Browse site A to Z

Search results

Go To Simple Search

Search Type: Criteria:

Long-term continuous positive airway pressure (CPAP) treatment - patient information

Description: This leaflet explains what obstructive sleep apnoea (OSA) is, what long-term continuous positive airway pressure (CPAP) treatment for OSA involves and how to use and look after the CPAP treatment equipment safely at home.
Url: /Media/UHS-website-2019/Patientinformation/Respiratory/Long-term-continuous-positive-airway-pressure-CPAP-treatment-3385-PIL.pdf

Patient-initiated follow-up (PIFU) for CLL, SLL, LMZL and HCL - patient information

Description: This booklet contains a summary of patient-initiated follow-up (PIFU) for chronic lymphocytic leukaemia (CLL), small lymphocytic lymphoma (SLL), leukaemic marginal zone lymphoma (LMZL) and hairy cell leukaemia (HCL).
Url: /Media/UHS-website-2019/Patientinformation/Cancercare/Patient-initiated-follow-up-PIFU-for-CLL-SLL-LMZL-and-HCL-3322-PIL.pdf

UHS AR 22-23-6

Description: 2022/23 Incorporating the quality account University Hospital Southampton NHS Foundation Trust Annual Report and Accounts 2022/23 Presented to Parliament pursuant to Schedule 7, paragraph 25(4)(a) of the National Health Service Act 2006 © 2023 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 33 Directors’ report 34 Remuneration report 57 Staff report 71 Annual governance statement 91 Quality account 106 Statement on quality from the chief executive 107 Priorities for improvement and statements of assurance from the board 110 Other information 188 Annual accounts 222 Statement from the chief financial officer 223 Auditor’s report 224 Foreword to the accounts 230 Statement of Comprehensive Income 231 Statement of Financial Position 232 Statement of Changes in Taxpayers’ Equity 233 Statement of Cash Flows 234 Notes to the accounts 235 5 Welcome from the Chair and Chief Executive Officer University Hospital Southampton NHS Foundation Trust (‘UHS’ or the ‘Trust’) experienced another challenging year during 2022/23. Nonetheless, the Trust and its staff have continued to deliver for patients and the wider system in which it operates. Trust highlights from 2022/23 include: • Delivering an 8% increase in activity (compared to 2019/20) under the elective recovery programme, which places us as one of the top performing trusts in England. • Being recognised in the NHS staff survey as the seventh highest trust for recommendation as a place to work nationally and the best performing trust in opportunities for career development. • Celebrating 50 years as a medical school with the University of Southampton and continuing to pioneer UK and world-first research studies. • Enhancing the reputation of our specialist care – for example our bone marrow transplant team at UHS have the best patient outcomes in Europe. However, as was the picture across the country, UHS had an extremely challenging winter with attendances at our emergency department often in excess of 400 a day. This was driven in part by high prevalence of streptococcus A (strep A) in the community along with other seasonal illnesses such as influenza and high incidences of COVID-19 at times. Moreover, the lack of availability of care home beds and other care packages in the community has resulted in challenges in discharging patients who are ready to leave hospital and therefore we have been operating at or near to capacity throughout the year. At the time of writing, there continues to be operational pressures due to industrial action by the Royal College of Nursing and British Medical Association. Throughout the disputes, we have attempted to balance the right of our staff to strike with the need to minimise the impact on the Trust’s operations and patients and ensure that safety was not compromised. Our leadership team has engaged proactively with the unions to agree, where possible, derogations (i.e. services that will continue to be staffed during strikes) to ensure that the running of our hospitals can continue and that patients remain safe. We would like to express our thanks to all staff who have gone over and above during these periods of industrial action by being willing to do different work to usual, often at anti-social times of the day. While we cannot influence national negotiations, we are focusing on what we can control within UHS. Our people strategy published last year sets out how we will grow and deploy our workforce of today and the future as part of a thriving community to deliver world-class patient care. Building on this, we have recently launched our inclusion and belonging strategy so that as a leadership team we can deliver what is required for all our workforce to feel they can belong and thrive at UHS. The Trust achieved its Cost Improvement Plan (CIP) target of £45.6m for 2022/23, the highest in our history but despite this, ended the year with a deficit of £11m. The deficit was driven by a combination of factors including a substantial increase in energy prices, higher costs of medicines and equipment and temporary staffing costs as well as changes in recent years in respect of the NHS funding infrastructure, which adversely impacted the Trust relative to others during the year. In terms of the broader context, the Hampshire and Isle of Wight Integrated Care System, in which the Trust operates, reported an overall deficit for 2022/23 driven in part by a significant increase in staffing numbers when compared to 2019/20 as well as structural factors. 6 We have continued to make progress on our estates strategy, building new theatres and carrying out improvements to existing facilities, as well as opening a new park and ride for staff at Adanac Park and progressing plans for a new innovation campus there. During 2022/23 we invested over £88m of capital expenditure to meet our ambition of increasing capacity and improving services in order to manage the increasing demand. All development is underpinned by our green plan, which sets out areas of focus for decarbonising UHS and achieving the net zero target set by the NHS. The Trust has continued to support the Hampshire and Isle of Wight Integrated Care System, which was formed on 1 July 2022 to facilitate integration and collaboration across health and social care partners in the region. In particular, UHS has worked closely with the Integrated Care Board and other providers in the development of the operating plan for 2023/24. We have also continued to work with other partners in the region, including local authorities and the University of Southampton. The 13,000 staff of UHS are our greatest asset and we would like to express our gratitude to them for continuing to go above and beyond to put patients first under very challenging circumstances. Without our staff, we would be unable to fulfil our ambition to be a world-class organisation with world-class people delivering world-class care. Jenni Douglas-Todd Chair 26 June 2023 David French Chief Executive Officer 26 June 2023 7 PERFORMANCE REPORT Performance report Introduction from the Chief Executive Officer The Trust experienced another challenging year with the need to balance the delivery of quality patient care with a significant increase in demand for the Trust’s resources and the need to do so whilst maintaining a sustainable financial position. The Trust saw the number of patients on a waiting list under the 18-week referral to treatment pathway increase to just over 55,000 patients at the end of the year. Despite this, however, the Trust was successful in reducing the number of patients waiting more than 104 weeks to nil and in reducing the number of patients waiting more than 78 weeks to 14 by the end of the year. In addition, the Trust’s performance under the elective recovery programme placed it as one of the topperforming trusts in the country. Demand for non-elective care also significantly increased during the year with the emergency department seeing more than 400 attendances per day at some points, especially during the winter months. The industrial action seen in the latter part of 2022/23 placed further pressure on the Trust and resulted in a need to cancel elective procedures and outpatients appointments. However, on balance, the Trust was able to manage these events through effective planning and the engagement and support of its staff. Although the Trust was successful in recruiting to substantive roles, especially in terms of reducing the number of Health Care Assistant vacancies, the anticipated reduction in use of bank and agency staff was not seen. This, among other factors, such as the substantial increase in energy costs and the rate of inflation, posed a significant challenge in terms of the Trust’s financial position. Despite achieving savings of £45.6m, the Trust reported a deficit of £11m for 2022/23. 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 billion in 2022/23. It is based on the coast in southeast 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 more than 3.7 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 160,000 inpatients and day patients, including about 75,000 emergency admissions sees over 650,000 people at outpatient appointments deals with around 150,000 cases in our emergency department delivers more than 100 outpatient clinics across the south of England, keeping services local for patients 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 55% is paid for by NHS England and 43% by the Hampshire and Isle of Wight Integrated Care Board. 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 (ICS) 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 (ICB). The ICP is a statutory committee jointly formed between the NHS integrated care board and all uppertier local authorities that fall within the ICS area. The ICP will bring 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 establishment of ICBs resulted in clinical commissioning groups (CCGs) being closed down. The Trust has been a university teaching hospital since 1971. The diagram below provides an overview of the overall organisational structure of the Trust. Division A Surgery Critical Care Opthalmology Theatres and Anaesthetics Public and foundation trust members Council of Governors Board of Directors Executive Directors Division B Division C Division D 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 Our values describe how we do things 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. Our 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 our staff had experienced during the COVID-19 pandemic and what we had learnt from this. The vision for UHS is to become an organisation of world class people delivering world class care. Our strategy is organised around five themes and for each of these it describes a number of ambitions we aim 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 2022/23 these objectives included: Outstanding patient outcomes, experience and safety Pioneering research and innovation World class people Integrated networks and collaboration Foundations for the future • Recovery, restoration and improvement of clinical services • Introducing a robust and proactive safety culture • Empowering and developing staff to improve services for patients • Always Improving strategy • Delivering a high-quality experience of care for all • Delivery of year two of the research and innovation investment plan • Strategy and partnership working • Growing, developing and innovating our workforce • A great place to work, develop and achieve • Compassionate and inclusive workplace for all • We Work in partnership with Integrated Care System and Primary Care Networks • Integrated Networks and Collaborations • Establishing Southern Counties Pathology Network • Establishing the Wessex Imaging Network • Develop Collaborations strategy • Creating a sustainable financial infrastructure • Making our corporate infrastructure fit for the future to support a leading university teaching hospital in the 21st century • Recognising our responsibility as a major employer in the community of Southampton and our role in delivering a greener NHS Performance against these objectives will be monitored and reported to the Trust’s Board on a quarterly basis. 14 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 2022/23 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 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 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 and support prioritised investment as identified in the Trust’s capital plan within locally available limits (capital departmental expenditure limit (CDEL)). • 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 2022/23, the Trust continued to experience the impact of the COVID-19 pandemic. The need to ensure a safe environment for patients through stringent infection control processes impacted the Trust’s capacity due to the need to isolate patients with COVID-19 in separate areas of the hospital. In addition, outbreaks of norovirus during the winter months placed further pressure on hospital capacity. The impact of the pandemic continued to be felt in terms of staff absence due to becoming infected with COVID-19 as well as the significant impact on staff mental health. The higher than normal (i.e. pre-COVID) levels of staff absence placed additional strain on the Trust’s operations and led to increased expenditure due to the requirement to enlist bank and/or agency staff to maintain safe staffing levels. 15 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 pressures of the COVID-19 pandemic led to increases in the waiting times for patients and the number of patients waiting for more than a year increased significantly. During the year, the Trust achieved its goal of no patients waiting more than 104 weeks by July 2022 and finished the year with only 14 patients waiting for more than 78 weeks. However, the length of time patients are waiting for treatment remains one of the key risks for the Trust. This situation was compounded by the sustained demand for non-elective activity, which saw attendances at the emergency department rise to over 400 patients per day during some periods of 2022/23 and was consistently higher than previously was the case. The significant increase in referrals, often requiring more complex treatment, has seen the number of patients on a waiting list under the 18-week referral to treatment pathway increase to just over 55,000 patients at the end of the year. In addition, the industrial action during the year placed further strain on the Trust’s ability to both provide urgent care and manage its elective recovery programme. Quality and compliance Furthermore, difficulties in obtaining care home beds and other care packages in the community has resulted in challenges in discharging patients who are ready to leave hospital and therefore the Trust has been operating at or near to capacity throughout the year. The Trust continued to monitor the quality of care delivered throughout 2022/23. The Trust continued its focus on infection prevention and control, which had proven successful during the COVID-19 pandemic. The Trust progressed its Always Improving strategy and successfully supported the identification and implementation of 84 quality improvement projects. In addition, the Trust continued to implement the patient safety incident response framework as well as taking other steps to drive a safety culture within the organisation. Furthermore, the Trust conducted further trials of shared decision making between clinicians and patients and is a leading site nationally for shared decision-making principles. Further information can be found in the Quality Account. 16 Partnerships The new arrangements for integrated care systems were implemented in July 2022 with the Trust becoming part of the Hampshire and Isle of Wight Integrated Care System. As such, the Trust’s senior management frequently meets with peers from across the system to consider and agree matters of wider concern across the system. In addition, the Trust worked with the Integrated Care Board in order to develop its financial and capital plans for 2023/24 and beyond. The Trust also attends the Southampton Health and Wellbeing Board at Southampton City Council and in the Hampshire and Isle of Wight Acute Provider Partnership Board. During 2022/23, the Trust continued to progress research activities and opportunities with the University of Southampton and Wessex Health Partners. Workforce In addition, work continued in the development of an elective hub at Winchester with Hampshire Hospitals NHS Foundation Trust, which will provide the Trust with additional capacity to carry out its elective programme. The Trust’s key areas of focus during 2022/23 were in respect of increasing the substantive workforce and reducing staff turnover. 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 1,068 whole-time equivalents above its plan for 2022/23. Included in this figure is the TUPE transfer of genomics staff from Salisbury. A particular area of focus was the recruitment of Health Care Assistants where the Trust was successful in reducing the number of vacancies from 27% to 18%. Whilst the Trust was successful in reducing staff turnover from 14.9% in 2021/22 to 13.5%, it remained above the 12% target. However, the Trust did experience a reduction in staff absence from 4.7% in April 2022 to 4.3% in March 2023, and initiatives to improve staff wellbeing were an area of focus during the year. Estate Innovation and technology The industrial action in late 2022 and early 2023 posed significant challenges for the Trust, including in terms of the need to engage additional temporary staff to ensure patient safety. The Trust continued to invest in and develop its estate during 2022/23 including successful completion of the Paediatric Intensive Care Unit project, which delivered single rooms and specialist accent lighting alongside delivery of a ‘twin care’ room. There were a number of other significant projects during the year, including refurbishments of wards and work on creating new theatres as well as projects to improve staff wellbeing. These were part of over £88m of capital expenditure in 2022/23 that also included equipment, digital and the backlog maintenance programme. The Trust continued to promote research and development during 2022/23, including through partnerships with the University of Southampton and Wessex Health Partners. Furthermore, the Trust continued to examine ways to make use of technology to improve its service delivery. In particular, the Trust has promoted the use of MyMedicalRecord, which gives patients the ability to co-manage their healthcare online and through an app. 17 Sustainable financial model The Trust did not achieve breakeven status at the end of 2022/23 and reported a deficit of £11.037m at year-end. This was due to a number of factors, including the Trust’s underlying deficit as well as the increase in energy prices. The Trust was more exposed than most to fluctuations in the wholesale price of gas due to its reliance on a gas-powered energy supply. In addition, the Trust’s 8% uplift in elective activity when compared to 2019/20 was not fullyfunded, which placed further pressure on the Trust’s existing financial resources, which had been used to ensure a breakeven position in 2021/22. The continued use of bank and agency staff as well as the costs of industrial action in late 2022 and early 2023 further eroded the Trust’s financial position. Notwithstanding the above, the Trust did succeed in obtaining a number of sources of nonrecurrent funding during the year, including a successful bid for £29.4m of funding through the Public Sector De-Carbonisation Fund, which will be used to fund green initiatives as part of the Trust’s capital programme. The financial outlook across the NHS continues to appear very challenging during 2023/24 and the Hampshire and Isle of Wight Integrated Care System is forecasting one of the highest deficits in England. 18 Performance analysis COVID-19 Impacts Although the pandemic has ended and serious cases of COVID-19 have reduced significantly, the Trust continued to be impacted by COVID-19 during 2022/23. Heightened infection prevention control measures in respect of patients with COVID-19 placed additional stress on the Trust’s capacity due to the need to isolate those patients and there was a consequential reduction in the Trust’s ability to make most efficient use of its available spaces. Furthermore, the ongoing impact on the Trust’s staff has led to higher staff absence than was the case prior to the pandemic, particularly due anxiety, infectious diseases and colds and flu. • The Trust experienced an average number of 98.7 patients per day who tested positive for COVID-19. During the winter months, this number increased substantially to nearly 200. • During the year, an average of 3.6 intensive care/high-dependency beds per day were occupied by COVID-19 patients. However, at times this increased to as much as ten. • Although staff sickness rates remained higher than pre-pandemic, the Trust saw a decrease in the absence rate from 4.7% at the beginning of 2022/23 to 4.3% by the end of the period. COVID-19 Cases UHS average number of confirmed COVID-19 patients in bed (08:00 census) 250 200 150 100 50 0 4/1/20225/1/2022 6/1/20227/1/2022 8/1/2022 9/1/202210/1/202211/1/202212/1/2022 1/1/2023 2/1/20233/1/2023 Intensive care/higher care beds UHS average number of confirmed COVID-19 patients in an ICU/HDU bed (08:00 census) 12 10 8 6 4 2 0 4/1/20225/1/2022 6/1/20227/1/2022 8/1/2022 9/1/202210/1/202211/1/202212/1/2022 1/1/2023 2/1/20233/1/2023 19 Number of patients Emergency access through the emergency department The Trust continued to experience high demand from patients presenting to receive care in the emergency department throughout the year above that seen prior to the COVID-19 pandemic. In particular, during the period between January and March 2023, the Trust averaged 352 attendances per day compared to 301 during the same period in 2019/20, an increase of 17%. The Trust also saw a significant increase in attendances during December due to both seasonal illnesses, but also due to the prevalence of streptococcus A in the community with attendances sometimes over 400 per day. Furthermore, the industrial action during the latter part of 2022 and early 2023 placed further pressure on the Trust’s ability to deliver services. In addition, the difficulties in discharging patients in need of care either at home or in another setting resulted in reduced flow from the emergency department to the relevant ward(s), which placed further strain on the Trust’s performance. During the year, in order to reduce emergency department attendances, the Trust trialled using General Practitioners to triage and see more straightforward patients who would otherwise have presented to the emergency department. Although this trial did result in a slight reduction in terms of number of patients and waiting times in ambulatory majors and majors, the affordability and value for money of this scheme is under review. Number of patients presenting to the emergency department 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 Apr-22 May-22 Jun-22 Jul-22 Aug-22 Sep-22 Oct-22 Nov-22 Dec-22 Jan-23 Feb-23 Mar-23 As a result of the increase in demand upon the emergency department, there continued to be a significant adverse impact on timeliness of care. The Trust failed to meet the national target of 95% of main emergency department/type 1 attendances seen within four hours, achieving 64.5% in March 2023, although this performance was above average in England. 20 % standard met Emergency access 4hr standard UHS vs NHSE average Type 1 performance 70% 0 10 60% 20 50% 30 40 40% 50 Apr-22 May-22 Jun-22 Jul-22 Aug-22 Sep-2 2 Oct-22 Nov-22 Dec-22 Jan-23 Feb-2 3 Mar-23 UH S NHSE average UHS rank amongst NHSE trusts Rank Ambulance handovers are an area of focus for NHS England, with a target of all handovers having to take place within 15 minutes and none waiting more than 30 minutes. The Trust performed well in this area with an average handover time of 17 minutes, having made the conscious decision to ensure that patients did not queue in ambulances at the expense of patients being queued within emergency department majors – thus impacting the Trust’s four-hour target, but meaning that ambulances were not queued outside the hospital as was seen in other areas of the country. Elective Waiting times Demand The year saw a continuation of the trend of increasing elective referrals experienced in 2021/22 following the pandemic, and referral rates continued to be above those seen prior to the pandemic. UHS Accepted Referrals 30,000 25,000 20,000 15,000 10,000 5,000 0 Apr-22 May-22 Jun-22 Jul-22 Aug-22 Sep-2 2 Oct-22 Nov-22 Dec-22 Jan-23 Feb-2 3 Mar-23 Number of accepted referrals 21 Activity The Trust experienced significant increases in terms of the number of hospital appointments, diagnostic tests and elective admissions during the year, exceeding levels in previous years. The Trust was one of the top performing trusts in terms of its elective recovery programme, achieving an 8% increase in its elective activity during the year when compared to 2019/20. However, performance in this area and in terms of outpatients appointments was negatively affected by the industrial action by nurses, junior doctors and other members of staff, which took place in late 2022 and early 2023 due to the need to cancel non-urgent procedures and appointments in favour of maintaining safe staffing levels in areas such as the emergency department. In addition, the continued presence of COVID-19 as well as other illnesses such as influenza and norovirus placed significant pressure at times on the Trust’s capacity due to the need to implement appropriate infection prevention control measures. Furthermore, difficulties in discharging patients fit to be discharged, but in need of a care package, placed additional strain on the Trust’s capacity. Elective admissions (including day case) Post-COVID-19 pandemic Elective (including day case) recovery (% of same month compared between March 2019 – February 2020) 105% 100% 95% 90% 85% 80% 75% Apr-22 May-22 Jun-22 Jul-22 Aug-22 Sep-22 Oct-22 Nov-22 Dec-22 Jan-23 Feb-23 % recovery Outpatient attendances Post-COVID-19 pandemic outpatient seen recovery (% of same month compared between March 2019 – February 2020) 140% 0 90% 10 20 40% 30 Apr-22 May-22 Jun-22 Jul-22 Aug-22 Sep-22 Oct-22 Nov-22 Dec-22 Jan-23 Feb-23 UH S UHS rank amongst NHSE trusts % recovery Rank 22 Diagnostics The Trust measures performance on a total of 15 frequently used diagnostic tests. In March 2023, 22% of patients were waiting more than six weeks for diagnostics compared with the national target of less than 1%. Patients waiting for a diagnostic test to be performed (sum of 15 different frequently used tests) UHS diagnostic waiting list volume 12,000 11,500 11,000 10,500 10,000 9,500 Apr-22 May-22 Jun-22 Jul-22 Aug-22 Sep-2 2 Oct-22 Nov-22 Dec-22 Jan-23 Feb-2 3 Mar-23 Diagnostic waiting list volume Percentage of patients waiting over 6 weeks for a diagnostic test to be performed Diagnostic 6 week wait performance UHS vs. NHSE average 35% 30% 25% 20% 15% 10% 5% 0% Apr-22 May-22 Jun-22 Jul-22 Aug-22 Sep-22 Oct-22 Nov-22 Dec-22 Jan-23 Feb-23 Mar-23 UH S NHSE average % standard met 23 Referral to Treatment The Trust continued to see an increase in the number of patients being referred for treatment during 2022/23 with just over 55,000 patients on a waiting list under the 18-week referral to treatment pathway at the end of the year. Averaged across the year, the volume of referrals exceeded the Trust’s theoretical capacity by around 3.5%. Due to this significant demand, the Trust only achieved 63.2% of patients being treated within 18 weeks of referral in March 2023 compared with the monthly target of more than 92%. However, despite this, the Trust remained in the top quartile when compared to other teaching hospitals, reflecting that this growth in demand continues to be a national challenge. During 2022/23, the national target was to ensure that there were no patients waiting over two years for treatment by July 2022, and that there were no patients waiting more than 78 weeks by the end of March 2023. Long-waiting patients were an area of particular focus for the Trust during the year with no reported two-year waits since November 2022 and only two between the period June-November due to patients choosing to delay their treatment. This was a significant improvement compared to the peak of 171 patients reported in December 2021. Similarly, the Trust made progress in reducing the number of patients waiting over 78 weeks for treatment. In February 2023, the Trust reported 84 patients in this category compared to the peak of over 900 patients in September 2021. By the end of March 2023, the Trust had managed to further reduce this number of patients to 14, with those in breach of the target all due to the complexity of the cases. UHS referral to treatment waiting list 56,000 54,000 52,000 50,000 48,000 46,000 44,000 Apr-22 May-22 Jun-22 Jul-22 Aug-22 Sep-22 Oct-22 Nov-22 Dec-22 Jan-23 Feb-23 Mar-23 24 Number on waiting list % standard met Percentage of patients waiting up to 18 weeks between referral and treatment RTT 18 week performance UHS vs. NHSE average 70% 65% 60% 55% 50% Apr-22 May-22 Jun-22 Jul-22 Aug-22 Sep-22 Oct-22 Nov-22 Dec-22 Jan-23 Feb-23 Mar-23 UH S NHSE average Percentage of patients waiting more than 52 weeks between referral and commencement of a treatment for their condition Number of patients Rank UHS Referral to treatment patients waiting more than 52 weeks 3,000 0 2,500 10 2,000 20 1,500 30 1,000 40 500 50 0 60 Apr-22 May-22 Jun-22 Jul-22 Aug-22 Sep-22 Oct-22 Nov-22 Dec-22 Jan-23 Feb-23 Mar-23 UH S UHS rank amongst NHSE trusts % of RTT patients RTT % of patients waiting more than 52 weeks UHS vs. NHSE average 5.0% 0 4.5% 20 40 4.0% 60 3.5% 80 Apr-22 May-22 Jun-22 Jul-22 Aug-22 Sep-22 Oct-22 Nov-22 Dec-22 Jan-23 Feb-23 Mar-23 UH S UHS rank amongst NHSE trusts Rank 25 % standard met Cancer Waiting Times The Trust is one of 12 regional cancer centres in the UK offering treatment for rare and complex cancers as well as cancer in children and brain cancer. The Trust has historically been in the upper quartile, relative to teaching hospital peers. Due to loss of key members of staff and industrial action, the Trust’s performance has slipped over the year with 72.5% of patients seen within two weeks in March 2023 following referral by a General Practitioner for suspected cancer (national target: > 93% per month). Cancer waiting times - 2 week wait performance UHS vs NHSE average 100% 0 80% 50 60% 100 40% 150 Apr-22May-22 Jun-22 Jul-22 Aug-22 Sep-22 Oct-22 Nov-22 Dec-22 Jan-23 Feb-23Mar-23 UH S NHSE average UHS rank amongst NHSE trusts Rank Referrals for January to March 2023 were at the highest for that month for the past five years and overall referral volumes in 2022/23 averaged 2,049 patients per month, 8% higher than in 2021/22 and 28% higher than in 2019/20. The national target was for 96% of patients to commence treatment within 31 days of diagnosis. However, in March 2023, the Trust only achieved 87.9%, but this figure hides considerable variation dependent on the tumour site and type of cancer with a range of 100% for haematology and children’s cancers to 71% for skin. The high rate of referrals led to a significant backlog in terms of patients waiting longer than 62 days for treatment. However, the Trust took steps to reduce this backlog by more than 50% through a dedicated recovery programme. In March 2023, the Trust treated 54.8% of patients within 62 days of referral compared to the target of more than 85%. Treatment for Cancer within 62 days of an urgent GP referral to hospital Cancer waiting times 62 day RTT performance UHS vs. NHSE average 80% 60% 40% 20% 0% Apr-22 May-22 Jun-22 Jul-22 Aug-22 Sep-22 Oct-22 Nov-22 Dec-22 Jan-23 Feb-23 Mar-23 UH S NHSE average % standard met 26 First definitive treatment for cancer within 31 days of a decision to treat % standard met Cancer waiting times 31 day RTT performance UHS vs. NHSE average 95% 90% 85% 80% 75% Apr-22 May-22 Jun-22 Jul-22 Aug-22 Sep-22 Oct-22 Nov-22 Dec-22 Jan-23 Feb-23 Mar-23 UH S NHSE average Quality priorities The Trust set eight quality priorities in 2022/23, which were aimed at ensuring it continued to deliver the highest quality of care. The quality priorities were shaped by a range of national and regional factors as well as local and Trust‐wide considerations. The Trust recognised the overriding issues of significant operational pressures being felt right across the health and social care system, including those associated with the previous two years of the COVID-19 pandemic. The challenge was to deliver the best quality care in the context of these operational pressures, and the Trust set its quality priorities accordingly. Out of the eight priories set, the Trust achieved five and partially achieved three. Priority One: Enhancing capability in Quality Improvement (QI) through our Always Improving strategy The transformation team has grown to over thirty team members including project support officers, project managers, benefit realisation managers. This has allowed the Trust to develop that systematic organisational approach to guide and support its staff in their QI projects. The Trust originally set a target of delivering fifty quality improvement projects but have successfully supported a total of 84 (55 local and 29 flow improvements). These are local change projects which were identified, proposed, led, and delivered by the people who do the work. To date over 1500 people have been trained in the Trust’s improvement approach, which exceeds the original target of 500. The Trust also developed a QI project register and held an Always Improving conference. Priority Two: Developing a culture of kindness and compassion to drive a safety culture The Trust only partially achieved this priority as plans to fully deliver training were affected by operational pressures. However, during the year a variety of communication platforms were used to make sure staff understood the Trust’s vision and were kept up to date with plans and progress. The Trust worked to develop and embed a ‘just culture’ allowing staff to speak up and ask, “what happened and how do we learn?” and developed ‘stop for safety’ staff huddles. Priority Three: We will improve mental health care across the Trust including support for staff delivering care The Trust only partially achieved this priority as several key quality improvement projects have not yet been delivered, and the mental health strategy not yet been finalised. However, a training needs analysis was completed and significant staff training and an education scheme were introduced in response to the findings of the analysis. Mental health champion training has been delivered to 153 staff and IT systems have been improved to help capture vital data to help shape the Trust’s service. 27 Priority Four: Recognising and responding to deterioration in patients During 2021/22 the Trust successfully introduced national Paediatric Early Warning System (nPEWS) into its Southampton Children’s Hospital and UHS is now part of the national test and trial of nPEWS which is assessing the usability of the scoring system. The Trust has also explored how nPEWS can be adapted for children with complex medical conditions requiring interventions (including non-invasive ventilation) as part of their normal care. A daily heat map of escalation times over a 24-hour period was piloted in 2022 and will be rolled out across all adult’s inpatient areas during 2023. The Trust has also performed well with its cardiac arrest audits, and training and education programmes have consistently been delivered. September 2022 saw the implementation of a 24-hour paediatric outreach service. There is a deteriorating patient group and several successful QI projects have been introduced. Priority Five: Improving how the organisation learns from deaths The Trust only partially achieved this priority as it has been unable to establish a learning from deaths steering group. The Trust has introduced a mortality governance coordinator/analyst and grown its bereavement care service. Priority Six: Shared Decision Making (SDM) The shared decision models started at UHS in 2021/22 and have continued to grow with investment in pilot roles to expand these models, which include several advanced nurse practitioner roles, models in paediatrics bringing Shared Decision Making to patients who are transitioning from paediatric to adult services, while in maternity we have introduced SDM in birth planning. When assessing delivery of SDM against NICE guidelines, UHS performs well, especially in targets related to Trust buy-in, governance and practices of pilot areas. This year the Trust has implemented training through key platforms and expanded patient involvement in the project. As a leading site nationally for SDM principles, UHS have worked with NHS England on creating materials for others to learn from. Priority Seven: Working with our local community to expose and address health inequalities During the year the Trust refocused its efforts on making sure that its involvement and participation activities support the health inequalities agenda, while also working to deliver responsive information and advice to patients, carers, and families. Priority Eight: Ensure patients are involved, supported, and appropriately communicated with on discharge During the year the Trust has focused on improved patient, carer and family involvement, and improved communication during the discharge process as well as prompting a more collaborative working between social and health care staff. Strong partnership working with external agencies has been developed to support a system approach to hospital discharge, develop digital solutions, develop the patient hub to support discharge and delivered education to UHS staff. 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 2023/24, in the Trust’s Quality Account for 2022/23. 28 Financial performance The Trust delivered a deficit of £11 million from a revenue position of over £1.2 billion, once items deemed as “below the line” by NHS England, such as the financial position of the Southampton Hospitals Charity, were removed. The Trust was unable to deliver the planned breakeven position. Several material cost pressures were incurred, including unfunded high-cost drugs costs and energy prices. These were unable to be off set in full by a savings programme, despite delivery of £45.6m of efficiencies (2021/22: £15m). Trust operating income rose by £64m from the previous financial year, most notably funding the NHS pay award, as well as additional elective recovery funding. Income reduced from the prior year in relation to ending a nationally funded project regarding testing for COVID-19. The Trust has however been successful in increasing funding for research and development. Trust operating expenditure rose by £78m, incorporating funded inflationary costs as well as the cost pressures outlined above. The Trust has also continued its reinvestment of surplus cash into infrastructure for the Trust, with capital investmen
Url: /Media/UHS-website-2019/Docs/About-the-Trust/Annual-reports-and-quality-accounts/UHS-AR-22-23-6.pdf

G29 Guideline on completion application and study assessment v1 14-10-20...

Description: Guideline on completion of the Sponsorship Application and Study Assessment Introduction According to the UK Policy Framework for Health and Social Care Research 2017, all health and social care research has a sponsor. The sponsor is the individual, organisation or partnership that takes on overall responsibility for proportionate, effective arrangements being in place to set up, run and report a research project. UHS is able to act as sponsor for research studies subject to review and approval by the R&D office. In order for UHS NHS FT to provide sponsorship in principle for a research study, the Chief Investigator is required to complete a Sponsorship Application and Study Assessment Form. This provides the R&D Office with information on the considerations which have been made in the development of the protocol in a number of areas to help assess the level of risk to the Trust and how this can be mitigated. Upon review, further assessment may be needed and the CI will be expected to be available to assist. Conditions of Sponsorship UHS NHS FT may act as sponsor, subject to the conditions below and the receipt and evaluation of a UHS Sponsorship Request and Study Assessment Form, for research where:  The study has an experienced Chief Investigator or if an inexperienced Chief Investigator they are willing to be mentored by an experienced UHS (or UoS) Chief Investigator/carry out CI training.  CI is based in Southampton and is a substantive employee of UHS NHS FT or holds an honorary clinical contract with UHS NHS FT and is a substantive employee of University of Southampton.  The study is due to be performed in an acute hospital setting and UHS NHS FT is a planned recruitment site.  The study is a student project where the lead investigator is an employee and/or student of University of Southampton and UHS is a planned recruitment site. N.B. Supervisors on student projects will need to meet the requirements of substantive employment/honorary contract with UHS NHS FT detailed above.  CI has demonstrated the ability and resources to support the research, including, but not limited to, that trial management arrangements have been considered. N.B. Trial management and sponsor oversight may be in the form of a Clinical Trials Unit (CTU)/Clinical Research Organisation (CRO) / trial management team funded in the study budget as appropriate.  UHS can appropriately indemnify the activities under the NHS Litigation Authority Indemnity Scheme. N.B. The Trust does not routinely sponsor internationally or enter into co-sponsorship arrangements. N.B. Sponsor would need to determine in collaboration with the CI if appropriate Page 1 of 9 R&D/Gen/Admin/G29 Guideline on completion of the CI Study Assessment and Sponsorship Application v1 14/10/2019 insurance cover can be arranged and any additional costs for such insurance cover are covered by the study funding.  The study has received the appropriate peer review assessed by risk to confirm the scientific robustness and clinical safety of the study. This may be as part of a grant funding application or using the UHS Peer Review form (R&D/Forms028).  The study has appropriate funding levels for the resources required to conduct the study. The purpose of this document is to assist in the completion of the Sponsorship Application and Study Assessment Form to avoid confusion and delays. Section 1  Please enter the study title,  Q1 – Proposed start and finish dates. Please be realistic with these dates, taking into account the length of time for obtaining regulatory approvals and study set-up. Please also enter the length of time a patient will be followed up, if no follow-up is required please mark as 0.  Q2 – Please indicate whether the application is for grant application or whether funding has already been granted. If neither of these options is appropriate then please explain, e.g. No funding secured.  Q3 – Please indicate if the study is an educational project. NB: Undergraduate student projects are usually sponsored by the University so please contact the appropriate Divisional Research Manager if sponsorship cannot be arranged with the University for any reason.  Q4 – Please complete the CI details with the best contact information. E.g. If only a soton email account is regularly checked then please put this. If the CI primary employer is not UHS then please indicate whether the CI has an honorary contract with UHS.  Q5 – Please indicate if the CI will also be PI for the study at UHS. NB this can be the same or different.  Q6 – No has been answered to Q5, please indicate who the PI will be at UHS if known.  Q7 – Please indicate whether the study is a Device study, a CTIMP/ATIMP or involves interventional techniques.  Q8 – Please indicate how many participants it is intended will be recruited to the study and if not patients, staff or healthy volunteers please explain e.g. School children, notes review etc.  Q9 – Please indicate which UHS resources will be used in the study e.g. clinic rooms, nursing staff etc. Page 2 of 9 R&D/Gen/Admin/G29 Guideline on completion of the CI Study Assessment and Sponsorship Application v1 14/10/2019 Section 2  Q10 – Please indicate if the study is in receipt of funding and if not please indicate how the costs of the study will be covered. You will be asked to elaborate in the Study assessment section.  Q11 – Please indicate what type of organisation is funding the study and what type of peer review has been performed. NB: For adoption onto the NIHR portfolio the peer review must be independent and high quality. This means independent of the organisation as well as the study. If in doubt please email sponsor@uhs.nhs.uk for assistance.  Q12 – Please indicate if the study has been costed by UHS R&D Finance.  Q13 – Please indicate if funding will cover all delivery activities at UHS and if not please specify how costs will be covered.  Q14 – If multi-site please indicate if funding is available to support delivery activity at other sites.  Q15 – Please indicate the type of scientific peer review the study has received.  Q16 – Please indicate whether the study is single or multi-centre, if the study is multi centre, please complete section 3.  Q17 – Please specify whether study management involves a CTU or CRO. If a CTU or CRO is involved then please enter the name and contact details. You will be asked to elaborate in the Study Assessment. Section 3 This section only needs to be completed if the study has more than one site.  Q18 – Please indicate whether UHS is to be lead site and if not which organisation will be lead site. Please also indicate why the lead site will not be acting as Sponsor.  Q19 – Please indicate how many sites are to be involved in the study (please do count UHS) and please list the proposed sites and their locations. Study Assessment In order to assist with the sponsorship decision, the risks associated with carrying out the protocol and managing the study have to be considered. Please complete the study assessment sections as set out taking into consideration the below points. These points are not exhaustive but should be used to assist you. Please note, we will work with you to mitigate any risk concerns. A: Study Legal and Regulatory Needs The MHRA is the competent authority in the UK and they are responsible for ensuring the regulations are enforced for certain types of study involving drugs and devices. Page 3 of 9 R&D/Gen/Admin/G29 Guideline on completion of the CI Study Assessment and Sponsorship Application v1 14/10/2019  To determine if your drug study needs MHRA approval please refer to the MHRA Algorithm. For drug studies requiring MHRA approval please indicate the MHRA risk category (Appendix 1)  To determine if your device study needs MHRA approval please refer to the MHRA guidance and speak to your Divisional Research Manager for further assistance. NB: Applications to the MHRA will incur a fee. The majority of studies will require a favourable opinion from a Research Ethics Committee. However there are some exceptions so please refer to the Governance Arrangements for Research Ethics Committees (GafREC) for further guidance. The Health Research Authority is the body that ensures studies are fit to run within the NHS and as such perform an assessment and approval on the majority of studies prior to them being able to open. There are a few studies which do not fall under the HRA and guidance can be found on the HRA website. The Confidentiality Advisory Group (CAG) are able to set aside the common law duty of confidentiality for medical purposes where it is not possible to use anonymised information and where seeking individual consent is not practicable. Approval of applications will only be considered where anonymised data will not suffice and consent is genuinely not practicable. For guidance please see the IRAS website. UHS does not normally sponsor studies that require additional insurance outside of NHS indemnity e.g. non UK sites, pathogen challenge studies. If your study has non-UK sites or has an unusual design which may mean it falls outside the NHS indemnity scheme then please discuss with your Divisional Research Manager in the first instance as UHS may not be able to act as Sponsor. B: Local Alignment If the study involves a drug then the protocol will need to have been considered by clinical trials pharmacy. Please indicate if this has been the case and who your point of contact was for this. If the study involves the use of any equipment being supplied to the Trust or devices being used in the study then the Medical Equipment Management Service should be contacted and are able to advise on supply and maintenance arrangements. Please indicate if this has been the case and who your point of contact was for this. If the study involves imaging for research purposes then the appropriate department should have been involved in advising on the protocol. Please indicate if this has been the case and who your point of contact was for this. If the study involves any other clinical services performing activities for research purposes in the Trust such as pathology and microbiology etc then they should be involved in protocol development. Please indicate if this has been the case and who your point of contact was for this. If the study is being carried out on inpatient wards then please indicate which wards and if you have been in contact with the ward matron please give contact details. C: Investigator Team Page 4 of 9 R&D/Gen/Admin/G29 Guideline on completion of the CI Study Assessment and Sponsorship Application v1 14/10/2019 Please give an indication of the number of studies for which you have acted as CI and what category these were i.e. CTIMP/ATIMP, Device, Novel Intervention, Observational. Please indicate how many of these were multi-site studies i.e. where more than one NHS organisation was recruiting participants. Please give an indication of the number of studies for which you have acted as PI and what category these were i.e. CTIMP/ATIMP, Device, Novel Intervention, Observational. D: Research Team Consideration should be made as to how the study will be delivered and what type of support might be required. Please indicate if any discussions have happened with the research nursing teams as to whether research nurses, clinical coordinators or clinical trials assistants will be needed to help deliver the protocol. Please indicate who was involved in these discussions. Please consider whether there are any special techniques, procedures or indications that staff will require training in. Please consider how the study team will be made aware of adverse event reporting requirements and procedures and how staff will be kept updated with amendments and new information on the study or intervention. E: Science Design Studies to be considered for sponsorship by UHS must have undergone peer review, either as a standalone process or as part of the funding application. If the peer reviewers have made comments then these should have been taken into consideration before submission of the protocol for sponsorship review. In order to ensure the study is able to definitively answer the research question and achieve its outcomes it is important that consideration has been made to the statistical aspects of the study. This will include power calculations, analysis plan and sample size calculations. Please indicate if there been a statistician involved in the study design. In order to deliver the study efficiently and ensure that funding flows to the appropriate recipients, it is important that there is a distinction between what is the standard patient pathway and what is additional research activity. Please indicate if this has been taken into account when designing the protocol and ensure it is clear in the protocol where the research pathway differs from that of standard care. F: Patient Safety Design The protocol should clearly state how potential participants are to be identified, together with the inclusion and exclusion criteria. Please indicate whether informed consent will be received from the potential participants and if not please explain why. Some interventions require close monitoring of participants for safety reasons e.g. 15 minute observations. Please indicate if any additional safety monitoring procedures over standard care are required. Please give details or refer to the section in the protocol where these procedures are documented. Page 5 of 9 R&D/Gen/Admin/G29 Guideline on completion of the CI Study Assessment and Sponsorship Application v1 14/10/2019 Some interventions, particularly early phase studies, have additional safety precautions that need to be in place for the study to be delivered e.g. emergency resuscitation equipment, notification of high dependency units, specialist personal protective equipment. Please indicate if any additional safety precautions are required. NB: This can be for patients or staff. Please give details or refer to the section in the protocol where these precautions are documented. Participant safety is one of the most important aspects of clinical research and therefore needs to be closely monitored. One of the main mechanisms for ensuring safety data is considered is to convene a safety/oversight committee. This committee should include a chair who is independent not only of the study but also of the institution. Please indicate if such a committee has been convened or is planned. Please indicate if a chair has been identified and how often the committee is likely to meet. G: Patient Group Design The recruitment process for participants should be clearly set out in the protocol, including how potential participants will be identified. Please indicate how long it is planned that recruitment onto the study will take. Please indicate if the participants are considered to be a rare patient group. A rare disease in Europe is defined by EURORDIS as a disease affecting less than 1 in 2,000 citizens. The NIHR considers a very rare disease as one that affects less than 1 in 100,000 of the general population. Please indicate the incidence of the disease area being studied. Please indicate if you are planning to recruit participants who are unable to consent for themselves. If you are including this group of participants then please be aware that the condition you are studying must be related to the reason why the participants lack capacity e.g. a dementia study or critical care study. Please ensure that the protocol sets out the procedure for assessing capacity and for gaining consent if the participant regains capacity prior to the end of the study. The protocol should also document the recruitment procedure this group of participants. H: Management and Monitoring Studies sponsored by UHS need to be managed appropriately and, as Sponsor, UHS delegate a number of duties to the CI and study teams. It is therefore important that someone is identified who will take on the management/coordination of the study. For simple studies it could be the CI themselves, a research fellow, a research nurse or CTA. Please indicate if a person has been identified and if they have please provide their contact details. If no dedicated resource has been identified then please indicate how the study will be managed. For more complex studies, and especially for multi-centre studies and early phase studies, a more specialised and dedicated resource for managing/coordinating the study will be needed. This is usually in the form of a clinical trials unit or a clinical trials organisation. These organisations do require specific funding and so this should have been considered when applying for funding for the study. If a CTU/CRO has been identified please provide contact details. If a CTU/CRO has not been identified then please discuss with your Divisional Research Manager in the first instance. Please indicate how much time the CI can dedicate to the study in work time Page 6 of 9 R&D/Gen/Admin/G29 Guideline on completion of the CI Study Assessment and Sponsorship Application v1 14/10/2019 equivalent (e.g. 1 day per week is 0.2WTE). It is important that the CI can demonstrate oversight of the study as a whole and if the study is multi-site then they need to be able to demonstrate oversight of the associated PIs at the other sites in addition. This oversight is not without its time commitment and therefore the CI needs to be able to dedicate the time needed to the study. To ensure that the study is causing no harm to participants’ safety monitoring/reporting is an essential part of study activity. Reporting time frames must be adhered to according to the leglisation, therefore please indicate who will responsible for safety reporting/monitoring. Please indicate if UHS sponsor team or an external organisation will be expected to conduct this. Please provide contact details. In order to ensure the study is running smoothly, according to the legislation and the protocol, monitoring of the study may be required during its lifetime. Monitoring ensures any problems are picked up quickly and actioned appropriately and is one of the mechanisms by which the Sponsor can demonstrate oversight of both patient safety and data quality. A monitoring plan will usually be produced based on the inherent risks of the study but may require specialist monitors e.g. for early phase studies, or more intense monitoring e.g. for a multi-site CTIMP study. Please indicate if monitoring will be provided by an external organisation or will be expected of the UHS Sponsor team. Please provide contact details. Studies usually generate a lot of data in order to answer the research question and to monitor patient safety throughout the study. To enable the efficient and effective analysis of that data a data management plan can help. There are a number of ways in which data can be managed, including electronic databases and eCRFs and dedicated data managers. The more complex a study the more important it is to have plans in place to manage the volume of data generated by the study and to ensure that it is accurate and clear. Please indicate if a data management plan is in place or is planned and if not please indicate how data will be managed. E.g. for a simple questionnaire study this may be a member of the study team collating the questionnaires and manually checking them for completeness. I: Finance It is the expectation of UHS as sponsor that every effort will be made to have every eligible study adopted onto the NIHR portfolio. Please speak to your Divisional Research Manager if you need assistance with this. If the study is adopted onto the NIHR portfolio then service support costs are made available to the Trusts recruiting patients. This funding is to support the recruitment process and patient safety. Therefore, if the study is not on the NIHR portfolio the study support costs will need to be covered by other means. Please indicate how these costs will be covered. Some studies can generate Excess Treatment Costs. In simple terms these are costs that would be incurred if the treatment or intervention became standard care. They are covered by the Care Commissioning Groups and have to be applied for in advance of study opening. Please indicate if you believe your study will incur these costs and if you are not sure please discuss with your Divisional Research Manager. N.B. All financial implications must be considered and agreed before study start and may require approval from the R&D Steering Group. J: Third party arrangements Page 7 of 9 R&D/Gen/Admin/G29 Guideline on completion of the CI Study Assessment and Sponsorship Application v1 14/10/2019 All external arrangements for IMP supply, equipment supply or movement of tissue and data must be in place prior to study start and it is therefore key to identify these as early as possible so any contract negotiation does not delay study opening. For studies involving drug and/or devices, a supplier of these products needs to be identified. Please indicate if you have identified a supplier and the contact details of the person you have been in communication with. If a supplier has not yet been identified, please contact Sponsor@uhs.nhs.uk for assistance If other supplies are needed for the study then please do make a note of this here and if any suppliers have been identified. Whilst the UHS sponsor team will identify agreements that need to be in place regarding the supply and control of drug and/or devices that are the subject of the study, there are other external agreements that may need to be in place. Please indicate if any equipment is being loaned or given to the Trust by a third party. Please answer no if UHS is purchasing the equipment. Please indicate if tissue and/or data is being imported or exported outside of the NHS. This can be for any purpose but may need to be detailed in an agreement. Submission Once you have completed your Sponsorship application and Study Assessment form please return it, together with your protocol (version controlled), peer reviews (unless performed by funder) and funding letter, to sponsor@uhs.nhs.uk and one of the Divisional Research Managers will be in contact with you. If you have any questions or queries or are struggling with the forms then please email sponsor@uhs.nhs.uk for assistance. Page 8 of 9 R&D/Gen/Admin/G29 Guideline on completion of the CI Study Assessment and Sponsorship Application v1 14/10/2019 Appendix 1 Taken from the MHRA Guidance Trial Categories based upon the potential risk associated with the IMP Examples of types of clinical trials Type A: no higher than that of standard medical care Trials involving medicinal products licensed in any EU Member State if:  they relate to the licensed range of indications, dosage and form or, they involve off-label use (such as in paediatrics and in oncology etc) if this off-label use is established practice and supported by sufficient published evidence and/or guidelines Type B: somewhat higher than that of standard medical care Trials involving medicinal products licensed in any EU Member State if:  such products are used for a new indication (different patient population/disease group) or  substantial dosage modifications are made for the licensed indication or  if they are used in combinations for which interactions are suspected Trials involving medicinal products not licensed in any EU Member State if  the active substance is part of a medicinal product licensed in the EU (A grading of TYPE A may be justified if there is extensive clinical experience with the product and no reason to suspect a different safety profile in the trial population)* Type C: markedly higher than that of standard medical care Trials involving a medicinal product not licensed in any EU Member State (A grading other than TYPE C may be justified if there is extensive class data or pre-clinical and clinical evidence)* *If a grading other than those indicated is felt to be justified the rationale and evidence should be presented in the CTA application Page 9 of 9 R&D/Gen/Admin/G29 Guideline on completion of the CI Study Assessment and Sponsorship Application v1 14/10/2019
Url: /Media/Southampton-Clinical-Research/Downloads/G29-Guideline-on-completion-application-and-study-assessment-v1-14-10-20....pdf

Feeding information for infants with congenital heart disease

Description: PARENT INFO Information on feeding for infants with congenital heart disease Contents 03 Introduction 04 What to expect � in the first few weeks � What is congenital heart disease? � What is likely to happen in the first few days or weeks of life? � What can you do during this time to help with bonding and feeding? 06 What to expect � weight gain & feeding � How much weight should my baby gain? � What are common feeding concerns? � What can you do if there are feeding problems? � Even if your baby drinks a high energy feed, they may not drink enough to gain weight and need a feeding tube � How will I know what and how much milk to feed when I go home? 04 What to expect � after surgery � What is likely to happen with weight gain and feeding after surgery? � What can I do about it? � How can I help my baby gain weight? � What can I do about it? Introduction Congenital heart disease (CHD) is one of the most common birth problems in babies. For lots of different reasons, your child may have problems with weight gain and feeding. We have written this booklet with the help of parents, and the information is based on what they have told us would have been reassuring to know as well as what to expect in terms of feeding and growth. What should you do if there is a problem? If you are ever worried about your baby's health contact their health care team as soon as you can, using the contact numbers you have been given. Your baby may need an urgent medical review if they have any of the following; � Does not want to breastfeed or is drinking less than half of their bottle of milk � Has fewer wet nappies than usual � Has a temperature of 38.5oC or more � Is quieter or sleepier than usual � Increased sweating during feeds � Increased vomiting � Not gaining weight or is losing weight � Is a different colour or has a slower or faster breathing rate � Or you are in anyway worried The information in this booklet is independent research arising from an Integrated Clinical Academic Clinical Lectureship, Luise Marino - ICA-CL-2016-02-001 supported by the National Institute for Health Research and Health Education England. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research, Health Education England or the Department of Health and Social Care. In an Emergency always dial 999 03 What to expect � in the first few weeks What is congenital heart disease? Congenital heart disease is the name that doctors use to describe heart defects babies have been born with. Congenital heart disease may be caused by holes between chambers of the heart, or a change in one or more of the heart vessels or valves. Sometimes babies are too poorly and skin to skin contact is not possible � If you are not able to hold your baby during this time, you will be able to stroke their cheeks and do other forms of positive touch such as massaging their feet and hands � Sing or talk to them at the same time, as they will already know the sound of your voice � Put a muslin cloth or toy that you have been holding near them as it will have your smell on it What is likely to happen in the first few days or weeks of life? Some babies will only have one heart surgery during the first few days of life, whereas others may need several during the first year of life and later on in life. PATIENT STORY: My baby didn't have anything by mouth for over a month as he had a feeding tube into his stomach. During this time we were able to use a dummy, which really helped his sucking. Even when he was in paediatric intensive care unit and ventilated (on the breathing machine) he sucked a dummy. Before he had his surgery, I was really worried he was never going to drink by mouth again and that he would have forgotten how to drink. He kept vomiting before his operation and needed lots of suctioning in his mouth which made him cry. After his surgery, we were warned it might take weeks for him to learn how to suck again. But by the 2nd day of being back on the ward he began to take 5ml by a bottle and by the end of the first week was managing most of the milk in his bottle. What he didn't manage to drink was put down his feeding tube. It was good to know at the beginning why he might find it difficult to drink as it made me relax a bit more about feeding times. What can you do during this time to help with bonding and feeding? Babies enjoy skin to skin contact There are a number of things you can do with your baby to help with bonding, as well as feeding. Where possible � try to have skin to skin contact with your baby, especially in the first few weeks, as this can be comforting for you both; � Skin to skin contact is where your baby is naked � except for a nappy � When you are sitting in a comfortable chair, lay your baby on your partially exposed chest � You can cover your baby with a light blanket to keep you both warm � Skin to skin contact has been shown to relax babies, helping them feel calmer � Dads can do this too! 04 05 What to expect � weight gain & feeding Babies who have their heart surgery during the first year may not gain enough weight on breast milk or standard infant formula and often need a high energy infant formula as well, shown in the table below. Your baby's health care team will work with you to come up with a feeding plan that suits your baby. Name Breast milk & infant formula Uses Breast milk is best for at least the first 6 months of life. If your baby is not able to breastfeed then expressing breast milk is an option. Where it is not possible to breastfeed or express breast milk babies should have infant formula These high energy feeds may be used in combination e.g. every other feed is a high energy milk or as a top up following their usual milk How much weight should my baby gain? Being a good weight will help prepare your baby for surgery and help your baby recover more quickly. � Your baby should gain around 200g per week for the first 6 months � Each baby's journey is unique and some babies gain weight as expected but for others weight gain is slower � A high energy feed may help your baby gain weight What are common feeding concerns? Babies with CHD are more likely to have feeding problems and many parents find feeding very stressful; as they feel that every drop of milk counts. � Heart defects increases the chance of your baby having symptoms of reflux or vomiting � This is because their tummy empties more slowly following a milk feed � Both of which increase their discomfort when feeding � your baby may squirm and wriggle a lot during a feed � Some babies with CHD may also have a syndrome e.g. Di-George which can impact on feeding Your baby's team or GP may be able to prescribe some medicines to help with some of the symptoms of reflux. High energy infant formula: SMA Pro High, Energy Similac High Energy, Infatrini High energy Infant formula � hydrolysed: Infatrini Peptisorb This high energy feed is partially digested and may be easier to tolerate, easing symptoms of reflux or vomiting 06 07 What can you do if there are feeding problems? If your baby is developing feeding difficulties such as retching or gagging with feeds, the following might help. Feeding tips � Although your baby will still need to drink a certain amount each day demand feeding can sometimes be better � offering your baby milk when they seem hungry � Stop feeding when your baby has had enough � often babies vomit if they are too full � Offer a high energy infant formula as they will need to drink less to get the same energy Babies also pick up on how you are feeling � Try to relax at feeding times, using mindfulness techniques can be helpful � It can be helpful to ask someone else to help with feeding times Positive touch and massage is a good way to bond with your baby, as well as overcoming feeding problems � Try to do baby massage 3 � 4 times per day � Gently stroke your baby's face for as long as they seem to enjoy it � If your baby doesn't enjoy having their face stroked, start by massaging their hands or feet � Talk to your baby whilst you do baby massage Reduced feeding � If your baby has not been able to finish the usual amount of milk for more than 2 days in a row, get in touch with your baby's health care team, as your baby may require an urgent cardiac review. Even if your baby drinks a high energy feed, they may not drink enough to gain weight and need a feeding tube Before and after surgery some babies may need a small tube down their nose into their tummy. The tube is used to give medicines as well as their usual feed. Some babies need a feeding tube for a few days and others will need them for months. The most common reasons babies need feeding tubes are: � Getting tired when feeding � Using all of their energy on feeding � Getting full quickly, so they are not able to finish all of their bottle feeds � Coughing or choking when drinking � Following a surgical procedure, as they might be sedated or drowsy � Vomiting � Severe reflux and discomfort on feeding For babies who have their usual milk through a feeding tube � Many will still be able to breastfeed or bottle feed as well � If they are having their usual feed via a feeding tube, make eye contact, smile and talk to them and where possible cuddle them as they are being fed � Some babies may have all of their usual milk through the feeding tube and have very little by mouth � If this is the case using a dummy may help your baby maintain some of these skills � Babies can learn about the taste of milk through dummy dips � When able to, offer your baby your clean little finger to suck on, which can be dipped in your baby's usual milk � Your finger or dummy should be coated in milk, but not dripping � During the day you can do this every 2 - 3 hours � If possible give your baby dummy dips at the same time as your baby is having a feed through the tube Longer term feeding tubes Some babies who have a feeding tube for many months may need to have a gastrostomy. A gastrostomy is a surgical opening through the abdomen into the stomach. A feeding tube is inserted through this opening which allows children to be fed directly into their stomach. This will mean the feeding tube from their nose to their tummy can be removed. 08 09 PATIENT STORY: We found out about our baby's heart condition at our 20 week scan. Our baby girl would be born with a hole in the heart called an atrioventricular septal defect (AVSD) and Down 's syndrome. She was born early at 35 weeks, and we spent time in a Special Care Baby Unit, before being transferred to our local hospital. She had to be fed with a feeding tube when she was born and we went home with this, which was daunting. She needed a feeding tube which was really difficult, and we spent a lot of time trying to breastfeed our little girl. However, in the first couple of months she struggled to gain weight � which was really stressful, as it was so disheartening every time she was weighed. We ended up having to have a high energy infant formula 4 times per day as well as expressed breast milk. It was really hard to know that even though we were trying with breast milk, she needed formula as well. She also needed extra vitamins because she was born early. Having a baby with a heart condition and Down's syndrome is so different � we have older children but found we had to forget everything we ever learned about being parents and start from scratch again! We learnt instead to go at our little girl's pace and stopped trying to rush things, and I am so glad we did, as looking back now things slowly but surely got better with time. Our little girl is now growing really well. She is a very smiley, playful little girl and is really enjoying all the tastes and textures that weaning can offer! We are still waiting for her surgery, but as she is now gaining weight well it worries us less and feeding is getting less stressful every day. The most important thing for us was that we were listened to when we had worries about our little girl's growth and feeding � we got lots of help. It was good to know at the beginning why she might find it difficult to drink as it made me relax a bit more about feeding times. How will I know what and how much milk to feed when I go home? Your baby's team will give you a 24 hour feeding plan which may include � A set number of breastfeeds or bottles per day with a fixed amount of milk per bottle e.g. 50mls of milk every 3 hours, which may help if your baby never seems hungry Or � A total amount of milk for the day which you can give on demand when you baby is hungry � Before your baby goes home, they will need to be gaining weight. If this is not happening your baby may go home with a feeding tube, (a small tube down their nose into their tummy). 10 11 What to expect � after surgery What is likely to happen with weight gain and feeding after surgery? Following surgery your baby will go to the paediatric intensive care unit and will be ventilated (on the breathing machine) for a few hours or days. Having a breathing tube causes a sore throat and as a result some babies do not drink their usual milk or eat quite as well as they normal would for number of days following surgery. � Keep trying with 3 small meals a day � a meal may just be a taste of puree on their lips or 1 � 2 teaspoons � If they signal they have had enough stop offering food or milk There are lots of different recipes and suggestions, but our top tips are as follows; Breakfast: � Add � � 1 teaspoon of smooth nut butter (almond, cashew, peanut) to warm baby porridge or � Add 1 tablespoon smooth fruit puree � To make the puree to the right consistency for your baby use your baby's usual milk instead of water Lunch & supper: � Offer protein at both main meals such as meat, fish, chicken or beans/lentils with a starch (rice/ potatoes/pasta) and vegetables � add � � 1 teaspoon of a smooth nut butter � As your baby gets older e.g. > 9 months of age and their portion size increases, increase the amount of nut butter to 1 � 2 teaspoons per meal � Following a meal offer a fruit or full cream yogurt based dessert or custard or rice pudding or mashed avocado � For older babies e.g. > 10 months, a teaspoon of grated cheese or cream cheese can be added to mashed potato or meat dishes, instead of a nut butter How can I help my baby gain weight? Following surgery your baby should start to gain weight. The aim would be to help them gain weight back towards the growth line (centile) they were born on. The speed at which catch up growth happens varies, but the ideal is around 12 weeks after surgery. Trying to achieve catch up growth often happens around the same time as you have started weaning your baby onto food. We have developed high calorie recipe books to guide you through the weaning process for babies and toddlers. This book can be used alongside our 3 recipe books: � For babies who need to make the most out of every mouthful � For toddlers who need to make the most of every mouthful � For young people who need to make the most of every mouthful What can I do about it? After surgery, some babies may take a few days to drink from a bottle or breastfeeding and might need a feeding tube for a bit longer. Once your baby is off the breathing machine, they are likely to have a feeding tube for a few days, which is used to give medicines and their usual milk � If you are able to start oral feeding; offer your baby 5 � 10 ml of your baby's usual milk 1 � 3 times a day � As your baby is able, increase the amount per feed and number of feeds until they are back to their usual feeding pattern For babies who have started solids � You may find they don't want to eat anything for a few days, this is quite normal and when they do they may only want to only eat smooth foods � Even in hospital babies learn by example, so eat with them or in front of them � Keep calm at feeding and mealtimes � some days will be better than others � Ask other family members to help with feeding RECIPE BOOK For toddlers who need most out of every to get the mouthful the to get o need uthful mo bies wh For ba out of every most E RECIPK BOO For yo ung the mo people wh o st out of every need to ge t mouth ful RECIP BOOKE 12 13 PATIENT STORY: I thought the day would never come when my little girl would eat or drink. Food for us has been such a difficult journey. When I look back now, there are times when I felt quite low about it all. If I could go back and tell myself then what I know now, I would say "don't worry so much � she will gain weight and eat eventually". I tried breastfeeding in the beginning but had to stop as all the stress of her being so little and poorly made my milk dry up. As she wasn't growing she had to have a feeding tube, which was really stressful in the beginning as she was vomiting ALL the time. She ended up having a gastrostomy (a feeding tube directly into the stomach) � which did help but she would still be sick after some feeds. When I went home I felt alone, as going out was such an effort and when we did people just stared and some made horrible comments � there were some kind people who had been through the same thing and gave advice of social media groups to join, which was a lifeline. She eventually started to gain weight... but by the time she was 1 year old she wouldn't eat or put anything in her mouth. We worked with a dietitian and speech & language therapist to come up with a feeding and eating plan and slowly she became a bit more interested in food. It took ages � at least 9 months before I could think of not giving her a feed down her gastrostomy. Now � she is just turning 2 years of age and has had her final surgery. She no longer uses the gastrostomy and we are planning to have that taken out soon. Mealtimes are so much better. Don't get me wrong, not all of them are good � but they are so much easier than they used to be. Although she is still little for her age, she is catching up quickly. I am glad we are out of the other side and each day is easier than the one before. 14 15 Get in touch charity@uhs.nhs.uk www.southamptonhospitalcharity.org Southampton Hospital Charity Mailpoint 135, Southampton General Hospital, Tremona Road, Southampton SO16 6YD Southampton Hospital Charity Charity registration number: 1051543 @charity_shc Southampton Hospital Charity Designed by Headfudge Design Ltd headfudgedesign.co.uk 023 8120 8881
Url: /Media/UHS-website-2019/Docs/Services/Child-health/DietaryAdvice/Feeding-information-for-infants-with-congenital-heart-disease.pdf

Preparing for surgery - patient information

Description: This booklet contains important information on how to prepare for surgery.
Url: /Media/UHS-website-2019/Patientinformation/Surgery/Preparing-for-surgery-3167-PIL.pdf

Recovering from a heart attack - patient information

Description: This booklet has been produced by the cardiac rehabilitation team to help you and your family understand more about your condition. We hope it will provide you with clear information about what has happened and help to answer some of the questions you are likely to have around getting back to normal.
Url: /Media/UHS-website-2019/Patientinformation/Heartandlungs/Recovering-from-a-heart-attack-1363-PIL.pdf

Cardiac surgery - patient information

Description: The aim of this book is to give you written advice about recovery following cardiac surgery. We know that for many patients going home after surgery can be a great relief but it can also be quite daunting. We hope this booklet will help.
Url: /Media/UHS-website-2019/Patientinformation/Heartandlungs/Cardiacsurgery-1362-PIL.pdf

Annual report 2021-2022

Description: 2021/22 Incorporating the quality report University Hospital Southampton NHS Foundation Trust Annual Report and Accounts 2021/22 Presented to Parliament pursuant to Schedule 7, paragraph 25(4)(a) of the National Health Service Act 2006 © 2022 University Hospital Southampton NHS Foundation Trust Table of contents Welcome from our chair and chief executive 6 Overview and performance 8 Performance report 9 Overview 10 Accountability report 36 Directors’ report 37 Remuneration report 59 Staff report 72 Annual governance statement 94 Quality report 105 Statement on quality from the chief executive 106 Priorities for improvement and statements of assurance from the board 109 Other information 182 Annual accounts 210 Statement from the chief financial officer 211 Auditor’s report 212 Auditor’s report including audit certificate 218 Foreword to the accounts 220 Statement of Comprehensive Income 221 Statement of Financial Position 222 Statement of Changes in Taxpayers’ Equity 223 Statement of Cash Flows 224 Notes to the accounts 225 5 Welcome from our chair and chief executive As we emerged from the most severe phase of the COVID-19 pandemic, 2021/22 was another challenging year for everyone at University Hospital Southampton NHS Foundation Trust (UHS). It was also a year on which we can look back with pride at what we achieved together in unprecedented circumstances. Amongst many notable achievements over the past twelve months, we have: • Led on globally ground-breaking research trials to inform the country’s COVID-19 vaccine booster strategy, including the world’s first COVID-19 vaccine booster study of mixed schedules. • Successfully managed infection prevention and control, putting us amongst the best in the country for minimising nosocomial spread. This was against a backdrop of, at times, R-rates in our local community that were amongst the highest in the country. • Published new strategies for digital and sustainability, which respectively set out how we are revolutionising our technical capability to meet changing patient needs and responding to the growing threat posed by climate change as part of the NHS-wide commitment to reaching carbon net zero by 2045. The pandemic also highlighted the vital importance of our staff’s wellbeing so we could continue to meet the needs of the most vulnerable and sick within our community and beyond. In response, we launched and have sustained a comprehensive programme of support to help our staff recognise and address the physical and emotional burden of the last two years. In financial terms, the Trust achieved its forecast breakeven position in 2021/22 on a turnover of £1.15 billion. Our strong, long-term financial performance meant we could continue investing in the capacity and condition of our estate. During the last year we have welcomed patients into our new ophthalmology outpatients area, expanded the majors area of our emergency department, built Hamwic House for treating cancer patients and opened four new operating theatres. Our ambition remains to increase capacity and improve facilities so that we can meet rising demand for our services, treating more people in improved settings than ever before. The momentum we are building is informed and driven by our five-year strategic plan, which describes our collective ambitions on our journey to becoming a world-class organisation. Our successes over the last twelve months were set against a backdrop of exceptional pressure on our services, unlike anything we have seen before. Like most hospital trusts, the lifting of COVID-19 restrictions in the wider community saw significant increases in attendances at our emergency department and increased referrals for treatments including surgery and cancer care. Everyone at UHS is working hard to restore services and bring waiting times down, although there are headwinds impacting our elective recovery. As we write this report, we have more than 200 patients in the hospital who no longer need our care but are waiting for discharge, either to a care home or to their own home with domiciliary care packages. Like many sectors, our local authority partners are struggling to buy or directly provide the capacity that is needed due primarily to workforce shortages. On occasion, the number of patients stranded in our hospitals means we have had to cancel scheduled surgery patients due to a lack of beds. Despite this, we are making good progress on recovering our elective performance, for example the number of elective surgery procedures in May 2022 was over 8% higher than in May 2019, prior to the COVID-19 pandemic. 6 Looking back over the year, our achievements would not have been possible without every single one of our 13,000 staff, who have gone above and beyond to put patients first. As a Trust Board we recognise that our people are our greatest asset. The results of this year’s NHS annual staff survey are encouraging, with the percentage of staff recommending UHS as a place to work being the sixth highest across all NHS trusts in England. However, we know we can do even better and our new people strategy will help us achieve this by introducing programmes which enable our people to thrive, excel and belong in a diverse and inclusive environment. We ended the year by saying farewell to Peter Hollins, who completed his second and final term as chair on 31 March 2022. In the six years of his leadership, the Trust has undergone a huge transformation to the benefit of both patients and staff. Peter has been a trusted and respected colleague whose outstanding leadership has set UHS on course to be a world-class organisation with world-class people delivering worldclass care. We welcome the formation of the Hampshire and Isle of Wight integrated care system on 1 July 2022, which will facilitate increased integration and collaboration across health and social care partners. We look forward to continuing strong relationships with all our partners as we work to develop an NHS of which all the communities we serve can be proud. Jane Bailey Interim Chair June 2022 David French Chief Executive Officer June 2022 7 OVERVIEW AND PERFORMANCE Performance report Introduction from our chief executive 2021/22 is the second year that the ways in which the Trust has worked, and the performance it has achieved, have been strongly influenced the COVID-19 pandemic. Our circumstances varied significantly through the year, however, by March 2022: • COVID-19 related restrictions had been removed across the wider community, but remained necessary within healthcare settings; • a combination of partial immunity and improved treatments had reduced the numbers of patients experiencing the most severe symptoms of COVID-19, but the total numbers of people being infected remained very high; and • the numbers of patients attending, or being referred to, healthcare services for other conditions had returned to pre-pandemic levels or higher. Our challenges and priorities have varied through the year in a similar manner, and have included: • providing sufficient urgent care capacity for patients with COVID-19 alongside those with other illnesses or injuries; • running our services with significantly increased levels of COVID-19 related absence amongst our staff, as infection rates have increased in the wider community; and • increasing the numbers of elective treatments provided, back to pre-pandemic levels and higher, to start to reduce patient waiting times and reverse the increases in waiting list sizes caused by COVID-19. Our performance this year has often been impacted by the adversity of the circumstances. We have not always been able to achieve the targets established prior to the pandemic, nor to deliver the standard of service that we would aspire to for our patients. The Trust is proud to have performed well in comparison to other hospital trusts across many performance measures, however, I would like to thank our patients for their understanding and patience, and all our staff for their resilience, commitment and dedication to care for patients and their colleagues. As we begin to emerge from the pandemic, and consider the year ahead, we look forward to working with patients, hospital colleagues, and partners across health and social care to: • continue the recovery from the impacts of the COVID-19 pandemic; • improve our performance against key measures, continuing to perform well in comparison with other hospitals and moving closer to the national targets; and • continue to adapt and improve services such that the outcomes and results achieved for patients will be better than ever before. 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 billion in 2021/22. 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 more than 3.7 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 in the top ten nationally for research study volumes as ranked by the NIHR Clinical Research Network. 12,000 Every year over staff at UHS: treat around 160,000 inpatients and day patients, including about 75,000 emergency admissions see over 650,000 people at outpatient appointments deal with around 150,000 cases in our emergency department deliver more than 100 outpatient clinics across the south of England, keeping services local for patients 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 offers a safe, ‘home away from home’ environment for women having a healthy pregnancy and expecting a straightforward birth. The NHS patient services provided by the Trust are commissioned and paid for by local clinical commissioning groups (CCGs) and, in the case of more specialised services (such as treatments for rare conditions), by NHS England. Just under half of the Trust’s NHS patient services are paid for by CCGs and just over half are paid for by NHS England. We provide these 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 Monitor (the independent regulator, now part of NHS England and NHS Improvement) and the healthcare services we provide are regulated by the Care Quality Commission. Being a foundation trust has enabled greater local accountability and greater financial freedom and has supported the delivery of the Trust’s mission and strategy over a number of years. The Trust has been a university teaching hospital since 1971. The diagram below provides an overview of the overall organisational structure of the Trust. Division A Surgery Critical Care Opthalmology Theatres and Anaesthetics Public and foundation trust members Council of Governors Board of Directors Executive Directors Division B Division C Division D 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 11 Trust Headquarters Division Always Improving Central Operations Clinical Outcomes Commercial Development Communications Contracting Corporate Affairs Data and Analytics Education and Workforce Estates, Facilities and Capital Development Finance Health and Safety Human Resources Informatics Medical Examinerss Service Occupational Health Organisational Development Quality Patient Safety Planning and Productivity Procurement and Supply Research and Development Safeguarding Strategy and Partnerships The Trust is also part of an integrated care system in Hampshire and the Isle of Wight, which is a partnership of NHS and local government organisations working together to improve the health and wellbeing of the population across Hampshire and the Isle of Wight. Our values Our values describe how we do things 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. Our 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 our staff had experienced during the COVID-19 pandemic and what we had learnt from this. The vision for UHS is to continue on its journey to become an organisation of world class people delivering world class care. Our strategy is organised around five themes and for each of these it describes a number of ambitions we aim 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 tax payer 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 2021/22 these objectives included: • Recovery restoration and improvement of clinical services • Introducing a robust and proactive safety culture • Empowering and developing staff to improve services for patients • Implementing the ‘Always Improving’ strategy • Delivering the first year of the research and investment plan • Restoring a full research portfolio and preparing for future growth • Delivering joint research and innovation infrastructure with UoS and Wessex partners • Increasing our people capacity (recruitment, retention, education) • Great place to work including focus on wellbeing • Building an inclusive and compassionate culture • Working in partnership with the integrated care system and primary care networks • Integrated networks and collaboration • Creating a sustainable financial infrastructure • Making our corporate infrastructure (digital, estate) fit for the future to support a leading university teaching hospital in the 21st century • Recognising our responsibility as a major employer in the community of Southampton and our role in delivering a greener NHS. Performance against these objectives will be monitored and reported to the Trust’s board of directors on a quarterly basis. Principal risks to our strategy and objectives The board of directors 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 2021/22 were that: • It would have insufficient capacity to respond to emergency demand, reduce waiting lists for planned activity and provide diagnostics results in avoidable harm to patients • It would not be able to provide service users with a safe, high quality experience of care and positive patient outcomes • It 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 • It would not secure the required ongoing investment to support our pioneering research and innovation, driving clinical services of the future 14 • It would not realise the full benefits of being a University teaching hospital through working with regional partners to accelerate research, innovation and adoption; increasing the number of studies initiated and the patients recruited to participate in these studies and the delivery of new treatments and treatments that would not otherwise be available to patients • It would not be able to increase the UHS workforce to meet current and planned service requirements through recruitment to vacancies and maintaining annual staff turnover below 12% and develop a longerterm workforce plan linked to the delivery of the Trust’s corporate strategy • It would not develop a diverse, compassionate and inclusive workforce, providing a more positive staff experience for all staff • It would not create a sustainable and innovative education and development response to meet the current and future workforce needs • It would not implement effective models to deliver integrated and networked care, resulting in suboptimal patient experience and outcomes, increased numbers of admissions and increases in patients’ length of stay. • It would be unable to deliver a financial breakeven position and support prioritised investment as identified in the Trust’s capital plan within locally available limits (CDEL). • It would not adequately maintain, improve and develop our estate to deliver our clinical services and increase capacity. • It would fail to introduce and implement new technology and expand the use of existing technology to transform our delivery of care through the funding and delivery of the digital strategy. • It would fail to prioritise green initiatives to deliver a trajectory that will reduce our direct and indirect carbon footprint and reach net zero direct carbon emissions by 2040 and net zero indirect carbon emissions by 2045 While the COVID-19 pandemic presented the Trust with new risks as it introduced more stringent infection control processes, stopped certain types of activity and responded quickly to care for large numbers of seriously ill patients who had tested positive for COVID-19, it also prompted innovation across a wide range of areas. However the ongoing impact of the pandemic on both our staff, patients who have had COVID-19 and patients who have waited longer than expected for treatment as a result, have added to the risks facing the Trust. This risk has continued into 2021/22 and has been coupled with increases in referrals for cancer and increased attendances to our emergency department and non-elective activity. National targets for performance have not been amended as a result of the pandemic, although the national plan has focussed on the recovery of activity levels as the first stage in a restoration of elective services. Capacity – The initial and subsequent waves of the COVID-19 pandemic have led to increases in the waiting times for patients and the number of patients waiting more than 52, 78 and 104 weeks has increased significantly. While there was a significant reduction in the number of patients waiting over 104 weeks in 2021/22, with the Trust expecting that no patients will be waiting more than 104 weeks by July 2022, its ability to reduce the overall waiting list and the length of time patients are waiting for treatment remains one of the key risks for the Trust. This may be compounded by future waves of the COVID-19, a continuation of the sustained demand for urgent non-elective activity and an ongoing number of referrals, often requiring more complex treatment due to delays in people visiting their GPs for the first time and presenting with more advanced disease. The Trust utilised the support available from the independent sector to continue cancer treatment and surgery for those patients at highest risk and continues to make use of independent capacity for cardiac surgery. It also increased the number of outpatient attendances which took place by telephone or video call. The Trust developed a clinical assurance framework during the year to better assess the risk of harm to patients as a result of delays in treatment and this has been utilised in decision-making around the allocation of resources to those areas where there is the greatest risk of potential harm to patients. In addition to opening additional capacity during 2021/22 (described in the Estates section below), the Trust also committed expenditure in 2021/22 to open further wards and operating theatres during 2022/23 and 2023/24. These initiatives will contribute to further improvements in elective waiting times in coming years. 15 Quality and compliance – The Trust continued to monitor the quality of care delivered throughout 2021/22. During the COVID-19 pandemic the primary focus became infection prevention and control, with the launch of an award-winning COVID ZERO campaign that saw the Trust reduce the transmission of the virus in hospital (nosocomial transmission). While the Trust continued to perform well overall, the Trust exceeded its annual threshold for Clostridium difficile infections and there was one MRSA bacteraemia during March 2022, the only such event in 2021/22. The Trust continued to develop its proactive patient safety culture during 2021/22 with changes to the way in which patient safety incidents are investigated and the launch of its Always Improving strategy and transformation initiatives in theatre efficiency, patient flow and outpatients. Reporting and investigation of incidents continued during 2021/22. The Trust continues to prepare for the implementation of the new patient safety incident response framework in June 2022/23. Partnerships – During 2021/22, the Trust and its partners continued to work together to discharge patients safely, to ensure patients requiring urgent cancer treatment and surgery were able to continue their treatment in the independent sector and to develop the regional COVID-19 saliva testing programme for local schools, hospitals and other employers. The new arrangements for integrated care systems will be implemented in July 2022. This is expected to reinvigorate work with partners at a system, place and provider level in Hampshire and Isle of Wight. The Trust is already part of an acute provider collaborative with other acute trusts in Hampshire and the Isle of Wight and is progressing a number of projects including the development of an elective hub at Winchester Hospital, diagnostics, pathology, endoscopy and imaging networks. The Trust also continued to progress research activity and opportunities with the University of Southampton and Wessex health partners. Workforce – The Trust continued to recruit nurses from overseas and through targeted recruitment campaigns during 2021/22 meaning that the number of nursing vacancies has remained relatively stable. Vacancies in other areas have increased reflecting a more competitive job market, particularly for lower band roles. The Trust also continued to work with its staff networks and specific focus groups to increase diversity in leadership roles. Staff turnover remained above the 12% target during 2021/22 and retention is a key element of the people strategy. While workforce capacity continues to be one of the biggest challenges faced by the Trust, during 2021/22 we have also focused on supporting our staff to respond to the COVID-19 pandemic and operational pressures by providing both the tools and time to help staff recovery. We are incredibly proud of the way that staff responded to the pandemic and continue to recognise this in whatever ways we can, however, we also want to ensure that staff continue to be able to contribute to patient care at their best and want to stay and develop with the Trust. Technology was also used at levels not previously achieved to continue to deliver training to staff and enable staff to work from home where possible, ensuring a safer environment for patients and staff in the hospitals. Estate – The Trust continued to invest in and develop its estate during 2021/22 including opening a new ophthalmology outpatient area, expansion of the majors area of the emergency department and four new operating theatres. These were part of £65 million of capital expenditure in 2021/22 that also included equipment, digital and the backlog maintenance programme. Innovation and technology – There have been exceptional levels of achievement in relation to COVID-19 related research activity, including in partnership with the universities. You can read more about these in part three of the quality account. The board of directors has also supported the funding of an expansion of research and innovation activity to allow the continued delivery of the Trust’s ambitions to innovate and improve and transform its services. 16 The Trust and its partners also been successful in securing external funding including one of only four successful NHSX awards to test the concept of federated trusted research environments with its Wessex health partners and core funding of £10.5 million for the National Institute for Health and Care Research (NIHR) Southampton Clinical Research Facility (CRF) for the period between September 2022 and August 2027. Sustainable financial model –The Trust achieved its forecast breakeven position in 2021/22. Income was more predictable in 2021/22 as block contract arrangements remained in place in response to the COVID-19 pandemic and ensured that costs were covered, however, funding from the elective recovery fund, particularly, in the first half of 2021/22 introduced a degree of income volatility as did changes to the framework for the elective recovery fund half way through the year. The Trust continues to maintain a strong cash position and to implement improvements and efficiency savings, allowing it to continue to invest in its services. The financial outlook across the NHS looks extremely challenging going into 2022/23 due to the reductions in non-recurrent funding and efficiency targets. The Trust currently has an underlying deficit, with pressures on energy prices and drugs cost growth within block contract arrangements, which had been supported with non-recurrent funding in previous years. While specific funding has been provided to address inflationary pressures there is a risk that inflation could exceed this funding and raw material and supply shortages could also impact on costs. Performance overview The Trust monitors a very wide range of key performance indicators within its departments, divisions, directorates and executive committee. Assurance for our board of directors and executive committee includes an integrated performance report which is reviewed monthly and contains a variety of indicators intended to provide assurance regarding implementation of our strategy and that the care we provide is safe, caring, effective, responsive and wellled. The integrated performance report also includes a monthly ‘spotlight’ section, to enable more detailed consideration of any topics that are of particular interest or concern. The selection of topics is informed by a rolling schedule, any performance concerns and requests from the board of directors. Assurance for our council of governors includes a quarterly Chief executive’s performance report, which includes a range of non-financial and financial performance information. 17 Performance analysis COVID-19 Impacts In 2021/22, the most prominent impacts of COVID-19 have been in relation to occupancy of inpatient beds by patients with a COVID-19 diagnosis and increased levels of staff sickness absence associated with COVID-19, in addition to normal levels of absence due to other causes. The impact of COVID-19 has varied significantly through the year, linked primarily to the prevalence of the disease within the wider community. In comparison to 2020/21: • bed occupancy (all types) did not reach the same exceptional peaks, however, it exceeded 50 patients between August 2021 and March 2022 and reached an average of 83 in March 2022; • the number of patients requiring treatment in intensive care and high care were much reduced, though still significant; • fewer patients were admitted requiring hospital treatment for COVID-19 alone, and greater numbers were admitted requiring treatment for other medical conditions who were also infected with COVID-19 at the same time; • staff sickness absence levels were typically higher, particularly in the second half of the year when national restrictions had been removed and COVID-19 infections in the community increased – the sickness absence rate (from all causes) peaked at 6% in March 2022 All bed types Intensive care/higher care beds 18 Staff sickness absence Emergency access through our emergency department Following a reduction during the first year of the pandemic, the numbers of patients who presented to receive care at our emergency department increased exponentially in 2021/22. Attendance levels exceeded the higher levels seen prior to the pandemic by approximately 10%. All patients presenting to the emergency department This exceptional increase in the clinical demand upon our department has had a significant adverse impact upon the timeliness of care, particularly for those patients who have a less urgent condition. The department has also continued to deliver services separately for those patients who have respiratory symptoms and those who do not, and to implement additional infection control measures. Emergency access performance is measured as the percentage of patients discharged from emergency department care or admitted to a hospital bed within four hours of arrival to the department. The national target of 95% was not achieved and the Trust experienced a large deterioration in our own performance to 64% (main ED/Type 1 attendances) by March 2022. Our performance compared favourably with other acute trusts in England despite this, however. 19 Emergency access four hour performance The number and duration of any ambulance handover delays are another important performance indicator. Ensuring that ambulance staff can ‘hand over’ the patients they convey to our emergency department without delay is important because this releases the staff and their vehicle to meet the needs of other medical emergencies in the community. We are very proud to have an exceptionally good record in this regard, working with colleagues in ambulance services to transfer arriving patients into our emergency department and the care of our staff even when the hospital is already fully occupied. 20 Elective Waiting times Demand 2021/22 has seen a continuation of the trend of increasing elective referrals, following a major reduction which occurred at the start of the COVID-19 pandemic. Referral rates to our services are now typically at, or above, the levels seen before the pandemic. Feedback from clinicians is that they are also seeing more patients with advanced disease than they would normally, because of delays in referral to the service/diagnosis. Accepted referrals The number of patients referred to hospital with suspected cancer increased exceptionally during 2021/22; the number of patients seen for a first consultant-led appointment was 27% higher than in 2020/21 and 18% higher than in 2019/20. Performance remained below the national target of 93% throughout the year, with a deterioration to 74% in December 2021 prior to a recovery to 90% in March 2022. Our performance also declined in comparison with other acute trusts in England. Most of the patients who waited longer than two weeks for their first appointment were within our breast service, which sees a very large number of referrals for suspected cancer and experienced a 22% increase in the number of patients seen compared to 2019/20. Additional consultants who specialise in breast cancer have now been recruited and performance in this service returned to target in April 2022. 21 Performance following ‘Two week wait’ urgent referral for suspected cancer 22 Activity The number of UHS hospital appointments, diagnostic tests and elective admissions all increased significantly during 2021/22. The number of appointments undertaken, and diagnostic tests performed, exceeded activity levels in both 2019/20 and 2020/21. The number of elective and day case admissions increased significantly compared to 2020/21 (the first year of the pandemic) yet remained approximately 10% below the levels achieved between April 2019 and February 2020 (prior to COVID-19). There were a wide range of factors influencing these activity levels, and the lower levels of admitted activity specifically, including: • the availability of beds for the admission of elective patients after emergency patients with COVID-19 and other conditions had been accommodated; • the availability of staff to deliver elective care, during periods of increased COVID-19 bed occupancy, and during periods of increased staff absence related to COVID-19; • additional infection prevention measures which were maintained, particularly within inpatient treatment settings where risks of COVID-19 transmission are otherwise increased. Most of the activity has been delivered within NHS hospitals in 2021/22 (local independent sector hospitals were used to replace NHS elective capacity in 2020/21), and we have recruited additional staff and invested in an additional ward, theatres and outpatient rooms in order to be able increase our treatment activity. The graphs below show 2021/22 activity levels as a percentage of those achieved prior to the COVID-19 pandemic. Elective admissions (including day case) 23 Outpatient attendances Diagnostics Our performance measures for diagnostics report on a total of 15 different frequently used tests. At the end of March 2022, 20% of patients were waiting more than six weeks to receive their investigation. This is a significant improvement compared to 28% of patients waiting more than six weeks at the end of March 2021, yet still significantly worse than the national target (1%) and UHS performance prior to pandemic. At the end of March 2022, the total waiting list size (including patients waiting less than six weeks) had increased by 14% compared to March 2021 and was 34% larger than before the pandemic. These trends reflect a combination of large reductions in diagnostic activity in the first year of the pandemic, followed by record levels of diagnostic tests being performed during 2021/22 (7% higher than before the pandemic) combined with very high levels of referrals for diagnostic testing over the same period. 24 The tests with largest numbers of longer waiting patients are non-obstetric ultrasound, peripheral neurophysiology, MRI and CT. Initiatives to improve performance include the recruitment of additional staff in the relevant professions and investment in additional equipment, in the context of NHS forecasts that diagnostic demand will continue to increase over the longer term. Patients waiting for a diagnostic test to be performed (sum of 15 different frequently used tests) Percentage of patients waiting over 6 weeks for a diagnostic test to be performed 25 Referral to Treatment Our waiting list from referral to treatment increased in size by 27% (9,768 patients) during 2021/22 and is now 36% larger than before the pandemic. Both referrals and hospital activity declined steeply at the start of the pandemic, but referral levels increased more quickly than hospital activity following this. The rate at which the waiting list is increasing has however reduced in the most recent six months. Number of patients waiting between referral and commencement of a treatment for their condition The national target is that at least 92% of patients should be waiting for treatment no more than 18 weeks from their referral to hospital. Our performance has deteriorated from 80% immediately before the pandemic, to 68% at the end of March 2022. Our performance continues to be typical of the major teaching hospital trusts that we benchmark with, and the trend has been similar to that experienced across trusts in England. Percentage of patients waiting up to 18 weeks between referral and treatment 26 The fact that some patients wait significantly longer than the 18 week target is a particular concern. In 2020/21 NHS England targeted the stabilisation of the numbers of patients waiting more than 52 weeks and the elimination of waiting times more than 104 weeks (except when patients choose to wait longer). The percentage of patients waiting more than 52 weeks at UHS reduced from 9% to 4%. The number of patients waiting more than 104 weeks reduced, from a maximum of 171, to 59 at the end of March 2022 (of whom only five were wishing to proceed with treatment at that time). The patients who typically wait longest for treatment continue to be those who require admission for surgical procedures in specialities such as ear nose and throat, orthopaedics and oral surgery. The Trust opened four additional operating theatres during 2020/21 and is working in collaboration with partners in the Hampshire and Isle of Wight integrated care system to implement further elective recovery plans. Percentage of patients waiting more than 52 weeks, between referral and commencement of a treatment for their condition 27 Cancer Waiting Times The timeliness of urgent services for patients with suspected cancer has unfortunately declined during 2021/22. The Trust continues to perform well in comparison with the teaching hospitals that we benchmark with and deliver a similar range of services, however. We have faced a range of challenges including: • a large increase in the number of new patients referred for investigation; • delays in the onward referral (for specialist investigation or treatment) of patients from other trusts which have also experienced increases in referrals; • the need to provide capacity to investigate and treat the full range of other conditions, alongside those patients with suspected cancer; and • an increase in the complexity of treatment required by new and existing patients, potentially because of delays in referral or treatment during the first year of the pandemic The national target is to provide the first definitive treatment to at least 85% of patients with cancer with 62 days of referral to hospital. UHS exceeded this level of performance in April 2021 but has not done so since then, performance deteriorated to 66% in January 2022 before recovering somewhat to 72% by March 2022. Treatment for Cancer within 62 days of an urgent GP referral to hospital The national target is to provide the first definitive treatment to at least 96% of patients within 31 days of a decision to treat being made and agreed with the patients. Trust performance has been very variable in 2021/22, ranging from 89% to 98% in individual months. Likewise, performance has ranged from below average in some months, to amongst the best in the group of teaching hospitals that we benchmark with. 28 First definitive treatment for cancer within 31 days of a decision to treat A range of initiatives are being pursued to maintain and improve the timeliness of our cancer services including: • changes to some of the processes for the referral and initial assessment of patients with suspected cancer, for example the inclusion of high quality photographs within referrals for suspected skin cancer; • projects to refine processes and procedures for the investigation of suspected gynaecological and urological cancers; • an operating services improvement programme designed to improve the flow of patients, and the numbers of patients treated, through our existing theatre facilities; and • staffing level increases and recruitment to clinical roles in specialities where the increases in demand require this. Quality priorities The Trust set four quality priorities in 2021/22, which were aimed at ensuring we continued to deliver the highest quality of care. The quality priorities were shaped by a range of national and regional factors as well as local and Trust‐wide considerations. We recognised the overriding issues of significant operational pressures being felt right across the health and social care system, including those associated with the second year of the COVID-19 pandemic, by limiting the number of priorities to four. We also acknowledged the risk that the delivery of our priorities could be disrupted by the ongoing pandemic and that we needed to be flexible in adapting the priorities to changing circumstances. The Trust set the following four priorities: 1. Introduction of midwifery continuity of carer for women at risk of complications in pregnancy. 2. To support staff wellbeing and recovery. 3. Managing risks to patients delayed for treatment and restoring elective programmes. 4. Reducing healthcare associated infection (HCAI) 29 The Trust achieved three of the quality priorities and partially achieved one priority. In relation to midwifery continuity of carer, the Trust’s performance exceeded the ambition that had been set by NHS England in 2020/21 following its national review of maternity services in 2015 as shown below. NHS England ambition set in 2020/21 35% of women will be booked to receive care in a continuity of carer team 35% of black and minority ethnic women booked to receive care in a continuity of carer team 35% of women living in an IMD-1 area (most deprived areas measured using indices of deprivation) Percentage achieved 41.7% 75% 80% The Trust continued to introduce programmes, interventions and wider support offerings to promote staff wellbeing and recovery in 2021/22. Our 2021/22 annual NHS staff survey results are positive with our scores relating to wellbeing above the benchmark average. Contributing factors to wellbeing such as staff engagement, morale, staff experience in areas such as kindness and respect, feeling valued and trusted to do their job were all above the benchmark average. More information about staff health and wellbeing is included in the staff report below. The Trust only partially achieved the priority relating to managing the risks to patients delayed for treatment and restoring elective programmes. The Trust’s performance against elective waiting time standards are described in more detail above. While the Trust focused on prioritising all patients waiting for surgery to ensure we continued to treat people based on need and urgency, we continue to recognise the impact of delays on people’s quality of life and, at times, outcomes. COVID-19 remained a key area of focus for the Trust in 2021/22 in terms of infection prevention. The Trust implemented a number of awareness campaigns, including its award-winning COVID ZERO campaign, and strategies to reduce in-hospital transmission of COVID-19 and kept these under review throughout the year. The chart below shows the trend of hospital-onset cases of COVID-19, which has broadly followed local and national prevalence of the virus, and the Trust’s performance compared very favourably with its local and national peers. 30 The table below provides an overview of the Trust’s performance against national and other infection prevention standards and limits to minimise infections, the majority of which have been achieved by the Trust. Category National Objectives: MRSA bacteraemia Clostridium difficile infection E coli Bacteraemia End of year RAG Action /Comment R One MRSA bloodstream infection attributable to UHS 2021/22 in March 2022. R 74 cases against a threshold of 64 for the year. G 138 cases in 2021/22 against a threshold of 151. Klebsiella Bacteraemia A 64 cases in 2021/22 against a threshold of 64. Pseudomonas Bacteraemia MSSA G 30 cases in 2021/22 against a threshold of 34. 43 cases in 2021/22 after 48 hours in hospital. Other: Hospital onset, healthcare associated COVID-19 103 hospital-onset probable healthcareassociated cases in 2021/22. 125 hospital onset definite healthcare associated cases in 2021/22. Prudent antibiotic Antimicrobial prescribing Stewardship G The standard contract requirement for reduction in antibiotic usage for 2021/22 was waived, as in 2020/21. Had it been applied as anticipated, the Trust would very likely have met this. Provide Assurance of Infection G The annual infection prevention audit assurance of Prevention Practice programme was reinstated in April 2021 for basic infection Standards the monitoring and assurance of infection prevention prevention and control practices but practice: subsequently suspended in September 2021. You can find more information about how the Trust delivered and measured its quality priorities, including feedback from patients and staff and improvement aims and quality priorities for 2022/23, in the Trust’s quality account for 2021/22, incorporated in the Trust’s annual report and accounts. 31 Financial performance The Trust delivered a surplus of £0.048 million from a revenue position of over £1.2 billion, once items deemed as “below the line” by NHS England and NHS Improvement, su
Url: /Media/UHS-website-2019/Docs/About-the-Trust/Annual-reports-and-quality-accounts/Annual-report-2021-2022.pdf

Papers CoG - 29.01.2025

Description: Date Time Location Chair Agenda Council of Governors 29/01/2025 14:00 - 15:30 Conference Room, Heartbeat/Microsoft Teams Jenni Douglas-Todd 1 Chair’s Welcome and Opening Comments 14:00 2 Declarations of Interest 14:03 3 Minutes of Previous Meeting 14:04 Approve the minutes of the previous meeting held on 23 October 2024 4 Matters Arising/Summary of Agreed Actions 14:05 There are no outstanding actions 5 Strategy, Quality and Performance 5.1 Chief Executive Officer's Performance Report 14:06 Receive and note the report Sponsor: David French, Chief Executive Officer 6 Governance 6.1 Chair and Non-Executive Director Appraisal Process 14:26 Approve the Chair and Non-Executive Director Appraisal Process Sponsor: Jenni Douglas-Todd, Trust Chair Attendee: Steve Harris, Chief People Officer 6.2 Audit and Risk Committee Terms of Reference 14:41 Provide feedback on the proposed changes before presentation to the Board of Directors Sponsor: Keith Evans, Audit and Risk Committee Chair Attendee: Craig Machell, Associate Director of Corporate Affairs and Company Secretary 6.3 Governors' Nomination Committee Terms of Reference 14:46 Approve the proposed changes to the Governors' Nomination Committee Terms of Reference Sponsor: Jenni Douglas-Todd, Trust Chair Attendee: Craig Machell, Associate Director of Corporate Affairs and Company Secretary and Karen Russell, Council of Governors' Business Manager 6.4 Annual Business Plan 14:49 Approve the Annual Business Plan for 2025/26 Sponsor: Jenni Douglas-Todd, Trust Chair Attendee: Karen Russell, Council of Governors' Business Manager 6.5 Non-Executive Director Appointment 14:52 Note the commencement of appointment of David Liverseidge Sponsor: Jenni Douglas-Todd, Trust Chair Attendee: Craig Machell, Associate Director of Corporate Affairs and Company Secretary and Karen Russell, Council of Governors' Business Manager 6.6 Governor Attendance at Council of Governors’ Meetings 14:57 Review governor attendance at Council of Governors' meetings Sponsor: Jenni Douglas-Todd, Trust Chair Attendee: Karen Russell, Council of Governors' Business Manager 6.7 Break 15:00 7 Membership Engagement and Governor Activity 7.1 Membership Engagement 15:10 Receive the report Sponsor: Jenni Douglas-Todd, Trust Chair Attendee: Sam Dolton, Events and Membership Officer 7.2 Governors' Nomination Committee Feedback 15:20 Chair: Jenni Douglas-Todd, Trust Chair 8 Review of Meeting 15:25 Review and feedback on the content of this meeting Sponsor: Jenni Douglas-Todd, Trust Chair 9 Any Other Business 15:27 Raise any relevant or urgent matters that are not on the agenda 10 Date of Next Meeting: 29 April 2025 15:29 Note the date of the next meeting Page 2 Minutes - Council of Governors (CoG) Open Session Date Time Location Chair Present 23 October 2024 14.35-15.45 Conference Room, Heartbeat Education Centre and Microsoft Teams Jenni Douglas-Todd, Trust Chair Jenni Douglas-Todd, Trust Chair JDT Shirley Anderson, Elected, New Forest, Eastleigh and Test Valley SA Katherine Barbour, Elected, Southampton City KB Lesley Gilder, Elected, Southampton City LG Sathish Harinarayanan, Elected, Medical Practitioners and Dental SH Staff Councillor Pam Kenny, Appointed, Southampton City Council PK Jenny Lawrie, Elected, Southampton City JL Brian Lovell, Elected, Rest of England and Wales BL Esther O’Sullivan, Elected, New Forest, Eastleigh and Test Valley EO Councillor Louise Parker-Jones, Appointed, Hampshire County LPJ Council Karen Smith, Elected, Health Professional and Health Scientist KS Staff Jake Smokcum, Elected, Nursing and Midwifery Staff JS Professor Emma Wadsworth, Appointed, Solent University EW Mike Williams, Elected, New Forest, Eastleigh and Test Valley MW In attendance Tracey Burt, Minutes TB Sam Dolton, Events and Membership Officer SD David French, Chief Executive Officer (for item 5.1) DF Craig Machell, Associate Director of Corporate Affairs and CM Company Secretary Farhanah Miah, Associate Governor FM Neylia Mustafapour, Associate Governor NM Karen Russell, Council of Governors’ Business Manager KR Apologies Patricia Crates, Elected, New Forest, Eastleigh and Test Valley PC Helen Eggleton, Hampshire and Isle of Wight Integrated Care HE Board (ICB) Professor Mandy Fader, Appointed, University of Southampton MF Ben Grassby, Elected, New Forest, Eastleigh and Test Valley BG Linda Hebdige, Elected, Southampton City LH 1 Chair’s Welcome and Opening Comments The Chair welcomed everyone to the meeting. In particular, the new governors and young Associate Governors. 1 2 Declarations of Interest There were no new declarations of interest relating to matters on the agenda. 3 Minutes of Previous Meeting The minutes of the meeting held on 24 July 2024 were approved as an accurate record of the meeting. 4 Matters Arising/Summary of Agreed Actions All actions had been completed. 5 Strategy, Quality and Performance 5.1 Chief Executive Officer’s Performance Report JDT welcomed DF, Chief Executive, to the meeting. For the benefit of the new governors, he advised that he had joined the Trust in 2016 as its Chief Financial Officer and had then become CEO four years ago. He highlighted the following: • new theatres had recently been opened on F Level which would allow for greater activity. • the waiting list was now stable at around 60,000 having previously been increasing at approximately 1,000 patients per month. He acknowledged the significant effort of staff in reducing the figure. • the Trust had delivered elective activity at 126% of pre-pandemic levels (2019/20), which placed it in the top quartile of peer teaching hospitals across the country. • over the last year, the volume of first time Outpatient appointments had increased by 9%, whilst follow up appointments had reduced by 9%. The challenge was to ensure that every follow up appointment added value. • in September 2024, the hospital’s ED performance had ranked 4th when compared to 20 peer teaching hospitals across the UK. • UHS had been asked to send its financial recovery plan to NHS England (NHSE). • the hospital was constantly looking for ways to stretch itself to do even better (e.g. theatre utilisation, Outpatients and length of stay) but that was a particular challenge, when UHS was already in the top quartile of peer teaching hospitals in the UK. • UHS was working with its local system partners to reduce the number of mental health patients admitted to the hospital, when they should be seen in more appropriate settings. • each day there were around 200/250 frail, elderly patients at UHS who did not meet the criteria to reside (nCTR). On a more positive note, DF advised that: • the new system to log and communicate pathology results (LIMS) had gone live in July 2024. The previous system had been approximately 25 years old and whilst there had been some initial issues externally, the new system was now more stable. • an event ‘We are UHS’ had taken place last week in the Trust. It had provided an opportunity for staff to recognise and celebrate the work done in the hospital. The highlight had been a UHS Staff Awards night at the Hilton Hotel in West End, sponsored by Southampton Hospital Charity and hosted by DF and Gail Byrne, Chief Nursing Officer. Around 400 staff had attended the event. In response to various questions from governors, DF advised that: 2 • the Trust did not always receive extra funding for doing additional activity. The government’s view was that the NHS was still not as productive as it had been prior to the pandemic and that it should be doing more, with fewer resources. DF did not consider that staff should be asked to work any harder and instead, ways needed to be found to ensure that processes were less labour intensive. • the number of Southampton City Council (SCC) and Hampshire County Council (HCC) residents, in the hospital, who did nCTR was very similar. Both councils had been subject to significant cuts in funding and were unable to fund sufficient care home places/domiciliary packages, which would enable those patients to leave the hospital. • the investigation regarding the Never Event that had occurred in September was still underway. KS said that she had been encouraged to hear DF talk about the LIMS project and the incredible work done by the Pathology Team, which she would feedback to the wider pathology community. DF advised that the Trust had commissioned an external review, which would be shared internally and externally. It was hoped that the review would help other hospitals who would, in the future, implement LIMS. 6 Governance 6.1 Governor Attendance at Council of Governors’ Meetings KR advised that under the Trust’s constitution, if a governor failed to attend two successive meetings of the CoG, without good reason, their tenure of office would be terminated. At the time of review, one governor had missed two successive meetings but this had been discussed and was with good cause. Decision: The CoG confirmed that it was satisfied that the failure of the governor to attend two successive meetings of the CoG had been due to reasonable cause and that they would attend future meetings within a reasonable period. No termination of office was therefore required. 6.2 Appointment to the Governors’ Nomination Committee KR advised that a vacancy had arisen on the Governors’ Nomination Committee (GNC) when Kelly Lloyd had left the Trust on 30 June 2024. Governors had been asked to express an interest in joining the GNC, which JL had done. The CoG had decided by unanimous vote to approve her appointment to the GNC. 6.3 Meeting with the Hampshire and IoW ICB - Chair Appointments JDT advised governors that Hampshire and IoW Integrated Care Board (ICB) would be meeting with them on 31 October 2024 at 4 p.m. The intention of the meeting was for the ICB to set out its aspirations for the future of healthcare within Hampshire and the IoW. The ICB had already begun talks with UHS about it working more closely with Hampshire Hospitals NHS Foundation Trust and they also planned for Portsmouth and Isle of Wight hospitals to work together more closely. KR advised that she would circulate the finalised agenda to governors in due course. 3 6.4 Strategy Session Planning KR advised that there would be a Strategy Session for the CoG on Wednesday 11 December 2024 in the Conference Room, Heartbeat Suite. She asked governors to suggest topics for the session and the following were mentioned: • Prof. Chris Kipps, Clinical Director of Research and Development, the Wessex secure data environment and public engagement. • the management of infection prevention within the hospital (e.g. C. difficile) and keeping staff and patients safe. It was suggested that Julie Brooks, Head of Infection Prevention, was invited to the session. • making boards of governors more effective/looking at case studies. SA and JL mentioned an excellent presentation they had heard by NHS Providers. KR said that Martin De Sousa, Director of Strategy and Partnerships, was already booked to attend the session. KR advised that she would circulate further details regarding the Strategy Session in due course. 7 Membership Engagement and Governor Activity 7.1 Membership Engagement SD introduced the Membership Engagement report. He advised that the Communications Team had been involved in organising the recent UHS Staff Awards night and he said that there had been good engagement on social channels and from the Daily Echo. The event would also be featured in the quarterly Connect digital magazine to be published in November. The team was now focussed on the Annual Members’ Meeting and Open Evening to be held on 21 November 2024 in the Heartbeat Lecture Theatre and Conference Room. Around 50 members had already signed up to attend and he was hoping that would rise to 80. He encouraged governors (6 had already signed up) to attend, as it would provide them with a good opportunity to engage with the membership. He advised that in December the virtual event research series would continue with an event on healthy ageing. The following comments were made: • JDT said that the data on emails sent out and the number of bounces was interesting. It suggested that there was some merit in a more focussed/targeted approach. • JDT noted the low engagement with the appeal for second hand clothing for patients to go home in. Governors wondered whether it was due to it being an appeal that had been done before, rather than one that was new. 7.2 Feedback from Strategy and Finance Working Group EO advised that Jake Wilkins, Associate Director, Always Improving, had given an interesting talk to the group on how the Trust’s strategy, transformation plans and improvement goals were delivered. KR noted that he had emailed a copy of his presentation direct to governors. 4 7.3 Feedback from Patient and Staff Experience Working Group KR advised that Shona Small, Complaints Manager and Debbie Watson, Head of Patient and Family Relations, had attended the group to discuss the annual complaints report, which they had circulated prior to the meeting. They had highlighted the nature and complexity of complaints and the challenges of dealing with people who could be difficult to help. The team had been struggling with a lack of resources but that was beginning to ease and they had been positive above the support they received from senior leadership and from one another. The team did also receive positive feedback but governors noted that there was no regulatory requirement for that to be recorded. 7.4 Feedback from Membership and Engagement Working Group SD advised that there had been a discussion about the Annual Members’ Meeting and the role of governors, on the evening. It had been decided that governors could choose whether they roamed, chatting to attendees, or manned the stand that would be in the Conference Room. JDT encouraged all governors to interact with members both at the event and, more generally, in their constituencies. 8 Review of Meeting Governors felt that the sound quality had improved, both in the room and for those who had joined via Teams. It was, however, noted that some attendees still spoke too quietly. FM said that she had been encouraged that governors’ views were valued and listened to. There was a suggestion that governors should bring their own cups for drinks and they asked to be reminded prior to the meetings. 9 Any Other Business There was no other business. 10 Date of Next Meeting The next meeting of the CoG would be held on 29 January 2025. 5 Item 5.1 Report to the Council of Governors - 29 January 2025 Title: Chief Executive Officer’s Performance Report Sponsor: David French, Chief Executive Officer Author: Sam Dale, Associate Director of Data and Analytics Purpose (type an ‘x’ in the appropriate box(es)) (Re)Assurance Approval Ratification Information Y Strategic Theme (type an ‘x’ in the appropriate box(es)) Outstanding patient Pioneering research World class people outcomes, safety and innovation and experience Integrated networks and collaboration Foundations for the future N/A N/A N/A Executive Summary: Information about Trust performance supports the Council of Governors in their role. This report is intended to inform the Council of Governors about aspects of the Trust’s performance. Contents: The Chief Executive Officer’s Performance Report is attached. Risk(s): N/A Equality Impact Consideration: N/A UHS Council of Governors January 2025 Chief Executive’s Performance Report 1. Purpose and Context The purpose of this report is to summarise the Trust’s performance against a range of key indicators. Where available, this report covers data from the period October 2024 to December 2024, noting that some quarterly performance data is reported further in arrears. Notable features of the last quarter include: • A significantly high volume of attendances to our Emergency Department in the period, averaging 448 patients per day. A reflection of a challenging national position which has significantly impacted four-hour performance. • An extremely challenging number of patients not meeting the criteria to reside with volumes peaking above 250 in recent weeks. These patients continue to occupy hospital beds, restricting flexibility in our elective programmes, and impacting flow through the hospital. • Whilst the waiting list has stabilised across the quarter, volumes continue to be above 60,000 with pressure predominantly in referral cohort. However, good progress has been made in reducing the longest waiting patients at both 78+ and 65+ weeks. • The organisation continues to benchmark well for cancer services, ranking in 1st place compared to peer teaching hospitals for two of the three standard waiting time metrics • The financial environment remains extremely challenging and is being monitored closely. UHS reported an £18.2m deficit after eight months which is £14.8m behind plan. This is predominantly due to savings targets not being fully achieved particularly those related to system transformation. • The trust remains on target to spend its full capital allocation for 2024/25 and has delivered elective recovery fund activity (ERF) at 128% of 2019/20 levels which is 15% above the trust’s target. 2. Safety Infection Control MRSA Bacterium infection Clostridium Difficile infection Target 0 78.0% Oct 2024 Nov 2024 Dec 2024 66.6% 59.4% 57.7% Attendances to the Emergency Department (ED) increased further in quarter three, averaging 448 per day across October, November and December in 2024. This represents an increase of 6.6% compared to the previous quarter and a 5.8% increase compared to the same period last year. The pressure on the emergency department across the festive period presented significant challenges on hospital flow and bed state - the four hour performance position reducing to 57.7% in December 2024. This position places the hospital in the third quartile when compared to twenty peer teaching hospitals for Type 1 attendances. Referral to Treatment (RTT) % incomplete pathways within 18 weeks in month Total patients on a waiting list Target => 92% Oct 2024 63.41% 60,879 Nov 2024 62.44% 60,338 Dec 2024 62.04% 60,387 Despite a small decrease in December, the trust’s RTT waiting list remained above 60,000 in every month within quarter three. The main pressure continues to be the referral element of the pathway with the number of patients waiting for surgery reducing. 62% of patients on the waiting list have been waiting less than 18 weeks - the organisation has consistently benchmarked in the top quartile when compared to peer teaching organisations for this metric. UHS continues to make good progress in reducing the longest waiting patients. UHS reported zero patients waiting over 78 weeks in December 2024 and 22 patients waiting over 65 weeks. The majority of these patients remain those impacted by the national shortage of corneal tissue. The organisation’s focus for the remainder of the year continues to be patients waiting over 52 weeks. Cancer Target Faster Diagnosis - within 28 days > =77% 31 Day target - decision to treat to first definitive treatment 62 day target - urgent referral to first definitive treatment => 96% => 70% Sep 2024 82.4% 93.1% 78.1% Oct 2024 84.8% 94.2% 77.5% Nov 2024 86.2% 94.4% 78.9% The organisation has made positive progress in improving cancer waiting times in quarter three. Delivery against the 28 day faster diagnosis has remained above the national target and seen month on month improvement achieving 86.2% for November. This places the organisation in first place compared to 20 peer teaching hospitals across the country. The hospital also ranks in first place for the 62day target. Page 4 of 6 The organisation continues to prioritise cancer patients and their treatments for all tumour sites and cancer types. Pathway efficiencies particularly around pathology and diagnostics are constantly being explored as well as regular dialogue with Wessex Cancer Alliance and the ICB on improvements and innovative techniques to ensure referrals are appropriate and timely. 5. Finance The financial environment remains extremely challenging as we head into the final quarter of 2024/25. The annual plan for 2024/25 was originally approved as a £14.5m deficit which was reduced to £3.3m following central support funding being issued for organisations in deficit. UHS is currently reporting an £18.2m deficit after eight months which is £14.8m behind plan. This is predominantly due to savings targets not being fully achieved particularly those related to system transformation not yet yielding financial benefits. These were always known to have greater risk attached due to the scale of change required. Of note both non criteria to reside and mental health schemes are challenged with patient numbers remaining at similar levels to 2023/24. Both these areas were targeted for significant reduction with the aim of delivering both quality and financial savings. The non delivery of system transformation schemes YTD means £9m of planned savings have not been achieved. Other challenges around industrial action and pay disputes have in many areas now been resolved although there are several areas still under discussion with unions. It should also be noted that UHS continues to deliver activity over and above its funded block contract levels which is valued at £20m YTD. This mainly relates to Emergency Department and Non Elective activity. The YTD deficit and underlying deficit run rate means there is now a significant challenge in delivering the financial plan for the year that would require a surplus to be delivered across the remaining four months and over delivery on efficiency savings targets within the plan. In response to this challenge UHS continues to work with both internal and external stakeholders on how improvements can be achieved. Despite this challenge the organisation has made significant efforts in making sure workforce growth is controlled and agency costs minimised. Agency expenditure is below 1% of total pay expenditure and continues to benchmark favourably when compared to similar organisations. Surge capacity (beds not normally commissioned) have also remained much lower levels than the previous year although has known peaks and troughs with the winter period often more challenging. The trust has also delivered elective recovery fund activity (ERF) at 128% of 2019/20 levels which is 15% above the trust’s target. iThis has helped deliver additional revenues of £20m across the first half of 2023/24 and helping to reduce long waiting patient numbers. Internal transformation initiatives also continue to drive incremental improvement in theatres productivity, outpatient productivity and length of stay with the former two workstreams showing noticeable improvements across the first half of 2024/25. Due to the scale of risk around financial delivery however, for both UHS and the HIOW system, the trusts financial recovery journey continues to be monitored closely as continuing to run in a deficit is not sustainable for the trusts cash or capital position. The trust however remains positive that in working with system partners, improvements can be achieved in time returning the trust to a breakeven footing. Further to this the trust remains on target to spend its full capital allocation for 2024/25 totalling £86m. This includes £1.75m funding (awaiting approval) towards Same Day Emergency Care (SDEC), £18m related to continued investment in decarbonisation funded via a Salix grant, and £7m related to the completion of the Southampton Community Diagnostics Centre planned for the Royal South Hants hospital (centrally funded). This continued investment in capacity, digital and estates infrastructure helps support continued efficiency improvement that provide foundations for the future. Page 5 of 6 6. Human Resources Indicator Staff recommend UHS as a place to work % Staff survey engagement score (out of 10) Q2 24/25 64.1% 6.84 Q3 24/25 Results under national embargo Results under national embargo The annual staff survey takes place throughout September to November. The survey has now closed and we have started to receive the initial results from our supplier, Picker. The HR and OD teams are analysing the initial results and will continue to do so as we receive further results. The participation rate decreased this year, from the previous year, and we will be sharing the results over the coming months as per the national embargo timeline, which is expected to lift February-March 2025. Following this we will be sharing the results trust-wide and supporting teams to receive and respond to the feedback. Indicator Staff Turnover (internal target; rolling 12 month) Sickness absence 12 month rolling (internal target) Target <=13.6% <=3.9% Oct 2024 10.8% 3.87% Nov 2024 10.6% 3.9% Dec 2024 10.7% 3.92% Turnover: In December 2024, there was a total of 99.5 WTE leavers, 22.5 WTE more than November 2024 (77 WTE). The highest since September 2024. Division C recorded the highest number of leavers (28 WTE). Within Division C, Allied Health Professionals staff group had the highest number of leavers (7 WTE), followed by the Nursing and Midwifery Registered staff group at 6 WTE. Divisions B and D had the second and third highest number of leavers (22 and 22 WTE respectively); with the largest numbers being Administrative and Clerical staff group for Div B (8 WTE), and Nursing and Midwifery Registered staff group for Div D (9 WTE). Sickness: In December 2024, the Trusts rolling 12-month sickness absence rate increased to 3.92% (0.02% above target). While the in-month sickness absence reduced from 4.2% in November 2024 to 4.1% in December 2024. Over November and December 2024, anxiety, stress and depression remained at 1% while cold, cough and flu – influenza increased from 0.7% in November to 0.9% in December. Page 6 of 6 Item 6.1 Report to the Council of Governors - 29 January 2025 Title: Chair and Non-Executive Director Appraisal Process 2024/25 Sponsor: Jenni Douglas-Todd, Trust Chair Author: Steve Harris, Chief People Officer and Karen Russell, Council of Governors Business Manager Purpose (type an ‘x’ in the appropriate box(es)) (Re)Assurance Approval Ratification Information Y Strategic Theme (type an ‘x’ in the appropriate box(es)) Outstanding patient Pioneering research World class people outcomes, safety and innovation and experience Integrated networks and collaboration Foundations for the future N/A N/A N/A N/A N/A Executive Summary: The NHS Foundation Trust Code of Governance requires that the Council of Governors (CoG) should take the lead on agreeing a process for the evaluation of the chair and the non-executive directors (NEDs). The Governors’ Nomination Committee (GNC) advises the CoG on that process. The appraisal process supports the board of directors (Board) in ensuring its overall effectiveness by making sure that any individual or collective development needs are identified and that the chair and non-executive directors continue to have capacity to meet the time commitment required for the role. The outcome of appraisal will also be relevant to any decision by the CoG to reappoint a non-executive director. Following recommendation by the GNC at its meeting on 15 January 2025, the CoG is asked to approve the Chair and NED appraisal process for 2024/25. Contents: The attached paper sets out the proposed appraisal process for 2024/25. Risk(s): N/A Equality Impact Consideration: N/A Chair and Non-Executive Director (NED) Appraisal Process for 2024/25 1. Introduction and purpose 1.1 The NHS Foundation Trust Code of Governance requires that the Council of Governors (CoG) should take the lead on agreeing a process for the evaluation of the chair and the non-executive directors (NEDs). The Governors’ Nomination Committee (GNC) advises the CoG on that process. The results of the appraisals are shared with the GNC and the CoG. 1.2 The Trust normally aims to complete the process by 31 March each year. 1.3 The new NHS England (NHSE) Fit and Proper Person Framework for boards was introduced with effect from 30 September 2023. NHSE are expected to launch new appraisals processes for all board members as part of a revised national framework for the management of senior leaders. A refreshed appraisal process for chairs was released in 2024, however the remaining board member processes are still outstanding with no clear date yet for implementation. 1.4 It is recommended therefore the Trust proceeds with the use of the existing NED appraisal framework and uses the new framework provided for the Chair appraisal. 1.5 This paper sets out the proposed process and timescales for the Chair and NED appraisals for 2024/25. 2. Overview of the process 2.1 The Chair of the Trust has responsibility for undertaking the appraisals for NEDs. The Chair’s appraisal process is conducted by the Senior Independent Director (SID). 2.2 Jenni Douglas-Todd, as Trust Chair, will undertake the NED appraisals. Jane Harwood, in her role as SID, will undertake the Chair’s appraisal. 2.3 The process will aim to: • Provide a structured review of performance against personal and organisational objectives set, and the performance of the Trust. • Reflect on demonstration of the Trust values. • Review attendance at key Trust meetings. • Plan for the future, including objective setting for the next year and the identification of a personal development plan. • Provide overall reporting and assurance to the GNC and CoG. Self evaluation Monitoring and reporting to GNC Seeking structured feedback from others Appraisal meeting and personal development plan Evaluation against organisational and personal objectives Appraisal of living the Trust values 2.4 The Trust will use the guidance forms provided by NHSE for NED appraisal. The Trust’s NED appraisal process is in line with guidance published by NHS England (NHSE). 3. NHSE Framework for Chair’s appraisal 3.1 NHSE have a national framework for appraisals of Chairs of provider organisations which was refreshed in 2024. This requests that Trusts ensure a robust multi-source feedback process is conducted. In the refreshed process this is now to be undertaken with consideration given to the NHSE new leadership framework. A summary of these 6 areas can be found in appendix A. The full framework can be found here. 3.2 A summary of the Chair’s appraisal is also required to be provided to the NHSE Regional Director. 3.3 It is intended that UHS use the templates provided for the Chair’s appraisal, and also include our own local values. Multi-source feedback will continue to be requested from Trust Board members and the CoG. Feedback will also be sought from the ICS. 4. Scope of Appraisal 4.1 Appraisals will cover all non-executive directors. This includes: • Jenni Douglas-Todd (Trust Chair) • Keith Evans (Deputy Chair) • Jane Harwood (Senior Independent Director) • Dave Bennett • Professor Diana Eccles • Dr Tim Peachey • Alison Tattersall An objective setting process will take place with David Liverseidge as very recent new starter. 5. Proposed process 5.1 The following is proposed as the process for the 2024/25 round of appraisals: • Use of the standard NED NHSE appraisal template. • Use a system of gaining qualitative feedback on each NED to be appraised from both the CoG and from the Board. • The Chair will meet with each NED to conduct the appraisal once feedback has been collated. • The SID will conduct the appraisal for the Chair. 5.2 To ensure meaningful views can be obtained, it is suggested that the CoG will be asked to provide positive feedback and areas of development in respect of the NEDs as individuals, and as a group. The Lead Governor (Shirley Anderson) will be asked to seek feedback from the council members. 6. Timetable of events Action Agree process and timescales with GNC Details GNC briefed on process and timescales. Who JDT and SH To be completed by 15 January 2025 Booking appraisal Appraisal meetings to be booked by KB meetings JDT (KB) 31 January 2025 Sending out forms All feedback forms to be sent out to SH appraisees and to Governors by close of play on 1 February 2024. Feedback forms to be sent to: • Governors (Via Lead Governor) • All Executives • All NEDs 1 February 2025 Seeking feedback Feedback to be provided to the Chief SA People Officer, who will collate it. SH 21 February 2025 Booking appraisal Appraisal meetings to be booked by KB meetings JDT (KB) 31 January 2025 Appraisal meetings held JDT to hold appraisal meetings with: JDT • Dave Bennett • Professor Diana Eccles • Keith Evans • Jane Harwood 31 March 2025 • Dr Tim Peachey • Alison Tattersall Objective setting meeting to be held with David Liverseidge as a new NED JH to hold appraisal meeting with JDT JH Summary reporting to GNC SH, JDT and JH to draft a summary report to be shared with GNC covering: • Feedback • Areas for development • Objectives going forward SH, JDT and JH Report to be provided to the GNC by SH, JDT and JH. Reporting to COG GNC, supported by Chief People Officer and Chair, to provide a summary report and assurance to the CoG. SH, JDT and JH Reporting to NHSE Summary report to be provided to SH NHSE in line with framework process. 31 March 2025 22 April 2025 29 April 2025 30 April 2025 7. The role of the GNC in assurance and scrutiny 7.1 The GNC will be provided with an annual report written by the Chair, supported by the Chief People Officer, which will provide an overview of the appraisals undertaken, including an overall performance summary and objectives. 7.2 The GNC will have a direct role in endorsing the appraisal process for the Chair. The SID will undertake the appraisal and provide a key summary to the GNC who will be asked to endorse the outcome. 7.3 The CoG will receive assurance from the GNC that appropriate performance appraisal of the Chair and NEDs has taken place. 8. Recommended next steps 8.1 Following recommendation by the GNC at its meeting on 15 January 2025, the CoG is asked to approve the Chair and NED appraisal process for 2024/25. Steve Harris Chief People Officer January 2025 Appendix A – Refreshed leadership framework competencies for the Chair Appraisal Driving high-quality and sustainable outcomes The skills, knowledge and behaviours needed to deliver and bring about high quality and safe care and lasting change and improvement - from ensuring all staff are trained and well led, to fostering improvement and innovation which leads to better health and care outcomes. Setting strategy and delivering long-term transformation The skills that need to be employed in strategy development and planning, and ensuring a system wide view, along with using intelligence from quality, performance, finance and workforce measures to feed into strategy development. Promoting equality and inclusion, and reducing health and workforce inequalities The importance of continually reviewing plans and strategies to ensure their delivery leads to improved services and outcomes for all communities, narrows health and workforce inequalities, and promotes inclusion. Providing robust governance and assurance The system of leadership accountability and the behaviours, values and standards that underpin our work as leaders. This domain also covers the principles of evaluation, the significance of evidence and assurance in decision making and ensuring patient safety, and the vital importance of collaboration on the board to drive delivery and improvement. Creating a compassionate, just and positive culture The skills and behaviours needed to develop great team and organisation cultures. This includes ensuring all staff and service users are listened to and heard, being respectful and challenging inappropriate behaviours. Building a trusted relationship with partners and communities The need to collaborate, consult and co-produce with colleagues in neighbouring teams, providers and systems, people using services, our communities, and our workforce. Strengthening relationships and developing Agenda item 6.2 Report to the Council of Governors - 29 January 2025 Title: Audit and Risk Committee Terms of Reference Sponsor: Keith Evans, Chair Author: Craig Machell, Associate Director of Corporate Affairs Purpose (Re)Assurance Approval Ratification Information x Strategic Theme Outstanding patient outcomes, safety and experience Pioneering research and innovation World class people Integrated networks and collaboration Foundations for the future x Executive Summary: The terms of reference for all Board committees should be reviewed regularly, and at least once annually, to ensure that these reflect the purpose and activities of each committee. The Code of Governance for NHS Provider Trusts requires that Council of Governors is consulted on the terms of reference. The terms of reference are approved by the Board of Directors. It is proposed to amend 10.2 to Code of Governance for NHS Provider Trusts and remove Charitable Funds Committee from Appendix A. No other changes are proposed. The Council of Governors is requested to provide any feedback on the proposed changes to the terms of reference prior to their submission to the Board of Directors for approval. Contents: Audit and Risk Committee Terms of Reference Risk(s): N/A Equality Impact Consideration: N/A Audit and Risk Committee Terms of Reference Version: 67 Date Issued: Review Date: Document Type: 29 February 2024 11 March 2025 30 January 2025 January 2026 Committee Terms of Reference Contents Paragraph 1 2 3 4 5 6 7 8 9 10 Role and Purpose Constitution Membership Attendance and Quorum Frequency of Meetings Conduct and Administration of Meetings Duties and Responsibilities Accountability and Reporting Review of Terms of Reference and Performance and Effectiveness References Appendices Appendix A Committee and Reporting Structure Page 2 2 2 3 3 3 4 6 6 6 Page 7 Document Status This is a controlled document. Whilst this document may be printed, the electronic version posted on the intranet 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 the intranet. Page 1 of 8 1. Role and Purpose 1.1 The Audit and Risk Committee (the Committee) is responsible for overseeing, monitoring and reviewing corporate reporting, the adequacy and effectiveness of the governance, risk management and internal control framework and systems and areas of legal and regulatory compliance at University Hospital Southampton NHS Foundation Trust (UHS or the Trust) and the external and internal audit functions. 1.2 The Committee provides the board of directors of the Trust (the Board) with a means of independent and objective review of financial and corporate governance, assurance processes and risk management across the whole of the Trust’s activities both generally and in support of the annual governance statement. 1.3 The duties and responsibilities of the Committee are more fully described in paragraph 7 below. 2. Constitution 2.1 The Committee has been established by the Board. The Committee has no executive powers other than those set out in these terms of reference. It is supported in its work by other committees established by the Board as shown in Appendix A. 2.2 The Committee is authorised by the Board to investigate any activity within its terms of reference. It is authorised to seek any information it requires from any member of staff and all members of staff are directed to cooperate with any request made by the Committee. 2.3 In carrying out its role the Committee will primarily utilise the work of internal audit, external audit and other assurance functions. It is also authorised to seek reports and assurance from executive directors and managers and will maintain effective relationships with the chairs of other Board committees to understand their processes of assurance and links with the work of the Committee. 2.4 The Committee is authorised to obtain external legal or other independent professional advice if it considers this necessary, taking into consideration any issues of confidentiality and the Trust’s standing financial instructions. 3. Membership 3.1 The members of the Committee will be appointed by the Board and will be independent non-executive directors of the Trust (other than the chair of the Board). The Committee will consist of not less than three members, at least one of whom will have recent and relevant financial experience, ideally with a qualification from one of the professional accountancy bodies. 3.2 The Board will appoint the chair of the Committee from among its members (the Committee Chair).The Committee Chair may be the deputy chair of the Board. However, in the event that the deputy chair must act as chair of the Board for an extended period of time, the deputy chair will resign as Committee Chair. In the absence of the Committee Chair and/or an appointed deputy, the remaining members present will elect one of themselves to chair the meeting. 3.3 Only members of the Committee have the right to attend and vote at Committee meetings. However, the following will be invited to attend meetings of the Committee on a regular basis: 3.3.1 representative(s) from the external auditor; 3.3.2 representative(s) from the internal auditor; Page 2 of 8 3.3.3 representative(s) from the local counter fraud service; 3.3.4 Chief Financial Officer; 3.3.5 Chief Nursing Officer; and 3.3.6 Associate Director of Corporate Affairs/Company Secretary. 3.4 The Chief Executive Officer will be invited to attend meetings of the Committee, at least annually, to discuss with the Committee the process for assurance that supports the annual governance statement. 3.5 Other individuals may be invited to attend for all or part of any meeting, as and when appropriate and necessary, particularly when the Committee is considering areas of risk or operation that are the responsibility of a particular executive director or manager. 3.6 Governors may be invited to attend meetings of the Committee. 4. Attendance and Quorum 4.1 Members should aim to attend every meeting and should attend a minimum of 75% of meetings held in each financial year. Where a member is unable to attend a meeting they should notify the Committee Chair or Company Secretary in advance. 4.2 The quorum for a meeting will be two members. A duly convened meeting of the Committee at which a quorum is present will be competent to exercise all or any of the authorities, powers and discretions vested in or exercisable by the Committee. 4.3 When an executive director or manager is unable to attend a meeting they should appoint a deputy to attend on their behalf. 5. Frequency of Meetings 5.1 The Committee will meet at least four times each year and otherwise as required. 5.2 At least once each financial year the Committee will meet with representatives of the external and internal auditors without management being present to discuss their remit and any issues arising from their audits. 5.3 Outside of the formal meeting programme, the Committee Chair will maintain a dialogue with key individuals involved in the Trust’s governance, including the chair of the Board, the Chief Executive Officer, the Chief Financial Officer, the Chief Nursing Officer, the external audit lead partner and the head of internal audit. 6. Conduct and Administration of Meetings 6.1 Meetings of the Committee will be convened by the secretary of the Committee at the request of the Committee Chair or any of its members, or at the request of external or internal auditors if they consider it necessary. 6.2 The agenda of items to be discussed at the meeting will be agreed by the Committee Chair with support from the Chief Financial Officer and the Company Secretary. The agenda and supporting papers will be distributed to each member of the Committee and the regular attendees no later than five working days before the date of the meeting. Distribution of any papers after this deadline will require the agreement of the Committee Chair. 6.3 The secretary of the Committee will minute the proceedings of all meetings of the Committee, including recording the names of those present and in attendance and any declarations of interest. 6.4 Draft minutes of Committee meetings and a separate record of the actions to be taken forward will be circulated promptly to all members of the Committee. Once approved by Page 3 of 8 the Committee, minutes will be circulated to all other members of the Board unless it would be inappropriate to do so in the opinion of the Committee Chair. 7. Duties and Responsibilities The Committee will carry out the duties below for the Trust. 7.1 Integrated Governance, Risk Management and Internal Control 7.1.1 The Committee will review the establishment and maintenance of an effective system of integrated governance, risk management and internal control across the whole of the Trust’s activities (clinical and non-clinical), that supports the achievement of the Trust’s objectives. In particular, the Committee will review the adequacy and effectiveness of: 7.1.1.1 all risk and control related disclosure statements (in particular the annual governance statement), together with the head of internal audit opinion, external audit opinion or other appropriate independent assurances, prior to submission to the Board; 7.1.1.2 the underlying assurance processes that indicate the degree of achievement of the Trust’s objectives, the effectiveness of the management of principal risks and the appropriateness of annual disclosure statements; and 7.1.1.3 the policies and arrangements for ensuring compliance with relevant regulatory, legal and code of conduct requirements and any related reviews, reporting and selfcertifications, including the NHS Constitution, the Trust’s NHS provider licence, registration with the Care Quality Commission and the Trust’s constitution, standing orders and standing financial instructions and management of conflicts of interest. 7.2 Internal Audit 7.2.1 The Committee will ensure that there is an effective internal audit function that meets the Public Sector Internal Audit Standards and provides appropriate independent assurance to the Committee, Accounting Officer and Board. This will be achieved by: 7.2.1.1 considering the provision of the internal audit service and the costs involved; 7.2.1.2 reviewing and approving the annual internal audit plan and more detailed programme of work, ensuring that this is consistent with the audit needs of the Trust as identified in any risk assessment; 7.2.1.3 considering the major findings of internal audit work (and the appropriateness and implementation of management responses) and ensuring coordination between the internal and external auditors to optimise audit resources; 7.2.1.4 ensuring the internal audit function is adequately resourced and has appropriate standing within the Trust; and 7.2.1.5 monitoring the effectiveness of internal audit and carrying out an annual review. 7.3 External Audit 7.3.1 The Committee will review and monitor the external auditors’ integrity, independence and objectivity and the effectiveness of the external audit process. In particular, the Committee will review the work and findings of the external auditors and consider the implications and management’s response to their work. This will be achieved by: 7.3.1.1 considering the appointment and performance of the external auditors, including providing information and recommendations to the council of governors in connection with the appointment, reappointment and removal of the external auditors in line with criteria agreed by the council of governors and the Committee; Page 4 of 8 7.3.1.2 discussing and agreeing with the external auditors, before the external audit commences, the nature and scope of the audit as set out in the annual external audit plan; 7.3.1.3 discussing with the external auditors their evaluation of audit risks and assessment of the Trust and the impact on the audit fee; 7.3.1.4 reviewing all external audit reports, including reports addressed to the Board and the council of governors, and any work undertaken outside the annual external audit plan, together with any significant findings and the appropriateness and implementation of management responses; and 7.3.1.5 ensuring that there is in place a clear policy for the engagement of external auditors to supply non-audit services taking into account relevant ethical guidance. 7.4 Financial Reporting 7.4.1 The Committee will monitor the integrity of the financial statements of the Trust and any formal announcements relating to the Trust’s financial performance. 7.4.2 The Committee will ensure that the systems for financial reporting to the Board, including those of budgetary control, are subject to review as to the completeness and accuracy of the information provided to the Board. 7.4.3 The Committee will review the annual report and financial statements before these are presented to the Board in order to determine their completeness, objectivity, integrity and accuracy and the letter of representation addressed to the external auditors from the Board. This review will cover but is not limited to: 7.4.3.1 the annual governance statement and other disclosures relevant to the work of the Committee; 7.4.3.2 areas where judgment has been exercised; 7.4.3.3 appropriateness and adherence to accounting policies and practices; 7.4.3.4 explanation of estimates or provisions having material effect and significant variances; 7.4.3.5 the schedule of losses and special payments, which will also be reported on separately during the financial year; 7.4.3.6 any significant adjustments resulting from the audit and unadjusted audit differences; and 7.4.3.7 any reservations and disagreements between the
Url: /Media/UHS-website-2019/Docs/About-the-Trust/Governors/Papers-CoG-29.01.2025.pdf

1 to 10 of 26

Previous 1 2 3 Next

Browse site A to Z

Search results

Long-term continuous positive airway pressure (CPAP) treatment - patient information

Patient-initiated follow-up (PIFU) for CLL, SLL, LMZL and HCL - patient information

UHS AR 22-23-6

G29 Guideline on completion application and study assessment v1 14-10-20...

Feeding information for infants with congenital heart disease

Preparing for surgery - patient information

Recovering from a heart attack - patient information

Cardiac surgery - patient information

Annual report 2021-2022

Papers CoG - 29.01.2025

Site policies

Contact details

Useful links