this process and enable more robust monitoring of private patient activity. 3.2 It is also required that the guidance set out in this policy is followed by all staff to enable accurate capture of revenue generated by private inpatient and outpatient activity across the Trust. 3.3 The treatment of private patients is encouraged, provided that it does not conflict with the Trust’s objectives or priorities, including its principal purpose of the provision of goods and services for the purposes of the health service in England and meeting national targets and standards. 3.4 This policy applies to all staff employed by the Trust, or sub-contracted to it. It should be read in conjunction with other Trust policies and procedures related to patient care, management and standing financial instructions. 4 Definitions Category II Consultant Category II work includes investigations or tests for non-clinical reasons. Examples are x-ray scans made on behalf of insurance companies or cardiac tests for DVLA purposes. The clinician who has the responsibility for the patient and clinical care, either the Trust clinician admitting the patient, or to whom the patient is assigned during their treatment. For the purpose of this document, Consultant may include other clinical staff with indemnity to deliver Private Practice. CQC Insured patient ISCAS Monitor Non-insured patients Overseas patient Patient Category PHIN – Private Healthcare Information Network Private patient charges Private Patient Service Private Patient Tariff Private Practising Privileges Private Practising Privileges Agreement Referral Self-pay patients Top Up Treatment Trust Undertaking to Pay Form The Care Quality Commission (CQC) is an executive non-departmental public body of the Department of Health and Social Care of the United Kingdom, which regulates and inspects health and social care services in England. This also includes how the CQC monitors private patient complaints. Insured patients are those whose treatment is funded through a medical insurance policy. The Consultants provide and charge the insurer for their services on a private and independent basis. An independent adjudication service provided to private patients in relation to complaints that require independent adjudication. Monitor is the independent organisation that authorises and regulates NHS foundation trusts in England, now part of NHS England and NHS Improvement. Non-insured patients are those who pay the full cost of private treatment via alternative resources such as legal claims or cruise ships. Payments will be made by these companies supported by a guarantee of payment. The Consultants provide and charge for their services on a private and independent basis. A person who is not ‘ordinarily resident’ in the UK and should be referenced in line with the Trust’s overseas visitor policy. Refers to a patient's status regarding payment for NHS services. It indicates whether the patient is a Category II, NHS, Overseas Visitor or private patient (paying). The Private Healthcare Information Network is the approved information organisation under the Competition & Markets Authority Private Healthcare Market Investigation Order 2014 which is required to collect data from the private healthcare operators about privately funded episodes in England, Wales, Scotland and Northern Ireland, and make publicly available performance measures by procedure, at both hospital and consultant level. PHIN publishes the data via its website at www.phin.org.uk/home Charges imposed in respect of goods and services provided to patients other than patients being provided with goods and services for the purposes of the health service. A dedicated service to assist with the coordination of all private patient activity within the Trust. The Trust’s price guide for private medical treatment. An arrangement authorised by the Trust that allows the individual doctor to carry out private treatment and procedures to the public. The agreement that is signed by the doctor upon requesting private practising privileges at the Trust. Referral of a patient to a Consultant or department within the Trust. Self-pay patients are those who pay for the cost of treatment provided by the Trust from their own resources. A patient is able to top up on treatment that is not available on the NHS service, alongside their NHS treatment. Relates to any appointments, out-patient, day-case or inpatient attendances, medical or surgical services or procedures and rehabilitation services given by the Trust. University Hospital Southampton NHS Foundation Trust The contract that a patient signs prior to receiving private treatment at the Trust that relates to the commitment to pay for the private service provision. 5 5.1 5.2 5.2.3 5.2.1 5.2.2 5.3 5.3.1 5.3.2 5.3.3 5.3.4 5.3.5 5.3.6 5.3.7 Staff Roles and Responsibilities Chief Executive Officer (CEO) The CEO is ultimately responsible for the private patient practice provided by the Trust. Chief Medical Officer (CMO) The CMO provides executive overview of the private patient services at UHS. Private Healthcare Services Programme Board The private healthcare services programme board oversees the private patient service by monitoring and ensuring the effective delivery of private patient services at the Trust. This board will link with Trust Executive Committee, divisional boards and clinical services. Service Management All clinical leads, divisional clinical directors, divisional directors of operation, service managers, senior advisors and key managerial staff must ensure this policy is understood and followed within their areas of responsibility. Clinical service leads and management must ensure that Consultants adhere to the principles as outlined within ‘A Code of Conduct for Private Practice: Recommended Standards of Practice for NHS Consultants’ 2004, updated in 2009. Ensure that the clinical leads are aware of Consultants’ private work and have jointly agreed where private patient time is scheduled within the Consultant’s or Career Grade Doctor’s job plan. Ensure accurate recording/ monitoring of senior medic’s time owing in relation to private activity carried out in NHS job plan time. The senior medic’s line manager must complete section A and B within the form provided in Appendix F NHS time owing. Time owing is to be repaid to the Department at a mutually agreeable future date/time but within no more than three months. Ensure that changes to Patient Category are approved upon receipt of Appendix F notification of change in Patient Category form, as required and in a timely manner so not to delay or impact on the patient treatment. Ensure that the provision of private activity does not interfere with, or interrupt NHS service provision. No member of staff outside the Cashiers team within the Trust is authorised to accept cash payments for services. All cash payments are limited in relation to paying for treatment, staff must be aware of their obligations in respect of current money laundering legislation, including: The Money Laundering, Terrorist Financing and Transfer of Funds (Information on the Payer) Regulations 2017 (Money Laundering Regulations 2017) and The Money Laundering and Terrorist Financing (Amendment) Regulations 2019 (Money Laundering Regulations 2019) and must always act in line with the Trust’s Standing Financial Instructions Policy. Any concerns should be raised 5.4 5.4.1 5.4.2 5.5 5.5.1 5.5.2 5.5.3 5.5.4 5.5.5 5.5.6 5.6 5.6.1 to the Private Patient Billing Team in relation to a cash transaction request before any transactions take place. Private Patients Service Management The private patient management team will be responsible for the day-to-day management of private patient services at UHS. They will ensure that systems are in place to process and record private activity and that departments are paid for private activity carried out within services across the Trust. The management team will ensure that finance and activity reports are provided to the divisions and care groups, weekly for patients who are due to be treated privately at UHS and monthly for activity and income that has been achieved under the private patient services within the Trust. The management team will ensure that the private practising privileges register is up to date and reflective of the authorised consultants with practising privileges at the Trust. Private Patient Service Coordinators The coordinators are responsible for managing the coordination of all private patient activity in liaison with the clinical services and the Consultant. These include liaising with all service administration to book patients into the service and ensure that the clinical teams have organised theatres and beds as required. The coordinator will ensure all pre-authorisation from private medical insurers (PMI) are sought in advance of treatment or arrangement for payment in advance for Selfpay patients. The coordinators will ensure, in conjunction with the private patient billing team, that a guided estimate is provided to the PMI or Self-pay patients prior to any treatment going ahead. The private patient theatre coordinator will also manage the private practising privilege register to ensure that all consultant requests have been approved to practice privately at UHS and their indemnity, appraisals and any other associated requirements such as Level 3 training for child protection are in date. The coordinator will link directly with the consultant to confirm theatre slots agreed and ensure that documentation is completed in relation to any NHS time owing and permissions are sought from the care group. They will not be responsible for arranging anaesthetic cover, this remains the responsibility of the Consultant. The coordinator will liaise with the care group operational service to arrange any bed requirements. Private Patient Service Billing Team The billing team is responsible for the day-to-day invoicing and collection of income for private patient services in conjunction with the private patient tariff. All estimate and final invoices will be raised in liaison with the private patient coordinating team. 5.7 5.7.1 5.7.2 5.7.3 5.8 5.8.1 5.9 5.9.1 5.10 5.10.1 5.11 5.11.1 Enquiries relating to private patient billing must be sent via: privatepatientbilling@uhs.nhs.uk. Clinical and administrative staff (All staff levels, all departments) All patients receive the same standard of clinical care. All staff are therefore required to treat patients in the hospital with no distinction between private and non-paying patients. When staff are informed of a private patient, it is their responsibility to ensure that this Patient Category is recorded on all documentation and hospital-based IT systems relating to that patient. All staff are responsible to ensure that any private patient enquiries relating to private patient treatment within their departments or have received a referral by a Consultant, have been alerted to the private patient coordinating team via email privatepatients@uhs.nhs.uk prior to any treatment taking place. For further guidance refer to See Appendix A, Referral process for a private patient to the Private Patient Service. The care groups bookings teams will provide support to consultants requesting theatre sessions, as set out in Appendix G of this policy. They will confirm to the Consultant the agree theatre sessions. They will not be responsible for arranging anaesthetic cover, this remains the responsibility of the Consultant. Administrative and Clerical/secretarial Staff Administrative staff would not normally be expected to provide secretarial services associated with private care unless specifically part of a service arrangement or specifically forms part of their job description. Secretarial duties would be provided privately and paid for by the consultant directly or via specific designated secretarial service provided by the private patient service team. An exception to the rule is where there are times when secretaries are dealing with NHS patients who are converting to private or private patients who are converting to NHS, there will be some secretary duties involved in this transition of a change in Patient Category. Junior medical staff Training grade and non-Consultant career grade doctors will only be asked to see a private patient in an emergency or out of hours. Training grade and non-Consultant career grade doctors are not routinely expected to take part in the management of private patients; this remains the responsibility of the Consultant for any delegated task or treatment carried out by other medical staff. Associate Specialist/Staff Grade/Specialty Doctors Staff may treat the private patients on behalf of the Consultant on a private basis, but only by special arrangement when the Consultant concerned, and the private patient has agreed. The member of staff must have private practising privileges at the Trust and be recognised by the private medical insurers. Consultants Consultants and other clinical staff who see patients on a private basis within the Trust must have approved private practising privileges in place for UHS to treat private patients at UHS. The Consultant must refer to the Private Practising Privileges Agreement which should be read in conjunction with this policy. 5.11.2 Consultants should not spend time discussing private treatment with patients during NHS consultations. When patients raise questions about the availability of private treatment, it is advised that consultants refer enquiries to their private secretaries or to the Trusts private patient service. Consultants may briefly answer factual questions about the availability of private treatment and should then inform the patient’s GP about the request for information. 5.11.3 The Consultant is responsible and accountable for all elements of the patient’s private treatment provided at UHS. The Consultant must ensure that all private referrals and private treatments/procedures provided at UHS have been alerted to the private patient service. Any unknown patients treated may be cancelled if the appropriate process has not been followed. See Appendix A, Referral process for a private patient to the Private Patient Service. 5.11.4 Consultants and Career Grade Doctors who see patients on a private basis within the Trust must: • Comply with ‘A Code of Conduct for Private Practice: Recommended Standards of Practice for NHS Consultants.’ This identifies responsibilities, levels of conduct and principles that should be observed by Consultants when undertaking private practice within the NHS. This also applies to Specialist and Associate specialist (SAS) colleagues; • Comply with all aspects of the Private Healthcare Market Investigation Order 2014 concerning the supply of privately-funded healthcare services in the UK including the supply of information to PHIN – Private Healthcare Information Network; • Comply with the Duty of Candour and Trust policy where it places a legal duty on hospital, community and mental health trusts to inform and apologise to patients if there have been mistakes in their care that have led to significant harm; • Ensure that all private patient activity has been declared to the Trust in accordance with the Trust’s Standards of Business Conduct Policy; • Ensure that care group management are aware of their private work and have jointly agreed where private patient time is scheduled within the Consultant’s or Career Grade Doctor’s job plan, with reference to the Consultant and Career Grade Doctor job planning policy available on Staffnet; • To refer and comply with the rules for extending NHS lists for private practice as set out in Appendix G Consultant Rules for extension of NHS Theatre Lists; • Ensure that the complaints procedure is adhered to as set out in this policy. 5.11.5 Consultants must not propose service prices for private treatments and procedures to patients on behalf of the Trust, unless it is provided in an estimate that has been issued by the private patient billing team. This ensures that the agreed Trust Private Patient Tariff charges are applied and ensure that private patient activity is not subsidised by NHS income; 5.11.6 Ensure capacity and resources are used effectively, wherever possible, private patients should be seen separately from scheduled NHS patients, for example in designated outpatient or diagnostic session. However, clinical need and also effective use of capacity may also lead to integrated patient scheduling, for example theatre lists or diagnostic imaging, when managed within the guidance set out in this policy; 5.11.7 On rare occasions, either the care group management team or the Consultant may request to undertake private work in NHS contracted time. To protect Consultants from any perception of conflict of interests and ensure that Consultants compensates the care group for the time; when this occurs, the Consultant must complete Appendix F NHS time owing, sections A and B; 5.11.8 Ensure that private commitments do not prevent staff from being able to attend an NHS emergency while they are on call for the NHS, including any emergency cover that they agree to provide for NHS colleagues. In particular, private commitments that prevent an immediate response should not be undertaken at these times. If private activity must proceed while on call, it is the Consultant’s responsibility to ensure that cover of an equivalent level of seniority has been arranged and that this has been communicated to switchboard and the other members of the medical team; 5.11.9 Ensure that all relevant staff are fully aware when a patient is private. This includes informing pathology, pharmacy, diagnostics imaging, theatres, ICU, wards and any follow-up care. Also ensure that private is selected under “category” section within the IT patient and requesting systems; 5.11.10 Ensure that private patient correspondence is not written on Trust headed paper, or typed by Trust staff during their NHS working hours; 5.11.11 Ensure that NHS secretaries are not used to provide support to private practice; a consultant must provide their own secretarial support by either paying for their own private secretary or using the Trust private secretary service, see Appendix D Secretary service expression of interest form; 5.11.12 Notify the private patient service of any impending private patient bookings on a frequency agreed by those individuals. This notification must be in advance of the treatment allowing time for payment/authorisation to be obtained. All private patient activity should be notified to the private patient service team via email privatepatients@uhs.nhs.uk prior to treatment taking place; 5.11.13 Ensure that information relating to the private patient’s care is given to the private patient service coordinator (e.g. procedure codes, level of bed, length of stay and any associated requirements.) to enable pre-authorisation with PMIs or to enable any estimates or invoices to be raised accurately prior to any procedure being provided; 5.11.14 Ensure the patient is aware of their Category (e.g. NHS or private) and are informed of consultation, treatment, tests or any associated costs relating to this provision of care in compliance with the requirements set out in the Private Healthcare Market Investigation Order 2014; 5.11.15 Ensure that insurance companies are updated upon request with the required medical information (e.g. treatment given to date, treatment plans, possible discharge dates and future care) and provide medical reports as required if any changes occur to the original plan to allow continued authorisation of the episode of care; 5.11.16 As a measure of good practice, ensure that the private health notes, verbal/telephone discussions with patients or images relating to the patient’s condition and previous procedures/treatments given are copied and placed in the relevant NHS health notes patient systems and other patient systems such as EDMS; this will ensure continuity of information relating to the treatment of the patient during their time at the Trust. 6 Indemnity 6.1 The Trust will continue to indemnify other medical staff and allied professionals for negligence in regard to private activity conducted on site, to the same extent as the indemnity for NHS activity. With the exception of Consultants who are directly responsible for their Private Patients and will maintain their own indemnity cover. 6.2 A copy of the indemnity certificate must be provided and logged annually with the private patient office in accordance with the terms and conditions set out in the Trust’s private practising privileges agreement. Failure to provide a valid indemnity certificate will affect the consultants practising privileges at the Trust. See section 19 of this policy and Appendix B for private practising privileges application. 6.3 A Consultant who does not have their own private professional indemnity and private practising privileges at the Trust will not be indemnified or authorised to oversee the planned care of another private Consultant’s private patients. 6.4 In line with NHS indemnity guidance, NHS bodies will not be responsible for a healthcare professional’s private practice, even in an NHS hospital. However, where junior medical staff, nurses or members of professions supplementary to medicine are involved in the care of private patients in NHS hospitals, they would normally be doing so as part of their NHS contract, and would therefore be covered. 7 Principles of Private Patient Practice 7.1 Private patients must receive the same high-quality care and attention that we provide to all our patients. There must be compliance with our standard procedures (e.g. for pre-operative assessment and MRSA screening and any other required testing) to ensure these apply equally to both NHS and private patients. 7.2 Income, with the exception of professional fees from private activity, will be reinvested into the Trust. The Trust must ensure that the provision of private activity does not interfere with or interrupt NHS service provision. 7.3 Under no circumstances should a practitioner cancel an NHS patient’s appointment to make way for a private patient (unless a clinical emergency and with the agreement of the service manager as set out in this policy). 8 Private patient facility charges and payment 8.1 The Trust reserves the right to charge clinical staff for the services, equipment and space used for private activity. It is the clinical staff member’s responsibility to recover these charges as part of their private practice. The private patient billing team will make available the charges for use of the services for private activity, on request. These will set out the terms and conditions of the arrangement. 9 Identification of private patients 9.1 It is the Consultant’s responsibility, or staff authorised on their behalf, (e.g. private secretary or private patient service) to ensure that all relevant departments are informed of a patient’s private Category, especially when a direct referral is made, or test requested, and to provide details of the procedure/treatment required. Private patients must always be clearly identified as ‘Private’ on all documentation, IT systems and on all requests for tests and referrals such as pathology and diagnostic imaging. In the Patient Admissions/ Outpatient Systems, PAS, the administrative Patient Category must be marked as ‘P’. 10 Treating a private patient 10.1 Private patients may be treated within any of the Trust’s facilities providing they, or their approved guarantor, have signed an “Undertaking to Pay form” agreeing to pay for their private hospital treatment. This form must be completed by authorised personal within the private patient service team prior to treatment. 10.2 The treatment of Private Patients must not interfere with the treatment of NHS patients. Any treatment must be based on clinical need, with NHS patients having priority where the need is equal. 10.3 The Trust will charge Private Patients for accommodation but does not guarantee a particular level of accommodation. The charge may vary depending on facilities available, and will include nursing and other staffing costs, standard drugs, dressings, and other expenditure. 11 Change of administrative Patient Category 11.1 Change of Patient Category from Private to NHS 11.1.1 Patients who choose to be treated privately are legally entitled to change their administrative Patient Category and receive NHS services on exactly the same basis of clinical need as any other NHS patient. 11.1.2 The right to free NHS services under the National Health Service Act 2006 is an underlying one and does not cease to exist simply because the patient in question is receiving private treatment. 11.1.3 Patients cannot opt in and out of NHS treatment from Private to reduce costs or to speed up treatment by disadvantaging other NHS patients. 11.1.4 Any patient changing their administrative Patient Category after having been provided with private services should not be treated on a different basis to other NHS patients as a result of having previous private Patient Category. 11.1.5 Where a patient chooses to change in Patient Category all concerned have a joint duty to ensure that the patient receives seamless care and that arrangements are 11.1.6 11.1.7 made with the NHS for such a change of Patient Category to occur in a planned and orderly manner. A private inpatient has a similar legal entitlement to change their administrative Patient Category during the course of their stay in hospital. The patient might decide to exercise that entitlement should a significant, unforeseen change in circumstances transpire e.g. when they enter for a minor procedure and are found to be suffering from a different, more serious condition or that they require emergency care for an unpredicted complication during their admission. A Change of Patient Category form (Appendix E) will need to be completed for all Private Patients wishing to change from private to NHS Patient Category, the form will need to be given to the service clinical lead for approval and a signed copy sent to privatepatients@uhs.nhs.uk to ensure a record of this decision is kept on file. o A change of Patient Category from private to NHS must be accompanied by an assessment by an NHS Consultant of the patient’s clinical priority for treatment as an NHS patient. o Patients referred for an NHS service following a private consultation or private treatment should join an NHS waiting list at the same point as if the consultation or treatment were an NHS service. Their priority on the waiting list should be determined by the same criteria applied to NHS patients. o If a patient is admitted to the Trust as a private inpatient, but subsequently decides to change to NHS Patient Category before having received treatment, there should be an assessment to determine the patient’s priority for NHS care before proceeding with the treatment and then adding to the relevant NHS waiting list. o The private patient must be made aware that they remain liable to charges for the period during which they were private up to their change to NHS Patient Category. In some circumstances, unless it is clinically inappropriate to do so, it may be necessary to discharge the patient and then readmit them at such time as they would normally have been admitted should they have retained NHS Patient Category throughout. 11.2 Changing of Patient Category from NHS to private 11.2.1 Patients may change their administrative Patient Category to private. The Consultant in charge of their care must agree, in the first instance, and the details of the facilities, charges and billing procedures must be clearly stated to the patient. 11.2.2 The Consultant receiving payment and responsible for the private patient must ensure that the patient is aware of the expected charges and has adequate funds or insurance cover for any treatment to take place. This applies even in emergency cases. 11.2.3 The Consultant must ensure that the patient is aware that the treatment they will receive is private. It is the Consultant’s responsibility to ensure that the change of 11.2.4 administrative Patient Category is properly recorded and that the private patient service is informed immediately of this change. In any instance when a patient wishes to transfer from NHS to private Patient Category during an episode of care, the Consultant must complete a ‘Change of Patient Category’ form (Appendix E) which should be signed by the Consultant and forwarded to the private patient service privatepatients@uhs.nhs.uk for administration purposes and to ensure a record is kept on file. 12 Top up drugs 12.1 The Department of Health and Social Care issued guidance in 2009 stating that patients may pay for additional private healthcare while continuing to receive care from the NHS (Department of Health Guidance on NHS patients who wish to pay for additional private care, March 2009). 12.2 The rules for Top Up cases include: • The Trust must never subsidise private care with public money. • Patients should never be charged for their NHS care, nor be allowed to pay towards an NHS service (except where specific legislation is in place to allow this). • No patient should lose their entitlement to the NHS care that they would have otherwise received, simply because they opt to purchase additional care for their condition. All reasonable avenues for securing NHS funding must be exhausted before suggesting a patient’s only option is to pay for care privately. • Private Top Up care and NHS care must be kept as clearly separate as possible and private care should be carried out at a different time and place to the NHS care that a patient is receiving. • Departing from these principles of separation should only be considered where there are overriding concerns of patient safety, rather than on the basis of convenience. Such decisions should be agreed in advance with the clinical lead or equivalent. • Where a decision has to be made without gaining prior approval from the clinical lead on the grounds of clinical urgency, the clinical lead should be informed as soon as possible afterwards. A record should be kept of all decisions to depart from these principles. 12.3 Top up Charges 12.3.1 The Private Patient Service with the patient’s Consultant must ensure that a private patient is provided with a written estimate of the costs of Top Up treatment, this will be provided by the private patient billing team and must not be predicted or guessed by the consultant to the patient. The patient must meet any additional costs associated 12.3.2 12.3.3 12.3.4 12.4 12.4.1 12.4.2 12.4.3 12.4.4 12.4.5 with the private element of care, such as additional treatment needed for the management of side effects. Any care which the Trust would normally have provided in the course of good NHS practice should continue to be offered free of charge on the NHS. Where the same diagnostic, monitoring or other procedure is needed for both the NHS element of care and the private element, the NHS should provide this free of charge as part of the patient’s NHS entitlement. Patients should not be unnecessarily subjected to two sets of tests or interventions. The Top up drugs will be charged in line with the Private Patient Tariff. Communication of top up drugs Effective communication with patients and patient representatives about treatment options should be maintained at all times. The necessary information must be provided for patients to make an informed decision about their care, including high quality written information. In line with current best practice Consultants should consider signposting patients to other sources of helpful information, such as relevant national or local charities or patient groups. If a patient seeks information on how to access a private treatment option, the Code of Conduct for Private Practice makes clear that NHS Consultants should provide them with full and accurate information about the private services that can be provided. It is good practice for the outcomes of cases involving the administration of unfunded treatments to be discussed at multi-disciplinary clinical governance meetings. The Trust should continue to provide free of charge all care that the patient would have been entitled to had he or she not chosen to have additional private care. It must always be clear whether an individual procedure or treatment is privately funded or NHS funded. 13 Overseas Private Patient 13.1 An overseas private patient is a patient who wants to pay for planned private treatment at the Trust, it is not to be confused with Overseas Visitors who would need to be tested for ordinarily residency to be entitled to receive free NHS treatment as per the guidelines NHS Overseas NHS visitors: implementing the charging regulations. Any overseas visitor patients should be referred via email to overseasteam@uhs.nhs.uk to determine eligibility. 13.2 If an overseas patient elects to be treated as a private patient, regardless of their overseas Patient Category, the charge of treatment will be in line with the Trust’s Private Patient Tariff charge. The patient will also be classed as a private patient and this policy will apply. 13.3 Should an Overseas private patient wish to convert to NHS, the consultant must arrange for the Overseas Visitors Team to be contacted to establish their eligibility to free NHS care via email overseasteam@uhs.nhs.uk and Appendix E Notification in change of Patient Category form will need to be completed. 13.4 If a patient is not deemed eligible for free NHS treatment, the patient will be chargeable in line with the overseas NHS tariff. Private patients visiting the UK specifically for treatment are required to declare this on their visa application. 14 Category II patients 14.1 Category II patients are patients that are having investigations or tests for non-clinical reasons. Examples are x-ray or scans made on behalf of insurance companies or requested by individuals for employment or emigration, also cardiac tests for DVLA purposes. 14.2 As with all private patient work, Category II work must be carried out in the Consultant’s own time. Category II work may only be carried out with the agreement of the care group management and follow the private patient policy guidance. 14.3 All Category II patients must be alerted to the private patient coordination team at the earliest possibility to ensure that any hospital fees are charged accordingly. 15 Repatriation of private patients 15.1 For private patients that are ready to be discharged who require repatriation to another country, the following applies: 15.1.1 For patients who are insured including repatriation cover, will be expected to use their insurance policy to arrange for repatriation in conjunction with the private patient coordinator who will arrange the transport and link with the ward manager who will source a bed at the destination hospital where applicable. 15.1.2 For patients who are insured for their care at UHS but their policy excludes repatriation cover, the patient will be responsible to pay for all associated repatriation costs. The private patient service will provide support in arranging the transport for the transfer to the agreed destination and liaise with the ward manager/bed manager to source a bed at the destination hospital where applicable. The patient will be invoiced for the full cost of the repatriation. 15.1.3 For patients who are not insured and have no repatriation insurance the patient will be responsible to pay for all associated repatriation costs. The private patient service will provide support in arranging the transport for the transfer to the agreed destination and liaise with the ward manager to source a bed at the destination hospital where applicable. The patient will be invoiced for the full cost of the repatriation. 15.1.4 Where a patient requires a nurse escort on a scheduled flight, reasonable endeavours will be made to assist in the organisation of an escort for the patient using an external nursing service, however, the patient will be directly responsible for paying for these services. If a member of UHS staff is used for the repatriation, the patient will be charged for all associated costs upfront. 16 Complaints 16.1 If a patient wishes to make a formal complaint, then the following process must be followed as set out in Appendix C Private Patient Complaints Procedure. If a complaint has not been resolved internally, with the patient or patient representative then this can be escalated to an independent adjudication service ISCAS for final resolution. 16.2 Consultants must inform the Private Patient Service privatepatients@uhs.nhs.uk about any complaints they receive that relate to their professional services at the Trust. 16.3 A Consultant is not authorised to respond to the complainant on behalf of the Trust. The Trust will provide a single response to a formal complaint that combines all parties’ responses to the complaint. 16.4 The Private Patient Service will provide an update of complaints received with details of resolution for the Private Healthcare programme board on a quarterly basis. 17 NHS time owing 17.1 The Trust is keen to maximize external income through private patient activity, the profits of which will be reinvested into the Trust for the benefit of all of our patient services. To ensure there is no perception of a conflict of interests, where a Clinician either asks to undertake, or is asked to undertake, private activity during paid NHS time (which includes SPA and administrative, or time on call), the Trust requires a log to be kept of time owing/time owed. 17.2 This request is to be agreed in advance with the clinical lead and Care Group Manager. If the private activity is an emergency then this request can be raised in retrospect to the clinical lead as soon as is possible after the event. Time owing is to be repaid to the Department at a mutually agreeable future date/time but within no more than three months from the event. 17.3 The repayment of time owing must mirror the number of NHS patients that were displaced. Time owing must be performed over and above current NHS job plan and be performed as unpaid overtime, this could be before or after an NHS list or at a separate evening/ weekend. Appendix F, NHS time owing, Part A should be completed. At the same time, the activity to make up NHS time from private activity should be identified and agreed with the consultant’s line manager and Part B should be completed. 17.4 If the consultant is unable to identify a time for when the NHS activity can be performed, then the original private patient request will not be approved. 18 Training 18.1 This Private Patient Policy does not have a mandatory training requirement or any other specific training needs, however anyone required to use any of the documentation cited in the policy should contact the Private Patient Service for assistance if required. 18.2 The Private Patient service will provide any ward training as and when required. 18.3 The Private Patient service will provide support in setting up new processes and procedures for private services at UHS. 19 Private Practising Privileges at UHS 19.1 All consultants or clinicians wanting to carry out private practice at UHS must have authorised private practising privileges at the Trust prior to any private work being carried out. 19.2 Consultants must seek prior approval and must submit an active medical indemnity certificate every year and be compliant with annual appraisal. Consultants will require and evidence level 3 child protection training if they treat children privately. 19.3 The consultant/ clinician will be required to complete a private practising privileges form (see appendix B Private Practising Privileges form), provide necessary certification including indemnity certificate and sign the Trust’s private practising privileges agreement. The completed forms and relevant supporting documentation should be sent to the Private Patient Service via email privatepatients@uhs.nhs.uk where the following process applies: • Their Divisional Clinical Director will authorise privileges as coordinated by through the private patient service. • A letter will be issued to the consultant/clinician confirming the outcome of their private practising privileges request. • All authorised consultants/clinicians will be registered on the Trust private practising privileges register. • It is the consultants/clinician responsibility to ensure that a valid indemnity certificate is provided each year and sent to the Private Patient Service, without this, privileges will be suspended. 19.4 Maintaining Private Practice Privileges at UHS • In order to maintain private practice privileges at UHS, consultants are expected provide annually to the private patient team an in-date indemnity certificate, last appraisal date, (VLE) Level 3 child protection completion date (where applicable) and to meet the requirements of the GMC with regard to appraisal and revalidation. Failure to provide this information or engage with appraisal and revalidation processes will result in suspension of private practice privileges at UHS until this is rectified. • All private practice must be included in the Consultant’s job plan and signed off. A job plan containing more than 15 PAs of activity (NHS+PP) will not likely be approved on safety grounds. 20 Use of NHS and Trust Brand Logo 20.1 The letters ‘NHS’ or the NHS logo, which form part of the Trust’s organisational logo, are protected by law and can only be used in where there is a benefit to the NHS. Neither the NHS logo or the Trust’s logo should be used in any marketing information or materials relating to your own private practice as this may be seen as the NHS formally endorsing these services. If you wish to promote the fact that you work for the NHS or the Trust then this should be done in an explanatory or descriptive manner using plain text. 20.2 The Trust is also subject to the following restrictions on the use of the NHS logo or its organisational logo in relation to its own private patient activities: • Trusts that offer private healthcare services must market and promote their private healthcare services completely separately. • Trusts are allowed to use their NHS organisation’s logo on communications specifically about their
Url: /Media/UHS-website-2019/Docs/Policies/Private-patient-policy.pdf

Transport to and from hospital: Orthopaedic outpatients at Royal South Hants Hospital - patient information

Description: This factsheet contains helpful information about organising hospital transport to and from your orthopaedic appointments at Royal South Hants Hospital (RSH) and what you need to bring with you.
Url: /Media/UHS-website-2019/Patientinformation/Muscles,jointsandbones/Transport-to-and-from-hospital-Orthopaedic-outpatients-at-Royal-South-Hants-Hospital-3706-PIL.pdf

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