NHS Foundation Trustgether2

Making life Better2gether

Annual Report and Accounts2013/14

Mental and Social Healthcare

2gether NHS Foundation Trust

Annual Report and Accounts 2013/14

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

Strategic Report

Directors’ Report

Remuneration Report

Staff Survey

Regulatory Ratings

Disclosures in the Public Interest

Statement of Accounting Officer’s Responsibilities

Annual Governance Statement

Quality Report

Annual Accounts

Contact Us

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Contents Our annual report explains who we are, what we do, what we have achieved over the last 12 months and what we plan to do in the future.

As an NHS foundation trust, we help ensure local accountability, ownership and control of local services.

Membership is free. To find out more information, please see page 42

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Opening of the day care unit and cafeteria at Stonebow Unit, Hereford

Strategic Report

Our strategic priorities are to deliver continuous quality improvements;

transformation to ensure sustainability; and ongoing

engagement

As we reflect on another year, I welcome the opportunity to highlight the challenges we have faced and the achievements we have delivered for our services users and carers. It is through the hard work and professionalism of our colleagues that we have been able to provide the high quality of services that we would want for our own family and friends.

Our 2013/14 Annual Report provides information to help service users, regulators and other stakeholders to assess our performance. It explains who we are, what we do, what we have achieved over the last 12 months and what we plan to do in the future. Our Annual Accounts have been prepared under a direction issue by Monitor under the National Health Service Act 2006. The main sections are as follow:

Our Strategic Report provides an analysis of the trust’s performance over the last twelve months April 2013 to March 2014 and our plans for 2014/15The Directors’ Report introduces you to members of the trust board and performance against regulatory ratingsOur Quality Report presents a review of our standards and performance during 2013/14 and our priorities for improvement in 2014/15Annual Accounts for 2013/14

Our organisation’s core purpose is to make life better – both for the people in our care and the carers who support them.

The people we serve are at the heart of what we seek to achieve and it is through the competence and compassion that is demonstrated by colleagues across the trust that we are able to deliver the high quality of care that we would want for our own family.

Our aim is to ensure that our service users, their families and carers are at the centre of everything we do:

We believe in what we do and everything we do is to help make life betterWe keep our service users safe and provide compassionate, competent care that is close to their homeWe deliver the best outcomes and experience for our service users and their carers

We are also a strongly performing trust, dedicated to making sure that the communities in which we work can benefit from sustainable and locally controlled health and social care service. Much of our work is focused on ensuring that we contribute to the emotional, economic and social wellbeing of the communities we serve through easily accessible, interconnected pathways of care. This is how we can make a biggest difference to the most people.

This does not come without challenges. The economic context of the health and social care communities in which we work requires us all to face significant challenges and over the year we have all continued to challenge what we do and how we do things.

Commissioner colleagues are seeking greater value from the money they have available and providers of services like us are striving to deliver better quality at less cost.

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Strategic ReportChief Executive’s Statement

Our strategy for providing quality based services is informed by best practice and active engagement.

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Like all NHS organisations, we are sometimes required to make difficult choices, deliver tough financial planning and ensure robust monitoring of our decisions to meet the increasing demand on our services. We know that a combination of increase in population size, increased prevalence and reducing stigma means that rising demand will continue. A NHS Confederation Mental Health Network publication indicates that by 2030 an additional two million people in England will be experiencing a mental health difficulty.

Over the last twelve months we have remained committed to reducing the cost of provision while providing the same or better quality of services within the resources available to us.

In our 2013/14 Quality Report you will read about our progress against targets over the past year and the priorities we have set ourselves in 2014/15. Our aim is to keep improving the standards of care we provide.

To monitor our progress, we have identified seven goals with ten associated targets - each is aligned to the themes of the NHS Outcomes Framework: Safety; Effectiveness; and User Experience.

I have no doubt that our commitment to putting safety first has led to willingness to do things differently.

We continue to participate actively in the South of England Improving Safety in Mental Health Programme and were one of the first twelve NHS organisations to pledge to reduce avoidable harm by 50% in line with the Secretary of State Sign Up to Safety initiative. Our high performance over 2013/14 is again testament to the dedication of all staff across the organisation. I am continually grateful for how colleagues continue to deliver care with a steadfast commitment to the people we serve.

To help improve what we do, we spend time listening, hearing and acting upon the experience that service users, their family and carers share with us. Our strategy for providing quality based services is informed by best practice an active engagement.

It is through open and honest conversations with commissioners, providers and the people we serve that continuous improvements in quality are understood and acted upon.

We start 2014/15 in a solid financial position. We will now work with our staff, Governors service users, carers, and commissioners to develop new and innovative ways to sustain the continuity of services for the benefit of our communities. Using our combined experience, we will continue to raise standards and deliver the best possible care.

Shaun CleeChief Executive 27 May 2014

QualityFor information on our progress against quality targets, please see page 71

RatingsFor information about how we performed against finance and governance risks, please see page 59

RemunerationFor information about our approach to remuneration, please see page 48

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About 2gether NHS Foundation Trust 2gether NHS Foundation Trust (2gether) provides specialist social and mental healthcare services across Gloucestershire and Herefordshire.

Directors

SeniorManagers

All otherEmployees

Total Directors

Male Female Total

3 2 5

47 60 107

428 1437 1865

478 1499 1977 All otherEmployees

SeniorManagers

25%

100%

75%

50%

0%

FemaleMale

We were one of the first ten mental health trusts in England to achieve foundation trust status when we were authorised by Monitor, the independent regulator, to operate as a foundation trust from 1 July 2007.

As a foundation trust, we are a not-for-profit, public benefit corporation. The applicant organisation, Gloucestershire Partnership NHS Trust, was established when we brought together specialist staff and services from four different organisations: Severn NHS Trust, East Gloucestershire NHS Trust, Gloucestershire County Council and Gloucestershire Health Authority.

We became 2gether in April 2008 as part of an initiative to strengthen our identity and pursue our vision of ‘making life better’ for individuals experiencing learning disabilities and mental ill health.

Over 7300 members help to make sure that the trust is an integral part of the communities we serve. Our continued aim is to seek ways that help our members to be engaged, well informed and consulted across a range of NHS initiatives.

On 31 March 2014, 2gether employed 1,977 people across a variety of professions including, doctors, nurses, Allied Health Professionals, social workers and support staff. This figure does not include bank staff who are invaluable in helping to provide a compassionate and caring service for our service users.

The following tables provide a breakdown at year end (31 March, 2014) of the number and percentage of male and female members of staff, excluding those on our staff bank:

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As a signatory of the Mindful Employer charter, we are committed to supporting staff with stress, anxiety, depression and other mental health conditions. We are also committed to promoting wellbeing and providing employment opportunities for people with mental health conditions.

The services we provide are determined and paid for by NHS commissioning organisations. These are the organisations that manage local budgets.

During 2013/14, our two main commissioners were Gloucestershire and Herefordshire Clinical Commissioning Groups (CCGs). We also held contracts with commissioners in our surrounding region and a contract with NHS Specialist Commissioners for Low secure mental health inpatient care.

Our comprehensive range of mental health services are provided according to core NHS principles - free care, based on need and not on someone’s ability to pay.

At any one time, we provide care and support to over 21,000 individuals and offer education and support to their carers and families. 2gether staff provide assessment, signposting and support for people with long term conditions such as dementia and Primary Mental Health Care including the treatment of common mental health problems like depression and anxiety through our Let’s Talk service.

Each of our Gloucestershire localities is aligned to our local general practice surgeries and deliver local services to our communities through multidisciplinary and specialist teams. In Herefordshire, we are working with commissioners to continue the transformation of services, providing enhanced community support to help people live independently at home and avoid hospital admission where appropriate.

We also deliver community and inpatient NHS learning disability services; adult inpatient mental health care at Stonebow, (Hereford), Wotton Lawn (Gloucester) and Charlton Lane (Cheltenham); psychiatric intensive care at Greyfriars (Gloucester); Assertive outreach and recovery services; children and young people emotional wellbeing services; eating disorder services; Section 136 care at the Maxwell Centre Assessment Suite; and drug and alcohol services in Herefordshire.

Our occupational health service provides services to public and private organisations through our Working Well identity. Our Gloucestershire based Back 2 Work services facilitate vocational opportunities and promote social inclusion for people in recovery from mental ill health.

Last year we:

received 41,115 referrals into our services provided support to 61,008 people through face to face contact with nearly 390,000 actual contactscared for 1,288 people in our three hospitals sites in Hereford, Gloucester and Cheltenhamprovided 96% of our services within the community to help make sure that our service users received care as close to their family and friends as possible - an essential factor in helping to improve a person’s recovery achieved accreditation under the Memory Services National Accreditation Programme (MSNAP) for the provision of assessment and diagnosis of dementia for Managing Memory 2gether in Gloucestershireachieved accreditation under the national Home Treatment Accreditation Scheme (HTAS) for our Gloucestershire Community Service Teamsachieved Accreditation for Inpatient Mental Health Services (AIMS) for Dean, Kingsholm and Priory Wards at Wotton Lawn, Gloucester; and Mortimer Ward, Stonebow, Hereford

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Vision and ValuesQuality is a central element of our vision and values, organisational strategy and annual business plan.

We continue to develop high quality services that meet the needs of our local communities at a cost that our commissioners can afford.

We are responsive, progressive and committed to delivering a quality of service that we would want for a member of our own family.

Our aim is to work with our commissioners and the local population to develop and deliver appropriate, cost effective and efficient services – offerings that meet the diverse needs of our local population.

We achieve this through having robust governance, a skilled and motivated workforce, productive partnerships and an effective use of information.

Our vision has four main elements:

To be the provider of choice for the population and commissioners we serveTo be an employer of choice in a competitive employment environmentTo provide high quality, cost effective services that are attractive to other commissioners and individualsTo ensure the long term stability and viability of our organisation

We are sustained by a strong set of values. They are:

Seeing from a service user perspective – in order to identify opportunities, problems and risks at an early stageExcelling and improving – striving for excellence to ensure we deliver innovation, best practice and learn from what we do Responsive – an adaptable and flexible approach to deliver services in new ways which meet the needs of service usersValuing and respectful – valuing and involving staff and investing in training and development to drive collective ownership and shared decision making Inclusive, open and honest – effectively communicating with staff, service users, partner agencies and the public by being honest and open and welcoming constructive feedback and recognising accountabilityCan do – having a proactive ‘can do’ approach which delivers on what we say and allows for productive working across professions and agencies Efficient – securing value for money and a culture of making the most of resources through robust evaluation and effective assessment of information

As an NHS foundation trust, our operational performance is measured against a series of national targets which are reported to Monitor, England’s health and social care regulator.

We are also regulated by the Care Quality Commission (CQC), who assesses us against a number of national safety and quality outcomes based on how we deliver safe, clinical care in a cost effective manner. We also report on a number of local safety and quality standards agreed with Gloucestershire and Herefordshire Clinical Commissioning Groups and through the Commissioning for Quality and Innovation (CQUIN) payment framework.

This year, we have fully met the CQC’s safety and quality outcomes. The CQC has not taken enforcement action against the trust in 2013/14 – there are no existing quality concerns outstanding.

In addition, the CQC undertakes unannounced inspections and this year, there have been three inspections at: Wotton Lawn Hospital; Hollybrook Learning Disability Unit; and Westridge Learning Disability Unit. No enforcement actions were taken against us.

We have also undertaken our own quality assurance reviews across all services. This is part of an internal clinical audit programme where visits review clinical practice and patient experience against the CQC Outcomes Framework.

You can read about our progress against our quality based objectives over 2013/14 and our plans for 2014/15 in our Quality Report. The report outlines our strategy, which was developed with our staff, Governors, commissioners and experts with lived experience.

The strategy also provides a framework to support our staff to deliver the highest possible quality of care and clearly demonstrates how our service users, their carers and families are at the heart of everything we do. Our focus is on delivering the areas that matter most to them: safe services; appropriate clinical outcomes; and the best user experience.

Our strategic priorities

Twelve months ago, we agreed three key priorities for the next three years. Our strategic operational plan for 2014/15 is structured around these three strategic priorities and provides the basis for our investments over the next twelve months:

continuous quality improvements transformation to ensure sustainability internal and external engagement to support delivery of a challenging agenda

During our 2013/14 financial year we made no significant changes to our strategic objectives, the services we provide or our investment strategy or long-term liabilities.

However, the environment in which we provide services continues to be complex and challenging. Against a backdrop of having already delivered significant

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transformational changes every year for the last six years, we know that in order to achieve our strategic priorities, the need for transformational change will continue.

To make these priorities a reality, we will continue to work with commissioners to understand and co-develop ways to maintain the health and wellbeing of the people in our communities.

Our Better for Less and Waste Less programmes continue to manage and monitor a range of efficiency schemes that balance our necessary savings with transformational change and improvements in quality.

Over the next two years for example, we will commence a programme of home and mobile working into our operational service delivery to help provide staff with more time to care. We will also benchmark our corporate services to understand the costs, efficiencies and effectiveness of our business functions compared to similar organisations.

Gloucestershire

In Gloucestershire, we are working with the Clinical Commissioning Group and Social Care Commissioners to lead on, for example:

develop a revised social work operational delivery model to enhance person centred care planning and assessment, personalisation, individual budgets, direct payments and care management to meet the national drive to increase personalisation

continue the development of a local payment system for Mental Health services based on National guidance and the 21 care clusters/care packages to support a move towards clearer and more measurable resource utilisation, alongside improved defined outcomes for each patient care cluster

continue to develop Intermediate Care Mental Health services, formed through the integration of our primary care mental health services and Increased Access to Psychological Therapy services

review and develop proposals for the delivery of Community Learning Disability Services, so services are reflective of the health needs of the people of Gloucestershire and demonstrate best practice in meeting those needs

Herefordshire

Over the last 3 years we have significantly transformed Mental Health Services in Herefordshire to provide a robust pattern of community based recovery services which embrace the models of care set out in the National Service Framework for Mental Health.

Our three year contract with Herefordshire commissioners came to an end in March and following contract discussions, an extension of one year has been agreed with an option to extend the contract for a further one year, into 2015/16.

Our operational plans are outlined in our 2013/14 Annual Plan submitted to Monitor. The plan outlines the risks, challenges and opportunities that we anticipate over 2014/15. In Herefordshire, for example, we seek to:

enhance our Improving Access to Psychological Therapy services to deliver the National requirement of being able to support 15% of the local population by March 2015Improve our community based dementia services to increase the potential for earlier assessment, education and support develop Psychiatric Liaison services to enable Herefordshire’s Acute Services provider to meet the needs of people accessing their services

We will also work to meet the requirements of our social care commissioners in Herefordshire; and to significantly transform our Learning Disability services in Gloucestershire.

The risks and uncertainties we face are associated with increased competition; new commissioner models; and the important emphasis of linking physical health, mental health and social care to provide better outcomes within a framework that emphasises continuity of care.

To succeed, we will continue to challenge our thinking and improve what we do. We are determined and committed to meet the challenges ahead and will continue to invest in our staff and the systems that enable us to provide the highest quality of care for our communities.

To achieve this, we will use the financial resources that staff have enabled us to build up over recent years and adjust our capital investment plans to make sure that we can do the things that staff have told us matter most to delivering services within a modern National Health Service.

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Priorities for quality improvement

We have identified seven goals with ten associated quality targets for 2014/15. The targets were agreed in collaboration with staff across the trust and are aligned to the three key themes set out in the NHS Outcomes Framework: Safety; and Effectiveness. They seek to:

improve the physical health care for people with schizophreniameasure the effectiveness of the falls prevention work for inpatientsensure appropriate access to psychiatric inpatient careimprove the experience of service users across a number of defined key areasminimise the risk of suicide of people who use our servicesensure the safety of people detained under the Mental Health Actensure we follow people up when they leave our inpatient units within 48 hours to reduce risk of harm

You can read more about our quality based priorities for improvement for 2014/15 in our 2013/14 Quality Report.

The Francis Inquiry Report also continues to provide far reaching and thought provoking effects on the NHS nationally. The reports provide a basis on which we can all learn lessons and agree what areas of the trust’s work we can seek to improve further.

We continue to exemplify our core values and seek new ways to further enhance our culture of openness and transparency. In response to the Francis Inquiry Report and Professor Berwick’s report, we:

continue to review and improve our internal engagement and communications to ensure staff are informed and empowered to provide feedbackmonitor actions that staff have generated following the Francis Inquiry Report through a new Workforce and Organisational Development Committee signed the Nursing Times’ Speak Out Safely campaign, encouraging all staff members who have a genuine patient safety concern to raise it within the organisation at the earliest opportunityhold public board meetings to make sure that conversations about quality are transparent and as publically accessible as possibleactively engage and involve service users, Governors, Gloucestershire Healthwatch, Herefordshire Healthwatch and other partners in support of our robust internal board assurance processes

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Forward Planning

All trust staff have the opportunity to make a valued contribution to service planning. They are the people who really make a difference when delivering what we say we will do.

Our redefined Balanced Scorecard assists that process by offering a more easily understandable and strategic performance management tool. Through communicating our model to staff and local communities, our aim is to make our strategic objectives:

easier to understandmore engagingfocused on the areas that have the greatest impact, where colleagues can add value facilitate improved awareness and ownership of organisational goals visibly link our objectives to what we wanted to achieve for our communities, our service users, their families, our staff and volunteers

The model represents our key objectives for 2014/15. These are the core activities that help us deliver a quality based service by trained and motivated staff.

The six objectives in the model’s inner circle are aimed at us getting the basics right. The six remaining high level objectives are the cornerstone initiatives that we believe are important for a modern mental health and social care organisation.

Each of our operational localities utilise the service plan model to help develop detailed plans which are subsequently monitored at locality board meetings.

The model is also embedded into our appraisal process and helps ensure that colleagues are appropriately supported in the contribution they make to achieve our organisational goals together.

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Listening to our Service Users

We believe that it is important that as many people as possible can access information about our trust and the services we provide for example through our public board meetings, engagement events and social media channels.

It is equally important that we offer as many ways as possible for people to comment and respond to what we do – especially in real time.

In 2014/15 we will continue to develop the ways that our service users can tell about the care they received. We will introduce text based feedback at the very point that people experience our services.

This will supplement the ways in which we already seek feedback including the continuation of the Friends and Family Test which asks whether a service user would recommend if the same care was necessary. We were one of the only mental health tests to implement the test ahead of national requirements.

Financial ReviewIn summary of our Annual Accounts for 2013/14, we ended the 2013/14 financial year in a solid financial position with an outturn surplus of £1.426m. The headline results for 2013/14 are set out below with a comparison to our previous financial year.

2013/14 £m 2012/13 £m

IncomeOperating ExpensesEBITDA

Net Finance costs

Surplus/(Deficit) from continued operations

Surplus/(Deficit) from discontinued operations

106.915(103.617)

3.298

(1.872)

105.633(102.201)

3.432

(1.953)

1.426 1.479

922

1.426 2.401

10 days 30 days

Number paidTotal Paid% age performance

Value paid (£000)Total value (£000)% age performance

In month

1,9952,31886%

YTD

20,16725,09980%

In month

2,2422,31897%

YTD

24,34025,09997%

5,0895,54592%

54,28162,52287%

5,3925,54597%

59,89762,52296%

We received a majority of our income for providing clinical care and treatment through block contracts with Gloucestershire and Herefordshire’s Clinical Commission Groups. We also received income through our neighbouring local authorities, NHS commissioners and other care providers.

The surplus from discontinued operations in 2012/13 was in relations to the closure of HMP Gloucester and Gloucestershire Substance Misuse services. No services were discontinued during 2013/14.

In 2013/14, operating expenses totalled £103.617m, an increase of 1.4% year on year.

Similar to all NHS organisations, we continue to operate in the context of unprecedented financial challenges. In 2014/15, we will deliver a Continuity of Service Rating of 4. It will also be the first year since becoming a foundation trust that we plan to deliver a financial breakeven position rather than a surplus as in previous years.

During 2014/15 we are expected to deliver £5.4m in efficiency savings in addition to the £6.4m we delivered in 2013/14. Our contracts will provide an income of £102.7m, a decrease of 4% over last year.

For 2014/15, we will also deliver a Monitor Continuity of Service Rating of 4 and have reviewed and adjusted our capital investment plans so we can progress the things that staff have told us matter to them.

We therefore intend to invest further in our staff and the systems they need to support and facilitate continuing change across the organisation. To provide this investment we will use the strong liquidity position our staff have enabled us to build up over recent years and forego a surplus in 2014/15.

Cost allocation and charging requirementsThe Directors confirm that 2gether NHS Foundation Trust comply with the cost allocation and charging requirements set out in HM Treasury and Office of Public Sector Information guidance.

Public Sector Payment PolicyThe cumulative Public Sector Payment Policy (PSPP) performance for the trust for the financial year 2013/14 was 80% of invoices paid within 10 days and 97% paid within 30 days as detailed in the table below:

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The Trust paid £0 interest under the Late Payment of Commercial Debts (Interest) Act 1998.

Income Disclosure

The Directors confirm that 2gether NHS Foundation Trust has met the requirement that income from the provision of goods and services for the purposes of the health service in England is greater than its income from the provision of goods and services for any other purposes.

Going Concern

After making enquiries, the directors have a reasonable expectation that 2gether NHS Foundation Trust has adequate resources to continue in operational existence for the foreseeable future. For this reason, they continue to adopt the going concern basis in preparing the accounts.

National Indicators

Quality considerations remained the foundations on which we made decisions in 2013/14.

To make sure our reporting is as open and accessible, national and local indicators are presented to our Trust Board; and our Council of Governors.

During 2013/14, we have worked hard to deliver the targets we set for 2013/14. We did not meet three of our targets, partially met two and achieved or exceeded

seven targets including 95% of adults followed up by our services within 48 hours of discharge from psychiatric inpatient care.

Where we have not met or where we have partially met our targets, we will monitor them again as quality indicators in 2014/15. Other targets will be local quality objectives.

We are committed to achieving our target and will continue to monitor this through clinical audit.

More information is available in our 2013/14 Quality Report.

The cumulative performance to date is depicted in the graph below. The trust’s performance has remained consistently high throughout 2013/14.

Cumulative PSPP Performance 2013/14

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Sustainability and Environmental Impact

The NHS Carbon Reduction Strategy establishes that the NHS should deliver a 10% reduction in its 2007 carbon footprint by 2015. This Carbon Footprint is measured on Building Carbon from Gas, Electricity, Heating Oil and Water.

In January 2014, we approved a new Estate Strategy. For the first time this incorporated Carbon Reduction Objectives and related Key Performance Indicators in line with the requirements of NHS England/Public Health England’s ‘Sustainable, Resilient, Healthy People and Places’ strategy.

Herefordshire - in April 2011 we were commissioned to deliver the mental health services in Herefordshire increasing our carbon footprint by 428 Tonnes. This counteracted the 6% carbon reduction that had been achieved. Our ‘zero priced services agreement’ also means that we are unable to influence infrastructure or utility consumption.

Gloucestershire - We are committed to delivering the target reduction of 10% by 2015 and 26% by 2020 against our baseline year of 2008/09 for the Gloucestershire footprint.

Trust Carbon Footprint

Percentage

Tonnes of CO2 from Gas,Heating oil, Electricity& Water

100% 90% 66% 20%

3,306 2,975 2,116 661

2008/09 2014/15 2019/20 2049/50

2008/09Weight of

CO2(Tonnes)

2009/10Weight of

CO2(Tonnes)

2010/11Weight of

CO2(Tonnes)

2011/12Weight of

CO2(Tonnes)

2011/12Weight of

CO2(Tonnes)

2012/13Weight of

CO2(Tonnes)

2012/13Weight of

CO2(Tonnes)

PercentageChangeagainst08/09

Trust Carbon Total 4,148 3,824 4,176 3,820 3,467 -16% 476 617

HerefordshireBaseline

Utilities Carbon Production in Gloucestershire

2008/09Weight of

CO2(Tonnes)

2009/10Weight of

CO2(Tonnes)

2010/11Weight of

CO2(Tonnes)

2011/12Weight of

CO2(Tonnes)

2012/13Weight of

CO2(Tonnes)

PercentageChangeagainst08/09

Baseline

GasElectricityHeating OilWaterTotal

15971633697

3306

12791592577

2935

14031638649

3114

11091734699

2921

115614378211

2687

-28%-12%20%60%-19%

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Utilities Carbon Production in Herefordshire

Waste data for Gloucestershire and Herefordshire

Waste data for Gloucestershire and Herefordshire

Please note: 2013/14 data is reported annually in June.

2008/09Weight of

CO2(Tonnes)

2009/10Weight of

CO2(Tonnes)

2010/11Weight of

CO2(Tonnes)

2011/12Weight of

CO2(Tonnes)

2011/12Weight of

CO2(Tonnes)

2012/13Weight of

CO2(Tonnes)

2012/13Weight of

CO2(Tonnes)

PercentageChangeagainst08/09

Waste – Tonnes of CO2(landfill)

88 80.3 66.31 69.1 65.98 -25% 37.4 37.4

Waste – Tonnes of CO2(treated and incinerated)

8.4 0 0.75 0.5 0.49 -94% 1.0 1.5

Waste – Tonnes of CO2(treated and landfill)

0 6.4 6.41 8.4 8.72 0.0 0.0

Waste – Tonnes of CO2(paper recycled)

0 2.25 = 0 20.31 = 0 25.23 = 0 58.26 = 0 6.6 = 0 6.0 = 0

HerefordshireBaseline

2008/09Weightof CO2

(Tonnes)

2009/10Weightof CO2

(Tonnes)

2010/11Weightof CO2

(Tonnes)

2011/12Weightof CO2

(Tonnes)

2011/12Weightof CO2

(Tonnes)

2012/13Weightof CO2

(Tonnes)

2012/13Weightof CO2

(Tonnes)

PercentageChangeagainst08/09

PercentageChangeagainst11/12

Pool CarDiesel

55.6 86.8 80.5 50.2 16% 2.6 2.6 1%

Pool CarUnleaded

179.3 166.9 180.9 173.1 26% 20.7 18.3 -12%

Pool CarSuper Unleaded

7.0 5.0 5.5 2.3 -44% 0.0 0.0 0%

Staff Claimedmileage

559.9 729.5 553.7 479.1 -22% withinGloucestershire

withinGloucestershire

withinGloucestershire

Travel Total 801.8 988.1 1087.4 704.7 -5% 46.6 41.8 10%

Pool CarSub Total

241.9

43.2

137.9

4.2

nodata

745.2

185.3 258.7 266.9 225.6 22% 23.3 20.9 -10%

HerefordshireBaseline

2011/12Weight of

CO2(Tonnes)

2012/13Weight of

CO2(Tonnes)

GasElectricityHeating OilWaterTotal

82702372

391

861672822

536

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Gas – our primary heating source is gas, with the exception of the Stonebow Unit and Westridge, which have oil fired boilers. Gas is also used for the generation of hot water. Over the reporting period there has been a 28% reduction in carbon. This is due to a programme of works installing, or improving roof insulation, and the replacement of older inefficient boilers; and solar water heating.

In 2013/14 insulation was improved in 18 Denmark Road and 62 Etnam Street.

In 2014/15 improved insulation is planned for Collingwood House, Colliers Court and Park House. A new boiler is planned for Lexham Lodge.

Electricity – we have delivered a 12% reduction in carbon from electricity between 2008/09 and 2012/13. Electricity is generally used for lighting, Information Technology and to a smaller extent for air conditioning. The reductions in electrical consumption have generally been the consequence of higher performance lighting and controls during refurbishment projects.

Heating Oil – two of our sites have used heating oil as their primary source of fuel for heating and hot water. They are Westridge and the Stonebow Unit.

The boilers were replaced in Westridge during the winter of 2012/13 and inefficient temporary oil fired boilers were in place duirng this reporting period causing the increase in consumption. Oil consumption should now drop significantly with the more efficient boilers.

In 2014/15 the oil fired boilers in the Stonebow Unit are scheduled to be replaced with Gas fired boilers significantly reducing the Herefordshire carbon footprint as gas is 30% less carbon intensive than oil and the new boilers will be more efficient.

Water – measured water consumption has increased steadily, and will continue to increase. This is the consequence of a trend towards the metering of water, instead of water bills being a product of rateable value. Previously we have been unable to estimate water volume from some buildings at all. Furthermore we are systematically flushing water outlets to combat the risk of microbiological population of our water systems, and providing more en-suite facilities.

Rainwater harvesting is in place in the Greyfriars Unit and will be incorporated into the refurbishment of Colliers Court.

Risks associated with Pollution from Sewerage, Effluent and Waste Water are minimal in the trust. In the main the trust’s Sewerage, Effluent and Waste Water is disposed of through connection to the Mains Sewerage System, under the auspices of Severn Trent and Thames Water. Sewerage, Effluent and Waste Water at the Westridge site is handled though a trust owned Treatment plant. This system requires frequent emptying for which contracts are in place for the management of the Waste. Outfall is monitored.

Building Management Systems – during 2014, we will adopt half hour monitoring of electricity, gas, heating oil and water consumption. Half hour of continuous energy monitoring permit us to understand the utility consumption cycle of a building so we can identify weaknesses in operation and in use. Building utilities consumption are collected on a continuous basis through a passive building management system connected to our IT network and recorded to a dedicated IT server. The Greyfriars Unit and Charlton Lane Centre have active building management system, which will enhance spot monitoring in the future.

Greenhouse gas emissions from air conditioning systems are now limited to the older infrastructure we have remaining. It was common practice to use hydrochlorofluorocarbons as a refrigerant gas commonly known as R22 because it is very efficient. Unfortunately it is not possible to just change the refrigerant gas for a modern, non ozone depleting gas, as they are less efficient.

We also have a programme of replacement for affected plant. On decommissioning the hydrochlorofluorocarbon is captured and taken to a specialist plant for rendering inert.

Waste - we have year on year increased our recycling capability, primarily through the volume of paper. During late 2012/13 and through 2013/14 we rolled out recycling of card, plastic and more accessible recycling of paper throughout Gloucestershire. The data for 2013/14 and 2014/15 will see significant reductions. We plan to introduce greater accessibility to recycling in Herefordshire during the next year.

Pollution from waste is extremely unlikely due to the rigorous systems we have in place to manage its waste streams. Appropriate sites are registered with the Environment Agency. We conduct waste audits at each site and review and inspect the practices of our waste contractors regularly.

Transport - our Carbon Reduction Strategy does not propose targets for transport carbon reduction; however we are making steady reductions.

Oil and petroleum - we undertake an annual audit of compliance for our oil installations and have systematically replaced the infrastructure over recent years.

Through the management processes we have in place, the risk of Oil and Petroleum Pollution from our oil storage associated with generators and oil fuelled heating is minimal. The control of Oil and Petroleum is managed through OFTEC (Oil Firing Technical Association for the Petroleum Industry Ltd).

21

22

Governance is the system by which the trust is directed and controlled to achieve its objectives and meet the necessary standards of accountability and probity. We have adopted its own governance framework which requires Governors, directors and staff to have regard for recognised standards of conduct including the overarching objectives and principles of the NHS, the seven Nolan Principles, the NHS Constitution and the NHS Foundation Trust Code of Governance.

The Foundation Trust Code of Governance can be found on the Monitor website, at

http://www.monitor.gov.uk/FTcode

The Code requires foundation trusts to:

Make certain information publicly available, either on the foundation trust’s website or on request. The trust provides such information both through its website, and via its Freedom of Information Act Publication Scheme. The trust is therefore fully compliant with these requirements of the Code

Confirm to Governors that where a Non-Executive Director seeks re-appointment, his/her performance continues to be effective. The trust provides Governors with annual summary appraisal information in respect of each Non-Executive Director, including the Chair, and this information is reprised in reports to the Council of Governors accompanying a resolution to re-appoint the Non-Executive DirectorProvide biographical and other relevant information to members to enable them to make an informed decision about any Governor seeking election or re-election. The trust uses an external organisation to manage Governor elections, and is fully compliant with this provision of the CodeMake clear within their annual reports where compliance with the Code has not been achieved

The Code requires foundation trusts to provide supporting explanation within the annual report to demonstrate compliance with certain provisions of the Code, and these are set out below. To avoid duplication, where the information required by the Code is already provided elsewhere in the annual report, a reference to its location is given to avoid unnecessary duplication.

This statement should also describe how any disagreements between the Council of Governors and the Board of Directors will be resolved. The annual report should include this schedule of matters or a summary statement of how the Board of Directors and the Council of Governors operate, including a summary of the types of decisions to be taken by each of the boards and which are delegated to the executive management of the Board of Directors.

Code of Governance requirement Trust responseReference

Any disputes are resolved in accordance with the procedure set out in the trust’s constitution, whereby the Trust Chair will seek to resolve the matter in the first instance. Where this cannot be achieved, the matter may be escalated to a special joint committee of Governors and Directors, or as a final step, referred to an external mediator.

Details of how the Board and the Council of Governors operate are given from pages 33, 37 and 39 of the Annual Report.

The annual report should identify the chairperson, the deputy chairperson (where there is one), the chief executive, the senior independent director (see A.4.1) and the chairperson and members of the Appointments and Terms of Service, and Audit committees. It should also set out the number of meetings of the Board and those committees and individual attendance by directors.

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

This information can be found on pages 29, 32 and 33 of the Annual Report

This information is set out in pages 36, 37 and 38 of the Annual Report

A.1.1

A.1.2

A.5.3

The NHS Foundation Trust Code of Governance

B.1.1

B.1.4

B.2.10

B.3.1

B.5.6

The Board of Directors should identify in the annual report each non-executive director it considers to be independent, with reasons where necessary.

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

A separate section of the annual report should describe the work of the Appointments & Terms of Service Committee, and the Governors’ Nomination & Remuneration Committee, including the process each has used in relation to Board appointments.

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

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

This information is set out from pages 29 and 30 of the Annual Report

This information is set out from pages 29-31 and page 35 of the Annual Report

This information is set out on pages 33 and 41 of the Annual Report

Interests are disclosed to the Council of Governors as part of the appointments process for Non-Executives, and the declaration of interests is a standing agenda item at Council of Governors’ meetings.

The Council of Governors received a presentation on the forward plan and feedback was taken into account when compiling the final version. This built on a number of Governor-led engagement events that have taken place during the year, enabling Governors to seek feedback from members and the public. Other measures such as a web portal have been put in place to enhance the ways in which Governors can communicate with members.

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

The Board evaluates its own performance after each meeting. Committees each produce an annual report for the Board, setting out how they have performed against their terms of reference. Committee remits have been reviewed through the year to ensure appropriate focus and reduce potential duplication of effort. Directors are subject to annual performance appraisals; for Non-Executive Directors, Governors are invited to contribute through a 360 feedback process. Non-Executive Director appraisals are presented in summary form to the Nomination & Remuneration Committee.

23

24

B.6.2

C.1.1

C.2.1

C.2.2

C.3.5

Where an external facilitator is used for reviews of governance, they should be identified and a statement made as to whether they have any other connection with the trust.

The directors should explain in the annual report their responsibility for preparing the annual report and accounts, and state that they consider the annual report and accounts, taken as a whole, are fair, balanced and understandable and provide the information necessary for patients, regulators and other stakeholders to assess the NHS foundation trust’s performance, business model and strategy. There should be a statement by the external auditor about their reporting responsibilities. Directors should also explain their approach to quality governance in the Annual Governance Statement (within the annual report).

The annual report should contain a statement that the Board has conducted a review of the effectiveness of its system of internal controls.

A trust should disclose in the annual report: (a) if it has an internal audit function, how the function is structured and what role it performs; or (b) if it does not have an internal audit function, that fact and the processes it employs for evaluating and continually improving the effectiveness of its risk management and internal control processes.

If the Council of Governors does not accept the audit committee’s recommendation on the appointment, reappointment or removal external auditor, the Board of Directors should include in the annual report a statement from the audit committee explaining the recommendation and should set out reasons why the Council of Governors has taken a different position.

Not applicable – no governance reviews by external facilitators have taken place.

This information is set out in page 8 of the Annual Report. The Annual Governance Statement starts at page 63 of the Annual Report

This information is set out in page 63 of the Annual Report

This information is set out in page 33 of the Annual Report

Not applicable – the Council of Governors has not considered a recommendation from the Audit Committee during the year.

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

the significant issues that the committee considered in relation to financial statements, operations and compliance, and how these issues were addressed;an explanation of how it has assessed the effectiveness of the external audit process and the approach taken to the appointment or re-appointment of the external auditor, the value of external audit services and information on the length of tenure of the current audit firm and when a tender was last conducted; and if the external auditor provides non-audit services, the value of the non-audit services provided and an explanation of how auditor objectivity and independence are safeguarded.

This information is set out in page 33 of the Annual Report

D.1.3

E.1.5

E.1.6

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

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

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

This information is set out from page 49 of the Annual Report

This information is set out in page 39 of the Annual Report

This information is set out in page 42 of the Annual Report

In preparation of this report, we have reviewed the extent to which the trust and this report are compliant with the NHS Foundation Trust Code of Governance. The Board of Directors is satisfied that 2gether NHS Foundation Trust has achieved the necessary standards in all respects.

Shaun Clee Chief Executive Date: 27 May 2014

25

GRiP Team mural,

Gloucester

Directors’ Report

Our high performance is

testament to the dedication of all staff

across the organisation

28

Directors’ ReportThe Directors confirm that so far as they are aware, there is no relevant audit information of which the auditors are unaware. The Directors have taken all the steps that they ought to have taken as Directors in order to make themselves aware of any relevant audit information and to establish that the auditors are aware of that information.

Accounting policies for pensions and other retirement benefits are set out in note 1.4 to the accounts and details of senior employees’ remuneration can be found in the trust’s Remuneration Report.

Board of Directors

Our Board of Directors provide leadership and help drive overall trust performance, ensuring accountability to Governors and our members.

The Board is legally responsible for the strategic and day-to-day operational management of the trust, our policies and our services. It maintains a scheme of delegation giving authority to Directors and others within certain limits to carry out actions required under financial procedures and the Mental Health Act.

Ruth FitzJohn, DL Dr RogerBrimblecombe

Martin Davis Martin Freeman

CharlotteHitchings

Joanna Newton John Saunders RichardSzadziewski

Jonathan Vickers

Directors’ Statement as to Disclosure to Auditors

Shaun Clee Paul Winterbottom Colin Merker

Trish Jay Carol Sparks Jason Burn Andrew Lee

29

Members of the BoardIndependent Non-Executive Directors

Ruth FitzJohn, DL – Chair Ruth has been our Chair since 1 April 2013, and also chairs our Council of Governors and the Appointments and Terms of Service Committee. For the previous six years she was Chair of NHS Gloucestershire and during 2011, 2012 and 2013, was also Chair of NHS Swindon.

Ruth had a successful, international career in IT management and strategic planning before joining the NHS where she has gained considerable experience as Vice Chair of the East Gloucestershire NHS Trust then Chair of the ‘3 Star’ Cheltenham and Tewkesbury Primary Care Trust.

Ruth was appointed a Deputy Lieutenant of Gloucestershire in September 2013.

Dr Roger Brimblecombe – Senior Independent Director (to 30 September 2013)Roger Brimblecombe began his career working in the Research Department of Bristol Mental Hospitals as a neuro-pharmacologist. He continued his research career with the Medical Research Council and the Ministry of Defence but then moved into the pharmaceutical/ biotechnology sector holding senior positions in various parts of the world including nearly 20 years as International VP for R&D in the SmithKline Corporation. He has served on the Councils of the Royal College of Pathologists and the Institute of Biology, as Chairman of the Society of Pharmaceutical Medicine and as President of a Section at the Royal Society of Medicine.

He is currently a member of the Home Office Advisory Council on the Misuse of Drugs and of the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment sponsored by the Department of Health and the Food Standards Agency.

Until January 2013, Roger was a member of an expert working party convened by the Department of Transport to study the issues associated with drug driving, and in January 2013 was appointed to a Home Office panel looking into the misuse of ketamine. He is also a Trustee/Vice Chair of the Bath & NE Somerset Volunteer Centre. Roger became Senior Independent Director in July 2011, and was the Chair of the Trust’s Development Committee and the Mental Health Act Scrutiny Committee until leaving the Trust on 30 September 2013.

Martin Davis - Independent Non-Executive Director (to 30 September 2013)Martin is a qualified accountant who has significant experience of working with Boards at national and local level, primarily within the Public, NHS and Charity sectors. Posts held have included Chief Executive, Finance Director and Non-Executive Director.

Martin has a long association with Gloucestershire, having previously served on a number of NHS bodies within the county, in both an Executive and

Non-Executive Director capacity. He is currently appointed as a voluntary Family Link Carer and he and his wife provide respite care for children with learning disabilities. He is also Honorary Treasurer and Trustee of the NHS Retirement Fellowship, a UK wide Charity. Martin chaired the trust’s Audit Committee and Charitable Funds Committee until leaving the trust on 30 September 2013 at the end of his term of office.

Martin Freeman – Independent Non-Executive DirectorMartin is a retired GP who joined the Trust as a Non-Executive Director on 1 April 2013. He has chaired the Trust’s Governance Committee since May 2013, and the Mental Health Act Scrutiny Committee since October 2013. He has gained knowledge and understanding of service delivery and strategic planning in his role as GP Clinical Lead for Dementia and GP Regional Lead of Dementia.

Martin has a great interest in the provision of care for people with mental illness, learning disability and dementia. Previously Chair of Governors for a large comprehensive school, he has also been the lead clinical support in business planning and service redesign, involved in closing Berkeley Community Hospital and building new Vale Community Hospital.

Charlotte Hitchings – Deputy Chair; Senior Independent Director (from 1 October 2013)Charlotte Hitchings was appointed as a Non-Executive Director from 1st March 2011, and reappointed by the Council of Governors on 1 March 2014. She was reappointed by the Council of Governors as the trust’s Deputy Chair in January 2014, and was appointed as the trust’s Senior Independent Director in October 2013. She now chairs the trust’s Delivery Committee, having previously been chair of the Governance Committee.

During a 20 year management career in commercial organisations she has led teams in marketing, business development, product development and community investment. Prior to becoming a self employed consultant and executive coach in 2004, Charlotte was Group Community Investment Manager with O2 plc and a member of O2’s Corporate Responsibility Advisory Council. For several years Charlotte served as Vice Chair of the Board of Governors and on the Budget Committee of King Edward VI Handsworth School.

Joanna Newton - Independent Non-Executive Director Joanna is the chair of the trust’s Charitable Funds Committee. She joined the trust on 1 April 2013, having previously been Chair of NHS Herefordshire, a role she held for seven years. She was also appointed Board Chair of the West Mercia Cluster of PCTs leading up to the transfer of commissioning to Clinical Commissioning Groups on 1 April 2013.

30

Prior to moving back to Herefordshire Joanna held senior roles in pharmaceutical marketing, principally for Procter and Gamble and SmithKline Beecham.

Over the last thirteen years, Joanna has held health sector Non Executive roles. Her first Chair role was with Herefordshire & Worcestershire Ambulance Trust in 2003. Since then she has also chaired the Health and Social Care Cross Border Group and the West Midlands Specialist Commissioning Board. Until recently Joanna has chaired the Board of Governors for her local school.

John Saunders, OBE - Independent Non-Executive Director (from 1 February 2014)Following a 20 year career in Corporate and Investment Banking (majoring in mergers and acquisitions) John moved to the public sector in various Chief Executive, Chair and Board Member roles. He has specialised in introducing commercial approaches to Public Sector challenges including negotiating private sector investments in education, health and infrastructure initiatives.

In 2010 he was given the remit of developing and delivering Governments Planning reforms to accommodate the essential £150bn National Infrastructure Investment. He has recently led the transformation of the Planning Inspectorate. John has contributed to change programmes in organisations such as BMW (Germany) and the Disney Corporation (USA). He is a former member of the UK Investment Task force and chaired the UK Investment Readiness Initiative.

John has a strong connection to the area having lived in Herefordshire for 14 years up to 2001. He is returning to live in the area in the near future. John took over as chair of the Audit Committee from March 2014.

Richard Szadziewski – Independent Non-Executive Director (to 28 February 2014)Richard is a qualified accountant and has experience of being the Director of Finance for seven unitary local authorities delivering robust and strategic budgets and financial strategies to deliver the objectives of the organisation. His extensive public sector experience includes permanent, interim and project roles in local authorities, a primary care trust and an integrated community health and adult social care provider and central government departments.

This has involved Richard in the full range of issues and change facing communities and public services. He combines his interim and project work with being an independent (non-executive) member of the Audit Committee of the Crown Prosecution Service nationally, carrying out technical assessments of Director of Finance candidates for recruitment consultancies and mentoring senior finance professionals. Richard was appointed as a Non-Executive Director from 1 March 2011. He chaired the Delivery Committee before taking over as chair of the Audit Committee from October 2013 until leaving the trust on 28 February 2014.

Jonathan Vickers - Independent Non-Executive Director Jonathan Vickers spent 25 years in the international oil and chemicals industries including board membership of Castrol and Burmah Chemicals.

Over the last decade, Jonathan has served as a Non-Executive Director on the boards of a range of public sector organisations including NHS South West Strategic Health Authority. Jonathan is an Independent Member of Department of Energy and Climate Change (DECC) Investment Committee and a board member at UK Sport. Jonathan was appointed as a Non-Executive Director from 1 April 2013, and chairs the trust’s Development Committee.

Executive Directors Shaun Clee - Chief ExecutiveShaun has over 36 years’ experience in the NHS having trained as a Registered Mental Health Nurse before moving into management in 1990. He brings a passion for providing services that are responsive to service users and carers and has significant experience in both the commissioning and provision of mental health, learning disability and substance misuse services, having led mental health services in South Warwickshire for a number of years.

He has also had executive board level responsibility for community hospitals, dentistry, sexual health, intermediate care teams, chiropody, physiotherapy, and occupational therapy as well as estates, information management and technology, estates and human resources and organisational development.

He is the current Chair of the NHS Confederation Mental Health Network, a Trustee and Board member of the NHS Confederation, a member of the NHS Confederation National Policy Forum, a member of the NHS Confederation Audit Committee and Chair of the South of England Clinical Faculty for Improving Safety in Mental Health, represents health on the National Criminal Justice Council and is a board member representing mental health and community services on Health Education England's South West Board.

Paul Winterbottom – Medical DirectorPaul has held the role of Medical Director since April 2003 and combines this with his role as Caldicott Guardian and Consultant Psychiatrist in the psychiatry of Learning Disabilities. He is particularly interested in support structures for parents with a learning disability, autistic spectrum condition and the development of inclusive communities. Paul is the Responsible Officer for doctors within the trust, reporting to NHS England. He is a member of the South West Executive Committee for the Royal College of Psychiatrists. Paul is also a Trustee for Gloucestershire Young Carers, a board member of Active Gloucestershire and Vice Chair of the Board of Governors for a local state primary school.

31

Colin Merker – Director of Service DeliveryColin has 36 years’ NHS Experience. He is a professionally qualified Chartered Engineer. For the last 22 years he has held Board level posts in a number of NHS Organisations. He has experience of commissioning services at a PCT and Regional level as well as operationally directing services at a provider level. He has experience of establishing and running a successful NHS Shared Service. He was Director of Mental Health Services in Coventry from 2002 and Chief Operating Officer of the Coventry & Warwickshire NHS Trust from 2006 until joining 2gether in 2009.

Trish Jay – Director of Quality Trish is a Registered Nurse and has worked in a wide range of clinical, managerial and director positions over the past 30 years. More recently, she has worked at Board level in health services in Herefordshire and Gloucestershire, as well as working as the lead nurse for a national care and housing charity.

Trish provides proactive professional leadership at Board level for nursing, allied health professionals and social care. She also maintains the standards required for Care Quality Commission registration and leads on our Quality Report, focusing on patient outcomes, safety and experience.

Carol Sparks – Director of Organisational Development Carol has 20 years’ experience in the NHS and is a Chartered Fellow of the Chartered Institute of Personnel and Development. She has responsibility for ensuring colleagues have the knowledge and skills to lead our services into the future, that our culture reflects trust values and the NHS Constitution, and last but not least that the health and wellbeing of staff is assured. Carol is particularly passionate about ensuring equality and diversity is integrated into how we work and deliver services.

Jason Burn – Director of Finance and Commerce (to 28 March 2014)Jason has worked in the NHS for over 20 years and prior to joining the trust on 4 March 2013, he was Acting Chief Financial Officer at Heatherwood and Wexham Park Hospital NHS Foundation Trust. Before that, he held the position of Director of Finance at Birmingham Women's NHS Foundation Trust.

Andrew Lee - Interim Director of Finance (1 March 2013 to 19 April 2013)Andrew is an experienced finance professional, having taken on a number of interim Director of Finance roles throughout the NHS. Andrew is a Director and Owner of AJL Consultancy Ltd.

The Board reviews its effectiveness after each meeting, and through developmental workshops throughout the year. These build on similar performance evaluations carried out during previous years. Board Committees’ objectives and Terms of Reference are reviewed annually, and Committee membership is regularly reviewed to take account of any new Non-Executive Directors joining the Board, and to ensure that Non-Executive Directors’ skills and knowledge are being put to the best possible use.

It is the Trust Chair’s responsibility to ensure Committee and Board membership is revitalised when appropriate. The balance of skills on the Board is considered when appointing replacements, thus ensuring that the Board’s mix of skills, knowledge and experience remains appropriate for the current and future requirements of the trust.

Except when joining the Board late in the financial year, all Board members have a performance appraisal during the year involving input from colleagues and, when appropriate, Governors and others in order to provide insight into effectiveness and too identify learning and development opportunities.

The results of the appraisals of the Executive Directors have been shared in summary with the Appointments and Terms of Service Committee of the Board of Directors. Similar arrangements have been followed for the summary of Non-Executive and Chair appraisals to be given to the Nomination and Remuneration Committee of the Council of Governors.

Each Board member has individual development and performance targets for the coming year, and it is the responsibility of the Trust Chair to ensure that the results of Directors’ performance appraisals are acted upon.

Balance of the Board and Appraisal

Note: Due to scheduling clashes, Board meeting dates for 2014 were changed at short notice which affected attendance for some Board members

Ex officio (by virtue of office) member of all committees other than AuditChair of Governance Committee from May 2013 and chair of Mental Health Act Scrutiny Committee from October 2013Chair of Charitable Funds Committee from October 2013Left the Trust on 30 September 2013Left the Trust on 30 September 2013Chair of Development Committee from October 2013Chair of Governance Committee to April 2013; chair of Delivery Committee from May 2013Left the trust on 28 February 2014Appointed 1 February 2014; chair of Audit Committee from March 2014Left the trust on 28 March 2014Left the trust on 19 April 2013

123456789

1011

1

2

3

4

5

6

7

8

9

10

11

1

32

Attendance at Trust Board and Board Committees by Non Executive and Executive Members

Name and position

Total Meetings 6 11111012 553C

ounc

il of

Gov

erno

rs

Boa

rd

Dev

elop

men

t

Cha

ritab

leFu

nds

Aud

it

Gov

erna

nce

Del

iver

y

Men

tal H

ealth

Act

Scr

utin

y

Ruth FitzJohn, DL, Trust Chair

Martin Freeman, Non-Executive Director

Joanna Newton, Non-Executive Director

Roger Brimblecombe, Non-Executive Director

Martin Davis, Non-Executive Director

Jonathan Vickers, Non-Executive Director

Charlotte Hitchings, Deputy Trust Chair

Richard Szadziewski, Non-Executive Director

John Saunders, OBE, Non-Executive Director

Shaun Clee, Chief Executive

Carol Sparks, Director of Organisational Development

Paul Winterbottom, Medical Director

Colin Merker, Director of Service Delivery

Trish Jay, Director of Quality

Jason Burn, Director of Finance & Commerce

Andrew Lee, Interim Director of Finance

5

4

3

2

1

2

4

3

2

4

2

2

2

4

2

-

1

1

2

5

-

8

-

9

1

3

2

2

4

2

10

-

1

5

3

3

2

3

5

5

1

3

-

-

-

3

4

-

-

3

-

2

-

-

5

-

-

-

2

-

5

-

-

-

1

9

7

-

-

-

11

2

-

3

10

2

11

5

1

-

-

11

8

-

-

-

2

-

-

4

2

8

4

9

-

-

-

3

2

1

1

2

2

2

1

1

-

-

-

3

3

-

11/12

11/12

10/12

4/5

4/5

6/12

11/12

11/11

2/2

11/12

11/12

11/12

12/12

12/12

11/12

-

Chairs of Board CommitteesAttendance by Non Executive Directors and Directors

Each of our board committees has an agreed Terms of Reference which defines its membership and scope. The Chair and Chief Executive by virtue of office may attend all meetings (except the Audit Committee).

The number of meetings and individual attendances at those meetings are detailed in the following table.

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Board CommitteesAudit Committee

All Non-Executive Directors, except the Trust Chair, are members of the Audit Committee. Martin Davis chaired the Audit Committee until 30 September 2013, with Richard Szadziewski taking over as chair until 28 February 2014. John Saunders will chair the Audit Committee in 2014/15.

The role of the Audit Committee is to provide the Board of Directors with a means of independent and objective review of financial and corporate governance, assurance processes and risk management across the whole of the trust’s activities, both generally and in support of the Annual Governance Statement.

There were five meetings of the Audit Committee held in the reporting period. The Audit Committee’s agenda is structured so as to enable consideration significant issues throughout the year. Standing agenda items include:

Internal Audit: the Committee has commissioned a full audit programme based upon risk as identified by the Board Assurance Framework and received regular reports on the outcomes and actions completed. Where appropriate, the findings of these audits were also reported to other Committees in order for action plans to be developed and their timely implementation monitored. One such example was the ‘critical risk’ finding regarding the Trust’s online incident reporting system, where the Governance Committee oversaw the production and implementation of an action plan to address the risks identified.

PWC was reappointed as the Internal Audit provider to the trust from 1 April 2013 on a three year contract. During 2013/14 the Committee conducted an evaluation of the effectiveness of Internal Audit through a number of structured interviews with Board members and PWC using Her Majesty’s Treasury (HMT) Internal Audit Quality Assessment Framework (May 2013). The assessment concluded that in general, Internal Audit provided an effective service and assurance to the trust. There were no major issues to address and the action plan was proposed in those areas where further improvement would add value to the trust. The actions covered both PWC and the trust.

External Audit: each year the Committee approves an External Audit Plan setting out the timetable for the audit of the annual accounts and the Quality Report. The Committee also receives at each meeting a summary of any additional significant risks identified through the planned audit work, as well as a summary of significant risk, regulatory and health sector developments which are pertinent to the work of the trust.

Deloitte was appointed as the trust’s External Auditor in 2012 for a maximum period of five years, through a competitive tendering process overseen by the Council of Governors. During 2013/14 the Audit Committee conducted an evaluation of the effectiveness of External

Audit using a questionnaire based on templates produced by KPMG’s Audit Committee Institute. The assessment covered quality of communication, the planning and conduct of the audit, the audit scope, the composition of the audit team, the independence of the auditor, and other matters, and concluded that the External Auditor was broadly performing well in each of these areas. An action plan was produced to identify areas for further continuous improvement.

Financial Reporting: the Committee receives a number of reports through the year on significant financial issues such as losses and special payments and valuation of intangible assets. In accordance with International Financial Reporting Standards the Committee also receives the ‘Going Concern’ report enabling the trust to make and document a rigorous assessment of whether the trust is a going concern when preparing its annual financial statements.

In reviewing and approving the financial statements, the Committee also reviews any changes to accounting policies, and receives a report outlining factors on which the Committee must take into account in order to satisfy itself that no material misstatements have been made in the accounts, and providing assurance that sufficient controls exist for the Committee to be assured that the Annual Accounts present an accurate assessment of the trust’s financial position, and the external auditor can rely on the information contained within the Letter of Representation.

Counter Fraud Reporting: the Committee approves a Counter Fraud Plan each year, and receives reports on Counter Fraud activity at each meeting.

Appointment and Terms of Service Committee

The Appointment and Terms of Service Committee is chaired by the Trust Chair and has a membership of all Non-Executive Directors. In the absence of the Chair, the Deputy Chair of the trust will lead the meeting. The Committee’s role is to agree the arrangements for appointment to and conditions of service for the posts of Chief Executive and Executive Directors. It also ensures there are appropriate arrangements for the consideration and management of succession planning.

During the year the committee met 4 times and considered:

the performance of each Executive Director and the Chief ExecutiveExecutive Director and Chief Executive paysuccession arrangementsthe allocation of clinical excellence awards for consultants, discretionary points to associate specialists and optional points to staff grades in line with trust’s policies and procedures and as necessary

35

AppointmentsAppointment of new Non-Executive Directors is for an initial period of three years subject to earlier termination or extension and is governed by the terms of the trust’s Constitution and the Standing Orders for the Council of Governors and Board of Directors.

ReappointmentsNon-Executive Directors are eligible for reappointment at the end of their period of office in accordance with the trust’s Constitution, but they have no absolute right to be reappointed. Decisions about reappointments are made by the Council of Governors.

In reaching a decision, in addition to having regard to the appraised performance of the individual, the Council of Governors will consider the performance of the trust, the make-up of the Board of Directors in terms of skills, diversity and geographical representation, the Board dynamics and the effectiveness of its team working.

The maximum term of office for a Non-Executive Director is six years.

Termination of Appointment Our Constitution sets out the following circumstances in which the appointment of a Non-Executive Director may be terminated by the trust:

Removal from the Board of Directors being approved by 75% of members of the Council of Governors at a general meeting of the Council of GovernorsThe Non-Executive Director being adjudged bankrupt or their estate being sequestrated and (in either case) not being dischargedThe Non-Executive Director making a composition or arrangement with, or granting a trust deed for, their creditors and not having been discharged in respect of itWithin the past five years, the Non-Executive Director having been convicted in the British Isles of any offence for which a sentence of imprisonment (whether suspended or not) for a period of not less than three months (without the option of a fine) was imposedThe Non-Executive Director being a person whose tenure of office as a Chair or as a member or director of a health service body having been terminated on the grounds that the appointment is not in the interests of public service, for non-attendance at meetings, or for non-disclosure of a pecuniary interestThe Non-Executive Director having had his/her name removed from any relevant list of medical practitioners prepared pursuant to paragraph 10 of the National Health Service (Performers Lists) regulations 2004 or Section 151, of the 2006 Act (or similar provision elsewhere), and has not subsequently had his/her name included in such a list; or a person who has had their professional clinical registration revoked. This provision shall not apply where a person’s registration lapses or their name has been removed at their own request, for example following retirement.

The Non-Executive Director having within the previous two years been dismissed, otherwise than by reason of redundancy or ill health, from any paid employment with a health service bodyThe Non-Executive Director being subject to a director’s disqualification order made under the Company Directors Disqualification Act 1986.The Non-Executive Director being a person who is a registered sex offender pursuant to the Sex Offenders Act 2003The Non-Executive Director ceasing to be a public member of the trustThe Non-Executive Director being or becoming a Governor of the trust

If the Council of Governors is of the opinion that it is no longer in the interests of the National Health Service that a Non-Executive Director continue to hold office then, subject to the provisions of the trust’s Constitution, their appointment may be terminated.

The following list provides examples of matters which may indicate to the Council of Governors that it is no longer in the interests of the National Health Service that a Non-Executive Director continues in office:

If an annual appraisal or sequence of appraisals is unsatisfactoryIf the Non-Executive Director no longer enjoys the confidence of the Council of GovernorsIf the Non-Executive Director loses the confidence of the public or local community in a substantial wayIf the Non-Executive Director fails to deliver work against agreed targets incorporated within their annual objectivesIf there is a terminal breakdown in essential relationships, for example between the Chair and Chief Executive, or between a Non-Executive Director and the other directors

The above list is not intended to be exhaustive or definitive. The Council of Governors will consider each case on its merits, taking all relevant factors into account.

36

Constituency Public: Stroud District

Public: Gloucester City

Public: Tewkesbury Borough

Public: Greater England

Public: Forest

2 to elect (3 candidates)

2 to elect (5 candidates)

2 to elect (3 candidates)

1 to elect (2 candidates)Dawn Christine mLewisMartin Kibblewhite

2 to elect

unopposed)

Candidates Total Votes Cast TurnoutEligible voters: 765 Valid votes cast: 112

Eligible voters: 1,303 Valid votes cast: 124

Eligible voters: 610 Valid votes cast: 107

Eligible voters:190 Valid votes cast: 39

N/A N/A

N/A N/A

N/A N/A

N/A N/A

N/A N/A

14.8%

9.6%

17.5%

20.5%

*Elected. The appointment term of all Governors is three years unless they are councillors representing first and second tier authorities. Local authority Governors may hold office for the period of their current term of office as a councillor.

Staff: Nursing

Staff: Allied HealthProfessions andSocial Care

Staff: Health andSocial Care SupportStaff

Staff: Managementand Administration

1 to elect

1 to elect

1 to elect

1 to electNo nominations receivedOne vacancy remains

Board RemunerationAccounting policies for pensions and other retirement benefits are set out in note 1 of the 2013/14 annual accounts.Details of senior employees’ remuneration can be found in the Remuneration Report; and details of company directorships and other significant interests held by Directors or Governors which may conflict with their management responsibilities are set out in note 18 of the 2013/14 annual accounts.

Council of GovernorsOur Council of Governors consists of public, staff, and local authority Governors. There is also a Governor appointed by the Gloucestershire Learning Disability Partnership Board. Governors are an essential link between our membership and the Board of Directors. They help ensure that the trust hears everyone’s views.

The constituencies for Public Governors are based on the six districts, city and borough council boundaries in the county. These local authorities themselves share one Governor nomination to the Council of Governors. Gloucestershire County Council has one nominated Governor position. We have one staff constituency made up of five classes of staff to ensure fair representation. Finally we ask for a nomination as Governor from the county’s main planning forum for services for people with a learning disability.Public and staff Governors are elected by members of their own constituency using the single transferable vote system. An election was held in July 2013 for a number of Public and Staff Governor positions. The turnout for the elections was as follows:

Council of Governors by constituency and current vacancies

Category of Governor Total numberof Governors

Vacancies asof 31

Public constituenciesCheltenhamCotswoldForestGloucesterStroudTewkesburyGreater England

Staff constituenciesMedical practitioners’ staff classNursing staff classAllied Health Professionals and Social Work staff classClinical and social care support staff classManagement, administrative and other staff class

Appointed GovernorsGloucestershire Primary Care TrustGloucestershire County CouncilNomination from six city/borough/district councilsGloucestershire Learning Disabilities Partnership Board

Total

3223321

13112

1111

28

2-11---

-1-11

11--

9

The Council of Governors has three primary roles:

to hold the Non-Executive Directors individually and collectively to account for the performance of the Boardto represent the interests of the trust’s stakeholders in the governance of the organisationto communicate the key messages of the trust to the electorate and appointing bodies

The trust's Lead Governor during the reporting period was Ros Taylor, elected Public Governor for Cheltenham Borough Council Constituency.

The trust’s constitution was amended in July 2013 to fully implement the requirements of the Health and Social Care Act 2012, particularly in relation to the role of Governors. The duties and powers of Governors are defined within the constitution and include:

reviewing and providing advice and comments to the Board of Directors on any strategic plans developing and approving a membership strategy, including feeding information back to their constituencies and stakeholder organisationsappointing or removing the Chair and the Non Executive Directorsdeciding the remuneration and allowances of the Chair and Non Executive Directorsappointing or removing the trust’s auditorsreceiving and reviewing the annual accounts, any report of the auditor on the accounts and the trust’s annual reportholding the Non-Executive Directors to account for the performance of the Board approving an appointment by the Non Executive Directors of the Chief Executiveenforcing standards of conduct for Governorssuch other responsibilities as the Board of Directors and Council of Governors may agree

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Further changes were agreed in March 2014 by the Board and the Council of Governors which create public Governor positions for Herefordshire, and appointed Governor positions for representatives of Clinical Commissioning Groups, and Herefordshire Council.

The Council of Governors has:met six times in the reporting periodappointed a new Non-Executive Directorre-appointed the Deputy Trust Chairassisted in the development of strategic plans and provided comments on draftsdeveloped a work programme for the coming yearreceived presentations from services and the Chief Executive on various aspects of their workapproved changes to the trust’s constitution and to the composition of the Council of Governorsagreed a process for approving significant transactions

approved a significant transaction as defined by the trust’s constitutionendorsed a Membership Engagement Planorganised two local engagement eventsreviewed the trust’s quality prioritiesselected local Quality Report indicators to be auditedre-appointed a Lead Governor (Ros Taylor, Public Governor, Cheltenham)received and provided comments on service user feedback including complaintsreceived and discussed the Annual Report and Accountsheld a joint Annual General Meeting with the Board of Directorsagreed the process of appraisal for the Chair and the Non-Executive Directors

38

The following table shows the composition of the Council of Governors during the reporting period, listing names, appointment dates and length of service.

Date of appointment/Nomination (Date ofreappointment)(resignation date)

Name ofGovernor(resigned)

Number ofConstituencyGovernors

Constituency

Ros TaylorGill Pyatt

James EdwardsVacantVacant

Pat Ayres MBERod Whiteley

Marion WinshipJoan Tranter

Sandra JohnNigel Hayward

Gillian HayesJinny Searle

VacantSamantha Tolley

John GillettRichard CastleMichael ParkerJodie Townsend

Francesca TolondJulie GarnhamEdward BuxtonMandy NelsonDawn Lewis

June 08 (June 2011)November 2013September 2013

July 2011July 2011

July 2013July 2010 (July 2013)

November 2013July 2013July 2013July 2013

July 2013July 2013

January 2013July 2013July 2013

July 2013July 2013July 2013July 2013July 2013

Elected Public Governors

Cheltenham Borough Council

Cotswold District Council

Forest District Council

Gloucester City Council

Stroud District Council

Tewkesbury Borough Council

Greater England

3

2

2

3

3

2

1

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MedicalNursing

AHP and Social Care

Support StaffManagement, Administrativeand Other Staff

Governors nominated by partner organisations

County Council RepresentativeDistrict, Borough or City CouncilLearning Disability Partnership BoardGloucestershire Primary Care Trust

November 2011July 2013

November 2011December 2012

July 2013July 2013

September 2012

Dr Amjad UppalDavid Maynard

Phil HennessyPaul Grimer

VacantKristoff Fraszczak

Elaine DaviesVacant

Diane TophamVacant

VacantCllr Duncan SmithFaye HenryVacant

September 2007January 2009

13

1

12

1111

Elected Staff Governors

Meetings of the Council of Governors and Board of Directors are both presided over by the Chair of the trust or, in her absence, the Deputy Chair of the Board of Directors.

It is the Chair’s role to ensure there is a positive working relationship between the Council of Governors and the Board of Directors. The constitution provides for the sharing of responsibilities and this is supported by standing orders for each forum. The trust has a formal process for the resolution of disputes between the two bodies if required but use of this process has not been necessary to date. Directors’ duties are set out in a scheme of delegation.

Both Non-Executive and Executive Directors have attended Council of Governors meetings to present information and to seek Governors’ views. The Council of Governors was consulted as part of the trust’s business planning process.

Governors have been provided with summaries of feedback received by the trust about its services. Actions taken in response to issues raised have also been reported.

The Chair informs the Council of Governors of the work of the Board through regular correspondence to Governors and reports at meetings. The Chief Executive has given several presentations to the Council on current and future developments for the trust. Some Governors have attended Board of Directors meetings and the Chair keeps the Board informed of the issues dealt with at the Council of Governors. The minutes of Council meetings are included on the agenda of the Board of Directors.

Members are informed of changes and proposals through a newsletter and invited to comment and make suggestions. Public and member events showcasing services or highlighting issues have been held at various venues, with Governors and Members attending.

The following shows the number of meetings of the Council of Governors attended by Governors during the reporting period. Attendance by Board members at Council of Governors meetings is detailed elsewhere in this report.

Notes: All Governors are appointed for a term of three years with the exception of local authority Governors who may hold office for the period of their current term of office as a councillor. Governors are eligible to stand for 2 terms

How Governors Work with Directors and Members

40

Attendance by Governors at Council of Governors’ meetings

Ros TaylorGill PyattJames EdwardsPat Ayres MBERod WhiteleyMarion WinshipJoan TranterSandra JohnNigel HaywardGillian HayesJinny SearleSamantha TolleyJohn GillettRichard CastleMichael ParkerJodie TownsendFrancesca TolondJulie GarnhamEdward BuxtonMandy NelsonDawn Lewis

5/62/30/20/65/61/12/60/30/15/51/51/10/16/64/53/51/11/12/55/52/5

Cheltenham

Cotswold

Forest

Gloucester

Stroud

Tewkesbury

Greater England

Staff

Dr Amjad UppalDavid MaynardPhil HennessyPaul GrimerKristoff FraszczakElaine DaviesVacantDiane Topham

4/61/13/65/60/10/5

3/6

MedicalNursing

AHP and Social Care

Support Staff Management, Administrativeand other staff

Nominated

County Council RepresentativeDistrict, Borough or City CouncilLearning Disability Partnership BoardGloucestershire Primary Care Trust

VacantCllr Duncan SmithFaye Henry (Governor)Nick Baker (DeputyGovernor)Vacant

2/65/66/6

Public Name PossibleAttendances

Nominations and Remuneration Committee

The Nominations and Remuneration Committee is a committee of the Council of Governors which advises the Council on the appointment, dismissal, remuneration and terms of service of the Chair and Non-Executive Directors of the Board. The Committee is normally chaired by the Trust Chair, unless they must be excluded from the meeting due to the business being conducted. In this instance, the Deputy Chair of the Committee, a Governor, will oversee the meeting.

The committee has delegated authority to manage and oversee the recruitment and appraisal processes for the Chair and Non Executive Directors on behalf of the Council.

Members of the committee are:Trust Chair (Committee Chair)Julie Garnham, Public Governor – Tewkesbury (until 30 June 2013)Francesca Tolond, Public Governor – Tewkesbury (until 30 June 2013) Sam Tolley, Public Governor – Stroud (until 30 June 2013)Duncan Smith, Nominated Governor Dr Amjad Uppal, Staff Governor – Medical StaffRos Taylor, Public Governor – Cheltenham (Lead Governor) (from 1 July 2013)Richard Castle, Public Governor – Stroud (from 1 July 2013)Michael Parker, Public Governor – Stroud (from 1 July 2013)

In 2013/14 the committee oversaw the appointment of two new Non-Executive Directors using an external executive search agency and open advertisement. The Committee also reviewed the annual appraisals of the Non-Executive Directors, and made recommendations to the Council of Governors on these matters, and on Non-Executive Directors’ remuneration. The Nominations and Remuneration Committee met three times during the reporting period.

Name Ruth FitzJohnJulie GarnhamFrancesca TolondSam TolleyDr Amjad UppalDuncan SmithRos TaylorRichard CastleMichael ParkerFaye Henry, NominatedGovernor RepresentativePaul Grimer, StaffGovernor RepresentativeDiane Topham,Staff Governor Representative

18 June 2013 2 October 2013 19 December 2013

Register of Governors’ and Directors’ interests

Our hospitality register and register of Governors’ and Directors’ interests, including that of our Trust Chair, is available from the Trust Secretary who may be contacted on:

01452 894000 john.mcilveen@glos.nhs.uk

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Membership As an NHS foundation trust, we help ensure local accountability, ownership and control of local services. We also seek to educate and inform people so that they in turn can become ambassadors for our Making Life Better Campaign to tackle the stigma that is so often experienced by people living with mental ill health.

Membership Constituencies and Eligibility Requirements There are eight membership constituencies – seven Public constituencies and a Staff constituency divided into five classes. Public constituenciesMembers of our public constituency must live in England, be over 11 years old and not eligible to become a member of our staff constituency. Six of our public constituencies are based on the city, borough and district councils of Gloucestershire. The seventh constituency is Greater England which includes Herefordshire.

On 1 April 2014, our public constituencies were amended in our constitution. This amendment established Herefordshire as a separate public membership constituency.

Staff ConstituencyMembers of the staff constituency are individuals who are employed by the trust under a contract of employment.

The trust provides automatic membership of the staff constituency and when ineligible to remain a member of the staff constituency, we provide automatic membership of a public constituency. All eligible members of staff become a member of the organisation unless they elect otherwise.

During 2013/14, there are five classes within the staff constituency. They were:

Medical staff: Those who are registered persons within the meaning of the Medicines Act 1956 and who hold a licence to practise.

Nursing staff: Those on the register maintained by the Nursing and Midwifery Council.

Allied Health Professionals and Social Work staff: Allied Health Professionals are staff registered with a regulatory body that is within the remit of the Council for the Regulation of Health Care Professions. Social Workers are staff registered with the Social Care Council.

Clinical and Social Care Support staff: Clinical and Social Care Support Staff are individuals who are employed wholly or mainly in direct clinical and care roles and who are not eligible for membership of the medical, nursing, allied health professionals or social work staff classes.

Management, administrative and other staff: Employees who are entitled to membership of the staff constituency but are not eligible for membership of the medical, nursing, allied health professionals, social work staff or clinical and social care staff classes.

On the 1 April 2014, our staff constituency was amended in our constitution. There are now three classes:

Medical and Nursing staffClinical and Social Work and Support staffManagement, administrative and other staff

Membership data On 31 March 2014, there were 7,336 members of our trust. 5190 are Public Members and 2146 are Staff Members. During 2013/14, there was a 25% increase in the average number of monthly new members joining the trust in comparison to the 2012/13.

Membership data is reported monthly to Trust Board. It is also presented at our Council of Governor meetings for information and discussion.

Throughout the year, our membership database is updated to reflect new and removed member details. A majority (71%) of member details that were removed from the database in 2013/14 were due to members moving home and not updated their new contact details with us.

Cheltenham

Gloucester

Greater England

Cotswolds

Stroud

Greater England (Herefordshire)

Tewkesbury

Forest of Dean820

1312

168

388

771

157

547

603

42

e

Membership of Public Constituencies

Percentage Membership of Public Constituencies

Membership by Constituency

Ethnicity

Public membership

CheltenhamCotswoldsForest of DeanGloucesterStroudTewkesburyHerefordshire (GE)Greater EnglandStaff

12%6%8%19%11%9%2%2%31%

County

White

Black andMinority Ethnic

97%

3%

92%

8%

White

Black andMinority Ethnic

Membership Strategy

Our membership strategy was reviewed by Governors during 2013/14 and agreed for ongoing implementation.

We encourage involvement, informed participation and greater engagement to help ensure that our member’s views are understood. This includes identifying opportunities for members to communicate with their Governor and encouraging members to stand for election to the Council of Governors.

Making membership meaningful is important to us – we seek to make sure that our members have the opportunity to share their views on the work of their trust. We also understand that members want to get involved in different ways at different levels and that this may change throughout their membership.

The overarching aims of our membership strategy are to:

Recruit and retain members representative of the communities we serve Promote the benefits of becoming a trust member Raise public awareness of mental health issuesCreate interest, enthusiasm and energy Encourage involvement, informed participation and greater engagementProvide timely, targeted and meaningful informationBuild opportunities for members to communicate with their Governor and trustDevelop meaningful and valuable membership that is both supported and sustained

A number of communication methods were used across the year to engage and communicate with our members. These include e-flyers, the trust website including a dedicated governor section launched in 2013/14, a quarterly members’ newsletter, letters, and member engagement events.

Due to delays in supporting strategies, we were unable to launch a new programme that gave new members the opportunity to decide what information they receive and how they want to be involved with the trust. This initiative will happen in 2014/15.

How much our members want to get involved is entirely up to them. Over the next twelve months, members will be able to choose one of four different types of involvement. Everyone will remain a full member of the trust but can chose to be more or less involved. We will also:

Seek to improve the information available online to members through a new membership portalLaunch a new style quarterly newsletter supplemented by regular e-news bulletinsInitiate a members survey to help understand members interests to develop a meaningful programme of activities Continue to hold regular engagement events Increase the use of social media to recruit and engage members allowing people to get information through communication tools of their choosingReview the members pack and supporting literatureEngage governors in the production of a new members charter

Become a Member

If you are interested in helping to shape local NHS services or want to support our campaign to tackle the stigma that is so often associated with mental ill-health, join us:

telephone: 01452 894165

email: 2gether.comms@glos.nhs.uk

web: www.2gether.nhs.uk/membership

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44

Commissioner

Gloucestershire CCG

Herefordshire CCG

Specialist Commissioning

No. of CQUIN

10

7

6

No. of Indicators

19

7

n/a

Our 2013/14 CQUIN targets were as follow:

Patient CareFrom April 2010, all NHS trusts have been legally required to register with the CQC. Registration is the licence to operate and to be registered, providers must, by law, demonstrate compliance with the requirements of the CQC (Registration) Regulations 2009.

2gether is registered with the CQC and has no conditions on its registration. You can read more about our license and statements received from CQC in 2013/14 within our 2013/14 Quality Report.

The Care Quality Commission has not taken enforcement action against 2gether NHS foundation trust during 2013/14.

Our three priorities, which are carried forward in our planning for 2014/15, are an ongoing commitment to quality, engagement and sustainability. Each seeks to ensure that the people in our care receive the most appropriate and safe service.

Safety is an intrinsic element of the high quality service we seek to provide – a service we would wish for our own family and friends. Along with other NHS trusts in the South of England, we are working together to deliver the Patient Safety Improvement Programme for Mental Health.

As part of this work and for more than two years, our senior leaders conduct monthly ‘walkrounds’ of our sites. This initiative is received positively by staff and is helping to make a difference in improving patient safety within the trust.

Some examples of improvements include repairs to internal and external doors; improved communication to service users and carers; and enhancements to the handover processes in high risk community teams.

Using our Foundation Trust Status

Our estate strategy focuses on delivering a patient environment that is fit for purpose; provides a good quality environment for patients and staff; flexible to meet future needs; meets all statutory requirements; and offers value for money.

Since achieving foundation trust status, we have been able to use our capital programme to reinvest in a number of areas and predominantly, our trust environments. Over the last three years for example, we have built a new Psychiatric Intensive Care Unit in Gloucester and opened Charlton Lane Hospital, our modern, specialist assessment and treatment centre for older people.

During 2013/14, we used continued to use our capital programme to fund appropriately, elements of our estate strategy. During 2013/14, we made the following investments in our buildings to help improve the care we provide:

Improved environment and patient safety works at Abbey Ward, Wotton Lawn, Gloucester, providing 100% en-suite facilitiesBegan similar safety improvement works on Priory Ward, Wotton Lawn, Gloucester, for completion in 2014/15Complete refurbishment of an existing trust-owned building to provide a 24 hour recovery inpatient unit 100% en-suite single sex accommodation and activity spaces Refurbishment of daycare and dining facilities in Stonebow Hospital, HerefordshireEnabling works for Forest and Stroud Hubs £170k

Local Indicators

Using the national contractual Commissioning for Quality and Innovation (CQUIN) framework, our two main commissioners - Gloucestershire and Herefordshire Clinical Commissioning Groups (CCGs) - agreed local indicators with us.

A proportion of the income we receive from our commissioners is conditional on the trust achieving the agreed local quality improvements in the provision of services.

In Gloucestershire, we meet 100% of our CQUIN targets; and in Herefordshire we meet 100% of our CQUIN targets.

For specialist Commissioning in Q1 there was a loss of £200.00 relating to one indicator for Physical Healthcare which arose as a GP letter was not sent out in a timely fashion. This figure equates to 0.5% of the Specialist Commissioning target.

In 2013/14, £2,080,492 of 2gether’s income was conditional on us achieving the CQUINs agreed with commissioners. We achieved £2,080,292.

In 2014/15, the income conditional on achieving our agreed CQUINs is £2,054,000.

Service Development & Partnerships

Let’s TalkOur Improving Access to Psychological Therapy (IAPT) Service in Gloucestershire and Herefordshire began running a range of new courses across over the year.

The new courses also launched a self-referral process for the people we serve in Herefordshire. The process already existed in Gloucestershire. This means that people can seek help either through their GP, by telephoning the service, through our iphone app or directly by booking a course online through the trust’s Let’s Talk microsite https://courses.talk2gether.nhs.uk/

The courses are free and are run on weekdays, weekends and evenings. They are aimed at helping with a number of mental health and wellbeing issues to help manage low mood, anxiety, self-esteem, wellbeing and obsessive compulsive disorder. In Gloucestershire an extended range of courses include sleep management, Irritable Bowel Syndrome, panic, anger and a range of courses specifically for older people including Mindfulness Based Stress Reduction.

Recovery CollegeA project that 2gether launched in partnership with Adult Education in Gloucestershire, Artshape, Family Lives, Mind Herefordshire and Herefordshire Council was selected for the national Health Foundation’s Shine programme funding.

2gether’s ‘Coaching for Recovery’ project established academic style courses at venues across Gloucestershire and Herefordshire. They offered a different approach to recovering from mental illness by teaching people the skills to manage their own condition and stay well, as well as gain the confidence, life skills and knowledge to live their lives to the full.

The renamed Severn and Wye Recovery College educated people with long term mental health conditions on ways to improve and maintain their emotional wellbeing.

Following the success of the college in 2013, a bid was granted by 2gether’s Charitable Funds committee to run further courses in 2014.

Whole Family – 2gether with Gloucestershire Young Carers were one of only eight partnerships across the UK to be chosen by the Carers Trust a national carers charity, to receive grant funding from the Department of the Environment.

The Gloucestershire Family Mental Health Empowerment Project ran over 2013, offering support to both parents and children in families where a parent experiences serious mental health issues.

By speaking with and involving all family members, the project aimed to minimise the impact of parental mental illness on dependent children by recognising and supporting the parents in their role; increasing identification of young carers; and building resilience of young carers and families.

Patient and Carer Information

Care Plan FolderIn direct response to feedback provided by our service users, we have developed a patient information pack and care plan folder. The folder reconfirms our 24 hour emergency contact details, guidance on questions that a service user may want to ask their co-ordinator and information on care planning.

The folder also contains a crisis card that provides contact details and instructions on what to do in an emergency. For our Wotton Lawn patients, a new handbook was also developed and will be distributed with the care plan folder.

All service users will receive the new folder starting from May 2014.

Supporting mental health and wellbeing at universityThe move from home to university is often associated with an increase in reported psychiatric symptoms. The range of mental health issues cover a wide spectrum of problems including stress, anxiety, depression, eating disorders, self-harm and substance misuse.

Working with staff at the University of Gloucester and local general practice surgeries, our Mental Health and Emotional Wellbeing Advisor provides appropriate assessment, signposting and treatment to the university’s varied student population, carers and staff.

Seeking to reduce stigma and social exclusion, the Advisor also provides mental health promotion, training and support to both students and staff at the University. This includes the development of posters, leaflets and flyers for distribution across campus; mental health related articles for publication in the University newspaper; and wellbeing events throughout the year.

45

Digital MediaWe continue to use a number of social media channels to make sure the public and our members have different ways available to them to make contact with the trust and receive information. At the end of March, the trust Twitter account had 1735 followers.

Our corporate social media accounts have been to share information about upcoming events, how to access services particularly raising awareness of new courses dates for our Let’s Talk, Improving Access to Psychological Therapy (IAPT) Service; and to share news and information about the trust, including upcoming Governor elections, winners of our annual staff awards and national awareness days.

In March 2014 for example, we highlighted the pledges that staff were making for NHS Change Day and on Mental Health Awareness Day (10 October 2013) we uploaded photographs of colleagues sharing information with shoppers at supermarkets across Herefordshire and Gloucestershire.

Our website remains the primary source for trust membership applications. Over the last year, there was a 15% increase in the number of new visitors to our website; and a 14% increase in total visitors to the site.

Although changes have been made to the corporate site over the last year which has been by members of the public, we know that we can still achieve more. Over the next year we will continue to refresh the contents of the site to help develop and engaging and up to date information portal.

Service experience Our Service Experience Strategy was launched at a public engagement event in May 2013. We have committed to strengthening our practice with six fundamental core values which will form an experience of service. The principles are:

courageous in tackling stigmacaring across traditional boundariesto communicate effectively and regularly with community partners, to act with compassion to service users, families and carersto be committed to and competent in delivering recovery oriented practice

Our overarching vision is that every service user will receive a flexible, compassionate, empathetic, respectful, inclusive and proactive response from 2gether staff and volunteers. As we serve our patients and their carers we will go beyond what people expect of us to ensure that we earn their trust, confidence and hope for the future.

The implementation of the work to deliver our service experience vision is monitored through the trust’s quarterly Service Experience Committee. Membership of the committee includes service users, carers, partner organisations and senior members of staff.

Our quarterly Service Experience Reports are also then discussed at our public trust Board meetings. This helps us to retain a continued awareness and monitoring of service user and carer feedback at the highest level of the organisation. Detailed information is also considered by our Board’s Governance Committee and our individual Locality Boards.

Complaints and Compliments

A total of 159 formal complaints were made to the trust between April 2013 and March 2014. This represents an 8% increase or 12 additional complaints when compared with the number received in the same period last year. However, during Quarter 2, five complaints were withdrawn when the individual complainants were further along in their recovery.

We continue to improve our response times in acknowledging a complaint. In 2013/14, 96% of complaints were acknowledged within the three day time standard. This is an increase of 10 percentage points since over the last two years.

The number of complaints that took over 60 days to resolve remained constant this year at 29% (n=46). The time taken may also reflect the complexity of some investigation that some complaints require. In some instances where a large number of issues have been investigated, partial responses have been given with agreement with the complainant, in order to provide updates as soon as possible.

Three cases were referred to Parliamentary Health Services Ombudsman (PHSO) which is two less than last year and represents 2% of complaints received. Two of the cases have been closed and neither were upheld.

Shaun CleeChief Executive 27 May 2014

47

Remuneration ReportOur Appointments and Terms of Service Committee has delegated responsibility from the Board of Directors to review and set the remuneration and terms of service of the Chief Executive and the Executive Directors.

All others senior managers are covered by Agenda for Change terms and conditions of service. The intention is to continue to review the definition of senior manager although the policy has been for all staff who are not board members to be employed on national terms and conditions of employment.

The Appointment and Terms of Service Committee is chaired by the Trust Chair and has a membership of all Non-Executive Directors. In the absence of the Chair, the Deputy Chair of the trust will lead the meeting.

The Appointment and Terms of Service Committee has adopted a policy of developing a very simple reward package that is based on a “spot” salary and where appropriate, recruitment and retention premia based on externally commissioned reviews. includes no additional other pay or non-pay benefits which are outside standard terms and conditions which apply to the majority of staff employed within the trust i.e. annual leave, sick pay.

Decisions it takes on the salary and terms of conditions of service of its Chief Executive and Board Directors will be informed by externally commissioned reviews that take in to account the market, the scope of responsibilities, performance and best practice. The committee also takes into account the awards for other staff groups when considering the remuneration of its Chief Executive and Executive Directors.

For all other senior managers, performance is managed in accordance with our appraisal policy and pay progression policy, both of which are consistent with Agenda for Change national terms and conditions of service and agreed locally with our Staff Side representatives.

The appraisal process for Executive Directors and senior managers employed on Agenda for Change terms and conditions ensures that objectives for each individual are aligned to the trust strategy and trust business.

For senior managers on Agenda for Change terms and conditions under the trust’s Pay Progression Policy, one increment may be withheld if levels of performance are not maintained.

The Committee receives an annual report on the performance of the Chief Executive and Executive Directors from the Chair and Chief Executive respectively. This follows the assessment of the appraisal objectives for each member of the Board that are agreed at the beginning of each financial year.

Having taken legal advice, we decided that the Chief Executive and Executive Directors are employed on substantive contracts with the trust. The current Chief Executive’s contract is subject to six months written notice from either party. The exception to this is in the case of incapacity and for reasons of qualification, conduct or capability. In these cases the contract is subject to three months’ notice of termination.

Executive Director contracts are subject to a notice period of six months to minimise the risk of lack of capacity at this level, whilst recruitment processes take place. None of the contracts for the Chief Executive or Board Directors contain clauses specifying termination payments which are in excess of contractual obligations.

Senior managers on Agenda for Change terms and conditions are employed on substantive contracts subject to three months written notice by the individual and statutory notice by the trust. No contract contains clauses specifying termination payments which are in excess of contractual obligations.

Our Appointments and Terms of Service Committee takes into account the awards for other staff groups when considering the remuneration of its Chief Executive and Executive Directors. Employment conditions reflect standard terms and conditions which apply to the majority of staff employed within the trust i.e. annual leave, sick pay.

For those senior managers who are also designated as Directors but are not Executive Directors, their remuneration is as determined under national terms and conditions and therefore applicable to the majority of staff employed by the trust.

Past and present employees are covered by the provisions of the NHS Pensions Scheme. The Scheme is an unfunded, defined benefit scheme that covers NHS employers, General Practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. As a consequence it is not possible for the NHS trust to identify its share of the underlying scheme assets and liabilities.

Therefore the scheme is accounted for as a defined contribution scheme and the cost of the scheme is equal to the contributions payable to the scheme for the accounting period. Further details can be found in note 1.4 of our annual accounts.

48

Membership and Attendance of the Remuneration CommitteeMembership and attendance of the Remuneration Committee by Non-Executive and Executive Members

Name and positionTotal MeetingsRuth FitzJohn, DL, Trust ChairMartin Freeman, Non-Executive DirectorJoanna Newton, Non-Executive DirectorRoger Brimblecombe, Non-Executive DirectorMartin Davis, Non-Executive DirectorJonathan Vickers, Non-Executive DirectorCharlotte Hitchings, Deputy Trust ChairRichard Szadziewski, Non-Executive DirectorJohn Saunders, OBE, Non-Executive Director

RemunerationCommittee3313211321

Salary and Pension Entitlement of Senior Managers: Remuneration

2013 – 14 2012 – 13

Nameand Title

OtherRemuneration(bands of£5,000) £000

Benefits inKind(Rounded tonearest £100)

Salary(bands of£5,000)£000

OtherRemuneration(bands of£5,000) £000

Benefits inKind(Rounded tonearest £100)

Salary(bands of£5,000)£000

Ruth FitzJohn -Chair(Start 01/04/13)

RogerBrimblecombeNon-ExecutiveDirector(Left 30/09/13)

Martin DavisNon-ExecutiveDirector(Left 30/09/13)

CharlotteHitchingsNon-ExecutiveDirector

RichardSzadziewskiNon-ExecutiveDirector(Left 28/02/14)

Martin FreemanNon-ExecutiveDirector

Joanna NewtonNon-ExecutiveDirector(Start 01/04/13)

JonathanVickersNon-ExecutiveDirector(Start 01/04/13)

Non ExecutiveDirectors

40-45

05-10

05-10

15-20

10-15

15-20

10-15

10-15

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

15-20

10-15

10-15

10-15

10-15

0

0

49

The Medical Director is a part time role whose payment is identified under Salary. Pay associated with clinical work is shown as Other Remuneration. The benefit in kind relates to travel expense allowances where subject to income tax.

Other remuneration to the Director of Finance and Commerce is in lieu of notice and annual leave.

2gether NHS Foundation Trust does not pay their Directors any annual or long term performance related bonuses.

2013 – 14 2012 – 13

Nameand Title

OtherRemuneration(bands of£5,000) £000

Benefits inKind(Rounded tonearest £100)

Salary(bands of£5,000)£000

OtherRemuneration(bands of£5,000) £000

Benefits inKind(Rounded tonearest £100)

Salary(bands of£5,000)£000

Executive Directors

0

0

0

0

65-70

150-155

0

0

0

0

0

0

0

0

0

0

0

120-125

0

0

0

0

0

0

John SaundersNon-ExecutiveDirector(Start 01/02/14)

00-05 0 0 0 0 0

Shaun CleeChief Executive

Carol SparksDirector ofOrganisationalDevelopment

Colin MerkerDirector ofServiceDelivery

Trish JayDirector ofQuality

Jason BurnDirector ofFinance andCommerce(Left 31/03/14)

PaulWinterbottomMedicalDirector

160-165

95-100

115-120

110-115

115-120

70-75

140-145

10-15

100-105

95-100

05-10

70-75

Locality/Service Directors

Les TrewinLocalityDirector

Ted QuinnLocalityDirector(Left 30/06/13)

Jan FurniauxActing LocalityDirector(Start 01/07/13)

Mark HemmingLocalityDirector

Mathew PageServiceDirector

ChristopherWoonServiceDirector

75-80

15-20

45-50

65-70

60-65

55-60

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

70-75

65-70

0

65-70

55-60

50-55

50

Salary and Pension Entitlement of Senior Managers: Pension Benefits*

0

0 - 2.5

10 - 12.5

5 - 7.5

5 - 7.5

2.5 - 5

0

0 - 2.5

30 - 32.5

17.5 - 20

20 - 22.5

7.5 - 10

0

30 - 35

25 - 30

30 - 35

50 - 55

65 - 70

0

100 - 105

80 - 85

100 - 105

155 - 160

195 - 200

0

485

340

517

877

1142

0

516

595

659

1067

1252

0

21

247

130

171

85

0

0

0

0

0

0

0 - 2.5

0

0 - 2.5

0 - 2.5

0 - 2.5

0 - 2.5

0 - 2.5

0

5 - 7.5

0 - 2.5

2.5 - 5

2.5 - 5

20 - 25

30 - 35

25 - 30

10 - 15

10 - 15

5 - 10

70 - 75

90 - 95

75 - 80

40 - 45

30 - 35

20 - 25

402

0

403

270

121

74

434

0

460

299

144

87

23

0

48

23

20

12

0

0

0

0

0

0

*NOTE: as Non-Executive members do not receive pensionable remuneration, there are no entries in respect of pensions for Non-Executive Directors.

Real increase in pension at age 60

Real increase in pension lump sum at age 60

Total accrued pension at age 60 at 31 March 2014

Lump sum at age 60 related to accrued pension at 31 March 2014

Lump sum at age 60 related to accrued pension at 31 March 2014

Lump sum at age 60 related to accrued pension at 31 March 2014

Real Increase in Cash Equivalent Transfer Value

Employers Contribution to Stakeholder PensionName

and Title

(bands of

£2,500)

(bands of

£2,500)

(bands of

£5,000)

(bands of

£5,000)

£’000£’000£’000£’000

Executive Directors

Shaun CleeChiefExecutive

Jason BurnDirector ofFinance

Carol SparksDirector ofOrganisationalDevelopment

Trish JayDirector ofQuality

Colin MerkerDirector ofServiceDelivery

PaulWinterbottomMedicalDirector

Locality/Service Directors

Les TrewinLocalityDirector

Ted QuinnLocalityDirector

JanFurniauxActingLocalityDirector

MarkHemmingLocalityDirector

MathewPageServiceDirector

ChristopherWoonServiceDirector

51

Median Pay

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

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

The calculation is based on the full-time, annualised equivalent of every member of staff employed by the trust during 2012/13, including bank staff and medical locums.

The disclosure of the median remuneration of the trust’s workforce and the ratio between this and the mid-point of the banded remuneration of the highest paid director has been audited.

2012/13

The banded remuneration of the highest-paid director in 2gether NHS Foundation Trust in the financial year 2012-13 was £195,000-£200,000. This was 7.19 times the median remuneration of the workforce, which was £27,630.

No employees received remuneration in excess of the highest-paid director.

2013/14

The banded remuneration of the highest-paid director in 2gether NHS Foundation Trust in the financial year 2013-14 was £215,000-£220,000. This was 7.1 times the median remuneration of the workforce, which was £28,928.

The highest paid director took on additional clinical responsibilities in November 2012, which are on-going. The additional responsibilities were inadvertently omitted from salary until March 2014, when back-pay for the full period was received.

The amount relating to prior financial years has been excluded from the figures stated for 2013/14. If the additional responsibilities worked in 2012/13 had been paid in that year, the highest paid Director’s remuneration would have been in the band £205,000-£210,000 and the correct ratio for that year would have been 7.1 which is the same as 2013/14.

No employees received remuneration in excess of the highest-paid director.

ExpensesGovernors

Governors do not receive remuneration but are paid reasonable expenses in order to perform their role.

At the 31 March, 2014 the total number of Governors in office was 19.

During the reporting period, 10 Governors received expenses payments. The aggregate sum of expenses paid to Governors during the reporting period is £900.

Directors

In 2013/14, 15 Directors were in office including starters & leavers. During the reporting period, all Directors claimed expenses to a total of £21,900.

Off-payroll engagements as at 31 March 2014

We are required to declare highly paid and/or senior off-payroll engagements.

The off-payroll engagements for more than £220 per day and that last for longer than six months are as follow:

Number of existing engagements as of 31 March 2014

Of which...

Number that have existed for less than one year at time of reporting:

Number that have existed for between one and two years at time of reporting:

Number that have existed for between two and three years at time of reporting:

Number that have existed for between three and four years at time of reporting:

Number that have existed for four or more years at time of reporting:

7

6

1

0

0

0

52

There were 4 engagements in the early part of 2013/14 which did not contain a clause allowing the trust to seek assurance as to tax obligations. All of these engagements terminated prior to the risk assessment exercise.

Of the 9 engagements from whom assurance has been requested but not received, 3 left before 31/3/14. The trust is pursuing the remainder in accordance with its procedure.

The following table details the off-payroll engagements of board members, and/or, senior officials with significant financial responsibility, between 1 April 2013 and 31 March 2014:

Number of off-payroll engagements of board members, and/or, senior officials with significant financial responsibility, during the financial year.

Number of individuals that have been deemed “board members and/or senior officials with significant financial responsibility” during the financial year. This figure should include both off-payroll and on-payroll engagements.

All existing off-payroll engagements, outlined above, have been subject to a risk based assessment as to whether assurance is required that the individual is paying the right amount of tax and, where necessary, that assurance has been sought.The following table details all new off-payroll engagements or those that reached six months in duration, between 1 April 2013 and 31 March 2014, for more than £220 per day and that last for longer than six months:

Number of new engagements, or those that reached six months in duration, between 1 April 2013 and 31 March 2014

Number of the above which include contractual clauses giving the trust the right to request assurance in relation to income tax and National Insurance obligations

Number for whom assurance has been requested

Of which...

Number for whom assurance has been received

Number for whom assurance has not been received

Number that have been terminated as a result of assurance not being received.

15

11

11

2

9

0

0

21

The above information has been audited.

Shaun Clee Chief Executive Date: 27 May 2014

53

Staff SurveyStaff Engagement

Engagement is one of our three key priorities and we have a range of mechanisms in place for staff to offer their suggestions, feedback and ideas for performance improvement. We are committed to involving and engaging staff so that they develop themselves, our business and how our services are delivered.

Formal consultation and negotiation arrangements are in place with accredited staff side representatives. The Joint Negotiating and Consultative Committee (JNCC) meets on a bi-monthly basis and discusses service changes, key issues affecting staff and endorses revised and new Human Resources policies and procedures.

In response to the Francis Inquiry Report, we established four working groups, each chaired by a member of staff with the assistance of an Executive Director.

Membership of the groups is drawn from across our services with an interest in the specific area of focus. The Staff Engagement working group for example include colleagues that are committed to improving communication at all levels. Its members include Staff Side representatives and colleagues from a variety of professional backgrounds – both clinical and corporate support services.

Our monthly Team Talk Core Brief meetings are facilitated by the Chief Executive or another member of our Executive Team. They are organised in Gloucestershire and Herefordshire simultaneously so that staff in both counties receive the information at the same time and are able to participate without impact on their time – either through travel or being away from their workplace.

Team Talk helps to make sure that trust managers receive relevant information and key messages in regards to performance, finances and other economic factors affecting the trust. Managers then cascade the information to their own teams.

Following consultation with managers, the Team Talk Core Brief format was enhanced to include a greater emphasis on staff generated topics for discussion. A staff survey showed 96% of respondents said that on the whole, they received the right level of information and detail on the areas that interested them most.

We continue to brief managers in regards to changes in Human Resource practice through electronic communications. The format helps to ensure that the information reaches the widest possible number of staff.

We also continued our annual Recognising Outstanding Service and Contribution Awards (ROSCAs) and long service award programme. The number of nominations for staff and volunteers has become more varied with increased representation across all the categories. During 2013/14 we extended the ROSCAs to include a

monthly Best Supportive Colleague Award. The new award helps to make sure that more staff who perform above and beyond, are recognised throughout the year.

At the start of 2014, we developed a new internal engagement initiative aimed at facilitating discussion around our future service strategy and how as a trust, we can meet the economic realities of the NHS. The Talk Back events stimulated conversation around our key priorities: quality, engagement and sustainability of services and was part of the trust’s wider staff engagement programme strategy.

The sessions consisted of ‘pop-up’ displays at a number of community and inpatient sites. This enabled as many people as possible to join the discussion and give feedback without impacting their work day significantly.

Over 300 staff joined the events to discuss progress, share challenges and generate ideas to help meet the financial challenges ahead.

The suggestions and feedback directly influenced a number of key initiatives that will be implemented during 2014/15. Over the next financial year, we will continue to provide updates on progress through our new staff intranet site and monthly Team Talk events.

Over the last twelve months, we also held staff engagement events to seek feedback from staff, Governors, public members, volunteers, service users, carers and other stakeholders as part of implementing the national NHS Equality Delivery System.

Our equality objectives were cascaded through managers to ensure ownership and to enable any local actions to be progressed with staff and through the appraisal process.

We also have a well-developed Joint Negotiation and Consultation Committee (JNCC) working closely with Staff Side representatives to understand the views and concerns of staff. The group regularly work collaboratively on key priorities to ensure a balanced and considered approach is taken to matters which impact on staff and the workplace.

A key development and priority for our internal engagement programme in 2014/15 is the launch of a new intranet site. Staff have been engaged in the development and structure of the site which is aimed at providing colleagues with a modern collaborative knowledge sharing tool.

A new weekly news update will be sent to staff each week, highlighting the key information that was uploaded to the new site that week.

54

Survey responses from 2gether staff were 8% above the national average and showed a 6% increase on our response rate in 2012.

These actions appear to have made a difference however more work will be done during 2014. This includes additional information, sign posting, and pulse surveys on our new intranet site. Similar to last year, the annual staff survey 2013 contained 28 Key Findings therefore the results are directly comparable.

Of the 28 Key Findings staff told us that there had been no significant change in 25 of them compared to the previous year but more detailed analysis showed there have been small improvements in most (26) of the Key Findings. For 3 Key Findings staff told us there had been clear improvements.

When comparing results across the 28 key areas with our peer trusts, we were*:In the best 20% in 2 areas (0)Better than average in 3 areas (3)Average in 10 areas (7)Worse than average in 9 areas (7)In the lowest 20% in 4 areas (11)

*The previous year’s figures are shown in brackets.

KF27 Percentage of staff believing the trust provides equal opportunities for career progression or promotion(higher score better)

KF4 Effective team working (Higher score better)

KF20 Percentage of staff feeling pressure in last 3 months to attend work when feeling unwell (Lower score better)

KF17 Percentage of staff experiencing physical violence from staff in last 12 months (lower score better)

Improvement Increase of 3%

Improvement Increase of 0.11%

Improvement Increase of 3%

Improvement Increase of 1%

89%

3.80

22%

5%

90%

3.83

22%

4%

92%

3.91

19%

3%

89%

3.83

22%

4%

Staff Survey Results

ResponseRate

Trust TrustNationalAverage

NationalAverage

Trust Improvement/Deterioration

2012 2013

Top 4 Ranking Scores 2013 Trust TrustNationalAverage

NationalAverage

TrustImprovement/Deterioration

2012 2013

50% 51% 56% 48% 6%

55

Improvement Increase of 5%

Improvement Increase of 10%

Improvement Increase of 5%

Improvement Increase of 1%

17%

37%

74%

70%

30%

59%

82%

78%

22%

47%

79%

71%

31%

67%

82%

77%

Bottom 4 Ranking Scores 2013 Trust TrustNationalAverage

NationalAverage

TrustImprovement/Deterioration

2012 2013

KF21 Percentage of staff reporting good communication between senior management and staff (High score better)

KF26 of staff having equality and diversity training in last 12 months (High score better)

KF6 Percentage of staff receiving job-relevant training, learning or development in last 12 months (High score better)

KF1 Percentage of staff feeling satisfied with the quality of work and patient care they are able to deliver (High score better)

Note: National Average Score is for Mental Health/Learning Disabilities Trusts

The comparison with last year demonstrates encouraging signs of improvement in that we reduced the number of areas in the worst or lowest 20% category, and in the average or above results we had 15 areas compared with 10 in the previous year. In addition our response rate for the 2013 survey was 56% compared with 48% the previous year. We believe this is an indicator of improved engagement with staff.

ROSCAs

56

Action plans to address areas of concern

When compared with the results of the 2012 survey, the 2013 survey has been encouraging with small improvements made in most areas. The trust has been extremely pro-active in the six months between the release of the 2012 results and the commencement of the 2013 survey with activity overseen by the new Workforce and Organisational Development Committee.

Staff are encouraged to attend regular monthly engagement workshops that take place around our many sites to discuss their concerns. Team Talk – our monthly managers meeting has been changed following their feedback, so that the primary focus is on those issues of interest and concern to them. This ensures the process is ‘bottom up’.

The Trust Board has approved a set of recommendations which will enable us to respond to the outcome of the 2013 survey. Three key findings have been set as priorities for the coming months. These are:

Staff receiving job-relevant training , learning or development in last 12 monthsStaff feeling satisfied with the quality of work and patient care they are able to deliver.Staff experiencing physical violence from patients, relatives or the public in the last 12 months.

These topics will always be on the agenda at staff engagement workshops for colleagues to give their opinions and identify actions that can be taken to make a difference. The trust has also agreed to continue with the actions we prioritised from 2012 to ensure we do not lose momentum in these areas and continue with the good progress already made. These were:

Communications between staff and senior managementStress at work Recommending the trust as a place to work or receive treatment

Engagement workshops, structured conversations and anonymous online surveys are very much a part of trust life and will continue as a means to seek the ideas of our staff as to how we can improve our services and ensure our trust is the first choice as a place to work or to receive treatment.

In response to the results and using the feedback from staff the trust has taken the following actions:

A new intranet is planned for early 2014 to improve communications throughout the trust We will change the style of our weekly electronic newsletter to make it more interesting and highlight key messagesWe will launch a ‘micro site’ in the second quarter of 2014/15 to enable those staff who work off site or remotely to access key trust information which would otherwise be on our intranet and therefore not easily accessible to them

The trust will shortly be implementing RiO2, a more streamlined version of our electronic patient record that will lessen the amount of time spent by staff updating data, thereby reducing ‘admin time’. We plan to condense and streamline the amount of statutory and mandatory training particularly for front line clinical staff to enable them to spend more time delivering care whilst continuing to receive relevant training and development.E-learning opportunities will be extended to reduce time out of the work place.We will be monitoring feedback for the quarterly Staff Friends and Family Test that commences in April 2014 and asking staff what actions can be taken to increase their satisfaction with the quality of work and care they are able to provide. We are reviewing protocols and safe systems of working to reduce the violence that our staff experience and this will be overseen by our Occupational Health and Safety Committee.We have a new leadership and development programme which complements the national programme and contains different programmes for Bands 5/6, Band 7, and Band 8 staff. We have also supported some 40 staff to access a range of regional and national programmes.

57

59

During our 2013/14 financial year, Monitor introduced a new Risk Assessment framework for all NHS foundation trust license holders that replaced the previous Compliance Framework. The new Risk Assessment framework seeks to identify poor governance and any significant risks to the financial sustainability of a provider that may endanger service continuity.

From 1 October 2013, all NHS foundation trusts, including 2gether, are provided by monitor with a quarterly risk rating performance for continuity of services. 2gether’s performance against both the Compliance Framework and the new Risk assessment framework are noted in the table below.

Summary of 2gether’s ratings for 2013/14 and comparison with 2012/13

The trust’s actual performance against the Financial Risk Rating plan for Q1 and Q2 2013/14 was above the plan. We scored financial Risk ratings of 4 compared to the plan of 3 due to our stronger than anticipated liquidity position. We scored 4 against the Continuity of Service rating which is the highest score obtainable.

The trust anticipates the Governance score will be Green throughout the year which indicates no governance issues have been identified.

Under the Compliance Framework

Financial Risk Rating

Governance Risk rating

Under the Risk assessment framework

Continuity of service rating

Governance rating

Q12013/14

Q22013/14

Q32013/14

Q42013/14

Annual Plan2013/14

3 4 4

4 4

Under the Compliance Framework

Financial Risk Rating

Governance Risk rating

Q12012/13

Q22012/13

Q32012/13

Q42012/13

Annual Plan2012/13

3 4 4 4 4

Regulatory RatingsMonitor is England’s sector regulator for health services. It has a statutory role to ensure the continued provision of NHS services by NHS providers, as identified by the provider’s commissioner. This includes overseeing the governance of NHS foundation trusts.

From 1 April 2013, NHS foundation Trusts required a license from Monitor that stipulates specific conditions that must be met for the trust to operate. These include financial sustainability and governance requirements.

Equal opportunities policy

2gether is committed to ensuring equality and diversity in the provision of our services, our staff and the work that we do. This means that we seek to:

deliver services equally and recognise the different and diverse needs of the community it servesbuild a workforce that is valued and whose diversity reflects the communities it serves, enabling the delivery of the best possible healthcare

Our ‘Managing Diversity Policy’ sets out the trust’s principles for recruiting, developing and promoting people irrespective of age, disability, race, nationality, ethnic or national origin, gender, religion, beliefs, sexual orientation, domestic circumstances, social and employment status, HIV status, gender reassignment, trade union membership or political affiliation.

You can read our Equality and Diversity Policy online

www.2gether.nhs.uk/equality-and-diversity The Director of Organisational Development is the Board lead for equality and diversity within the trust.

We strive to embed equality and diversity throughout our services and ensure it underpins all relevant training. We will be actively reviewing how this works during 2014/15 and refreshing our approach as needed. Our Social Inclusion Team works closely with our HR Team to ensure that as far as possible we reduce the barriers to employment, and link with our diverse community.

We work collaboratively across the county and with neighbouring NHS organisations to embed the national NHS Equality Delivery System. This is a framework which enables NHS organisations to embed equality and diversity into our service planning so that our objectives make a significant difference to health outcomes, reduce the barriers to accessing health services and supporting our staff particularly for those groups or communities who share one or more protected characteristic as described in the Equality Act 2010.

Positive about Disabled EmployeesWe are committed to employing disabled people and is pleased to be able to use the ‘Positive About Disabled People’ disability symbol and will:

Interview all applicants with a disability who meet the minimum criteria for a job vacancy and consider them on their abilitiesMake every effort when employees become disabled to make sure they stay in our employmentTake action to ensure all employees develop appropriate awareness to make our commitments work.

We are also a signatory to the Mindful Employer initiative, and actively develops and promotes a significant number of health and wellbeing benefits and initiatives to staff which are available via the trust intranet.

Focus on Health and Safety

We are committed to providing safe environments for our staff and ensuring that service users and carers can access services safely. This work is overseen by its Occupational Health and Safety Committee which meet regularly and includes accredited safety representatives, managers and specialist from estates and health and safety.

In the last twelve months we upgraded our on-line Datix incident reporting system, have reviewed our user guides and set-up User Group to inform future developments. We are reviewing the training that is available and will continue to enhance the system to ensure we can learn lessons from incidents, accidents and near misses.

Colleagues have a proactive approach to reporting, especially patient safety incidents. This helps to improve the quality of reporting and our subsequent analysis. All Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR) reportable incidents are investigated and any remedial actions identified and implemented, either locally or trustwide.

We continue to educate colleagues on the importance of documenting every incident that occurs. This helps ensure that incidents against our staff are investigated by the most appropriate authority.

During 2013/14 we trained a significant number of Site Responsible Officers and are ensuring they have the tools and resources to hand to manage their site, as well as easy access to subject specialists.

Counter fraud

Our robust and effective Counter Fraud Service demonstrates our commitment to ensuring that public money is not defrauded – this helps make sure that NHS funds are used for patient care and services.

Over the year, Gloucestershire Local Counter Fraud Service (LCFS) has assisted us to reduce opportunities for the commission of fraud and corruption to an absolute minimum.

They have also helped to increase liaison with other government, public and private organisations and the national and regional offices of NHS Protect to improve the impact of our counter fraud activity.

We continue to encourage the honest majority of staff to report any concerns to the LCFS about potential fraud and corruption or areas of high fraud risk. The LCFS then take appropriate action and pursue appropriate sanctions. The outcome of this activity is reported to act as deterrence to others.

Disclosures in the Public Interest

60

Staff Sickness

Working Well, our occupational health service, promotes and helps protect the health and wellbeing of people in work – both within 2gether and for external organisations. The service provides independent advice to both managers and employees including the health of individuals at work; appropriate return to work procedures; the working environment; and health risks associated with the workplace.

During 2013/14, the percentage of staff who registered no sick leave continued to increase and a reduction was noted in the total days lost due to long term sickness. However, the average working days lost due to sickness absence and the days lost due to short term sickness increased when compared to 2012/13.

Days Lost (Long Term) *

Days Lost (Short Term)

Total Days Lost

Total Staff Years

Average working Days Lost

Total Staff Employed In Period (Headcount)

Total Staff Employed In Period with No Absence (Headcount)

Percentage Staff With No Sick Leave

08WA2013/14Number

08WA2012/13Number

16,553

13,554

30,107

1,717

17.5

2,320

873

37.6%

17,287

11,868

29,155

1,991

14.6

2,298

818

35.6%

Staff sickness absence

Public Involvement

We continue to recognise the important links between improved wellbeing, recovery and the feeling of inclusion. The Mental Health Strategy for England recognises the need to tackle mental health stigma for and with people in local communities.

Our approach is to champion social inclusion across the services we provide and involve service users, carers and the wider public in what we do. We believe that partnership through public involvement is key to helping the trust to develop services with an aim of providing high quality care for all.

Engaging communities – in May, over 70 people also joined us at an engagement event at Herefordshire town Football Grounds. The day focused specifically on helped people learn more about how mental health services across the county are developing and gather views on how mental health services could continue to improve.

Another important goal was how we could all develop ways to tackle the stigma that is often associated with mental illness.

Engaging experts by experience – the 15 Steps Challenge is a national initiative developed by the NHS Institute for Innovation and is designed to enable service users and carers to give their ‘first impression’ of a care environment.

During 2013-2014, the 15 Step Challenge was implemented across all inpatient environments in Herefordshire and Gloucestershire. A team of Experts by Experience worked alongside the Social Inclusion Team to visit each environment for a short period of time, taking 15 steps onto each ward. Follow up visits were conducted 6 months later allowing time for changes to be made.

As a result, changes were made to signage and notice boards, the introduction of staff photograph boards, and easier access to activity resources.

Engaging Children and young People – in July 2013, young people from Gloucestershire services chaired a conference and presented ideas about Improving Access to Psychological therapies for children and young people. Members of the service and our commissioners participated in the meeting.

Ahead: Meeting the challenge – in early 2014, a series of ‘thinking ahead 2gether’ public involvement events have been arranged. The events will encourage conversations on how we can continue to deliver sustainable and quality based services that meet the needs of our communities.

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Statement of Chief Executive's Responsibilities as the Accounting Officer of 2gether NHS Foundation TrustThe NHS Act 2006 states that the chief executive is the Accounting Officer of the NHS Foundation Trust. The relevant responsibilities of the accounting officer, including their responsibility for the propriety and regularity of public finances for which they are answerable, and for the keeping of proper accounts, are set out in the NHS Foundation Trust Accounting Officer Memorandum issued by Monitor.

Under the NHS Act 2006, Monitor has directed 2gether NHS Foundation Trust to prepare for each financial year a statement of accounts in the form and on the basis set out in the Accounts Direction. The accounts are prepared on an accruals basis and must give a true and fair view of the state of affairs of 2gether NHS Foundation Trust and of its income and expenditure, total recognised gains and losses and cash flows for the financial year.

In preparing the accounts, the Accounting Officer is required to comply with the requirements of the NHS Foundation Trust Annual Reporting Manual and in particular to:

observe the Accounts Direction issued by Monitor, including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis make judgements and estimates on a reasonable basis state whether applicable accounting standards as set out in the NHS Foundation Trust Annual Reporting Manual have been followed, and disclose and explain any material departures in the financial statements ensure that the use of public funds complies with the relevant legislation, delegated authorities and guidanceprepare the financial statements on a going concern basis

The accounting officer is responsible for keeping proper accounting records which disclose with reasonable accuracy at any time the financial position of the NHS foundation trust and to enable him/her to ensure that the accounts comply with requirements outlined in the above mentioned Act. The Accounting Officer is also responsible for safeguarding the assets of the NHS foundation trust and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.

To the best of my knowledge and belief, I have properly discharged the responsibilities set out in Monitor's NHS Foundation Trust Accounting Officer Memorandum.

Shaun Clee Chief Executive Date: 27 May 2014

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As Accounting Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the NHS foundation trust’s policies, aims and objectives, whilst safeguarding the public funds and departmental assets for which I am personally responsible, in accordance with the responsibilities assigned to me.

I am also responsible for ensuring that the NHS foundation trust is administered prudently and economically and that resources are applied efficiently and effectively. I also acknowledge my responsibilities as set out in the NHS Foundation Trust Accounting Officer Memorandum.

The purpose of the system of internal control

The system of internal control is designed to manage risk to a reasonable level rather than to eliminate all risk of failure to achieve policies, aims and objectives; it can therefore only provide reasonable and not absolute assurance of effectiveness.

The system of internal control is based on an on-going process designed to identify and prioritise the risks to the achievement of the policies, aims and objectives of 2gether NHS Foundation Trust, to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically.

The system of internal control has been in place in 2gether NHS Foundation Trust for the year ended 31 March 2014 and up to the date of approval of the Annual Report and accounts.

Capacity to handle risk

To support the trust’s Board and me as Accounting Officer, the Board has in place:

A Governance Committee, of Executive and Non-executive Directors, supported by Clinical Directors and Heads of Profession which is responsible for planning and co-ordinating all aspects of information governance, clinical governance and quality managementAn Audit Committee, comprising only Non-executive Directors, to review the adequacy of arrangements for risk managementA Delivery Committee that oversees more detailed elements of operational performance management including economy, efficiency and effectiveness on behalf of the Board

A Mental Health Act Scrutiny Committee that oversees the measures in place to ensure the trust’s continued compliance with the Mental Health Act, Mental Capacity Act, Human Rights Act and associated codes of practiceA Development Committee that oversees the preparation of business development plans, and works with other Committees to ensure ongoing monitoring business plan implementation and performance, and ongoing management of Business Case risks A Charitable Funds Committee that oversees the management, in accordance with Charity Commission requirements, of funds held on trust by the Board of Trustees

These committees, chaired by Non-executive Directors, are directly accountable to the Board and report to it. Committees have recently undergone a review of membership and objectives to ensure that they remain sufficiently focussed on relevant quality, performance and financial risks, and to further improve coordination between Committees in their support of the Board.

Risk management arrangements, including the duties of relevant committees, directors, managers, clinicians, specialist advisors and individual employees, are set out in the trust’s Risk Management Strategy. This strategy has been shared with local health, social care and key voluntary sector organisations in line with an agreed communications plan.

Through meetings, reports and correspondence, the Chair, Directors and I have regularly exchanged information about risks with Monitor, the CQC and our partners including Clinical Commissioning Groups, Gloucestershire County Council, and Herefordshire Council. Whenever possible and appropriate the trust works jointly with these partners to manage risks.

Lead Executive Directors have been identified for Clinical Governance and Patient Safety, Finance, Risk Management, Mental Health Act, Infection Prevention and Control, Safeguarding Children and Vulnerable Adults, Security, Service User Experience and Occupational Health and Safety. They provide leadership for the management of the risks presented. The trust’s aims and objectives in relation to risk management, together with a description of the underlying principles, are set out in a Risk Management Strategy. The strategy is underpinned by policies, procedures and guidance documentation.

The strategy and supporting information has been brought to the attention of all managers and is widely available in all work areas through the trust intranet. All managers have been required to draw the attention of employees to their duties and responsibilities in relation

Annual Governance StatementScope of Responsibility

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to the identification and control of risks. The Board promotes a culture of openness in reporting without fear of unwarranted repercussions. This is reinforced in the advice and training given to staff.

To help minimise the number of incidents and ensure risks are appropriately controlled, all new staff are required to attend corporate induction training prior to commencing employment with the trust, and to undertake a local induction during their first week in the work place. For all staff, annual appraisals include a review of training including attendance at mandatory risk management courses appropriate to their authority and duties. Monitoring, benchmarking and other means are used to identify examples of good practice that can be introduced into services and systems as appropriate.

The risk and control framework

Most processes, policies and procedures adopted by the trust contribute to the management and control of risk. The Risk Management Strategy sets out a process for the assessment and prioritisation of risks and describes the level at which risks may be simply monitored, those that must be treated and the level at which the Board must be informed of a risk and ensure that mitigating actions are in place and working.

The following are identified as particularly important tools supporting the trust’s Risk Management Strategy:

An Assurance Framework has been developed by the Board. The process includes the identification and monitoring of:

The trust’s principal objectivesThe risks to these objectives The key controls on the risksThe sources of assurance that the key controls are adequate

The Audit Committee reviews the information provided by the assurance framework on a quarterly basis, on behalf of the Board. Further quarterly scrutiny of the assurance framework is provided by me as the Accounting Officer and the trust’s Executive Directors.

The assurance framework is reviewed annually by the Trust Board. The assurance framework provides a means for assessing and categorising the assurances the Trust Board receives and highlights any assurance gaps. Individual senior managers are identified as the ‘risk owner’ with responsibility for developing risk treatments and monitoring their continued effectiveness, responding to changes in conditions as they arise.

Risk Management – The trust understands its comprehensive risk profile. The Risk Register is a log of risks of all kinds that threaten success in achieving the Trust’s aims and objectives. It provides a structure for collating information about risks that helps both in the analysis of risks and in decisions about whether or how those risks should be treated. The register is reviewed by the Governance Committee quarterly, and Locality Risk registers are reviewed by Locality Boards each quarter.

The Governance Committee reviews management responses to risks and decisions relating to the trust’s risk appetite. The Board’s Development Committee augments this general oversight of risk by ensuring that business and commercial risks are properly identified, assessed and mitigated.

The trust has also appointed a Local Security Management Specialist to ensure the safety and security of the trust’s property and assets and, in accordance with guidance from the Secretary of State, has maintained a Counter Fraud Service during the year. Committee agendas include a standing item to identify any matter requiring inclusion in the trust’s risk register. This has assisted in the identification of a number of risks throughout the year, for which mitigating actions have been put in place.

Risk Dashboard – This document is produced by the Risk Manager each quarter for the Governance Committee. The purpose of the Dashboard is to provide the committee with a view of the trust’s risk management performance in respect a range of activities by using KRIs (Key Risk Indicators), and determine the level of assurance relating to each risk and the mitigating actions.

Risk Rating/Grading System – This assists the Board, managers and staff in deciding priorities and highlighting areas which need particular attention.

Authority to treat risks – This is delegated to the lowest competent level to ensure prompt and effective action is taken without bureaucratic delays.

Incident Reporting – The trust expects all incidents to be reported via the trust’s web-based system, Datix. All staff have been trained in how to report incidents and this forms part of the trust’s corporate induction programme for new staff. These incidents are analysed on a quarterly basis and reported to the relevant committees within the trust with patterns and trends identified to inform future actions.

Whistle-blowing Policy – A policy is in place to enable staff to report any suspected malpractice, danger or wrongdoing without fear of unwarranted repercussions. The policy has been reviewed and updated within the financial year.

Clinical Audit and Assurance Processes – The trust regards clinical audit and clinical assurance processes as important tools in promoting the adoption of clinically effective practice and is committed to maintaining an effective programme of review which includes participating in national audits.

Internal Audit – The integrity of the trust’s arrangements for both general and financial management and control is a fundamental requirement of sound risk management. The trust actively commissions a comprehensive programme of internal audit designed to provide assurance on the main risks of the trust, and responds positively to the auditor’s findings and recommendations.

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A full programme of internal audit reviews was carried out during the reporting period, with findings graded as critical, high, medium or low risk as appropriate. One critical risk was documented, regarding the timely review of incident reports on the trust’s online incident reporting system. The trust has reviewed all relevant incidents and updated the system database to ensure that incidents are forwarded to the correct person for review.

A review of the trust’s Cost Improvement Plans produced one high risk finding concerning some savings plans for which documentation (Product Descriptions and Quality Impact Assessments) was not in place at the start of the financial year, meaning that the time available to achieve these savings was reduced. The trust has put measures in place to agree future savings plans and complete the appropriate documentation prior to the start of the financial year wherever possible.

Health and Safety Inspection – Compliance with health and safety legislation and internal policies is central to the welfare of staff and service users. There is an annual health and safety programme and risk assessments are carried out based on priority. A programme of training and audits to assess compliance with health and safety regulations, codes of practice and procedures is maintained.

Training – Training is an essential prerequisite of safe working. The trust aims to ensure it assesses the risk management training needs of all staff and that staff receive adequate training and professional education to enable them to carry out their duties safely.

Quality Governance – The trust has robust arrangements in place to monitor and improve the safety and experience of care provided to those who use our services, support delivery of the Monitor Quality Governance Framework, and provide the Board with evidence which in turn enables the Board to make an informed quarterly declaration of compliance to Monitor.

Quality is a central element of the trust’s vision and values, organisational strategy, and annual business plan. Together with the Quality Report, these mechanisms enable the Board to take assurance that quality governance is embedded into the organisation.

The Board is supported in identifying risks to quality through the work of its committees, notably the Governance Committee which reviews quality matters on a monthly basis, is constantly challenging of what we can do to continuously improve, and reports to the Board on these issues.

The Audit Committee also considers quality and the governance processes associated with it, and is supported by a programme of internal audits. Aspects of quality which are considered to be higher risk are included in the clinical audit and assurance programme, with action plans arising from these audits being monitored by the appropriate committee to ensure implementation and delivery of the intended outcome.

CQC outcome standards are allocated to specific directors, and both the Board and the Governance Committee receive regular reports on CQC Compliance.

Board agendas include a number of standing items relating to quality, including reports on Patient Safety and Serious Incidents, Quality Report monitoring, and Service reports. The Board uses checklists based on the Burdett Trust’s report ‘Sustaining Quality during Turbulent Times’ to ensure that all relevant quality issues have been identified and adequately reviewed.

A comprehensive monthly performance dashboard provides timely monitoring information on all quality targets, and data assurance processes are in place to ensure that quality information presented to the Board is robust.

Following the publication of the Mid Staffordshire NHS Foundation Trust Public Inquiry (the Francis report), and the subsequent report by Professor Don Berwick ‘A promise to learn – a commitment to act: Improving the safety of patients in England’ the trust instigated a comprehensive and ongoing programme of engagement in order to identify and embed learning.

Monitoring of the resulting detailed action plans takes place through a new Workforce and Organisational Development Committee structure with 4 work streams led by trust staff covering Staff Engagement, Culture, Workforce Planning, and Training and Development. Progress is monitored by the Executive Committee, with the Governance Committee receiving regular updates on progress against an overall high-level action plan. Similar updates have been provided to the Council of Governors.

The Medical Director and Director of Quality take the executive lead for quality, working closely with the Chief Executive and other Directors. There are nominated non-executives for quality and governance, including a focus on complaints. The Board takes an active leadership role in quality in order to promote a quality-focused culture throughout the trust, and Board members participate in a regular programme of service visits and patient safety walkabouts.

The organisation is structured to enable quality accountability in appointed Clinical Directors, Heads of Profession, and Lead Nurses. A Quality Management Team provides support in embedding this quality culture and ensuring that learning is captured from complaints, incidents and other initiatives.

The trust actively engages with patients, staff and other key stakeholders on quality; the Quality Report and public Board papers are published, and quarterly updates on the Quality Report are shared with stakeholders such as Clinical Commissioning Groups, Gloucestershire Healthwatch, Herefordshire Healthwatch and Health & Social Care Overview and Scrutiny Committees, and feedback is encouraged. The Council of Governors’ agenda includes a standing item on service and quality issues, and there is active development of patient experience through the Director of Social Inclusion.

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Regular surveys of service users inform the quality debate and ensure quality of service.

Review and Assurance – Each level of management, including the Board, frequently reviews the risks and controls for which it is responsible. These reviews are monitored by and reported to the next level of management and the results recorded on the risk register. Any need to change priorities or controls is either actioned or reported to those with authority to take action.

Lessons that can be learned, from both successes and failures, are identified and disseminated to those who can gain from them by the Assistant Director of Governance or the Risk Manager. The Board ensures an appropriate level of independent assurance is provided on the whole process of risk identification, evaluation and control.

Information Governance – The trust maintains a number of systems and processes to ensure that all information, but particularly personal identifiable information, is kept safe, accurate and only shared with appropriate authority.

The trust has appointed, at Board level, a Caldicott Guardian and a Senior Information Risk Officer to oversee this area of risk. The trust self-assessed at Level 2 in the Department of Health Information Governance Toolkit, and is committed to maintaining full compliance with the Information Governance Toolkit standards by tracking information flows, auditing compliance with relevant policies and procedures, raising the awareness of staff, training, and improving the trust’s information technology infrastructure.

The trust has implemented a range of solutions to ensure information is managed securely and to prevent the theft or accidental loss of information, including secure port control so that data cannot be downloaded on to any media except approved encryption media. All laptops are now fully encrypted before they are distributed and all staff have access to network shared drives to remove the need to store information locally on the PC.

Information governance training is given to all new staff through corporate induction. Information governance refresher training forms part of the trust’s suite of mandatory training, and must be completed by all staff on an annual basis.

The trust reported one serious information governance incident via the Information Governance Toolkit incident reporting tool during the year, concerning the accidental disclosure of limited patient information to an unauthorised recipient. The incident was automatically referred to the Information Commissioner whose investigation found that the actions taken by the trust to recover the information and prevent a recurrence were both timely and robust. The Information Commissioner therefore concluded that that no further action was required.

Involvement – The trust aims to involve service users, carers, members, the local community and its own staff in matters that affect them and to ensure the manner of their participation will enhance their own confidence that the Trust and its employees will always act professionally, and listen to and take account of their views. The trust has established a membership and created a Council of Governors which represents the interests of constituents and members of the public, and holds the trust’s Non-executive Directors to account for the performance of the Board.

Human Rights – Fundamental to the work of the trust is the protection and promotion of the human rights of its service users and others in contact with the organisation. The trust ensures that its responsibilities are carried out through a programme of staff training, policy review, audit and inspection of services. The Board of Directors has appointed a committee of the Board to ensure the rights of detained patients are properly safeguarded. The Director of Organisational Development is the trust’s lead for human rights.

Equality and Diversity – Supporting its work on human rights the trust utilises the NHS Equality Delivery System as the basis for ensuring it meets its legal obligations under the Equality Act 2010. Feedback obtained from service users, carers, volunteers, staff, partner agencies, volunteers and others enables the Trust to reduce health inequalities based on a protected characteristic, reduce stigma and discrimination and improve our working environment and employment practices.

The trust requires equality impact assessments to be undertaken on all policies, practices, activities and services. These are then reviewed by trained nominated individuals in the trust prior to being published on the trust’s intranet and internet sites. Through the use of equality impact assessments the trust will make reasonable adjustments to ensure people with protected characteristics have their rights secured and are provided with fair and appropriate access to high quality care.

The trust has continued to develop its commitment to equality this year by implementing changes to its service planning process and embedding the use of the Equality Delivery System into service delivery. The trust encourages applications from under-represented groups for election as a Governor or appointment as a Non-Executive Director.

In addition to supporting the trust’s Risk Management Strategy, the structures, policies and procedures set out in this Annual Governance Statement also allow the trust to address risks to compliance with the terms of its licence. One such risk is that the trust’s governance structures and reporting lines may not be sufficiently focussed to enable an appropriate level of oversight of the Trust’s operations, management and control. The Trust has taken a number of actions to mitigate this risk.

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The trust’s Governance structures are subject to regular review to ensure that they remain fit for purpose. During the year, the Executive Team was formally constituted as an Executive Committee of the Board, and now reports formally to the Board in the same way as other Committees.

The Executive Committee’s terms of reference include a duty to support the Accounting Officer in the management of risk within the trust. Executive Director portfolios have been revised to take account of changes in personnel, to optimise the capacity of the Executive Directors to oversee the trust’s operations end exercise effective management and control, including managing risks to compliance with the conditions of the trust’s licence.

The responsibilities of Executive Directors and the remits of Non-Executive Committees of the Board are referred to throughout this Annual Governance Statement. Committees have been reviewed during the year with new objectives agreed which reflect the strategic objectives agreed by the trust at the beginning of the year.

Committee terms of reference have been revised to remove any overlaps in Committee responsibilities while processes have been put in place to improve coordination, and allow prompt and efficient referral of issues between Committees, and from Committees to the Board, Council of Governors and Locality Boards.

Committee membership has been reviewed to ensure continued oversight of performance standards, and to maintain compliance with relevant legislation, licence conditions and good practice. Dates for Delivery Committee meetings have been changed to enable the Committee to receive the most up to date performance information which is subjected to detailed scrutiny and challenge on behalf of the Board, and reported to each meeting of the Board in the Committee Summary report.

Constitutional changes have been effected to enable the Council of Governors to undertake new statutory duties, including holding Non-Executive Directors to account for the performance of the Board, approving significant transactions above an agreed financial value, and approving changes to the trust’s constitution.

The trust’s Corporate Governance Statement also provides assurance to the Board that risks to compliance with the terms of its licence are being appropriately addressed. Before signing off its Corporate Governance Statement, the Board receives and reviews a detailed report summarising the evidence upon which the Board might rely in making each individual declaration within the Corporate Governance Statement.

The Board also considers reports it has received through the year and takes account of the work undertaken through the year by its Committees in assessing the trust’s performance, overseeing compliance with relevant legislation, and ensuring the efficient, effective and economic operation of the trust.

Key Risks

The trust faced a number of key risks during the year and beyond, and has taken significant action to mitigate these as follows:

Patient Safety (In year risk and beyond): The trust joined the NHS South West Quality and Safety Improvement Programme for Mental Health, in January 2011.

Originally a two year programme of work but subsequently extended until 2015, the overall aim of the programme is to reduce harm to service users, by focussing on improving safe and reliable care, safe and effective medicines management, patient and family centred care and communication, and leadership.

The trust’s commitment to the aims of this programme are illustrated by an on-going programme of capital works designed to improve patient safety at Wotton Lawn Hospital and specifically to further improve ligature risk management beyond compliance with current guidance, whilst also improving facilities from a privacy and dignity perspective. Going forward, the trust will continue with its rolling programme of annual ligature risk assessments at each inpatient unit.

The trust maintains a robust approach on the reporting and investigation of Serious Incidents which includes the active promotion of incident reporting using Datix, and a comprehensive training and induction programme in incident reporting.

The trust’s patient safety agenda is a top priority for the Board, which receives monthly patient safety reports and quarterly reports detailing compliance against the CQC,s Essential Standards for Quality and Safety, and regulations.

The Board’s oversight of patient safety issues is supported by the work of its Committees.

The Governance Committee reviews quality, and the associated risks on a monthly basis, which are then reported to the Board. Ownership of quality is clear, with clinical leads for specific areas. The Governance Committee also ensures that learning points from incidents, complaints and claims are captured, reviewed and disseminated throughout the organisation.

An ongoing engagement and learning process, supported by a new Workforce and Organisational Development Committee structure and monitored regularly by the Governance Committee, ensures that lessons from the Francis and Berwick reports is captured and embedded within the trust in order to improve the quality of service and patient safety. The Audit Committee also considers quality and the governance processes associated with it, through a programme of internal audits. Some higher risk areas of practice, such as Patient Safety and Serious Incidents, are reported monthly to the Board.

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The organisational Risk Register collates all risks and monitors progress on mitigation, including those impacting on quality. Aspects of quality which are considered to be higher risk are included in the annual clinical audit programme. Quality targets are monitored each month by the trust Board and the Delivery Committee through the trust’s performance dashboard. Executive Director Safety Walk-rounds also take place each month in order to highlight patient safety risks which can be actioned.

Efficiency savings (In year risk and beyond): The trust faces an ongoing need to make efficiency savings in an increasingly difficult financial climate for the health economy, while maintaining the ability of the trust to achieve its strategic objectives.

A savings programme has been agreed by the Board, and incorporates two main strands – Better for Less, and Waste Less. These programmes are projected to deliver savings of £9.38 million during 2014/15 and 2015/16. Clinicians have been fully involved in generating these schemes, and have ownership of some of the initiatives.

Quality Impact Assessments are drawn up for each savings scheme and are reviewed and signed off by the Medical Director and Director of Quality, thus minimising any adverse effect of efficiency savings on safety and quality.

Given the anticipated financial position of the public services in the coming year it will be essential to plan and deliver efficiency and further savings in a timely manner and ensure all quality targets are still achieved. Processes to identify, monitor and manage these effectively are in place, and achievement of savings targets will remain under constant review by the trust.

The trust has a number of mechanisms in place to ensure that efficiency savings do not impact negatively on quality. In addition to clinical input to and ownership of efficiency schemes through quality impact assessments, quality and safety issues are considered by the trust’s Governance and Delivery Committees.

The Trust Board has incorporated into its agendas elements of the quality checklists contained within the Burdett Trust’s report ‘Sustaining Quality in Turbulent Times’ to ensure a sustained focus on patient safety and quality improvement, especially when considering efficiency and savings matters.

The foundation trust is fully compliant with the registration requirements of the Care Quality Committee.

As an employer with staff entitled to membership of the NHS Pension Scheme, control measures are in place to ensure all employer obligations contained within the Scheme regulations are complied with. This includes ensuring that deductions from salary, employer’s contributions and payments into the Scheme are in accordance with the Scheme rules, and that member Pension Scheme records are accurately updated in accordance with the timescales detailed in the Regulations.

Control measures are in place to ensure that all the organisation’s obligations under equality, diversity and human rights legislation are complied with.

The foundation trust has undertaken risk assessments and Carbon Reduction Delivery Plans are in place in accordance with emergency preparedness and civil contingency requirements, as based on the UKCIP 2009 weather projects, to ensure that this organisation’s obligations under the Climate Change Act and the Adaptation Reporting requirements are complied with.

Review of economy, efficiency and effectiveness of the use of resources

The trust has a number of key processes designed to ensure the economy, efficiency and effectiveness of the use of resources. These include:

Monthly monitoring by the Trust Board of performance in relation to contracts, services, financial performance and associated risk ratios, training and attendance targets, resource usage and the delivery of national and local target trajectoriesThe use of reference cost benchmarks for service review and economic improvementThe use of internal audit to review the efficiency and effectiveness of corporate business processesActive management of NICE Technical Appraisals and Guidelines implementation including planned auditsService and pathway redesign within the trust’s services

At a strategic level, the Delivery Committee is responsible for overseeing the efficient, economic and effective use of resources. The Board of Directors receives regular reports from its committees and itself receives regular finance and performance reports. The Board reviews the trust’s financial position on a monthly basis, and approves the quarterly compliance reports required by the independent regulator, Monitor.

Internal Audit conducts a review of the trust’s internal control systems and processes as part of an annually agreed audit plan. This review encompasses the flow through the organisation of information pertaining to risk and assurance. It ensures that systems are in place, are appropriate, and can be evidenced by a range of documents available within the organisation. Internal audits have reviewed the governance arrangements within the organisation over a range of financial and other functions to ensure that there is an appropriate and robust approach to the use of resources.

The Executive Committee has responsibility for overseeing the day-to-day operations of the trust and for ensuring that resources are used efficiently, effectively and economically.

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Annual Quality Report

The directors are required under the Health Act 2009 and the National Health Service (Quality Accounts) Regulations 2010 (as amended) to prepare Quality Accounts for each financial year. Monitor has issued guidance to NHS foundation trust boards on the form and content of annual Quality Reports which incorporate the above legal requirements in the NHS Foundation Trust Annual Reporting Manual. The trust has put a number of processes in place to assure the Board that the Quality Report presents a balanced view, and that there are appropriate controls in place to ensure the accuracy of data.

The trust has a Data Quality policy which is reviewed annually, and which places ultimate responsibility for data quality with the Chief Executive. Operationally, the Director of Quality oversees the production of the Quality Report, while the Director of Service Delivery has responsibility for data quality.

Data quality is overseen by an Information Governance Committee which reports to the Trust Board’s Governance Committee. Corporate data quality objectives have been agreed by the Executive Committee. Clinicians are involved in the production of the Quality Report through approval of the constituent data and involvement in the development of the Quality Report objectives. Minutes of the Board’s Delivery Committee demonstrate the involvement of clinicians in the operational aspects of data quality.

The trust has processes in place to ensure that data are used to inform reporting and decision making, and is subject to a system of internal control and validation. Internal and external reporting requirements have been critically assessed and data provision is reviewed regularly.

Data is used to populate a Performance Dashboard which is reviewed by the Executive Committee, Delivery Committee, Service Directorates and the Trust Board, subjected to appropriate levels of challenge, and used to inform strategic and operational decision making and monitor performance.

A Data Quality Assurance Group, comprising senior operational managers from each Service Directorate in the trust has lead responsibility for clinical data quality in their respective services. The Group is chaired by the trust’s Information Development Manager, and provides a forum for dissemination of policy and process changes as well as the opportunity to address data quality issues in a consistent manner across all services. The Group reports to the Operations Management Meeting which is chaired by the trust’s Director of Service Delivery.

A RiO System User Group, established as part of the local implementation of the RiO Electronic Patient Record System across the trust, provides a forum for the Information representative to ensure that data quality issues arising from the use of the Electronic Patient

Record System can be tackled consistently across all trust services

Real time automated data quality reports derived from RiO are available in a secure manner to operational managers, team managers and individual clinicians throughout the trust. Each clinician can view a report of each patient on their caseload which highlights missing key data items on that person’s record. These are refreshed on a 24 hour basis and enable managers to monitor data quality performance and clinicians to identify and fix specific data quality issues.

A number of mechanisms exist to ensure that staff have the knowledge, competencies and capacity for their roles in relation to data quality. Managers monitor staff competencies and development needs through the annual appraisal process, and ensure that staff have access to appropriate training opportunities.

The trust has put training programmes in place to ensure staff have the capacity and skills for effective collection, recording and analysis of data. RiO training is provided to all appropriate staff, and RiO support materials are available on a dedicated intranet page. Individual members of staff have their own training records and are responsible for identifying their own individual skill requirements in relation to data quality.

Training provision is regularly reviewed by the Strategic Training Group, and training provision is periodically evaluated by clinical managers.

The trust has a comprehensive suite of Care Practice Policies in place to ensure the quality of care provided to service users. Care Practice Policies are subject to regular programme of consultation, review and update to incorporate emerging good practice and inform existing training and awareness programmes. An annual programme of local audits measures compliance against these policies, and results are reported to the Governance Committee or Mental Health Act Scrutiny Committee as appropriate.

In the development of the annual Quality Report, the trust utilises several sources of information and data to develop an holistic and rounded analysis of its performance against the nationally and locally defined quality measures. These have included internal data and information such as clinical audit findings, patient care performance data and NICE compliance.

The trust has also drawn on information from independent studies such as the service user experience survey, staff survey, NHSLA accreditation and achievement of CQUINs, as well as external bodies such as the Care Quality Commission assessment of compliance. This triangulated approach provides an assurance that the information provided to the Trust Board on its Quality Reports is both measured and objective.

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We have involved stakeholders including Governors, Gloucestershire Healthwatch, Herefordshire Healthwatch, Overview and Scrutiny Committees and commissioners, in the development of our Quality Report objectives and have taken that opportunity to include many of their very useful comments and suggestions. The comments received indicate an agreement that the Quality Report is representative and that there are no significant omissions of concern.

Our commissioners have confirmed that the accuracy of the data presented in the Quality Report accords with the data and information they have available and that there are robust arrangements in place to monitor and review the quality of services. Quality Reports are produced on a quarterly basis to enable continuous feedback to be collected.

Review of effectiveness

As Accounting Officer, I have responsibility for reviewing the effectiveness of the system of internal control. My review of the effectiveness of the system of internal control is informed by the work of the internal auditors, clinical audit and the executive managers and clinical leads within the NHS foundation trust who have responsibility for the development and maintenance of the internal control framework.

I have drawn on the content of the Quality Report attached to this Annual Report and other performance information available to me. My review is also informed by comments made by the external auditors in their management letter and other reports. I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the board, the audit committee and governance committee, and a plan to address weaknesses and ensure continuous improvement of the system is in place.

The Assurance Framework provides me with evidence that the effectiveness of controls that manage the risks to the organisation achieving its principal objectives have been reviewed.

In maintaining and reviewing the effectiveness of the system of internal control:

The Board has reviewed its assurance frameworkThe Board or its committees have considered all major assurance reports received by the trust and ensured action plans were developed to address any weaknessesThe Audit Committee has reviewed all internal and external audit reports and ensured action is taken to address the recommendations. The Governance Committee has also considered the results of the monitoring of incidents and complaints to ensure any lessons were carefully reviewed and acted upon

The Board and Governance Committee have closely monitored arrangements for the prevention and control of infection. They have also monitored all service areas and continued the implementation of a substantial clinical governance development planThe Risk Manager has reported on the management of the risk register and supporting processes Non-executive and Executive Directors, the Chair and I have visited services and met staff, service users, carers, members and governors as part of an informal programme of review

Conclusion The trust firmly believes that it has comprehensive and robust governance processes in place, and can confirm that no significant internal control issues have been identified.

Shaun CleeChief Executive Date: 27 May 2014

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gether2Making life Better

Quality Report2013/14

NHS Foundation Trust2gether

Mental and Social Healthcare

It is through open and honest conversations that continuous improvements are understood and acted

upon

Quality Report

Contents“

”

An annual update on how we are seeking to deliverquality

Part 1Statement on Quality from the Chief ExecutiveIntroduction

Part 2aLooking ahead to 2014/15Priorities for Improvement 2014/15

Part 2bStatements relating to the Quality of the NHS Services ProvidedReview of servicesParticipation in Clinical Audits and National Confidential EnquiriesParticipation in Clinical ResearchUse of the CQUIN payment frameworkCQUIN Goals for 2014/15Statements from the Care Quality CommissionQuality of Data

Part 3Looking Back: A review of Quality in 2013/14IntroductionSummaryDomain 1: Preventing people from dying prematurelyDomain 2: Enhancing quality of life for people with long-term conditionsDomain 3: Helping people to recover from episodes of ill health or following injuryDomain 4: Ensuring people have a positive experience of careDomain 5: Treating and caring for people in a safe environmentMonitor Indicators & Thresholds for 2013/14Mandated Quality Indicators for 2013/14Community Survey 2013Staff Survey 2013PLACE Assessment Results 2013/14

Annex 1Statements from our Partners on the Quality ReportGloucestershire Clinical Commissioning GroupHerefordshire Clinical Commissioning GroupHealthwatch HerefordshireHealthwatch GloucestershireGloucestershire Health and Care Overview and Scrutiny CommitteeThe Royal College of Psychiatrists

Annex 2Statement of Directors’ Responsibilities in respect of the Quality Report

Annex 3Glossary

Annex 4How to Contact UsAbout this reportOther Comments, Concerns, Complaints and ComplimentsAlternative Formats

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“

”

Introduction A warm welcome to our 2013/14 Quality Report: an opportunity to provide an annual update on how we are seeking to deliver quality and demonstrate our core purpose of making life better. Our aim is to deliver the best possible care and treatment at all times.

Over the last year, our quality initiatives have continued to focus on our primary goals of safe services; appropriate clinical outcomes; and the best user experience. These are the areas that matter to our service users and the assurances that we would seek for our families.

Colleagues continue to provide critical assessment and evaluation of emerging practice to help ensure that service users receive the best possible care.

It is their dedication and innovation that has helped us to deliver successful quality initiatives such as an improvement in our 48 hour follow-up target and the establishment of our Severn & Wye Recovery College.

On behalf of the Board, I recognise and thank the enthusiasm and achievements of all clinical and support service staff who have helped contribute to the quality improvements highlighted in this report.

Quality Priorities in 2013/14 Quality considerations remained the foundations on which we made decisions in 2013/14. In last year’s report, we identified 11 goals and 12 targets across five domains. As you will read in Part 3 of this report, we have worked hard to deliver the targets we set for 2013/14 and have exceeded or met 7 targets, partially met 2, and not

met 3 targets. During times of national uncertainty and continued economic challenges, our teams have demonstrated continued quality in their work while delivering greater value for less money. Where we have not met our targets, we are working with clinical teams to utilise the improvement methodologies and principles we have learned through the NHS South of England Patient Safety Improvement Programme. We also continue to enhance the support we provide our service users during times of crisis.

Quality Priorities for 2014/15 In order to build on last year’s work, we have identified seven goals with ten associated targets. These are aligned to the three key themes set out in the NHS Outcomes Framework: Safety; Effectiveness; and User Experience. They are to:

Improve the physical health care for people with schizophrenia Measure the effectiveness of the falls prevention work for inpatientsEnsure appropriate access to psychiatric inpatient careImprove the experience of service users across a number of defined key areasMinimise the risk of suicide of people who use our servicesEnsure the safety of people detained under the Mental Health ActEnsure we follow people up when they leave our inpatient units within 48 hours to reduce risk of harm.

Part 1: Statement on Quality from the Chief Executive

Quality Consideration remained the foundation on which we made decisions in 2013/14

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You can read more about our quality based priorities for improvement for 2014/15 in Part 2a of this report. Annex 1 contains statements of assurance from local partners in commissioning; Health, Community and Care Overview and Scrutiny Committees; and Healthwatch, England’s consumer champion for health and social care.

It is important that we are realistic in our ambition and there are always areas where we can do better. Our scores in the Patient Led Assessments of the Care Environment (PLACE) on page 121 were above the national average in 50% of the assessed areas within our eight inpatient sites. We know that the environment in which people are cared for is an important element for their recovery so we continue to work on improving the areas where we were below the national average.

We are also pleased that our community survey scores for 2013 on page 118 show continued improvements on 2012 and that these are similar to other trusts. However, in partnership with service users, carers and staff we are seeking to improve these scores in 2014/15 and we are introducing a series of new initiatives in response to the community survey. Service User Voice A continued influence on how we improve what we do is the feedback from our service users. We do this through a combination of paper surveys; speaking with service user groups; and collating real time data to help us react and improve services as quickly as possible; and service user groups. The feedback we gain and the improvements we make are reported at public meetings; and at an operational level, feedback provides guidance to Directors and Senior Managers to help prioritise the areas that matter most to our service users. Over the last year we have also been extremely privileged to hear directly from service users and carers at Trust board meetings.

The strength of the individuals who presented their inspirational and emotional experiences of recovery and loss, provide continued motivation to deliver the highest quality of services.

Continued Assurance During a year of massive organisational change in the NHS, we have remained committed to our core purpose of making life better – both for the people in our care and the carers who support them. In order to build on the work we achieved over the last two years, we have had the courage to learn from best practice; changing commissioner intentions; and the people we serve. We challenge our thinking to improve what we do even further, and highlight the areas where we need show enhanced leadership to make sure that our communities receive the emotional wellbeing services they need. I hope that you find our Quality Report useful in helping to learn more about the safety, effectiveness and positive experiences we seek to achieve for the communities we serve.

This report is consistent with internal and external information presented to and agreed by the Trust’s Governance Committee and the Trust Board. Each meeting receives monthly updates and quarterly quality reports against our agreed targets. Our Trust Board is held in public and we discuss quality issues with our Council of Governors. Our aim is to ensure that conversations about quality data and information are transparent and as publically available as possible. As such, I declare that to the best of my knowledge, the information contained in this document is accurate.

Shaun CleeChief Executive2gether NHS Foundation Trust

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This section of the report looks ahead to our priorities for quality improvement in 2014/15. We have developed our quality priorities for improvement under the three key dimensions of effectiveness; user experience and safety and these have been approved by the Trust Board following discussions with our key stakeholders.

We are aiming to improve outcomes for service users through these actions being mindful that a key national priority is:

“Measuring and publishing information on health outcomes helps drive improvements to the quality of care people receive”

High Care Quality for all: NHS Next Stage Review (2008)

Following feedback from service users, carers, staff, our Governors, our commissioners and both Herefordshire and Gloucestershire Healthwatch, we have streamlined our priorities for improvement for 2013/14 into 7 goals and 10 associated targets. These targets will be measured and monitored with the period of time varying from monthly, quarterly or annually depending what we are measuring and how often the data is collected.

How we prioritised our quality improvement initiatives

The quality improvements in each area were chosen by considering the requirements and recommendations from the following sources:

Documents and organisations:

Putting Patients First: The NHS England Business Plan for 2013/14-2015/16NHS Outcomes Framework 2014/15Care Quality Commission (via the Quality Risk Profile and CQC Compliance Reviews at our sites)Department of Health, with specific reference to ‘No health, without mental health’ (2011) and ‘Mental health: priorities for change (January 2014)Internal assurance inspectionsMonitorKing’s Fund report on Quality AccountsNational Institute for Health & Care Excellence publications including their quality standardsPreventing suicide in England: One year on. First annual report on the cross-government outcomes strategy to save lives. HM Government.

The feedback and contributions have come from:

Healthwatch Gloucestershire Healthwatch HerefordshireGloucestershire Health, Community and Care Overview and Scrutiny Committee (HCCOSC) and Council colleaguesHerefordshire Overview and Scrutiny Committee and Council colleaguesGloucestershire Clinical Commissioning GroupHerefordshire Clinical Commissioning GroupInternal assurance and Internal Audit reportsNHS South of England Mental Health Patient Safety Improvement ProgrammeTrust’s Service Experience Committee (comprising service users and carers)Trust’s GovernorsTrust clinicians and managers.

A set of principles were developed with the Governors to assist with the identification of the quality priorities, in that they should

Seek to:find, celebrate, share and maintain good practiceDetermine where practice can be improved.

Be measureable across all geographical locations where services are provided, so that results can be both aggregated and individually compared for the purpose of internal benchmarking. Also, where appropriate reflecting specific local requirements, a local indicator could be chosen.

Refer to historical data, where available to identify and show any change in quality over time.

In addition to identified measurable indicators, there should also be quality reporting on the outcome measures and indicators used in services to demonstrate effective interventions.

The proposed priorities for improvement were then considered and agreed by the Governance Committee, which is a sub-committee of the Board and has clinical and managerial representation from across the Trust and is chaired by a Non-Executive Director. This Committee meets formally monthly to consider information relating to quality across all of the services we provide.

b)

c)

d)

Part 2a: Looking ahead to 2014/15Quality Priorities for Improvement 2014/15

a)

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The priorities for improvement are applicable for services in both Gloucestershire and Herefordshire unless specified, and where they are different it is a reflection of the different quality priorities in each county.

Progress on the implementation of each of the quality improvement areas will continue to be reported to the Trust Board every quarter. This information will also be shared with our major stakeholders. These targets represent a small sample of the large number of quality initiatives which are undertaken, but are areas which will potentially have a significant impact on safety and quality.

In addition to our quality priorities for the coming year, our annual report outlines the plans to improve services in partnership with our commissioners.

In Herefordshire, we will:

Enhance our Improving Access to Psychological Therapy services to deliver the National requirement of being able to support 15% of the local population by March 2015Improve our community based dementia services to increase the potential for earlier assessment, education and support Develop our Psychiatric Liaison services to enable Herefordshire’s Acute Hospital Services provider to meet the needs of people accessing their services.

In Gloucestershire, we will:

Develop a revised social work operational delivery model to enhance person centred care planning and assessment, personalisation, individual budgets, direct payments and care management to meet the national drive to increase personalisationContinue the development of a local payment system for Mental Health services based on National guidance and the 21 care clusters/care packages to support a move towards clearer and more measurable resource utilisation, alongside improved defined outcomes for each patient care clusterContinue to actively contribute to the review of Crisis Resolution and Home Treatment Team review led by commissionersContinue to develop Intermediate Care Mental Health services, formed through the integration of our primary care mental health services and Increased Access to Psychological Therapy servicesReview and develop proposals for the delivery of Community Learning Disability Services, so services are reflective of the health needs of the people of Gloucestershire and demonstrate best practice in meeting those needs.

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Goal Target Drivers

Improving the physical health care for people with schizophrenia

1.1The Trust will ensure that 90% of service users with a serious mental illness will have had an annual physical check.

This will be assessed via the National Audit of people with Schizophrenia.

To support NHS England’s commitment to reduce the 15-20 year premature mortality in people with psychosis and improve their safety through improved assessment, treatment and communication between clinicians.

During 2013/14, we could demonstrate that 86% (Gloucestershire) and 47% (Herefordshire) of service users with a serious mental illness had an annual physical health check.

Continue to measure the effectiveness of the falls prevention work for in-patients

1.2The number of falls resulting in harm (fractures) will be maintained at 3 or less across all our inpatient units.

This is an area of good practice within the Trust, therefore it is important to maintain achievements.

objective in Herefordshire.

Through the NHS South of England Mental Health Patient Safety Improvement Programme, the Trust has been able to reduce, over the past three years, the harm from falls by 50%.

Ensure appropriate access to psychiatric inpatient care

1.3The proportion of people gate kept by the Crisis & Home Treatment Team prior to admission will be 95%. This will ensure appropriate access to inpatients services.

Department of Health Outcomes Framework - key measure on appropriate access.

During 2013/14 99.1% of people accessing Trust inpatient services were gate kept by the Crisis & Home Treatment team. This is an area of good practice within the Trust, therefore it is important to maintain achievements.

National priority for effective care. There is historical data available for year on year comparison.

Effectiveness

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Goal Target Drivers

Improving the experience of service user in key areas. This will be measure

survey questions for both people in the community and inpatients

2.1Did 2gether Trust staff involve a member of your family or someone else close to you, as much as you would like in your care?

Target :To achieve a response of ‘Yes’ for 53% or more of the people surveyed. This was the national average percentage for the 2013 survey

2013 Trust score = 50%

This was an area relating to patient experience where

being required following the 2013 CQC national community mental health survey results.

on during 2014/15 and set the associated targets.

There is historical data available for year on year comparison.

2.2Did we organise the care and services that you need?

Target :To achieve a response ‘Yes’ for 59% or more of the people surveyed. This was the national average percentage for the 2013 survey

2013 Trust score = 57%

2.3Have you been given information on how you can contact your Care Co-ordinator or lead professional if you have a problem?

Target :To achieve a response of ‘Yes’ for 72% or more of the people surveyed. This was the national average percentage for the 2013 survey

2013 Trust score = 66%

2.4Have you been offered a written or printed copy of your care plan?

Target :To achieve a response of ‘Yes’ for 41% or more of the people surveyed. This was the national average percentage for the 2013 survey

2013Trust score = 40%

User Experience

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Safety

Goal Target Drivers

Minimise the risk of suicide of people who use our services

3.1Reduce the numbers of deaths relating to

with services when compared data from previous years.

In 2013/14, 22 deaths from suspected suicide were reported. We aim to report fewer than this in 2014/15.

Gloucestershire Suicide Prevention Strategy and Action Plan Preventing suicide in England: One year on.First annual report on the cross-government outcomes strategy to save lives.

The 2013/14 plan to report fewer than 18 deaths from suspected suicide was not achieved It is a high risk area with historical data available for year on year comparison.

Ensure the safety of people detained under the Mental Health Act

3.2Reduce the number of people who are absent without leave from inpatient units who are formally detained. There were 110 reported occurrences during 2013/14. We aim to report fewer than this in 2014/15.

NHS South of England Patient Safety Improvement Programme

Preventing suicide in England: One year on.First annual report on the cross-government outcomes strategy to save lives.

We did not achieve this target during 2013/14. It is a high risk area with historical data available for year on year comparison.

Ensure we follow people up when they leave our inpatient units within 48 hours to reduce risk of harm.

3.395% of adults will be followed up by our services within 48 hours of discharge from psychiatric inpatient care.

(This is a local target. The national target is that 95% CPA service users receive follow up within 7 days).

This is an area of good practice within the Trust, during 2013/14 we achieved 95% therefore it is important to maintain achievements.

There is historical data available for year on year comparison.

Part 2b: Statements relating to the Quality of NHS Services ProvidedReview of ServicesThe following section includes responses to a nationally defined set of statements which are common across all Quality Accounts/Reports.

The statements provide assurance that we are providing services according to national standards, measuring and monitoring the quality of care we provide and are participating in, and learning from national projects.

The purpose of this section of the report is to ensure we have considered the quality of care across all our services which we undertake through comprehensive reports on all services to the Governance Committee (a sub-committee of the Board).

During 2013/2014, the 2gether NHS Foundation Trust provided and/or sub-contracted the following NHS services:

Gloucestershire Our services are delivered through multidisciplinary and specialist teams. They are:

One stop teams providing care to adults with mental health problems and those with a learning disabilityPrimary Mental Health Care servicesSpecialist services including Early Intervention, Crisis Resolution and Home Treatment, Assertive Outreach, Managing Memory, and Children and Young People ServicesInpatient care Improving Access to Psychological Therapies.

Herefordshire We provide a comprehensive range of integrated mental health and social care services across the county. Our services include:

Providing care to adults with mental health problems in Recovery Teams and Older People’s teamsChildren and Adolescent Mental Health careSpecialist services including Early Intervention, Assertive Outreach and Crisis Resolution and Home Treatment and Substance Misuse ServicesInpatient care Improving Access to Psychological Therapies.

The 2gether NHS Foundation Trust has reviewed all the data available to them on the quality of care in all of these NHS services through a systematic plan of quality reporting and assurance that is considered by the Trust’s Governance Committee and the Board.

The income generated by the NHS services reviewed in 2013/14 represents 94.9 % of the total income generated from the provision of NHS services by the 2gether NHS Foundation Trust for 2013/14.

Participation in Clinical Audits and National Confidential Enquiries

During 2013/2014 three national clinical audits and four national confidential enquiries covered NHS services that 2gether NHS Foundation Trust provides.

During that period, 2gether NHS Foundation Trust participated in 33% national clinical audits and we are awaiting confirmation of the percentage of confidential enquiries of the national clinical audits and national confidential enquiries which we were eligible to participate in. The national clinical audits and national confidential enquiries that 2gether NHS Foundation Trust was eligible and participated in during 2013/2014 are as follows:

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National Clinical Audits

Clinical Audits Participated Yes/No Reason for no participation

National Audit of Schizophrenia Yes

National Audit of Psychological Therapies for Anxiety and Depression Yes

Prescribing Observatory for Mental Health No The Trust is not a member of the

Observatory.

Participated Yes/No Reason for no participation

Child Health Yes

Suicide and Homicide by People with Mental Illness

Yes

Sudden Unexplained Death Study Yes

Deaths of People with a Learning Disability

Yes

National Audit of SchizophreniaTrustParticipation

OrganisationalQuestionnaireCompleted

Audit of Practice Service User Questionnaires Carer QuestionnairesSubmissions Minimum

Number ofSubmissions

Submissions MinimumNumber of

Submissions

Submissions MinimumNumber of

Submissions

Participating Complete 100 100 32 50 13 25

National Audit of Psychological Therapies for Anxiety and DepressionTrustParticipation

OrganisationalQuestionnaireCompleted

Audit of Practice Service User Questionnaires Carer QuestionnairesSubmissions Minimum

Number ofSubmissions

Submissions MinimumNumber of

Submissions

Submissions MinimumNumber of

Submissions

Participating Complete 100 100 32 50 13 25

Participation in the Prescribing Observatory for Mental Health (POMH-UK)Topic Trust Participation National Participation

Teams Submissions Teams Submissions

Topic 13a: Prescribing for ADHD 0 Teams 0 Submissions 374 Teams 5523 Submissions

Topic 7d: Monitoring of patients prescribed Lithium 0 Teams 0 Submissions 6306 Teams 883

SubmissionsTopic 4b: Prescribing Anti Dementia Drugs 0 Teams 0 Submissions 420 Teams 9005 Submissions

National Confidential Enquiries

The national clinical audits and national confidential enquiries that 2gether NHS Foundation Trust participated in, and for which data collection was completed during 2013/2014 are listed below alongside the number of cases submitted to each audit or enquiry as a percentage of the number of registered cases required by the terms of that audit or enquiry.

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% cases submitted

Information not published

People with Mental Illness99.31%*

Sudden Unexplained Death Study 98.39%*

Deaths of People with a Learning Disability Information not published

*Information published July 2013

The report of 1 national clinical audit was reviewed in 2013 and 2gether NHS Foundation Trust intends to take the following action to improve the quality of healthcare provided.

Ensure an increased focus on the physical health of people diagnosed with schizophrenia (via Target 1.1 2014/15)

The Trust participated in the first round of the National Audit of Schizophrenia in autumn 2011, the final report of which was published in April 2012. 2gether NHS Foundation Trust has taken part in the second round of this audit in 2013-2014. Local reports are due to be published in July 2014 and the National report is due to be published in November 2014.

Clinical audits of our services

Within our services there is a high level of clinical participation in local clinical audits, demonstrating our commitment to quality across the organisation. All clinically led local audits are reported to the Governance Committee in summary form to ensure that actions are taken forward and learning is shared widely. The table below show the status of the audit plan at the end of the year. During this process we internally identified 480 recommendations to further improve our practice as part of our commitment to continuous improvement.

Clinical Audits 2012/13 audit programme

2013/14 audit programme

Total number of audits on the audit programme 92 140*

Audits completed (as at 31st March 2014) 55 82

Audits that are progressing and will carry forward 19 36

18 22

*This includes internal 24 mock CQC assurance peer reviews

The reports of 82 local clinical audits were reviewed by the provider in 2013-2014 and 2gether NHS Foundation Trust intends to take the following actions to improve the quality of healthcare provided:

The Trust has undertaken a review of its key clinical policies Assessment and Care Management CPA and Assessing and Managing Clinical Risk and Safety to ensure that the quality of the services that the Trust provided is delivered in line with evidenced based best practice in 2013-14. There will be re-evaluation of practice during 2014-15.

The Trust has continued to review and develop its training programme to all staff (clinical and non-clinical) in line with the learning that is established from the clinical audit programme. This has, and will continue to drive the constant review and evaluation of training modules and their contents.

Specific examples of change in practice that have resulted from clinical audits are:

Following completion of the NICE ‘Clinical Guideline 120 Psychosis with co-existing substance misuse’ audit, one of the learning points was the need for a closer working relationship with the local substance misuse provider in Gloucestershire. To address this, a recommendation was made in the action plan to commence and progress a clear shared care process and pathway. This recommendation will change practice and improve quality.

Following completion of the locally determined audit on the ‘Safe use of Clozapine’, two recommendations identified that there was inconsistent monitoring across teams, and the records did not match information recorded on the required database. To address these issues, two recommendations were made in the action plan for all teams to adopt a standard database and all care coordinators to have access to it. This will change practice and improve quality.

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Participation in Clinical Research

The number of patients receiving relevant health services provided or sub-contracted by 2gether NHS Foundation Trust in 2013/2014 that were recruited during this period to participate in research approved by a research ethics committee is 56, in data reported by the Western Comprehensive Local Research Network (WCLRN). This figure is a significant decrease from last year’s figure of 271. This can be attributed to a number of influencing factors; including the sudden closure of HMP Gloucester only 2 months after the site opened for recruitment to the N-Alive trial; a Randomised Control Trial (RCT) designed to test the effectiveness of giving naloxone-on-release to prisoners with history of heroin use to prevent fatal opiate overdoses.

Our planned recruitment to this trial was 16 participants per month. Complex studies such as these take a significant period of time to set up and the unexpected closure of the prison left us with a gap in our portfolio. Subsequent attempts to open the trial at HMP Eastwood Park were unsuccessful with the prison health service unable to support the trial. Trials to replace this study on our portfolio take time to set-up.

We also experienced staff losses within the research team, which heavily impacted our ability to increase our portfolio across both mental health and dementia. The need for research experienced staff and long lead in times when setting up research trials highlights the necessity to maintain a constant staffing structure that allows succession planning for trial implementation, and building of the portfolio across all our healthcare specialties in the Trust, so that all our clinical staff are appropriately supported in conducting research trials.

Staff departures and changes within services have impacted the ability to increase our National Institute for Health Research (NIHR) portfolio. Currently we have 7 approved NIHR studies recruiting or active in Gloucestershire, with the decrease on last year in part due to a number of portfolio studies closing recruitment, and entering follow up phases. This highlights the need to develop a rolling programme of studies to help counterbalance the long set-up period required before opening new studies to recruitment.

In 2013/14, the Trust registered and approved 35 studies in Gloucestershire, which includes a mix of clinical and commercial trials, confidential inquiries, service evaluations and student research. Of these studies, 10 were portfolio clinical research based in mental health or dementia, the remainder made up from non-portfolio, commercial or student studies. We currently have 8 live service evaluation or student research projects initiated and co-ordinated by Trust staff or students.

We continue to participate in research that fits with the Trust core values which means we are focussing closely on research studies that align with our continuing commitment to improving the quality of care we offer and to making our contribution to wider health improvement. We have a number of NIHR studies due to open in the

next financial year, expanding across social inclusion (Time to Change programme) through to commercial dementia clinical trials.

Research Sponsors

Examples of the portfolio of activity are listed below:

Mental Health

PPiP – Prevalence of neuronal cell surface antibodies in patients with psychotic illnessDPIM Polymorphisms in Mental Illness: investigating genetic factors involved in schizophrenia, bipolar disorder, alcoholism and autism and exploring possible treatment optionsNational Confidential Inquiry into Suicide and Homicide by People with Mental IllnessREFOCUS randomised controlled trial: Developing a recovery focus in mental health services in EnglandREFOCUS Process Evaluation – qualitative analysis of the REFOCUS TrialIBPI – Web-based Integrated Parenting Intervention for Bipolar Parents of Young ChildrenOBSERVA – An observational post-authorization safety specialist cohort monitoring study to monitor the safety and utilization of Asenapine (Sycrest) in the mental health trust setting in England.

Dementias and Neurodegenerative Disease

Dendron 067 – A Double-Blind, Placebo-Controlled, Randomized, Parallel Group, 12-Month Safety and Efficacy Trial of Leuco-methylthioninium bis(hydromethanesulfonate) in Subjects with Behavioral Variant Frontotemporal Dementia (bvFTD)Brains for Dementia ResearchGERAS: Observational Study of costs and resource use of Alzheimer’s disease in EuropePD Rehab – Parkinson Disease.

It is estimated that 700,000 people are living with a form of dementia in the UK today, a number forecast to double within a generation.

Despite being relatively common, knowledge and treatments are very limited, partly because research cannot, in many cases be achieved without the use of human tissue.

At present the only way to accurately diagnose dementia is upon post mortem. Brains for Dementia Research, the first major venture jointly funded by the Alzheimer’s Research Trust and the Alzheimer’s Society, demonstrates the importance charities, doctors and scientists place on the project in driving the search for effective treatments for Alzheimer’s disease and allied dementias. Brains for Dementia Research is enabling four leading brain tissue banks and one tissue donation centre to recruit and clinically assess potential donors, collect and provide donated brain tissue for quality research into causes and treatments for dementia.

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Brain banks have historically been at the forefront of research on neurodegeneration, however, the reduction in the number of post mortems carried out and the impact of Alder Hey on the public perception of donating tissue for research has adversely affected the availability of post mortem brain tissue, causing major problems for research into age related neurodegenerative conditions.

Participants (both cases and controls) meet with the Researchers and after giving their informed consent will complete a series of assessments, with follow up at various intervals until the time of their death, at which time the procedures for brain tissue donation will be followed. To date the 2gether NHS Foundation Trust has recruited a total of 27 participants into the study.

Future Developments

Nationally there are a number of changes within the NIHR that will affect the infrastructure of research, which should not affect the delivery of research activity within our Trust. Research networks will now move into clustered six divisions/themes, which results in mental health merging with dementia and neurology. Networks such as the Mental Health Research Network and Dendron will cease to exist within the new structure after 1 April 2014.

We continue to receive support funding from the WCLRN via the R&D consortium for Gloucestershire to provide a research infrastructure within the Trust. We currently have a Senior Clinical Studies Officer/Team Leader, two full time Clinical Studies Officers/Clinical Trial Co-ordinators and one full time Assistant Clinical Studies Officer working across mental health and dementia. We are expanding our training of Bank Research Staff to enable us to support commercial trials. We look forward to the development of a Health Research Centre, where clinical trials of medicinal products (CTiMPs) will be focussed by our research champion.

Our success in the last year includes the completion of the REFOCUS trial (funded through an NIHR programme grant awarded to Professor Mike Slade of the Institute of Psychiatry) which has now closed and is in data analysis stage. We successfully recruited to time and target on this complex and large scale study.

Our work over the next 12 months includes building our research activity in Herefordshire, and moving forward within the new NIHR structure, which will see our research staff working more flexible across the research network, with the possibility of incorporating neurology and primary care work.

As part of minimising the impact on recruitment to research trials, we are developing an internal staff structure that gives us greater security, and helps to retain highly skilled staff that require significant experience and training. We will be looking to build strong charitable and academic links across the region as we move forward with the development of our new Health Research Centre, providing a focus for commercial research across dementia and mental health.

Use of the Commissioning for Quality & Innovation (CQUIN) framework

The national contractual use of CQUINs is to support the essential focus upon quality improvement in the provision of services and incentivise through specific quality payments.

Although the main focus of CQUINs is on quality improvements for our service users, a proportion of 2gether NHS Foundation Trust’s income in 2013/14 is conditional on achieving quality improvement and innovation goals agreed between 2gether NHS Foundation Trust and Gloucestershire Clinical Commissioning Group, Herefordshire Clinical Commissioning Group and NHS South West Specialised Commissioning Group (for the provision of low secure mental health NHS services).

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Income conditional on

reaching 2013/14 CQUIN targets

was c£2.1M

2013/14 CQUIN Goals Gloucestershire Goal Name Description Goal

weightingExpected value

Quality Domain

Carers for people with dementia

Plans to be put in place to ensure that for every person who is admitted to hospital, where there is a diagnosis of dementia, their carer is sign-posted to relevant advice and receives relevant information to help and support them

Pre-

CQUIN

0 Patient Experience

Increased use of telehealth/telecare technologies.

2gether NHSFT will increase the use of this technology for 2013/14 by the end of Quarter 1.

Pre-

CQUIN

Effectiveness

NHS Safety Thermometer

Improve data collection on pressure ulcers, falls, urinary tract infection in those with a catheter & VTE

5.00% £84,350 Safety

Venous thrombo –embolism (VTE)

Reduce avoidable death, disability & chronic ill health from VTE

5.00% £84,350 Safety

Patient Experience Improve responsiveness to the personal needs of patients (Patient Experience)

12.00% £202,440 Patient Experience

Learning Disability Outcomes

Further develop, apply and audit a tool that captures how interventions result in improvements for the individual or LD population

16.00% £269,920 Patient Experience

Medicines management

Make plans to encourage generic prescribing within Primary care generic standard release venlafaxine tablets

4.00% £67,480 Effectiveness

Physical health of people with Mental Health problems

Clinical teams to share the caseload registers with the patient’s GP (& 2gether Primary health care worker) practice & provide GPs with the diagnosis information. Aim to ensure that 70% of service users on enhanced CPA within community team caseloads with Diabetes, CHD and COPD, hypertension and obesity have either completed a physical health check with their GP or that there is recorded evidence of an outreach attempt to facilitate it.

16.00% £269,920 Effectiveness

Increasing access for people from BME population to community services

Development and Delivery of training package and work with BME partners/Community Development Workers in the county to develop a partnership

availability to those with dementia and their carers.

4% £67,480 Effectiveness

Outcomes measures for PBR clusters

Propose between 1 – 3 PROMs / CROMs for each PbR care cluster, by the end of Q1 and commence quarterly reporting on outcomes by care cluster, by the end of Q3

8% £134,960 Effectiveness

Suicide prevention ASIST Training

Applied Suicide Intervention Skills Training is a two day workshop that offers intensive training for front-line staff. Emphasis is on teaching 60 staff in this practical training to prevent immediate risk of suicide.

10% £168,700 Safety

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Goal Name Description Goal weighting

Expected value

Quality Domain

Appropriate care for frequent ED attenders

To participate in and contribute to with CCG and GHNHSFT to review all frequent ED attendees (self harm) and propose a plan to ensure appropriate care from primary care, mental health services and acute services to reduce the potential for future incidents.

20% £337,4000 Effectiveness

Herefordshire Goal Name Description Goal

weightingExpected value

Quality Domain

Digital First Report on current Digital First initiatives in 2gether and agree an implementation plan

Pre-

CQUIN

0 Effectiveness

Carers for people with dementia

Plans to be put in place to ensure that for every person who is admitted to hospital, where there is a diagnosis of dementia, their carer is sign-posted to relevant advice and receives relevant information to help and support them

Pre-

CQUIN

0 Patient Experience

NHS Safety Thermometer

Improve data collection on pressure ulcers, falls, urinary tract infection in those with a catheter & VTE

5% £17,675 Safety

Patient Experience Improve responsiveness to the personal needs of patients (Patient Experience)

20% £70,698 Patient Experience

In patient discharge summaries

To improve timely communication of the outcome summary from inpatient teams to general practices

10% £35,349 Safety

Recovery Star The extension in the use of recovery star model that was introduced in 2012’13

15% £53,024 Patient Experience

Outcome measure CAMHS

To increase the use of a recognised outcome measure for new referrals to CAMHS

20% £70,698

EffectivenessImprove responsiveness to carers of inpatients

To improve the experience of carers of inpatients

20% £70,698 Patient Experience

Antipsychotic reviews Timely review of patients prescribed

antipsychotic within a care home setting

10% £35,349 Safety

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Low Secure Services Goal Name Description Goal

weightingExpected value

Quality Domain

Optimising Pathways To help providers understand the whole care pathway and plan to optimize an individual’s length of stay within specialized mental health

Physical Healthcare To improve the physical health and wellbeing of all patients as part of their overall treatment and rehabilitation plan.

Care Programme Approach

A baseline audit and development of action plan to ensure the CPA process is effective and

Provision of Literacy & Numeracy

The provision of resources to improve literacy, numeracy, IT and vocational skills within secure care environments provides better opportunities for future participation in various aspects of life.

Increased Utilisation of Communications Technology

Increased Utilisation of Communications Technology

Dashboard This indicator is aimed at ensuring that Providers continue to embed and routinely use the required clinical dashboards for specialised services.

20% £8,000

20% £8,000 Patient Experience

20% £8,000

10% £4,000 Innovation

10% £4,000 Innovation

20% £8,000

Efficiency

Efficiency

Efficiency

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The total combined potential value of the income conditional on reaching the targets within the CQUINs during 2013/14 was £2,080,492 of which £2,080,292 has actually been achieved.

For Specialist Commissioning in Quarter 1, there was a loss of £200.00 relating to one indicator for Physical Healthcare which arose as a GP letter was not sent out in a timely fashion. This figure equates to 0.5% of the Specialist Commissioning target.

In 2012-13, the total potential value of the income conditional on reaching the targets within the CQUINs was £2,301,000 of which £2,290,000 was achieved (99.52%).

2014/15 CQUIN Goals

CQUIN goals for 2014/15 have been agreed with Gloucestershire and Herefordshire Clinical Commissioning Groups and NHS England (for the provision of low secure mental health NHS services). These include:

National CQUINs applicable to all generic mental health services

Friends & Family Test NHS Safety ThermometerImproving physical healthcare to reduce premature mortality in people with severe mental illness.

Gloucestershire (Local)Development of a personality disorder pathway in collaboration with primary carePatient experience survey

Herefordshire (Local)Seamless transition from children & young people’s services to adult servicesTimely review of patients prescribed antipsychotic medication within a community settingReduction in all falls (regardless of whether injury was sustained).

Low SecureFriends & Family TestImproving physical healthcare to reduce premature mortality in people with severe mental illnessClinical DashboardCollaborative Risk AssessmentsSupporting Carer Involvement.

Statements from the Care Quality Commission

The Care Quality Commission (CQC) is the independent regulator of health and adult social care services in England. From April 2010, all NHS trusts have been legally required to register with the CQC. Registration is the licence to operate and to be registered, providers must, by law, demonstrate compliance with the requirements of the CQC (Registration) Regulations 2009.

2gether NHS Foundation Trust is required to register with the CQC and has no conditions on its registration. This means that the Trust has continued to demonstrate compliance with the regulations and we are registered to provide the following regulated activities:

Assessment or medical treatment to persons detained under the Mental Health act 1983Diagnostic and screening proceduresTreatment of disease, disorder or injury

The locations from which the Trust is registered to provide these regulated activities are confirmed on the CQC website www.cqc.org.uk.

The Care Quality Commission has not taken enforcement action against 2gether NHS Foundation during 2013/14;

The Trust continues to receive monthly Quality Risk Profiles from the CQC.

The most recent Quality Risk Profile (published in March 2014), declares no risk to compliance with any of the 16 essential standard outcome areas for quality and safety above a ‘Low amber rating’. This is on a scale that increases risk from Low/High Green to Low/High Yellow to Low/High Amber to Low/High Red. Low Green is the lowest risk rating and High Red is the highest risk rating. The table on the next page shows Trust performance across all outcome areas at year end.

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Outcome No Outcome description Assurance1 Respecting and Involving people who use services Low Yellow2 Consent to care and treatment Low Yellow4 Care and Welfare of people who use services High Green5 Meeting nutritional needs Low Green6 Co-operating with other providers Low Yellow7 Safeguarding people who use services from abuse Low Yellow8 Cleanliness and Infection Control Low Green9 Management of Medicines High Yellow10 Safety and Suitability of premises Low Green11 Safety, availability and suitability of equipment. High Green12 Requirements relating to workers Low Yellow13 High Green14 Supporting staff High Yellow16 Assessing and monitoring the quality of service provision High Green17 Complaints Low Yellow21 Records Low Green

CQC Inspections of our services

The Care Quality Commission (CQC) has monitored the Trust’s compliance with its standards by undertaking the following inspections of services during the last year of 2013/14, and the full reports are available on the CQC website under the location of the service.

http://www.cqc.org.uk/search/hospitals/2gether

Westridge Learning Disability Unit: An unannounced CQC inspection of this in patient service for people with a learning disability took place on 4 September 2013, where the inspectors reported that all standards inspected had been met. The inspection found that people using this service were provided with safe care in appropriate environments, were safeguarded from harm, with appropriate levels of staff on duty and quality monitoring systems in place. Patients told the inspection team that they were happy with the service provided, that everything was fine and that they liked the routine. They also said that relatives visited and were able to keep in regular contact.

Hollybrook Learning Disability Unit: An unannounced CQC inspection of this in patient service for people with a learning disability took place on 17 October 2013, where the inspectors reported that all standards inspected had been met. The inspection found that the team were respecting and involving the people who use the service, provided for their care and welfare, cooperated with other providers, with appropriate levels of staff on duty and quality monitoring systems in place.

A provider who had worked with the Trust to move a person into community services told the CQC they were impressed with the support provided. They said Trust staff had worked alongside their staff until the person had

settled. Training had been provided for their staff to ensure that they had a good understanding of the person. They said, "I can't speak highly enough of the support from Hollybrook" and "really good training was provided to our staff".

Wotton Lawn HospitalThe CQC conducted an unannounced compliance inspection on the 18 & 19 December 2013, where the inspectors reported that all standards inspected had been met. The inspection found that staff were respecting and involving the people who use the service, provided for their care and welfare, had appropriate levels of staff on duty and quality monitoring systems in place. People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

The comments from patients that the CQC spoke to included "I really make use of the great facilities here such as the gym. The occupational therapists have really helped me to get well". "I have been coming here for 10 years and it has improved so much, the building is better, the staff are more helpful, the food is brilliant and there are more therapies". "The staff sit and talk with me for ages and help me to feel better, they are really nice".

Mental Health Act reviewsRegular visits by the Care Quality Commission Mental Health Act Commissioner continue to all our services where the Act is used. All visit reports made by the Commissioner and the Trust responses are scrutinised initially by the Director of Service Delivery and then by the Trust’s Mental Health Act Scrutiny Committee.

There has also been a Countywide 120 review of the Mental Health Act in Herefordshire.

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The CQC conducted an announced Mental Health Act inspection on 29 November 2013 into use of seclusion at Westridge and Hollybrook. Recommendations were made and our actions included:

A review of the Trust’s Seclusion Policy in line with the Mental Health Act 1983 code of Practice chapter 15Updating the Positive Behaviour Management (PBM) physical intervention record, to identify where any physical intervention’s including restraints take placeIntroducing National Early Warning Scores (NEWS) charts.

These actions have been completed, however further work is now taking place on the Trust’s Seclusion Policy following further observations from Mental Health Act Commissioners.

In addition we have reviewed the care provided to a patient regarding consent to treatment for intramuscular injections, including a request for a second opinion approved doctor, informing the patient and the next of kin of an unauthorised treatment and subsequently ensuring that this treatment was appropriately authorised. In addition, we informed the patient and their next of kin inform of their rights to advocacy and legal advice. Safeguarding Children and Children in Care Special Review in Gloucestershire

2gether NHS Foundation Trust has participated in one CQC special review relating to Safeguarding Children and Children in Care in Gloucestershire.

For the Trust, the review included visits to our Children & Young Peoples Service and Adult Mental Health services at Wotton Lawn Hospital, which included reviewing community teams working in these areas too. This was a follow up review to ascertain progress against a previous review which took place in 2010. The reviewers visited all provider agencies within Gloucestershire under the commissioning arrangement of Gloucestershire CCG.

The Trust will not receive the investigation report until May 2014, and as such, will progress the actions during 2014/15.

Changes in service registration with Care Quality Commission for 2013/14

The following requests to change our registration with the CQC have been made:

Removal of Laurel House, 29-31 Alexandra Road, Gloucester as a location from the 3rd March 2014Addition of Laurel House as a location at 123 Swindon Road, Cheltenham from the 3rd March 2014.

The relocation of the service has resulted in an improved environment for those accessing mental health rehabilitation inpatient services.

Quality of Data

Statement on relevance of Data Quality and actions to improve Data Quality

Good quality data underpins the effective provision of care and treatment and is essential to enabling improvements in care. 2gether NHS Foundation Trust submitted records during 2013/14 to the Secondary Uses Service for inclusion in the Hospital Episode Statistics which are included in the latest published data (Month 11 data is reported below, as this was the only available information at the date of publication).

The percentage of records in the published data which included:

the patient’s valid NHS number was: 99.7% for admitted patient care (99.1% national); and 100% for outpatient care (99.3% national)

the patient’s valid General Practitioner Registration Code was:100% for admitted patient care (99.9% national); and 100% for outpatient care (99.9% national)

2gether NHS Foundation Trust has taken the following action to improve data quality building on its existing clinical data quality arrangements:

During 2013/14 the Trust has continued to progress data quality improvement. There was a clear focus on data items underpinning the proposed Payments by Results (PBR) framework. The work centred on improvements in HoNoS scoring and outcome measurement, cluster reviews and ensuring all appointments were within agreed deadlines contained in the Trust’s Data Quality Improvement Policy.

In the second half of the year an automated Data Quality Exceptions Report was implemented across all RiO supported services. This real-time tool enables clinicians and managers to monitor data quality continuously and address any gaps that are identified. It is comprehensive in that it includes PBR type data mentioned above but also covers clinical data associated with care planning and risk management and patient demographic data such as GP Practice, CCG and ethnic background.

An audit of Incident Reporting was specifically requested by the Trust in order to review a known problem area. The review was rated as Critical Risk, and resulted in an Internal Audit opinion that there was a considerable risk that the Incident Reporting system may fail to meet its objectives. A number of issues were identified relating to the Incident Reporting system’s database configuration, the accurate and timely reporting of incidents, the reporting of trends and incident statistics, and procedures in place for ensuring lessons are learnt and communicated. The Trust made significant improvements, both before and since the audit, to improve performance. These included an upgrade to the online Incident Reporting system,

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a review of all relevant incidents and updating the contacts database within the system to ensure that incidents are forwarded to the correct person for review. Additional members of staff have received training in managing the system, in order to increase resilience, and a new Health and Safety Manager has been appointed, along with administrative support for the Incident Reporting system.

Information Governance Toolkit

Ensuring that patient data is held securely is essential, as such the Trust complies with the NHS requirements on Information Governance and assesses itself annually against the national standards set out in the Information Governance Toolkit which is available on the Health & Social Care Information Centre website:

http://systems.hscic.gov.uk/infogov

2gether NHS Foundation Trust Information Governance Assessment Report overall score for 2013/14 was 83% and was graded green. This is the same overall score as in 2012/13.

The Toolkit has been the focus of regular review throughout the year by the Information Governance and Health Records Committee, and the Information Governance Advisory Committee. In this year’s assessment:

22 key indicators were at level 322 key indicators were at level 21 key indicator was deemed not relevant.

The Toolkit has been the subject of an audit by the Trust’s Internal Auditors, which produced a classification of low risk.

The Trust’s efforts will remain focussed on maintaining the current level of compliance during 2014/15 and ensuring that the relevant evidence is up to date and reflective of best practice as currently understood, and that good information governance is promoted and embedded in the Trust through the work of the Information Governance and Health Records Committee, the IG Advisory Committee and Trust managers and staff.

Clinical Coding Error Rate

2gether NHS Foundation Trust was not subject to the Payment by Results clinical coding audit during 2013/2014 by the Audit Commission.

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Part 3: Looking Back: A Review ofQuality during 2013/14

IntroductionThe 2013/14 quality priorities were agreed in May 2013 and published in last year’s Quality Report, and are accessed through the following link:

http://goo.gl/qx4o0c

The quality priorities were grouped under five broad areas of quality improvements. This section of the report outlines the achievements and progress made in each of the five areas to date, against what we said we would do. It also outlines key service developments which have positively impacted on the care we provide as it is important to us that we constantly strive to improve quality overall.

Figure 1 below provides an overview of achievement against our targets for the year. The table overleaf provides a summary of our progress against these individual priorities. Each are subsequently explained in detail throughout Part 3.

Figure 1 – Summary of Quality Measure Achievement 2013/14

Achieved

Partially Achieved

Not Achieved

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2012-2013 Actual

2013-2014 Target

2013-2014 Actual Domain 1: Preventing people from dying prematurely

1 factors of people in contact with services when compared data from previous years

18 <18 22

2

95% of adults will be followed up by our services within 48 hours of discharge from psychiatric inpatient care:

Gloucestershire Herefordshire

89%70%

>95% 95%95%

3

70% of community patients with a serious mental illness will have had an annual physical health checkGloucestershireHerefordshire

- 70% 86%47%

Domain 2: Enhancing quality of life for people with long-term conditions

4

Improved access to dementia services for Black & Ethnic minority communities through training an agreed number

receive this training. (Gloucestershire).

- 70% 70%

5

Ensure appropriate and timely reviews of prescribed antipsychotic medication for people with dementia living in a care home through three monthly reviews, providing demonstrable evidence of improvement during Quarter 4(Herefordshire)

- - 93%

6

In order for us to effectively monitor how our service users feel we are performing - 90% of adults in contact with services will describe the impact of interventions on their discharge through the completion of nationally recognised outcome measures

- 90%

Range 62% - 100%

Partially Achieved

7Children and Young Peoples Services and CAMHS will report on improved outcomes of those who use the service - - Achieved

Domain 3: Helping people to recover from episodes of ill health or following injury

895% of people will be seen by the Crisis & Home Treatment Team prior to admission, to ensure appropriate access to inpatients services.

98.8% 95% 99.1%

Domain 4: Ensuring people have a positive experience of care9 Undertake local surveys of both community and inpatient

services by asking the following questions and improve on our 2012/13 scores Did you have enough time to discuss your condition, treatment and care?

helpful? Did we involve your family and carers as much as you would like? Has your mental health care service helped you to start achieving your treatment goals?

74%

53%

50%

42%

>74%

> 53%

>50%

>42%

95%

96%

93%

89%

10 Ensure that 100% of carers are offered assessments

- 100% 90%

Domain 5: Treating and caring for people in a safe environment and protecting them from avoidable harm

11

To reduce the number of serious incidents as a proportion of patients on the Trust’s caseload to an annual average of 0.2 incidents per 1000 caseload(Patient harm serious incidents are reported nationally e.g. pressure ulcers, severe self-harm incidents)

<0.2 0.18

12Reduce the number of patients who are absent without leave from inpatient units who are formally detained by 50%

53 <27 110

Summary Report on Quality Measures for 2013/2014

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Effectiveness

Domain 1: Preventing people from dying prematurely

In 2013/14 we remained committed to continue our quality work to reduce the risk of premature death in people with serious mental illness and learning difficulties. We set ourselves 3 targets against the goals of:

Minimise the risk of suicide of people who use our services Ensure we follow people up when they leave our inpatient units within 48 hours to reduce risk of harmImprove the physical health of patients with mental health problems.

Target 1.1Reduce the numbers of deaths relating to identified risk factors of people in contact with services when compared data from previous years

We aimed to minimise the risk of suicide amongst those with mental disorders through systematic implementation of sound risk management principles, and set ourselves a specific target for there to be fewer deaths by suicide of patients in contact with teams. This was a new quality target for 2013/14 but we have included historical information from 2011/12 onwards for comparison.

Figure 2 shows the number of reported suspected suicides of people in contact with our services over a 3 year period. Last year saw 18 deaths (7 less deaths than the 25 reported in 2011/12) however, this year we have reported 22 suspected suicides. We have therefore not met this target.

30

23

15

8

0

Quarter 4Quarter 3Quarter 2Quarter 1

3

5

10

7

6

7

23

4

5

7

6

30

23

15

8

0

Awaiting inquestNatural CausesAccidentalNarrativeOpenSuicide

3

2

3

10

5

2

2

11

14

11

21

8

Figure 2 – Number of Suspected Suicide Deaths Per Annum

Figure 3 – Inquest Conclusions

2011/12 2012/13 2013/14

2011/12 2012/13 2013/14

Whilst we report all deaths which appear to be as a consequence of self harm as suspected suicide, ultimately it is the coroner who determines how a person came by their death. Figure 3 provides the number of suicide, open and narrative conclusions following an inquest being heard for the same cohort of service users.

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The first report on the national suicide prevention strategy1 notes that sadly for the first time since 2007 the national suicide rate has risen. The findings within the Trust are consistent with the national picture. The report details 6 key areas for local services to work together to promote suicide prevention, namely:

Implement NICE guidelines on self-harm, and support additional psychosocial and physiological interventions;Work collaboratively to support service users facing debt, housing problems and unemployment;Increased focus on support for people bereaved by suicideIncreased focus on understanding and addressing the factors associated with suicide in malesImprove access to psychological therapies for children and young peopleWork closely and collaboratively with coroners.

Our teams are mindful of these recommendations and continue to work closely with service users who are at risk of suicide to support them through times of crisis. Initiatives such as the implementation of both the inpatient and community suicide prevention toolkit, annual ligature assessments within our inpatient services, and the provision of Applied Suicide Intervention Skills Training (ASIST) have helped to improve staff awareness of issues associated with suicide.

We will continue to report suspected suicides as a key quality target for 2014/15.

Target 1.295% of adults will be followed up by our services within 48 hours of discharge from psychiatric inpatient care

This is a local target and one which we first established as a quality target in 2012/13. The national target is that 95% of CPA service users receive follow up within 7 days2.

Discharge from inpatient units to community settings can pose a time of increased risk of self-harm for service users. The National Confidential Inquiry into Suicides and Homicides3 recommended that ‘All discharged service users who have severe mental illness or a recent (less than three months) history of self-harm should be followed up within one week’

One of the particular requirements for preventing suicide among people suffering severe mental illness is to ensure that follow up of those discharged from inpatient care is treated as a priority and that care plans include follow up on discharge. Although the national target for following up service users on CPA is within 7 days, in recognition that people may be at their most vulnerable within the first 48 hours, we aim to follow up 95% of people within these 2 days.

This has been an organisational target for two years and the cumulative figures for each year end are seen in the table below:

1)

2)

3)

4)

5)

6)

Target 2012-13 2013-14

Gloucestershire Services >95% 89% 95%

Herefordshire Services >95% 70% 95%

The Trust did not meet this local target during 2012/13, but in 2013/14 has met the target.

Target 1.370% of community patients with a serious mental illness will have had an annual physical health check

There is a long established association between physical comorbidity (the presence of multiple illnesses) and mental ill health. People with severe and enduring mental health conditions (Serious Mental Illness - SMI) experience worse physical health and reduced life expectancy compared to the general population.

People with schizophrenia and bipolar disorder die an average 25 years earlier than the general population largely because of physical health problems. People with SMI are at increased risk of a range of physical illnesses and conditions, including coronary heart disease (CHD), diabetes, respiratory disease, greater levels of obesity and metabolic syndrome.

1Preventing suicide in England: One year on. First annual report on the cross-government outcomes strategy to save lives. January 2014.2Detailed requirements for quality reports 2013/14: Monitor, February 20143Five year report of National Confidential Inquiry into Suicide and Homicide by people with mental illness Department of Health – 2001

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In recognition of this we wanted to ensure that 70% of service users on our caseload who have a diagnosis of schizophrenia or bi-polar affective disorder (as these are the most at risk group of people) had an annual physical health check. To achieve this, we routinely undertook a physical health check for all services users with these diagnoses who were admitted to our inpatient units. For the majority of people living in the community this was more complicated, and involved our teams working closely with colleagues in primary care to identify service users and support them to attend their GP surgery for the health check.

Target 2013-14

Gloucestershire Services >70% 86%

Herefordshire Services >70% 47%

In Gloucestershire 273 service users had evidence of completed, planned or attempted physical health check. This equates to 86% of the cohort where information was returned. We met this target.

In Herefordshire 162 service users had evidence of completed, planned or attempted physical health check. This equates to 47% of the cohort where information was available. We did not meet this target and will review our systems in Herefordshire for promoting this in 2014/15.

This is such an important area of work, we were pleased that it has become a national CQUIN for all mental health services including ourselves for 2014/15 and therefore we wanted to continue to report this as quality priority for 2014/15.

Domain 2: Enhancing quality of life for people with long-term conditions

We continue to be aware that people who have a mental illness or a learning disability need support to live with their long-term condition and we wanted to make more quality improvements to our service that would assist in this area. In this domain, we set ourselves 4 targets against achieving 3 goals:

Improve the experience of people with dementia in Gloucestershire and HerefordshirePeople will feedback to us whether the service they have received has improved their quality of lifeChildren and Young Peoples Services will use mechanisms to gain feedback on whether the service has improved their quality of life.

Target 2.1Improved access to dementia services for Black & Minority Ethnic (BME) communities through training an agreed number of staff. 70% of an identified group of registered staff will receive this training. (Gloucestershire)

There are at least 25,000 people with dementia from BME groups (House of Commons All Party Parliamentary Group on Dementia4). In Gloucestershire, 4313 people over the age of 65 come from a BME community (2011 census5). Small numbers from BME communities’ access 2gether NHS Foundation Trust’s Dementia Services. There are no national statistics held on the prevalence ofdementia in BME populations and the Royal College of Psychiatrists noted that identifying dementia among BME elders is an area that has been neglected in research.

It is likely that dementia is more common among Asian and Black Caribbean communities. This is because high blood pressure, diabetes, stroke and heart disease, which are risk factors for dementia, are more common among Asian and Black Caribbean communities.

Therefore, an in house training programme focusing on BME awareness and engagement was developed during April-June 2013 for 2gether NHS Foundation Trust staff working in the following areas:

Community Dementia Nursing ServiceMemory Assessment ServiceLater Life One Stop TeamsCharlton Lane Hospital (Willow Ward)

The course aimed to enable staff to develop and enhance their awareness of BME perspectives to assist in improving access to services. The associated learning outcomes were as follows:

Understanding the issues facing older BME communities when accessing servicesDescribe positive support & practice for BME peopleRecognise the opportunities for effective partnership working to support BME people to access services.

A local target to train 70% of the cohort of staff working in the teams described above was set and by the end March 2014 64 staff (70%) had been trained therefore meeting the target.

4All-Party Parliamentary Group on Dementia: Dementia does not discriminate. July 20135Office for National Statistics

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In addition, we worked with BME partners and Community Development Workers in the county to develop and deliver a partnership plan to improve access, flexibility and availability to those with dementia and their carers. The partnership plan focused on five key areas:

To undertake a bench marking exercise to examine BME uptake of services as a proportion of the BME population by localityReview and refresh all available resources for BME communities relating to dementiaTo focus on promoting vascular health within BME communitiesTo develop a cultural barometer to support teams and services when they are working within BME communitiesTo improve signage and welcome for all communities to dementia environmentsTo build storyboards, using consistent methodology, which evidence good practice and positive evaluations of working within BME communities.

Target 2.2Ensure appropriate and timely reviews of prescribed antipsychotic medication for people with dementia living in a care home through three monthly reviews, providing demonstrable evidence of improvement during Quarter 4. (Herefordshire)

Antipsychotic medication is used to manage the psychological and behavioural symptoms of dementia. These include aggression, agitation, and shouting and sleep disturbance.

It is important to find ways to help manage with these symptoms as they can cause major problems for the person with dementia and their carers. However, there are risks with using such drugs and research has shown that people with dementia should only be prescribed this type of medication when they really need them. An independent review led by Professor Sube Banerjee published in November 2009 found that an estimated 150,000 people with dementia in the UK were being inappropriately prescribed antipsychotic drugs and these contributed to 1,800 deaths a year.

Clinical Guidelines for Dementia6 state that medication should only be considered if there is severe distress or an immediate risk of harm to the person with dementia or others. If antipsychotics are used then treatment should be time limited and reviewed at least every three months, or sooner according to clinical need.

Noting the importance of this, both from a clinical effectiveness and a safety perspective, we agreed a CQUIN with our commissioners for Herefordshire mental health services. During the year we have:

Established a database with the numbers of people with dementia in care homes (who are on the Trust’s caseload) and the percentage of these people who were prescribed antipsychotic medicationIdentified the number and percentage of these people who have had a medication review within a three month periodExplored the barriers to fast and efficient data reporting for this group and identified plans to overcome these barriers.

The results of our audit undertaken during Quarter 4 show that of the 57 people with a diagnosis of dementia living in a care home setting who were in contact with our dementia services, 93% (53) had received a medication review within a 3 month period, demonstrating that we met this target.

Target 2.3In order for us to effectively monitor how our service users feel we are performing - 90% of adults in contact with services will describe the impact of interventions on their discharge through the completion of nationally recognised outcome measures

There are a variety of outcome measures in use in mental health services, outcome measures are used to measure the quality of care and ascertain how effective an intervention has been. These measures can be:

Patient reported outcome measures (PROMS). These provide a means of gaining an insight into the way patients perceive their health and the impact that treatments or adjustments to lifestyle have on their quality of life. These instruments can be completed by a patient or individual about themselves, or by others on their behalf.

Clinical outcome measures. These are measures which are completed by clinical staff at the initial assessment, review and then discharge from service, and can calculate whether there has been; clinically significant improvement, stability or clinically significant deterioration. Put simply, if the ratings show a difference, then that might mean that a person’s health has changed.

1.

2.

3.

4.

5.

6.

6National Institute for Health and Care Excellence: CG42 Dementia: Supporting people with dementia and their carers in health and social care. Updated March 2011

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The most frequently used clinical outcome measure within mental health services is HoNOS (Health of the Nation Outcome Scales. HoNOS covers the following areas:

Overactive, aggressive, disruptive or agitated behaviourNon-accidental self-injuryProblem drinking or drug-takingCognitive problemsPhysical illness or disability problemsProblems associated with hallucinations and delusionsProblems with depressed moodOther mental and behavioural problemsProblems with relationshipsProblems with activities of daily livingProblems with living conditionsProblems with occupation and activities.

This year we have reviewed how many of our service users have described the impact of interventions through the use of HoNOS, and we can report that 78.8% of mental health service users had had a first outcome measure undertaken at assessment, and 61.9% had a comparison second outcome measure completed.

The March 2014 report outlines the improvement in the overall outcome score reporting an average improvement of 52% across all mental health areas of need.

In addition, we have been working with service users locally to pilot the use of a Patient Reported Outcome Measure, as they have highlighted their desire that outcome measures should focus on recovery and wellbeing rather than on diagnosis and symptoms which feature heavily in HoNOS.

The Short Warwick-Edinburgh Mental Well-being Scale (SWEMWEBS) has been piloted which asks service users to rate the following 7 statements at initial assessment, review and discharge, and the scores are them compared:

I’ve been feeling optimistic about the futureI’ve been feeling usefulI’ve been feeling relaxedI’ve been dealing with problems wellI’ve been thinking clearlyI’ve been feeling close to other peopleI’ve been able to make up my own mind about things.

The 4 week pilot was run in community services, and a selection of wards to establish whether the methodology would be useable across a larger scale. We had 208 returns of the questionnaire equating to a 21% return rate. A few small changes to the methodology have been made in response to feedback and we have determined whilst this worked well for people living in the community, it was less successful for use with inpatients due to the acuity of their illness. SWEMWBS will not, therefore be used in inpatient service but we will be running a launch event for all staff on 1 May 2014.

Within our services for people with a Learning Disability, the Health Equality Framework (HEF) is successfully being embedded as a legitimate outcome measure for learning disability services locally, with on-going and increasing interest from other trusts, services and policy makers from the Department of Health, NHS England and Public Health England. In the 6 months period reported upon the overall improvement in before and after measurement scores was averaged as 9%, this reflects positive improvement noting the complexity of people’s problems.

The HEF was used for all new referrals (not existing) to the Gloucestershire Learning Disability Service in 2013/14 and is being implemented in Herefordshire Learning Disability Service (as the service came back to the Trust in September 2013).

This target has not been met across all services; however significant progress has been made to implement the use of outcome measures within our services.

Target 2.4Children and Young Peoples Services and CAMHS will report on improved outcomes of those who use the service

In 2011, following a successful joint bid with Gloucestershire Commissioners, the Gloucestershire Children and Young Peoples Service (CYPS) became part of phase 1 of a national modernisation plan for CAMHS services across the country known as Children and Young People Improving Access to Psychological Therapies (CYP IAPT.) This now has a very high profile in government with regular reports to the Cabinet Office.

We joined the Oxford/Reading learning collaborative of trusts led by Oxford Health working with Reading University. This project is unlike adult IAPT in that it required trusts to sign up to a range of initiatives which lead to whole service transformation and the measurement and improvement of outcomes for children and young people. These included:

High level post graduate training for staff to embed practice in the delivery of evidence based interventions for a range of treatments including Cognitive Behavioural Therapy (CBT)Post graduate leadership training for key service managers to lead the service transformation and change service cultureDevelopments in children and young people’s participation at an individual therapeutic level and to influence service delivery and development; to listen to and recognise the value of collaboration in improving experience and effectivenessImproving access to services by working towards a self-referral process

1.

2.3.4.5.6.

7.8.9.10.11.12.

1.2.3.4.5.6.7.

100

The collection of Routine Outcome Measures (ROMs) to assess, monitor and measure the delivery, progress, experience and effectiveness of interventions across the whole service on a session by session basis, as developed by CAMHS Outcome Resource Consortium (CORC) at the Anna Freud Centre, London. Phase 1 sites are working towards 90% data completeness to enable meaningful analysis of outcomesThe use of the data to inform practice at an individual, team and service levelThe delivery of data and service information quarterly to a national database developed by the CORC for use by the Department of Health to analyse needs and performance.

The collection of ROMs across the service has been steady and we are one of the top performing trusts nationally in the volume of data provided to the national team. Currently, approximately 60% of new cases into the service have been entered onto the national database with initial contextual and assessment measures. We have managed to share our experience at a national event to support other trusts.

The data that we submitted during the period 1 January 2012 – 31 December 2013 shows that children and young people are very positive about the ROMs and fed back that using session by session monitoring promotes collaboration and feelings of empowerment. Our data submission showed improvements in outcomes on the Child Outcome Rating Scale (CORS) as judged by the children and young people in treatment.

In our Herefordshire CAMHS, we have been training staff to implement the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA). HoNOSCA was developed in response to the need to measure the health and social and functioning of children and adolescents experiencing mental health difficulties. Specifically, HoNOSCA is a routine outcome measurement tool that assesses changes in behaviour, social and emotional functioning of children and adolescents with mental health problems. HoNOSCA is designed to be used at the start of the young person’s treatment, on completion to assess treatment outcome and at six month review. It also provides a tool for the management, recording and reporting of data. By the end of September 2013, all CAMHS clinical staff had been trained in the use of HoNOSCA.

In terms of implementation, our data shows that 91% (378) of children and young people entering treatment from 2 July 2013 – 6 March 2014 had an initial HoNOSCA completed. We also reviewed HoNOSCA ratings for those people who were discharged from the service, and all had who were discharged received a second HoNOSCA which indicated an improved outcome.

We have met this target.

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Domain 3: Helping people to recover from episodes of ill health or following injury

We continue to strive to provide services that achieve the best possible outcomes for people who develop treatable conditions. Specifically, in 2013/14 we wanted to help people recover from illness or injury and prevent conditions from becoming more serious. In this domain, we set ourselves 1 goal of ensuring appropriate access to psychiatric inpatient care with 1 associated target.

Target 3.195% of people will be gate kept by the Crisis Resolution & Home Treatment Team prior to admission, to ensure appropriate access to inpatients services.

Crisis Resolution and Home Treatment Teams provide a 24-hour service to people in their own homes to avoid hospital admissions where possible and provide the maximum opportunity to resolve individual crises. Their role in mental health services is to ensure that individuals experiencing severe mental distress are supported in the least restrictive environment and as close to home as possible, thereby avoiding the potential for an unnecessary admission to hospital.

When an admission to hospital is needed, the Crisis Resolution & Home Treatment Teams will arrange this, working closely with inpatient staff to ensure continuity of care, and then will also help service users to return home as quickly as possible, supporting them after discharge.

The national target is that 95% of people admitted to acute mental health wards will be “gate kept” by the Crisis Resolution & Home Treatment Teams7. An admission has been “gate kept” by a Crisis Resolution & Home Treatment Teams if they have assessed the service user before admission and if they were involved in the decision-making process, which resulted in admission.

Trust performance against this target is detailed in Figure 4 below, and it is seen that we have consistently exceeded the requirement over a 2 year period. We met this target.

7Detailed requirements for quality reports 2013/14: Monitor, February 2014

100%

98.5%

97%

95.5%

94%2012/13 2013/14

2gether NHS Foundation TrustNational Target

Figure 4

User Experience

Domain 4: Ensuring people have a positive experience of care

In this domain, we have set ourselves 2 goals of improving service user experience and carer experience with 2 associated targets.

Target 4.1Undertake local surveys of both community and inpatient services by asking the following questions and improve on our 2012/13 scores.

Quarterly local surveys of the same questions above have been implemented in our community and inpatient settings using an IPAD survey. This is across the Trust in both Gloucestershire and Herefordshire and the results below were seen in the survey data undertaken at the end of Quarter 4.

Our scores in these areas were below the national average during 2012/13, the national averages for these questions during 2012/13 are shown in brackets.

InpatientCommunityRecoveryTotal Responses

InpatientCommunityRecoveryTotal Responses

InpatientCommunityRecoveryTotal Responses

InpatientCommunityRecoveryTotal Responses

Question 1 Did you have enough time to discuss your condition, treatment and care? (72%)

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Question 2 Did you find talking with a member of your care team helpful? (49%)

Question 2 Did you find talking with a member of your care team helpful? (49%)

Question 2 Did you find talking with a member of your care team helpful? (49%)

4133816

395

3732015

372

90%95%94%94%

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88

22650

87

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099% 95%

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098% 89%

The sample size was significantly higher in Quarter 4 than previous quarters, with all results significantly above the average for the National Patient Survey results 2012/2013. We have met this target.

Friends and Family Test (Net Promoter Question)A further question was asked of people undertaking the same survey. This is the Friends and Family Test (Net Promoter Question). The stated aim of the test is to provide a simple metric to easily measure and compare patient experience within and between organisations, and so to drive improvements in care8.

The following five-point response scale is used to answer the question:

Extremely likelyLikelyNeither likely nor unlikelyUnlikelyExtremely unlikely

The Friends and Family score is calculated consistently across England to help compare different NHS organisations. It is the proportion of patients who would strongly recommend our Trust’s services minus those who would not recommend or who are indifferent i.e:

This gives a score of between -100 and +100 presented as a numerical score and not a percentage. Therefore, a score

who answered the question would recommend the service.

Results - The overall Friends and Family Test score for Quarter Four (2013/14) for 2gether NHS Foundation Trust services is +31 an improvement on the previous quarter. There were 483 responses in this quarter and of those 224 stated they were ‘Extremely Likely’ to recommend services. 10 people said they are ‘Extremely Unlikely’ to recommend the Trust. This score represents an overall increase in people who will promote the service.

Number of ‘Neither likely nor unlikely’; ‘Unlikely’ & ‘Extremely Unlikely’ ÷ Number of Participants x 100

Number of ‘Neither likely nor unlikely’; ‘Unlikely’ & ‘Extremely Unlikely’ ÷ Number of Participants x 100Minus

1.2.3.4.5.

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8Friends and Family Test - Do you wish they were here? Health Service Journal 12 July 2013 page 16.9NHS England (2013) December Commissioning for Quality and Innovation (CQUIN): 2014/15 guidance.10Assessment and Care Management Policy (Incorporating the principles of Care Programme Approach) 2gether (2014)

Question Herefordshire community

Herefordshire Inpatient

Gloucestershire Community

Gloucestershire Inpatient

How likely are you to recommend this service to friends and family if they needed similar care or treatment?

41 0 31 37

NHS England have published guidance9 to inform commissioning for quality in 2014/15 and require the full implementation of the Friends and Family Test from (at the latest) 1st July 2014. 2gether NHS Foundation Trust has included the Friends and Family question in our patient experience surveys for the last two years and has proactively reported results.

The overall cumulative Trust Friends and Family Test score for 2013-2014 = +24.

A text messaging system was launched at the end of March 2014. In addition to the friends and family test score the respondent will also have the opportunity to provide comments on their ratings which will provide valuable feedback for services.

Target 4.2Ensure that 100% of carers are offered assessments

The Trust recognises a carer as “a person who provides paid or unpaid help and support on a regular basis to a partner, child, relative, friend or neighbour, or client, who is frail or has a physical or mental illness, disability or substance misuse issues”10

When a service user is referred to the Trust, we attempt to identify if they have a carer. Where a carer is identified, we aim to contact them and inform them of their right to a formal assessment under the Carer’s (Recognition and Services) Act 1995 and the Carers and Disabled Children’s Act 2000. This involves making them aware of the services that are available, including those such as funded Carer Breaks and Emergency Care Schemes which may not be accessed without a carer assessment in place. Reassurance is offered that a carer’s assessment does not involve an assessment of the person’s capability to care and is not an assessment of finance and savings.

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In recognition of the value we place on the support carers provide to service users, and in support of our Carers Charter, we aimed to ensure that 100% of them were offered the opportunity for an assessment. We did not meet this target, and the highest overall compliance achieved in the year was 90%. This figure was identified via the Trust’s clinical audit programme. Whilst overall compliance did not exceed 90% with a range of 84-94%, Gloucestershire Community Learning Disability Team did ensure that 100% of carers were offered an assessment.

We did not meet this target.

Further Trust work regarding the experience of care

Quality of care includes the quality of caring. This means how personal care is provided; the compassion, dignity and respect with which service users are treated, and the extent to which they are given the level of comfort, information and support they require. The Trust is implementing the 6Cs (National Nursing Strategy – Culture of Compassionate Care 2012) throughout the organisation. In our quarterly reports we report on our development work in this area as well as focusing upon equality and diversity work, and partnership working with voluntary agencies in both counties.

The Trust work on developing a culture of compassion is closely connected to the Francis report. Strong progress has been made throughout the year. Staff are actively encouraged to pledge their commitment to the 6c’s and as of the end of March 2014, 519 staff had completed their online pledges. Senior nurses throughout the Trust continue to support the 6c’s initiative, this includes the writing and submission of “6c’s stories from practice” that are submitted to the National 6c’s website, to the development of a “Trust Wide Positive Practice” event was held in March 2014; this event championed the small scale quality improvement ideas that our staff have made that make a big difference to patients and their carers. The 6c’s action plan is currently being reviewed to recognise the many original actions that have now been completed and to set new actions for the coming year; this work is being led via the Trust Nursing Professional Advisory Committee.

Examples of ensuring people have a positive experience of care include the following:

Recovery Colleges have been set up and run during 2013/14 in both Herefordshire and Gloucestershire. A recovery college provides courses and educational workshops that teach people to become experts in their own recovery and self-care. Through developing knowledge and life skills, students are able to learn more about their condition and treatments and gain the power and resilience to recover and stay well. The colleges offer a relatively new method of recovery for Gloucestershire and Herefordshire, which is seeing great results in other parts of the country. The courses we offer have been co-produced with people with lived experience of psychosis who will also teach on the course and will be called peer trainers.

Target 2013-14

Carers Assessments 100% Overall Compliance 90%

“It’s the best group I’ve been part of. It’s been quite a hard journey, and it’s made me realise I’m still on a journey, but it’s helped me on the path to getting better.” (age 41)

“Being with a group of people similarly affected by enduring mental health problems makes you feel more hopeful and less on your own. It makes you feel you can take control of your life and do useful things. It’s a totally different way of doing things.” (Age 28)

“It’s been brilliant. The saying knowledge is power is very true. The more you know, the less fearful you are and the more you feel able to manage your own condition.” (Age 57)

a)

105

Feedback from Recovery College students provided to 2gether’s Communication Team has been overwhelmingly positive and some examples are provided below:

b) During the year, the Social Inclusion team have been involved in facilitating:

Mental Health awareness training for health care assistants at Gloucestershire Hospitals Foundation Trust in conjunction with an Expert by Lived Experience. Delivered session to 30 participants, intended to raise awareness of the working with individuals with mental health needs in a physical hospital setting through the sharing of patient experience storiesEmotional Wellbeing program for Elder Asian Ladies. This aimed to increase awareness of common mental health needs, access to services and emotional wellbeing strategies. This group is now being supported to engage in further activity with Adult EducationDevelopment of Equality and Diversity program for mental health for co-delivery with Gloucester CollegeAdvertising and promotion of resilience training for Children and Young Peoples Service and partners through locality networks. This will enhance the skills of staff and volunteers working in this field when dealing with challenge emotional issuesDepartment of Work and Pensions vocation seminar: providing over view with key partners of the service providing locally for those who experience mental ill health and wish to secure vocational opportunityPartnership working with Carer’s Gloucestershire to enhance the ‘Mental Health Voice’ forum to ensure it is productive and able to articulate service experience effectivelyPanel membership at Rednock Secondary school feedback to A level Psychology students on Mental Health projects.

c) The Managing Memory 2gether Team Gloucestershire, presented at the following events during Quarter 2:

Age UK 20/8/13 – Talk to the Home from Hospital TeamDementia Link Workers – 19/8/13Let’s Get Together Social Groups for people with memory problems and dementia – Cam 4/9/13 & Wotton under Edge 11/9/13Gloucestershire Rural Community Council In touch events (Dementia focus) Moreton in Marsh 17/9/13 and Cirencester 18/9/13Protected Learning Event for GP’s in Tewkesbury.

Complaints

A total of 159 complaints were received and recorded by the Trust between the 1 April 2013 and the 31st March 2014. This represents an 8% increase in number from the previous year (n=147; see Figure 4).

In real terms, this represents a slightly higher number of complaints as 2013/14 figures do not include complaint figures for Gloucester Prison HealthCare or for Gloucestershire Substance Misuse Service as we ceased providing these services prior to the start of the year (if we exclude historical complaints from these services, in 2011/12 there would be 9 fewer complaints than shown, and in 2012/13 there would be 6 fewer complaints). However, during Quarter 2, five complaints were withdrawn so the figure could more accurately be considered as 154 complaints. The five complaints withdrawn occurred when the individual complainants were further along in their recovery.

Variations in contracted service provision should also be taken into account when reviewing Figure 5. For example, in 2010/11 the Trust was not providing services in Herefordshire. In addition, over the last three years there has been more emphasis on encouraging people to express their complaints and concerns.

106

180

135

90

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Figure 5 – Annual Number of Complaints

2009/10 2010/11 2011/120 2012/13 2013/14

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There has been an improvement in the times to acknowledge complaints with 96% (n=153) of complaints being acknowledged within the three day time standard during 2013/14. Also there has been ongoing development work to improve the timeliness of responses to complainants, keep them informed if there are delays, and processes to determine if they were satisfied with the responses provided.

This year, the number of complaints that took over 60 days to resolve remained constant at 29% (n=46), in many instances this reflected the complexity of the investigation that some complaints require.

All complainants, in their formal response letters from the Trust are invited to contact the Service Experience Team if they feel their complaint remains unresolved or if they are unhappy with our response. They then have the opportunity to continue to engage with us through resolution meetings.

This year, there were 22 Local Resolution Meetings representing 14% of the complaints recorded. On this basis, 86% (n=137) of complaints responses appear to have resolved the complainants concerns (this percentage also includes complaints which have been withdrawn).

Three cases were referred to the Parliamentary Health Services Ombudsman which is two less than last year. Two of the cases have been closed and one is outstanding.

The quarterly Service Experience Report to the Trust Board outlines in detail the themes of complaints, the learning and the actions that have been taken. Learning from complaints, concerns, compliments and comments is essential to the continuous improvement of our services.

108

SafetyDomain 5: Treating and caring for people in a safe environment and protecting them from avoidable harm

Protecting service users from further harm whilst they are in our care is a fundamental requirement. We seek to ensure we assess the safety of those who use our services as well as providing a safe environment for service users, staff and everyone else that comes into contact with us. In this domain, we have set ourselves 2 goals to:

Minimise the risk of harm to people who use our services Ensure the safety of patients detained under the Mental Health Act.

There are 2 associated targets.

Target 5.1Reduce the number of serious incidents as a proportion of patients on the Trust’s caseload to an annual average of 0.2 incidents per 1000 caseload.

A serious incident requiring investigation11 is defined as an incident that occurred in relation to NHS‐funded services and care resulting in:

Unexpected or avoidable death of one or more patients, staff, visitors or members of the publicSerious harm to one or more patients, staff, visitors or members of the public or where the outcome requires life‐saving intervention, major surgical/medical intervention, permanent harm or will shorten life expectancy, or result in prolonged pain or psychological harm (this includes incidents graded under the NPSA definition of severe harm)

A scenario that prevents or threatens to prevent a provider organisation’s ability to continue to deliver health care services, for example, actual or potential loss of personal/organisational information, damage to property, reputation or the environment, or IT failureAllegations of abuseAdverse media coverage or public concern for the organisation or the wider NHSOne of the core set of ‘Never Events’ as updated on an annual basis.

We report, investigate and learn from all such incidents, and additionally we try to understand if the rate of such events is increasing or decreasing. We believe that if the rate decreases, and is sustained at a reduced rate over time, that this can be attributed to the delivery of high quality, consistent care. We set ourselves a target to reduce the number of serious incidents as a proportion of service users on our caseload to an annual average of 0.2 incidents per 1000 caseload.

Figure 6 charts our reporting rate over a 3 year period. The monthly rate is shown via the blue line and clearly identifies the variation in reporting rates on a monthly basis. The annual rate is shown by the green line and reveals an average of 0.27 incidents per 1000 service users on the caseload for 2011/12, and an average of 0.25 incidents per 1000 service users on the caseload for 2012/13. The average rate during 2013/14 was 0.18 serious incidents per 1000 service users on the caseload and is therefore lower than the target rate of 0.2 incidents shown by the red line. This provides good assurance that staff are vigilant in their efforts to minimise harm to service users.

We met this target

0.60

0.45

0.30

0.15

0.002011/12 2012/13 2013/14

Rat

e Monthly RateTarget RateAnnual Rate

Figure 6 – Serious Incident Rate per 1000 Caseload

11National Patient Safety Agency: Information resource to support the reporting of serious incidents. August 2010

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Serious Incidents Reported during 2013-14

During 2013-14, 44 serious incidents requiring investigation were reported by the Trust, and the types of incidents reported are seen in Figure 7. This year sees a reduction in the numbers of reported serious incident from previous years, 66 were reported during 2011-12 and 61 were reported in 2012-13. The most frequently reported serious incidents are “suspected suicide” and attempted suicide. This is consistent with previous years and provides a clear indication that suicide prevention must remain a key priority for us. As identified in Target 1.1 on page 23 we will continue to focus on this crucial area. Figure 8 shows a 3 year comparison of reported serious incidents.

Two homicides were reported during 2013-14. Both of these related to tragic incidents in which the perpetrators were no longer in contact with services and did not meet the criteria for independent mental health homicide investigations. One of these incidents was closed during the year with no further action required and one will be investigated under the auspices of the Multi-Agency Statutory Guidance for the Conduct of Domestic Homicide Reviews. This is a police led process in which the Trust will fully participate.

There have been no Department of Health defined “Never Events” within the Trust during 2013-14. Never Events are serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented.

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Figure 8 – Serious Incidents by Type 2011-2014

2013/142012/132011/12

Suspected SuicideAttempted suicideFall causing fractureDeliberate self harmNatural cause deathHomicideSerious assultUnexpected deathArson

22103312111

Figure 7 – Serious Incident Type 2013-14

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Target 5.2Reduce the number of patients who are absent without leave from inpatient units who are formally detained under the Mental Health Act by 50%.

We are committed to protecting service users from further harm whilst they are in our care and we are aware of the particular vulnerability of patients who are detained under the Mental Health Act. Some patients do abscond or do not return from agreed leave whilst in our care, and we refer to this as being ‘Absent without Leave’ (AWOL) in accordance with the Mental Health Act Code of Practice12 (22.2) specific definitions.

Our aim in 2013/14 was to reduce the number of patients who are absent without leave from our inpatient units who are formally detained by 50%. In order to reduce the numbers of detained patients who abscond, the Trust has been reviewing how many people abscond from our wards and looking at specific initiatives to reduce this occurring. Our learning from work on specific wards over the year includes:

Determining if there are certain factors on admission to hospital that make a person more likely to abscond e.g. concerned about their home or pets whilst in hospitalTaking pro-active steps to reduce the risk by resolving the person’s concernsBeing clear about the expectations of ward staff in relation to knowing at all times where patients areHaving a sign in/sign out boardProviding “Leave” cards detailing the time of return, contact details and providing clarity regarding the pre-leave agreement

Using Safety Cross methodology to log AWOLs by the ward staff to visually promote knowledge of frequency of reported AWOLs and raise team awarenessProviding Pay As You Go mobile phones to communicate as required if the patient leaving the ward does not have credit on their own phone

We are sharing the learning across many organisations now as part of the collaborative NHS South of England Mental Health Patient Safety Programme. The Patient Safety Programme is developmental in its approach and testing new ideas on a small scale is used to find successful solutions.

We have reviewed the number of incidents that occur when a detained patient absconds or does not return from leave when agreed. We have not met the target as there is a rise in the reported incidence however we are aware of improved reporting in specific categories since we have been focussing upon this area, and reporting has since become more accurate, consistent and robust.

The baseline, against which reduction was measured, was 53, which was the total number of reported incidents in 2012/13. The total number of detained patients reported as being absent without leave during 2013/14 was 110 and whilst we did not meet our target, the reported incidents did not lead to patient harm.

2012/13 2013/14

Quarter 1 15 23

Quarter 2 9 25

Quarter 3 5 24

Quarter 4 24 38

Totals for year 53 110

As we did not achieve this target but have established greater confidence in our reporting processes, this will continue as a quality indicator in 2014/15.

12Code of Practice: Mental Health Act 1983 (2008 Revised)

Gloucestershire These wards work 3 shifts in 24 hours

Herefordshire These wards work 2 shifts in 24 hours

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Safe staffing levels

The National Quality Board, sponsored by Jane Cummings, Chief Nursing Officer in England, published new guidance in November 2013 to support providers and commissioners to make the right decisions about nursing, midwifery and care staffing capacity and capability: ‘How to ensure the right people, with the right skills, are in the right place at the right time : A guide to nursing, midwifery and care staffing capacity and capability’.

In line with this guidance, the Trust published its planned and actual staffing levels on each ward from the beginning of February 2014. The staffing levels were all reviewed during 2013. We will be reporting the achievement of the staffing levels by ward on the Trust website from May 2014.

The agreed minimum staffing levels of each ward, as of April 2014 are outlined below. There are increased numbers of staff to reflect patient need.

Ward Early Late Night

Qualified Unqualified Qualified Unqualified Qualified Unqualified

Dean 2 3 2 3 2 1

Abbey 3 2 3 2 2 1

Kingholm 2 3 2 3 2 1

Priory 3 2 3 2 2 1

Greyfriars 3 3 3 3 2 2

Montpellier 2 3 2 3 2 2

Willow 2 5 2 5 1 3

Chestnut 2 3 2 2 1 2

Mulberry 2 4 2 3 1 2

Laurel House 2 1 1 2 1 1

Honeybourne 2 1 1 2 1 1

Westridge 2 3 2 3 1 3

Hollybrook 2 6 2 6 1 5

Ward Day Night

Qualified Unqualified Qualified Unqualified

Mortimer 3 2 2 2

Jenny Lind 2 1 1 1

Cantilupe 2 3 2 1.5

Oak House 1 1 1 1

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The Trust is committed to publishing the exceptions to planned staffing numbers on each shift. A pilot was run during February 2014 on the methodology which is outlined below. During February 2014, there were 1,428 shifts (Herefordshire units work 12 hour shifts this table assumes their day time shift equates to 2 shifts).

In summary:There were no exception reports where the staff on duty for any shift did not meet the needs of the patients86% of the shifts exactly complied with the planned staffing levels11.4% of shifts during February had a lower staff skill mix than we had planned, however the staffing numbers were compliant. This was a reduction in qualified staff by 1 per shift with an increase of health care assistants, with the ward managers’ assessment being that the staffing met the needs of the patients2.6% of shifts during February had a lower number of staff on duty than we had planned, however this met the needs of the patients on the ward at the time.

Exception Code 1

Exception Code 2

Exception Code 3

Exception Code 4

Exception Code 5

Ward

Bed number

Number of fully

compliant shifts in

the month

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numbers met – skill mix non compliant but met needs of

patients

Minimum staff numbers not compliant but met needs of

patients

Minimum staff numbers met – skill mix non-compliant and did not meet

needs of patients

Minimum staff numbers not compliant did

not meet needs of patients

Other

GloucestershireDean 14 84/84 0 0 0 0 0

Abbey 18 84/84 0 0 0 0 0

Priory 22 51/84 32 1 0 0 0

Kingsholm 15 84/84 0 0 0 0 0

Montpellier 12 84/84 0 0 0 0 0

Greyfriars 10 68/84 15 1 0 0 0

Willow 16 81/84 0 3 0 0 0

Chestnut 14 60/84 0 24 0 0 0

Mulberry 18 82/84 2 0 0 0 0

Laurel 12 6784 17 0 0 0 0

Honeybourne 10 64/84 20 0 0 0 0

Westridge 8 59/84 25 0 0 0 0

Hollybrook 8 58/84 25 1 0 0 0

Herefordshire Mortimer 21 82/84 2 0 0 0 0

Jenny Lind 8 82/84 2 0 0 0 0

Cantilupe 10 53/84 24 7 0 0 0

Oak House 10 84/84 0 0 0 0 0

Total 1227/ 1428 164 37 0 0 0

Mental Health Patient Safety Programme

Since January 2011, 2gether NHS Foundation Trust has been involved in the NHS South West Quality and Patient Safety Improvement Programme for Mental Health. The NHS South of England and the Institute for Healthcare Improvement (IHI), an international body, have revised the safety programme with some original and new aims to be achieved by March 2015, and are facilitating this programme for Mental Health, which is being led by a collaborative “faculty”.

Shaun Clee, Chief Executive for 2gether NHS Foundation Trust, is the lead Executive for this programme, across the South of England. The South of England programme is currently funded until September 2014.

The Berwick report “A promise to Learn a Commitment to Act” has been reported on frequently within the Trust, and this year NHS England has announced a proposal to establish and support 15 Patient Safety Collaboratives as a key element of the wider National Patient Safety Plan in England.

The aims of this are to deliver definitive improvements in specific patient safety issues over the next five years as a minimum and build local capability and energy for change.

The overall aim of the NHS South of England Patient Safety Programme is to reduce avoidable harm to inpatients and community patients in our care, by making improvements in the way we work, and thereby improving the patients’ experience of what is provided.

Harm reduction to users of mental health services is achieved by focusing improvement efforts on the following work streams:

Senior Leadership for safety Safe and reliable delivery of mental health careGetting medicines rightImproving the physical care of patientsDelivering person and family centred careCommunication and team work.

Progress and development is reported on 6 monthly via the Trust Governance Committee.

We challenge our thinking to keep improving

what we do

Indicators & Thresholds for 2013/2014The following table shows the 10 metrics that are monitored during 2013/14. These are the indicators and thresholds from Monitor and follow the standard Department of Health national definitions. Note that some are also the Trust Quality targets, and some may have more stretching targets than Monitor require as a threshold.

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2011/2012 Actual

2012-2013 Actual

National Threshold

2013-2014 YTD

1 Clostridium Difficile objective 0 1 0 1

2 MRSA bacteraemia objective 0 0 0 0

3 7 day CPA follow-up after discharge 100% 98.6% 95% 99.1%

4 CPA formal review within 12 months 96.6% 95.1% 95% 96.4%

5 Delayed transfer of care 4.2% 0.9% 0.9%

6 Admissions gate kept by Crisis resolution/home treatment services

99% 98.8% 95% 99.1%

7 Serving new psychosis cases by early intervention teams

G127% H114% 100% 95% 100%

8 MHMDS data completeness: identifiers 99.5% 99.7% 99% 99.7%

9 MHMDS data completeness: CPA outcomes 86.9% 79.7% 50% 80.6%

10 Learning Disability – six criteria 6 6 6 6

7.5%

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There are a number of mandated Quality Indicators which organisations providing mental health services are required to report on, and these are detailed below. The comparisons with the national average and both the lowest and highest performing trusts are benchmarked against other mental health service providers.

1. Percentage of patients on CPA who were followed up within 7 days after discharge from psychiatric inpatient care

The 2gether NHS Foundation Trust considers that this data is as described for the following reasons:The Trust performs well against this indicator as staff work hard to provide timely follow up as they are aware that service users are more vulnerable and at higher risk during this timeIn recognition of this awareness there is a local quality target of follow up within 48 hours of discharge from inpatient care.

The 2gether NHS Foundation Trust has taken the following action to improve this percentage, and so the quality of its services by:

Keeping its local quality target of follow up within 48 hours as a key quality target for 2014–15.

Mandated Quality Indicators 2013-2014

Quarter 1 2013-14

Quarter 2 2013-14

Quarter 3 2013-14

Quarter 4 2013-14

2gether NHS Foundation Trust 100% 99.6% 97.7% 98.5%

National Average 97.4% 97.5% 96.7% 97.4%

Lowest Trust 94.1% 90.7% 77.2% 93.3%

Highest Trust 100% 100% 100% 100%

2. Proportion of admissions to psychiatric inpatient care that were gate kept by Crisis Teams

The 2gether NHS Foundation Trust considers that this data is as described for the following reasons:Staff respond to individual service user need and help to support them at home wherever possible unless admission is clearly indicatedDuring 2014/15, crisis teams also gate kept admissions to older people’s services beds within Gloucestershire.

The 2gether NHS Foundation Trust has taken the following action to improve this percentage, and so the quality of its services, by:

Reminding clinicians who input information into the clinical system (RiO) to complete the ‘Method of Admission’ field with the appropriate option when admissions are made via the Crisis TeamReminding clinicians who input information into RiO to ensure that all clinical interventions are recorded appropriately in RiO within the client diary.

Quarter 1 2013-14

Quarter 2 Quarter 3 2013-14 2013-14

Quarter 4 2013-14

2gether NHS Foundation Trust 95.3% 99% 100% 99.5%

National Average 97.7% 98.7% 98.6% 98.3%

Lowest Trust 74.5% 89.8% 85.5% 75.2%

Highest Trust 100% 100% 100% 100%

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3. The percentage of staff employed by, or under contract to, the Trust during the reporting period who would recommend the Trust as a provider of care to their family or friends.

The 2gether NHS Foundation Trust considers that this data is as described for the following reasons:The Staff Survey does not ask this specific question in the 2013 survey, however it does ask whether “staff would recommend the Trust as a place to work or receive treatment” and this Key Finding is made up of three separate and underlying questions, which ask about patient care, recommendation of the Trust as a place to work, if family or a friend needed treatment being happy with the standard of careAgainst each of these individual questions staff responded more positively in 2013 than in 2012 although results remained slightly below the median of like-type trustsA series of Focus Groups and Engagement workshops have been running during 2013 and have sought further feedback from staff on this Key Finding. Feedback from these events has been that staff are complimentary about the care the Trust provides although there is some frustration regarding perceived lack of resources and the amount of time required to complete administrative functions. In general, staff would recommend the services of the Trust. Staff feedback has also been that they would be less likely to recommend the Trust as a place to work because of major change and transformation of services (mainly in 2012), and a perception that communications are poor and staff feel dis-empowered.

The 2gether NHS Foundation Trust has taken the following action to improve this score, and so the quality of its services, by:

Introducing a new intranet in May 2014 to improve communications throughout the TrustChanging the style of our weekly electronic newsletter to make it more interesting and highlight key messagesLaunching a ‘micro site’ in the second quarter of 2014/15 to enable those staff who work off site or remotely to access key Trust information which would otherwise be on our intranet and therefore not easily accessible to themImplementing RiO2, a more streamlined version of our electronic patient record that will lessen the amount of time spent by staff updating data, thereby reducing ‘admin time’Condensing and streamlining the amount of statutory and mandatory training, particularly for front line clinical staff to enable them to spend more time delivering care whilst continuing to receive relevant training and developmentExtending E-learning opportunities to reduce time out of the work placeIncreased monitoring of the Staff Friends and Family test and further highlighting where improvements can be made.

4. “Patient experience of community mental health services” indicator score with regard to a patient’s experience of contact with a health or social care worker during the reporting period.

The 2gether NHS Foundation Trust considers that this data is as described for the following reasons:

The level of assurance is good as the scores for the questions asked in the survey suggest that the Trust’s performance is generally moving in a positive direction. Scores for this indicator suggest that our performance is ‘about the same’ as other similar organisations. The exception to this relates to the question about involvement, and in this domain the score suggests that our health and social care staff are 'better' at taking the views of people into account than other similar organisations during this reporting period. This reflects the work to enhance service experience and involvement that has been and continues to be undertaken.

NHS Staff Survey2012

NHS Staff Survey2013

2gether NHS Foundation Trust Score 3.19 3.46

National Median Score 3.54 3.55

Lowest Trust Score 3.06 3.01

Highest Trust Score 4.06 4.04

* Rate is the number of incidents reported per 1000 bed days.

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NHS Community Mental Health Survey

2012

NHS Community Mental Health Survey 2013

2gether NHS Foundation Trust Score 8.4 8.7

National Average Score Not available Not available

Lowest Score 8.2 8.0

Highest Score 9.1 9.0

The 2gether NHS Foundation Trust has taken the following action to improve this score, and so the quality of its services, by:

Undertaking work to ensure that we maintain and further enhance best experience of our health and social care workers and to fulfil the Trusts Service Experience Strategy (launched in May 2013) to ‘go beyond what people expect of us’. This work is linked with our Service User Charter, Carer’s Charter and Staff Charter. Experience information and inclusion activities are reported in our Quarterly Service Experience report to the Trust Board. A co-produced action plan specifically to consider the results of the Patient Survey was presented to the Trust’s Governance Committee in November 2013. A regular agenda item to actively listen to patient and carer stories has also been introduced to the Board meeting agenda.

5. The number and rate* of patient safety incidents reported within the Trust during the reporting period and the number and percentage of such patient safety incidents that resulted in severe harm or death.

The 2gether NHS Foundation Trust considers that this data is as described for the following reasons:Not all of the Trusts reported incidents meet the criteria for uploading to the National Reporting & Learning Systems (NRLS), for example, whilst the Trust documents all deaths by natural causes within its risk management system it only uploads those in which natural causes are not suspectedNRLS data is published 6 months in arrears; therefore data below for severe harm and death will not correspond with the serious incident information shown in the Quality ReportThe Trust is in the highest 25% of reporters and it is believed that organisations that report more incidents usually have a better and more effective safety culture.

The 2gether NHS Foundation Trust has taken the following action to improve this rate, and so the quality of its services, by:

Including additional local guidance within the Trust’s Incident Reporting Policy to assist staff in classifying categories of harmUndertaking a detailed internal audit of its Incident Reporting Systems to ensure effective processes are in place for the timely review and approval of, and response to reported patient safety incidents.

October 2012 – March 2013 April 2013-September 2013

Number Rate* Severe Death Number Rate* Severe Death2gether NHS Foundation Trust

1,551 38 3 14 1,500 33.16 2 13

National 112,252 - 588 897 122,523 - 442 1,106

Lowest Trust 3 0 0 0 0 0 0 0

Highest Trust 6,737 52.1 122 59 6,609 67.06 36 76

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Community Survey 2013During 2013, the CQC published results of an independent survey taken in 2013 that tested the experience of our community service users, comparing the results with most other mental health trusts. 2gether NHS Foundation Trust received one of the highest percentage response rates in the country to the questionnaire at 33% returned. Full details of this survey can be found on the CQC website

http://www.cqc.org.uk/public/reports-surveys-and-reviews/surveys

Across each of the nine domains in the survey our scores were reported as ‘About the Same’ as other trusts. The results are tabulated below together with the scores out of 10 for 2gether Trust calculated by the CQC. The scores are broadly the same as other trusts

Table 3: 2gether’s scores compared with scores of other trusts

Score (out of 10)

Domain of questions How the score relates to other

trusts

8.7 Health and Social Care workers Same as others

7 Medications Same as others

7.3 Talking Therapies Same as others

7.6 Care Coordination Same as others

6.7 Care Plan Same as others

7.1 Care Review Same as others

6.1 Crisis Care Same as others

5.2 Day to Day Living Same as others

6.8 Overall Same as others

These results are an improvement from last year’s results. In 2012, Talking Therapies was scored within the ‘Worst performing trusts’ category and it has now improved to ‘Same as Others’, which is in line with our other results.

In only three of the specific question areas our results differed from other trusts with statistical significance. Specifically patients in the sample rated that 2gether NHS Foundation Trust staff are significantly:

Better at taking patient views into accountBetter with providing enough support for patients they need it with financial advice or benefitsWorse at asking about patients’ use of non-prescription drugs.

When the results are considered further for areas where improvements could be made, there are important areas to consider within our action planning process. These include:

the explanations provided to people about the medications that they are prescribedsystems to help people identify, understand and be involved in developing their care planSupporting inclusion within the care review process.

Whilst these questions do not have significant score differences from other trusts in this survey, they are areas that people report through other forms of service experience feedback and are worthy of our further practice development activity and focus.

Work is underway to extrapolate data from the Quality Health scores to give a more detailed indication of participant responses from the separate counties of Herefordshire and Gloucestershire. This will enable targeted actions if there are differences in experiences between the two counties. There are agreed action plans now in place.

The demographic results of the survey suggested that very few people from minority groups or communities responded to the survey invitation. The results will be feedback to the Social Inclusion Team in order that to continue to encourage feedback from people who are less seldom heard.

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Each year the Trust takes part in the National NHS Staff Survey as commissioned by the Department of Health. The survey is an opportunity to understand how our staff view the Trust as an employer compared with the staff pledges contained in the NHS Constitution. The 2013 survey took place during September and November 2013. The results were released in February 2014.

As in the previous year’s survey there were 28 Key Findings so the results from this year are directly comparable with those of the 2012 survey. Of the 28 Key Findings staff told us that there had been no significant change in 25 of them compared to the previous year but more detailed analysis showed there have been small improvements in most (26) of the Key Findings. For 3 Key Findings staff told us there had been clear improvements.

When compared with like-type trusts in the 28 key areas, with the previous year’s figures shown in brackets, we were:

In the best 20% in 2 areas (0)Better than average in 3 areas (3)Average in 10 areas (7)Worse than average in 9 areas (7)In the lowest 20% in 4 areas (11)

The previous year’s figures are shown in brackets. The comparison with last year demonstrates some signs of improvement in that we reduced the number of areas in the worst or lowest 20% category, and in the average or above results we had 15 areas compared with 10 in the previous year. In addition our response rate for the 2013 survey was 56% compared with 48% the previous year. We believe this is an indicator of improved engagement with staff.

The five key findings for which the Trust compares most favourably with other mental health/learning disabilities trusts in England were:

Staff believing the Trust provides equal opportunities for career progression or promotionEffective team workingStaff feeling pressure in last 3 months to attend work when feeling unwellStaff experiencing physical violence from staff in last 12 monthsStaff saying hand washing materials are always available.

The five key findings for which the Trust compares least favourably with other mental health/learning disabilities trusts in England were:

Staff reporting good communication between senior management and staff*Staff having Equality and Diversity training in last 12 months*Staff receiving job-relevant training, learning or development in last 12 months*

Staff feeling satisfied with the quality of work and patient care they are able to deliver*Staff experiencing physical violence from patients, relatives or the public in last 12 months.

The above five key findings include the four areas* where the Trust featured in the lowest 20% of like-type trusts.

The key findings where the Trust’s results were worse than average when compared with like-type Trusts were:

Staff agreeing that their role makes a difference to patientsWork pressure felt by staffStaff suffering work related stress in the last 12 monthsStaff experiencing physical violence from patients, relatives or the public in the last 12 monthsStaff experiencing harassment, bullying or abuse from patients, relatives or the public in the last 12 monthsStaff feeling able to contribute toward improvements at workStaff job satisfactionStaff recommendation of the Trust as a place to work or receive treatmentStaff motivation at work.

It should be noted that although the Trust remains below average in the key findings shown above, statistically speaking there has been no change since the previous year, although analysis of the survey shows that there have been improvements in all but one of these key findings. The exception is the percentage of staff experiencing physical violence from patients, relatives or the public in the last 12 months. This key finding has been identified as a key priority for the Trust. The survey also shows that there has been a statistically significant improvement to staff recommending the Trust as a place to work or receive treatment.

The Trust has been pro-active in the six months between the release of the 2012 results and the commencement of the 2013 survey with activity overseen by the new Workforce and Organisational Development Committee. Staff are encouraged to attend regular monthly engagement workshops that take place around our many sites to discuss their concerns.

Team Talk – our monthly managers meeting has been changed following their feedback, so that the primary focus is on those issues of interest and concern to them. This ensures the process is ‘bottom up’. We have continued with engagement programmed since the Staff Survey closed and during January to March, all staff have been invited to attend a series of ‘Talk Back’ sessions to discuss the challenges and opportunities that lie ahead.

Staff Survey 2013

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The Trust Board has approved a set of recommendations which will enable us to respond to the outcome of the 2013 survey. Three key findings have been set as priorities for the coming months. These are

Staff receiving job-relevant training , learning or development in last 12 monthsStaff feeling satisfied with the quality of work and patient care they are able to deliverStaff experiencing physical violence from patients, relatives or the public in the last 12 months

These topics will always be on the agenda at staff engagement workshops for colleagues to give their opinions and identify actions that can be taken to make a difference. The Trust has also agreed to continue with the actions we prioritised from 2012 to ensure we do not lose momentum in these areas and continue with the good progress already made.

Specific actions have already been identified such as a full review of statutory and mandatory training with the aim of streamlining and condensing courses and increasing opportunities for e-learning. We will be monitoring feedback for the quarterly Staff Friends and Family Test that commences in April 2014 and asking staff what actions can be taken to increase their satisfaction with the quality of work and care they are able to provide.

Protocols and systems are being reviewed for dealing with violent behaviour towards staff and this will be overseen by our Occupational Health and Safety Committee.

We will also be ensure that the progress made on the three key priorities from the previous year, communications between staff and senior management, stress at work and recommending the Trust as a place to work or receive treatment is maintained. Following much feedback from colleagues, our new intranet will go live in May 2014 and will provide a means of better communications and will be a source of relevant easy to find information.

Engagement workshops, structured conversations and anonymous online surveys are very much a part of Trust life and will continue as a means to seek the ideas of our staff as to how we can improve our services and ensure our Trust is the first choice as a place to work or to receive treatment.

We are committed to working with staff side representatives to improve the working environment and we will continue to understand from managers what additional support they require as our new leadership and development programme gets underway.

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PLACE assessments are Patient-Led Assessments of the Care Environment (PLACE) which have replaced the old Patient Environment Action Team (PEAT) inspections. The assessments will apply to hospitals, hospices and day treatment centres providing NHS funded care.

Good environments matter. Every NHS patient should be cared for with compassion and dignity in a clean, safe environment. Where standards fall short, they should be able to draw it to the attention of managers and hold the service to account. PLACE assessments provide motivation for improvement by providing a clear message, directly from patients, about how the environment or services might be enhanced. PLACE inspections were undertaken at all Inpatients Units within the Trust during May and June 2013 and the published results are overleaf.

PLACE Assessment Results 2013/14

Blue = Above National Average ScoreRed = Below National Average Score

Site % Cleanliness% Food and Hydration

% Privacy Dignity and Wellbeing

% Condition, Appearance and

Maintenance

Charlton Lane 98.02 87.93 90.15 90.00

Hollybrook 93.79 73.52 92.80 86.36

Honeybourne 99.40 79.11 83.33 89.42

Laurel 98.84 82.30 88.89 85.58

Oak House 97.30 0 78.06 54.90

Stonebow 98.49 81.41 87.78 88.60

Westridge 96.07 88.08 84.17 83.93

Wotton Lawn 98.83 82.75 90.93 94.17

AVERAGE 97.59 82.16 87.01 84.12

MEDIAN 98.26 82.30 88.34 87.48

MAX 99.40 88.08 92.80 94.17

MININUM 93.79 73.52 78.06 54.90

n/a but scored as

National Results - 2013 The national average score for Cleanliness was 95.74%. The national average score for Food and Hydration was 84.98%. The national average score for Privacy, Dignity and Wellbeing was 88.87%.The national average score for Condition, Appearance and Maintenance was 88.75%.

Highest Score Lowest Score Inter-Quartile Range2

Cleanliness 100% 24.46% 94.71% - 99.38%

Condition, Appearance and Maintenance

100% 36.25% 82.95% - 92.71%

Privacy, Dignity and Wellbeing

100% 52.26% 82.36% - 93.13%

Food and Hydration 100% 26.67% 83.62% - 92.73%

The scores received were outlined in the following categories:

Cleanliness: These scores were viewed favourably with the minimum being 93.79% and the Maximum 99.40%, Matrons were particularly pleased as this is a key element of the Matrons Charter.

Food: The scores in the area of Food were lower than expected in comparison to feedback on the day of the inspections. It is felt that pre-visit forms required for completion were designed for acute inpatient hospitals standards and did not take into account the flexible patient centred nature of food provision in our units.

Privacy and Dignity: Scores ranged from 78.06% to 94.17 %. It is felt that some points were lost in regard to the requirement for anti-ligature fittings for example shower curtains which are rarely used.

Condition appearance and maintenance: Oak House was the only area that scored poorly which was not unexpected because of the management arrangements for the building, whereby the Trust is unable to influence investment or maintenance. It is a building that we acquired when we took over provision of Mental Health Services in Herefordshire and recognise that it does not meet the high standards that we would usually expect. We are actively involved in ongoing work with the commissioners to ensure that changes are made that improve the appearance and maintenance of the building and, therefore, the experience of people who use it.

Action plans have been developed for each unit to ensure that all areas identified as a concern are addressed and will be monitored by the Matrons.

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Annex 1: Statements from our partners on the Quality Report

Gloucestershire Clinical Commissioning Group

NHS Gloucestershire CCG Comments inResponse to 2gether Quality ReportNHS Gloucestershire Clinical Commissioning Group (CCG) welcomes the opportunity to provide comments on the Quality Report prepared by 2gether NHS Foundation Trust (2g) for 2013/14.

We are very pleased that 2g have worked jointly with partnership organisations, including the CCG during 2013/14 to maintain and further develop and improve the quality of commissioned services and outcomes for patients. It would have been good to have seen this referenced in the report.

As the 2013/14 Quality Report clearly demonstrates, 2g has been open and transparent regarding challenges and concerns. We were very pleased to be invited to attend the Trust Governance Committee meetings, and the CCG would like to acknowledge this transparency. The Trust has been supportive of, and engaged with the joint development of the Mental Health Clinical Programme Group, which aims to achieve the best possible quality outcomes and value for the population, patients and carers within the limited resources available.

2g have demonstrated improvement in the safety, effectiveness and patient experience of mental health and learning disability services provided. The CCG would wish to see particular focus on continuing improvement in these areas for 2014/15. Whilst there is a positive perspective on achievement of targets in 2013/14 within the report, there are a number of areas where targets were not achieved, and it would be helpful to reflect a slightly more balanced view.

We are pleased to note the reduction in the number of serious incidents reported. However, timely resolution of recommendations and implementation of actions arising from investigations, so ensuring learning from incidents is embedded across the Trust, would inform the continuous development and improvement of the patient quality and safety experience. In terms of data quality it is noted whilst 2g has identified DATIX as a major risk, there is no reference included within the report. We also note that there is no reference to the Review of Crisis Services commissioned by the CCG which commenced in 2013, and we would wish to see reference to this review included within the final report.

The CCG acknowledge 2g’s continued strong focus on patient and carer experience and quality of caring, which demonstrates a joint commitment to delivering high quality, compassionate care, and also dignity and respect with which service users are treated. The CCG would welcome increased use of staff and patient stories to promote and inform learning, and emphasis on care and compassion in practice. We are pleased to note a slight increase in staff

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satisfaction and 2g will need to maintain a focus on improving communication with its staff.

We were pleased to note an increased level of clinical participation in local clinical audits. However, were disappointed to note a significant decrease in participation in Clinical Research, which we would like to see improved for 2014/15.

There are robust arrangements in place with 2g to agree, monitor and review the quality, safety and effectiveness of services and engagement with patients and carers. The Clinical Quality Review Group continues to meet on a quarterly basis and brings together GPs, senior clinicians and managers from both 2g and CCG. We have received assurance throughout the year from 2g in relation to key quality, safety, effectiveness and patient and carer engagement issues, both where quality and safety has improved and where it occasionally fell below expectations, with remedial plans put in place and learning shared wherever possible.

The priorities for 2014/15 have been developed in partnership, and the quality priorities identified demonstrate a high level of engagement between the CCG and 2g. However, as stated above we would wish to see more of a focus on wider partnership working with other NHS and voluntary sector organisations. 2g are engaged in partnership working with the Local Authority and Voluntary sector bodies in Gloucestershire through the Health and Wellbeing partnership arrangements, but there is no reference to this within the report. The CCG is pleased with the approach taken by 2g, which is reflected in the Quality Report, to persist with and reinforce the values of honesty, transparency and effective engagement with stakeholders. Upholding these values ensures that the population of Gloucestershire will maintain trust and confidence in these core NHS services. 2g need to be in a strong position to manage both present and future challenges, and to work with the CCG to deliver mental health and learning disabilities services that provide best value and quality, safe and effective care for the people of Gloucestershire. Gloucestershire CCG fully endorse the proposals set out in the Quality Report whilst acknowledging the very difficult financial challenges 2g have to address. Gloucestershire CCG confirms that we consider the Quality Report to contain accurate information in relation to the quality of services that 2g NHS Foundation Trust provides to the residents of Gloucestershire and beyond.

Jennifer SangerSenior Quality Manager13.05.14

Healthwatch Gloucestershire (HWG) commentson the 2gether FT Quality Report 2013/14

Thank you for the opportunity to comment upon and contribute to the Trust’s Quality Report. We can confirm that an early draft was shared with us and that there was a useful opportunity to consider detailed content, ask questions and to make suggestions. This approach from the Trust characterises what we at HWG have seen as an approach that welcomes feedback about services. The comments that follow have been made by a number of HWG board members and they have been informed by comments that we have received from the public during 2013/14 about services provided by the Trust, which we have shared with them and with the Clinical Commissioning Group (CCG). In future years we hope to extend the range of people that will work with us to consider the Quality Report.

General comments

Healthwatch Gloucestershire is a new organisation, which has worked since April 2013 to gather and represent the views of people who live in Gloucestershire about their health and social care, and then to communicate them to those organisations that provide services, in this case the 2gether Trust. Our contribution to this Quality Report is one of several ways in which we work with the Trust to provide independent, regular and continuous feedback from the public.

We have established a sound working relationship with the Trust in our first year, enabling information to flow from the public to the Trust, which, in turn, forms part of its continuous examination of the quality of patients’ experience of their care. In 2014/15 we look forward to developing a greater range of contacts with the Trust, organising more visits to its services, and becoming more involved in the development of its clinical, quality and patient experience strategies.

HWG welcomes the very clear and prominent commitment in this Report to achieving the best user experience, whether that is by using surveys, examining comments or hearing patient stories.

We thought that the Report was an accessible and readable one. Expressions such as “making life better” are unambiguous and clear to the reader. We were pleased that it is easy to see which of the targets were met, entirely or partly, and which not met, and we appreciated this being said in straightforward language.

In the latter part of the Report, the detailed explanations of performance, longer term trend information and visual representations were comprehensive and informative. However, at times the separation of summary information from detailed explanation can be confusing.

Priorities and Performance in 2013/14

The Report contains a great deal of detailed information about which we have been able to ask questions and seek clarification. We have highlighted a small number of the performance indicators for comment. As a general point it would be helpful in future if some of the data sets could be presented in such a way that historical trends can be seen even within the summaries. In this way readers can see current year performance in context and identify longer-term performance patterns. (The presentation from page 24 is informative in this respect.)

Also, where a target was not met, e.g. 1.1, the summary commentary could include a statement as to when it is anticipated that the 90% intention regarding annual physical checks will be met.

It is not easy for the general reader to gain a sense of the relative significance of failure to reach particular targets. What is the risk associated with such failure? While it would be desirable to achieve all the objectives that had been set, presumably greater risk is attached by the Trust to missing some compared to others? Could some form of rating or colour-coding be considered in future so that the relative impact and importance of a missed target can be better understood?

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Falls Prevention Work

It was not easy to determine whether or not the target in respect of the number of falls was achieved.

User Experience

The results of the surveys concerning involvement were below national averages. We have discussed whether survey questions are necessarily the most appropriate way to obtain such evidence, nevertheless it would be useful to see some trends as to whether these satisfaction levels are improving and over what timescale the Trust is anticipating to match and/or exceed average performance. We were pleased to see that these areas have specific commissioning focus in 2014/15.

Safety: Minimise the risk of suicide (3.1)

What was the reported level and what is the historical data to enable the 2013/14 performance to be understood within a wider context? This is an example where it would be helpful if summary and detailed explanation might be reported together.

Ensure safety (3.2)

Similarly, it is difficult to understand the reported performance in the absence of the original target and any historical data.

2013/14 CQUIN goals

It would be useful to show achievement of CQUIN at the level of individual schemes rather than simply at an aggregated level.

Complaints

The Report provides information about the number of complaints and processes associated with responding to and reporting them. Given the importance of learning from complaints, would it be possible for their broad themes to be summarised and reported in future Quality Reports?

The PLACE assessment provides an important opportunity to hear how services are seen from the patients’ perspective. We very much hope that those sites that are showing below average assessed scores can be improved as urgently as possible.

Staff Survey

The results of the survey are a cause for concern, particularly as they relate to levels of training and development. We welcome the high priority that this area will continue to receive in 2014/15.

HWG identified some key themes in its feedback to the Trust during the year, which was based on a relatively small number of comments from the public. These included concerns over time taken to access some services; lack of joined up care, especially between police, GP and Trust services; and concerns about discharge from mental health services and on-going support. We also received specific compliments about the quality of dementia care provided by the Trust.

Claire FeehilyChair, Healthwatch Gloucestershire12 May 2014

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Gloucestershire Health and Care Overview and Scrutiny Committee

Comments on the 2gether Trust NHS Foundation Trust Quality Account 2013/14

On behalf of the Health and Care Overview and Scrutiny Committee I welcome the opportunity to comment on the 2gether NHS Foundation Trust Quality Account 2013/14. As a newly elected county councillor and newly appointed Chairman of the (new) Health and Care Overview and Scrutiny Committee (HCOSC) I have valued the attendance of the Trust at committee meetings to contribute to debate and respond to members’ questions. During the course of this year the committee has developed a constructive working relationship with the Trust and I hope that this will continue. I would particularly like to thank Ruth FitzJohn and Shaun Clee for attending meetings and responding to member’s questions.

Ensuring that patients are safe, receive effective care and that they are listened to are important factors in patient care and it is therefore good to see that these are the priorities for the Trust.

County councillors are concerned that the reported levels of suicide and self harm in Gloucestershire have been above the national average. The committee focussed its January 2014 agenda on this matter and the 2gether Trust along with Public Health representatives were key witnesses in this debate. This is a complex issue and the committee agreed that the Trust’s evidence demonstrated that it is proactive in this regard; although it is of course disappointing that there were 22 reported suspected suicides in 2013/14 which means that the Trust did not meet its target. It is therefore important that the Trust continues to keep suicide as a key quality target and it is good to see that this is reflected in this Quality Account.

I am concerned with the findings of the staff survey and welcome that the Trust Board has approved a set of recommendations that will enable the Trust to respond to the issues raised by this survey.

I know from the attendance of the Trust at meetings of the committee that it is committed to promoting and improving mental health. However due to the structure of this document it is difficult to understand how the work of the Trust translates into positive health outcomes for patients and service users.

Cllr Steve LydonChairman 09.05.2014

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HerefordshireClinical Commissioning Group

NHS Herefordshire CCG Comments

Herefordshire Clinical Commissioning Group (CCG) is pleased to receive 2gether NHS Foundation Trust quality account for 2013/14 which provides an overview of the quality of services during the period, and sets out priorities for the forthcoming year.

Following a review of the information presented, coupled with commissioner led reviews of quality across all providers, the CCG is satisfied with the accuracy of the report. This recognises the Trust commitment to quality and demonstrates further development which mirrors the aspirations of commissioners.

With commissioning priorities which reflect the national focus on parity of esteem, the CCG support all measures intended to improve delivery against access standards alongside the commitment to follow up after discharge which is recognised to deliver improved outcomes for service users.

Herefordshire CCG has set out a quality framework which includes assurance visits and regular quality review meetings between provider and commissioners to scrutinise and challenge quality. We look forward to continuing this work during the coming year to ensure the delivery of high quality, high performing and safe services for the residents of Herefordshire.

Yours sincerely,

David Farnsworth Executive Lead Nurse Herefordshire CCG12.05.2014

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Re: 2gether FT Quality Accounts 2013/14

Healthwatch Herefordshire is pleased to be asked to comment on the Annual Quality Report. After consideration Healthwatch Herefordshire would like to give the following feedback on observations on the 2gether Draft Quality Account:

HWH has been impressed by 2g's openness and willingness to share information with HWH and we would very much like this to continue and grow in the future. We would particularly welcome the opportunity to meet regularly to discuss options for service developments in the Herefordshire area and also to assist in developing data sets which are responsive to the particular issues in Herefordshire.

The 2g Quality Accounts 2013 included a reference to a Link legacy report that was a qualitative study of 7 Carers who had been involved in a mental health crisis. The conclusions within the report were asking for a more open and systematic response to listening and responding to Carers in trying to avoid an emerging situation.

The Trust became a signatory to the Herefordshire Carers Charter and they also have their own Charter epitomised in the ‘Think Carer’ badges worn by staff. These ‘standards’ in the Charters are a good basis for quality monitoring what is essentially a way of working with Carers as partners in care, which would include; keeping Carers well informed and well supported. We recognise and appreciate that 2Gether does have dedicated Carers Assessors and they have recently commissioned link workers to work alongside families with people with dementia, within a much improved service design. The Crisis Team operates on a 24 hour basis sighted on avoiding admissions and their contact details are made known to families which is an improvement from the situation that had given rise to the Link report. Carers are invited to service experience meetings and the Trust has been proactive in seeking out views to improve services which is commendable.

We would also appreciate seeing specific area plans for Herefordshire service development with specific measurable targets which can be jointly monitored by the Trust and HW? We are particularly keen that patient involvement, both adult and young people, is extended into the Herefordshire service area.

We clearly support your efforts to improve scores on some safety aspects such as suicide prevention and look forward to receiving details of how this is to be achieved.

The 2014/15 CQUIN Goals include the new Friends and Family Test, we are supportive of this and would very much like to see the data for Herefordshire separated from Gloucestershire and also see it broken down into specific service delivery areas so that specific local issues can be identified allowing corrective actions to be implemented.

We note that in the 2013/14 Quality Measures that the target for community patients receiving annual physical health checks was only 47% in Herefordshire compared with 86% in Gloucestershire, this is clearly an area where we would support your efforts to make improvements.

In summary we very much look forward to working with you in the next year to support you in your plans for service developments and quality improvements in Herefordshire and we would be enthusiastic partners in helping you to refine your plans to achieve this.

We look forward to working with you and continue to be a ‘critical friend’.

Once again thank you for allowing us to comment.

Yours faithfully

Ian Stead Healthwatch Herefordshire Lead Board Member for Mental Health12.05.2014

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The Royal College of Psychiatrists Statement of Participation in National Quality Improvement Projects managed by The Royal College of Psychiatrists’ Centre for Quality Improvement

Trust Participation National Participation

Service Accreditation Programmes and Quality improvement Networks

Forensic Mental Health Services (Quality Network) 0 Services 109 Services

Perinatal Mental Health Services 0 Services 36 Services

Child & Adolescent Inpatient Mental Health Services 0 Units 99 Units

Child & Adolescent Community Mental Health Teams 1 Team 57 Teams

Electroconvulsive Therapy Units 2 Clinics 88 Clinics

Working Age Inpatient Mental Health Units 5 Units 144 Units

Older People Inpatient Mental Health Units 5 Units 54 Units

Psychiatric Liaison Teams 0 Teams 42 Teams

Rehabilitation Mental Health Units 0 Units 37 Units

Psychiatric Intensive Care Units 1 Unit 31 Units

Inpatient Learning Disability Units 2 Units 21 Units

Memory Services 2 Services 80 Services

Home Treatment Teams 3 Teams 26 Teams

Eating Disorder Units 0 Units 27 Units

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Annex 2: Statement of Directors’ Responsibilities in respect of the Quality ReportThe directors are required under the Health Act 2009 and the National Health Service Quality Accounts Regulations 2010 as amended to prepare Quality Accounts for each financial year.

Monitor has issued guidance to NHS foundation trust boards on the form and content of annual Quality Reports (which incorporate the above legal requirements) and on the arrangements that foundation trust boards should put in place to support the data quality for the preparation of the quality report.

In preparing the Quality Report, directors are required to take steps to satisfy themselves that:

the content of the quality report meets the requirements set out in the NHS Foundation Trust Annual Reporting Manual 2013/14the content of the Quality Report is not inconsistent with internal and external sources of information including:

Board minutes and papers for the period April 2013 to June 2014Papers relating to Quality reported to the Board over the period April 2013 to June 2014Feedback from Gloucestershire commissioners dated 13 May 2014Feedback from Herefordshire commissioners dated 12 May 2014Feedback Governors dated 13 March 2014Feedback from Herefordshire Healthwatch dated 12 May 2014Feedback from Gloucestershire Healthwatch dated 12 May 2014The Trust’s complaints report published under regulation 18 of the Local Authority Social Services and NHS Complaints Regulations 2009, dated April 2014The 2013 national patient surveyThe 2013 national staff survey The Head of Internal Audit’s annual opinion over the Trust’s control environment dated May 2014CQC quality and risk profiles dated April 2013 to March 2014

the Quality Report presents a balanced picture of the NHS foundation trust’s performance over the period coveredthe performance information reported in the Quality Report is reliable and accuratethere are proper internal controls over the collection and reporting of the measures of performance included in the Quality Report, and these controls are subject to review to confirm that they are working effectively in practice

the data underpinning the measures of performance reported in the quality report is robust and reliable, conforms to specified data quality standards and prescribed definitions, is subject to appropriate scrutiny and review; and the quality report has been prepared in accordance with Monitor’s annual reporting guidance (which incorporates the Quality Accounts regulations) (published at www.monitor.gov.uk/annualreportingmanual) as well as the standards to support data quality for the preparation of the quality report (available at www.monitor.gov.uk/sites/all/modules/fckeditor/plugins/ktbrowser/_openTKFile.php?id=3275).

The directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing the Quality Report.

By order of the Board

NB: sign and date in any colour ink except black

Date

Chair

Date

Chief Executive

o

o

o

o

oo

o

o

o

ooo

o

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27 May 2014

27 May 2014

Annex: Glossary

BME

CAMHS

CBT

CCG

CORC

CPA

CQC

CQUIN

CYPS

GriP

HoNOS

IAPT

InformationGovernance (IG) Toolkit

MHMDS

Monitor

MRSA

NHS

NICE

NIHR

Black & Minority Ethnic

Child & Adolescent Mental Health Services

Cognitive Behavioural Therapy

Clinical Commissioning Group

CAMHS Outcomes Research Consortium (CORC)

Care Programme Approach: a system of delivering community service to those with mental illness

Care Quality Commission – the Government body that regulates the quality of services from all providers of NHS care.

Commissioning for Quality & Innovation: this is a way of incentivising NHS organisations by making part of their payments dependent on achieving specific quality goals and targets

Children and Young Peoples Service

Gloucestershire Recovery in Psychosis (GriP) is 2gether’s specialist early intervention team working with people aged 14-35 who have first episode psychosis.

Health of the Nation Outcome Scales – this is the most widely used routine Measure of clinical outcome used by English mental health services.

Improving Access to Psychological Therapies

The IG Toolkit is an online system that allows NHS organisations and partners to assess themselves against a list of 45 Department of Health Information Governance policies and standards.

The Mental Health Minimum Data Set is a series of key personal information that should be recorded on the records of every service user

Monitor is the independent regulator of NHS foundation trusts.They are independent of central government and directly accountable to Parliament.

Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium responsible for several difficult-to-treat infections in humans. It is also called multidrug-resistant

The National Health Service refers to one or more of the four publicly funded healthcare systems within the United Kingdom. The systems are primarily funded through general taxation rather than requiring private insurance payments. The services provide a comprehensive range of health services, the vast majority of which are free at the point of use for residents of the United Kingdom.

The National Institute for Health and Care Excellence (previously National Institute for Health and Clinical Excellence) is an independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health.

The National Institute for Health Research supports a health research system in which the NHS supports outstanding individuals, working in world class facilities, conducting leading edge research focused on the needs of patients and the public.

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The National Patient Safety Agency is a body that leads and contributes to improved, safe patient care by informing, supporting and influencing the health sector.

Plan Do Study Act is a suggested method for quality improvement in healthcare.Psychiatric Intensive Care Unit

Patient-Led Assessments of the Care Environment

Patient Reported Outcome Measures (PROMs) assess the quality of care delivered to NHS patients from the patient perspective.

The Quality and Risk Profile is a monthly compilation by the CQC of all the evidence about a trust they have in order to judge the level of risk that the trust carries to fulfil its obligations of care

This is the name of the electronic system for recording service user care notes and related information within 2gether NHS Foundation Trust. In a major exercise, it has been implemented across almost all the Trust’s areas of operation during 2010.

Routine Outcome Monitoring (ROMs)

Serious Incident Requiring Investigation, previously known as a “Serious Untoward Incident”. A serious incident is essentially an incident that occurred resulting in serious harm, avoidable death, abuse or serious damage to the reputation of the trust or NHS.In the context of the Quality Report, we use the standard definition of a Serious Incident given by the NPSA

The Shortened Warwick-Edinburgh Well-being Scale is a scale for assessing a population´s mental wellbeing.

Venous thromboembolism is a potentially fatal condition caused when a blood clot (thrombus) forms in a vein. In certain circumstances it is known as Deep Vein Thrombosis.

NPSA

PDSA

PICU

PLACE

PROM

QRP

RiO

ROMs

SIRI

SWEBS

VTE

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About this report

If you have any questions or comments concerning the contents of this report or have any other questions about the Trust and how it operates, please write to:

Mr Shaun CleeChief Executive Officer2gether NHS Foundation TrustRikenelMontpellierGloucesterGL1 1LY

Or email him at:

shaun.clee@glos.nhs.uk

Alternatively, you may telephone on:

01452 894000 or fax on: 01452 894001

Other Comments, Concerns, Complaints and Compliments Your views and suggestions are important us. They help us to improve the services we provide.You can give us feedback about our services by:

Speaking to a member of staff directlyTelephoning us on 01452 894673Completing our Online Feedback Form at http: //www.2gether.nhs.uk/feedback-formCompleting our Comment, Concern, Complaint, Compliment Leaflet, available from any of our Trust sites or from our website at www.2gether.nhs.ukUsing one of the feedback screens at selected Trust sitesContacting the Patient Advice and Liaison Service (PALS) Advisor on 01452 894072Writing to the appropriate service manager or our Chief Executive

Alternative Formats

If you would like a copy of this report in large print, Braille, audio cassette tape or another language, please telephone us on

01452 894000 or fax on: 01452 894001

Annex 4: How to Contact Us

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We ended the 2013/14 financial year in a good

financial position

During 2014/15 we are expected to deliver £5.4m in efficiency savings in addition to the £6.4m we delivered in

2013/14

Annual Accounts

Our Psychiatric Intensive Care Unit is ‘one of the best in the world’

STATEMENT OF COMPREHENSIVE INCOME For the year ended 31 March 2014

12 Months to 31 March 2014 12 Months to 31 March 2013NOTE £000 £000 £000 £000

Operating income from continuing operations 6 106,915 105,633

Remuneration (76,340) (73,839) Drugs (1,652) (1,663) Clinical supplies & services (571) (737) Non clinical supplies & services (914) (2,220) Miscellaneous other operating expenses (24,140) (23,742) Operating expenses of continuing operations 7 (103,617) (102,201)

OPERATING SURPLUS / (DEFICIT) 3,298 3,432

Finance costsFinance income - interest receivable 9.1 88 99 Finance expense - financial liabilities 9.2 (26) (28) Finance expense - unwinding of discount on provisions 14 0 (9) PDC dividends payable (1,934) (2,015)

Net finance costs (1,872) (1,953)

Surplus/(deficit) from continuing operations 1,426 1,479

Surplus/(deficit) of discontinued operations and gain/loss on disposal of discontinued operations

3 0 922

SURPLUS/(DEFICIT) FOR THE YEAR 1,426 2,401

Gain/(loss) from transfer by absorption from demising bodies 6,095 0

Impairments 10.3 (302) (843)

Revaluations 10.3 5,273 138

TOTAL COMPREHENSIVE INCOME/(EXPENSE) FOR THE YEAR

12,492 1,696

The notes on pages 141 to 175 form part of these financial statements.All transactions within the Statement of Comprehensive Income are attributable to the beneficiaries of the Trust (taxpayers).

STATEMENT OF COMPREHENSIVE INCOME For the year ended 31 March 2014

12 Months to 31 March 2014 12 Months to 31 March 2013NOTE £000 £000 £000 £000

Operating income from continuing operations 6 106,915 105,633

Remuneration (76,340) (73,839) Drugs (1,652) (1,663) Clinical supplies & services (571) (737) Non clinical supplies & services (914) (2,220) Miscellaneous other operating expenses (24,140) (23,742) Operating expenses of continuing operations 7 (103,617) (102,201)

OPERATING SURPLUS / (DEFICIT) 3,298 234,3

Finance costsFinance income - interest receivable 9.1 88 99

9.2 (26) (28) Finance expense - unwinding of discount on provisions 14 0 (9) PDC dividends payable (1,934) (2,015)

(1,872) (1,953)

624,1 974,1

disposal of discontinued operations3 0 229

SURPLUS/(DEFICIT) FOR THE YEAR 624,1 104,2

Gain/(loss) from transfer by absorption from demising bodies 590,6 0

Impairments 10.3 (302) (843)

Revaluations 10.3 372,5 831

TOTAL COMPREHENSIVE INCOME/(EXPENSE) FOR THE YEAR

12,492 696,1

rust (taxpayers).

Signed

Shaun Clee, Chief ExecutiveDate: 27 May 2014

Forward to the Financial Statements

These financial statements for the period ended 31 March 2014, have been prepared by 2gether NHS Foundation trust under Paragraphs 24 and 25 of Seclude 7 to the National Health Service Act 2006.

Annual Accounts

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CM

MY

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CMY

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STATEMENT OF FINANCIAL POSITION At 31 March 2014

At 31 March 2014

At 31 March 2013

At 1 April 2012

NOTE £000 £000 £000

NON-CURRENT ASSETSIntangible assets 10.1 376 640 662 Property, plant and equipment 10.3 75,188 64,210 65,338 Trade and other receivables 11 19 11 5 TOTAL NON-CURRENT ASSETS 75,583 64,861 66,005

CURRENT ASSETSTrade and other receivables 11 2,596 3,936 4,814

Non-current assets for sale and assets in disposal groups 10.5 400 474 495

Cash and cash equivalents 15 30,408 27,645 20,301 TOTAL CURRENT ASSETS 33,404 32,055 25,610 TOTAL ASSETS 108,987 96,916 91,615

CURRENT LIABILITIESTrade and other payables 13.1 (11,054) (11,432) (9,780) Borrowings 13.3 (36) (34) (34) Provisions 14 (1,680) (1,769) (351) Other liabilities 13.2 (356) (634) (95) TOTAL CURRENT LIABILITIES (13,126) (13,869) (10,260) TOTAL ASSETS LESS CURRENT LIABILITIES 95,861 83,047 81,355

NON-CURRENT LIABLILITIESTrade and other payables 13.1 0 0 0 Borrowings 13.3 (397) (432) (463) Provisions 14 (54) (30) (58) Other liabilities 13.2 0 0 0 TOTAL NON-CURRENT LIABILITIES (451) (462) (521) TOTAL ASSETS EMPLOYED 95,410 82,585 80,834

FINANCED BY TAXPAYERS’ EQUITY:

Public Dividend Capital 45,123 44,790 44,735 Revaluation reserve 23,050 17,155 18,134 Other reserves 1,157 1,157 1,157 Income and expenditure reserve 26,080 19,483 16,808

TOTAL TAXPAYERS’ EQUITY Pages 3 & 4 95,410 82,585 80,834

The financial statements on pages 136 to 175 were approved by the Audit Committee on 27th May 2014 and signed on its behalf by:Signed

Shaun Clee, Chief ExecutiveDate: 27 May 2014

137

STATEMENT OF CHANGES IN TAXPAYERS’ EQUITY For the Period 1 April to 31 March 2014

TotalPublic

Dividend Capital

Revaluation Reserve

* Other Reserves

Income & erutidnepxE

Reserve£000 £000 £000 £000 £000

Taxpayers Equity at 1 April 2013 82,585 44,790 17,155 751,1 19,483

624,1 0 0 0 624,1

1 April transfers from demising bodies. 590,6 0 0 0 590,6

reserves 0 0 269 0 (962)

Impairments (302) 0 (302) 0 0Revaluations - property, plant and equipment 372,5 0 372,5 0 0Transfer to retained earnings on disposal of assets 0 0 (38) 0 83Movements arising from classifying non current assets as assets for sale 0 0 0 0 0

Other recognised gains and losses 0 0 0 0 0

schemes 0 0 0 0 0

Public Dividend Capital received 05 05 0 0 0PDC adjustment for cash impact of payables/receivables transferred from legacy teams 382 382 0 0 0

Taxpayers Equity at 31 March 2014 95,410 45,123 23,050 751,1 26,080

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STATEMENT OF CHANGES IN TAXPAYERS’ EQUITY For the Period 1 April 2012 to March 2013

TotalPublic

Dividend Capital

Revaluation Reserve

* Other Reserves

Income & Expenditure

Reserve£000 £000 £000 £000 £000

Taxpayers Equity at 1 April 2012 80,834 44,735 18,134 751,1 16,808

104,2 0 0 0 104,2

April transfers from demising bodies. 0 0 0 0 0

reserves 0 0 0 0 0

Impairments (843) 0 (843) 0 0Revaluations - property, plant and equipment 831 0 831 0 0Transfer to retained earnings on disposal of assets 0 0 (274) 0 472Movements arising from classifying non current assets as assets for sale 0 0 0 0 0

Other recognised gains and losses 0 0 0 0 0

schemes 0 0 0 0 0

Public Dividend Capital received 55 55 0 0 0PDC adjustment for cash impact of payables/receivables transferred from legacy teams 0 0 0 0 0

Taxpayers Equity at 31 March 2013 82,585 44,790 17,155 751,1 19,483

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STATEMENT OF CASH FLOWS For the year ended 31 March 2014

12 Months to 31 March 2014

12 Months to 31 March 2013

NOTE £000 £000 OPERATING ACTIVITIES

892,3 234,3 0 229

OPERATING SURPLUS/DEFICIT 892,3 453,4

NON CASH INCOME AND EXPENSE:

Depreciation and amortisation 693,2 092,2Impairments 57 773Reversals of impairments (408) (13) (Gain)/loss on disposal 7 (7) (Increase)/decrease in trade and other receivables 972,1 149Increase/(decrease) in trade and other payables (511) 492,2Increase/(decrease) in other liabilities (278) 045Increase/(decrease) in provisions (65) 083,1

NET CASH GENERATED FROM/(USED IN) OPERATIONS 397,5 12,156

CASHFLOWS FROM INVESTING ACTIVITIES

Interest received 79 99(96,000) (58,000)

96,000 58,000 Purchases of intangible assets 0 0Purchases of property, plant and equipment (1,698) (3,335) Sales of property, plant and equipment 271 315

Net cash generated from/(used in) investing activities (1,429) (2,723)

CASHFLOWS FROM FINANCING ACTIVITIES

Public dividend capital received 05 55

transfers of payables/receivables) 283 0

(33) (31) Interest paid 0 0

(27) (28) PDC dividend paid (1,874) (2,085)

(1,601) (2,089)

Increase/(decrease) in cash and cash equivalents 15 367,2 443,7

Cash and cash equivalents at 1 April 27,645 20,301

Cash and cash equivalents at 31 March 30,408 27,645

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1. ACCOUNTING POLICIES

statements of NHS Foundation Trusts shall meet the accounting requirements of the NHS Foundation Trust Annual Reporting Manual (FT ARM) which shall be agreed with HM Treasury.

statements have been prepared in accordance with the FT ARM 2013/14 issued by Monitor. The accounting policies contained in that manual follow International Financial Reporting Standards (IFRS) and HM Treasury’s Financial Reporting Manual (FReM) to the extent that they are meaningful and appropriate to NHS Foundation Trusts. The accounting policies have been applied consistently in dealing with items considered material in relation to the

prior year.

1.1 Accounting convention

prepared under the historical cost

the revaluation of property, plant and equipment, intangible assets, inventories

liabilities. For this reason, they continue to adopt the going concern basis in

1.2 Subsidiary undertakingsFollowing Treasury’s agreement to apply IAS 27 to NHS Charities from 1 April 2013, the Trust has established that as the Trust is the corporate trustee of the linked NHS Charities 2gether NHS Foundation Trust Charitable Fund and ‘New Highway Charity’, it effectively has the power to exercise control so as

the transactions are immaterial in the context of the group and transactions have not been consolidated. Details of the transactions with the charities are included in the related parties’ notes.

1.3 IncomeIncome in respect of services provided is recognised when, and to the extent that performance occurs and is measured at the fair value of the consideration receivable. The main source of income for the Trust is contracts with commissioners in respect of healthcare services.

activity which is to be delivered in the

deferred.

Income from the sale of non-current assets is recognised only when all material conditions of sale have been met, and is measured as the sums due under the sale contract.

Salaries, wages and employment-related payments are recognised in the period in which the service is received from employees. The cost of annual leave entitlement earned but not taken by employees at the end of the period is

the extent that employees are permitted to carry-forward leave into the following period.

Pension costs Past and present employees are covered by the provisions of the NHS Pensions

under these provisions can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions. The scheme is

covers NHS employers, GP practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted

scheme: the cost to the NHS Body of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period.

statements do not differ materially from those that would be determined at the reporting date by a formal actuarial valuation, the FReM requires that “the period between formal valuations shall be four years, with approximate assessments in intervening years”. An outline of these follows:

a) Accounting valuationA valuation of the scheme liability is carried out annually by the scheme actuary as at the end of the reporting period. This utilises an actuarial assessment for the previous accounting period in conjunction with updated

the current reporting period, and are accepted as providing suitably robust

The valuation of the scheme liability as at 31 March 2014, is based on valuation data as 31 March 2013, updated to 31 March 2014 with summary global member and accounting data. In undertaking this actuarial assessment, the methodology prescribed in IAS 19, relevant FReM interpretations, and the discount rate prescribed by HM Treasury have also been used.

The latest assessment of the liabilities of

the scheme is contained in the scheme actuary report, which forms part of the annual NHS Pension Scheme (England and Wales) Pension Accounts, published annually. These accounts can be viewed on the NHS Pensions website. Copies can also be obtained from The Stationery

b) Full actuarial (funding) valuationThe purpose of this valuation is to assess the level of liability in respect of the

into account its recent demographic experience), and to recommend the contribution rates.

The last published actuarial valuation undertaken for the NHS Pension Scheme was completed for the year ending 31 March 2004. Consequently, a formal actuarial valuation would have been due for the year ending 31 March 2008. However, formal actuarial valuations for unfunded public service schemes were suspended by HM Treasury on value for money grounds while consideration is given to recent changes to public service pensions, and while future scheme terms are developed as part of the reforms to public service pension provision due in 2015.

The Scheme Regulations were changed to allow contribution rates to be set by the Secretary of State for Health, with the consent of HM Treasury, and consideration of the advice of the Scheme Actuary and appropriate employee and employer representatives as deemed appropriate.

The next formal valuation to be used for funding purposes will be carried out at as at March 2012 and will be used to inform the contribution rates to be used from 1 April 2015.

c) Scheme provisionsThe NHS Pension Scheme provided

below. This list is an illustrative guide only, and is not intended to detail all the

Annual pensions are normally based on 1/80th for the 1995 section and of the best of the last three years pensionable pay for each year of service, and 1/60th for the 2008 section of reckonable pay per year of membership. Members

Scheme Regulations have their annual pensions based upon total pensionable earnings over the relevant pensionable service;

ffect from 1 April 2008 members can choose to give up some of their

NOTES TO THE ACCOUNTS

141

annual pension for an additional tax free lump sum, up to a maximum amount permitted under HMRC rules. This new provision is known as “pension commutation”;

Annual increases are applied to

by the Pensions (Increase) Act 1971, and are based on changes in retail prices in the twelve months ending 30 September in the previous calendar year. From 2011-12 the Consumer Price Index (CPI) has been used and replaced the Retail Prices Index (RPI); and

enhancement, is available to members of the scheme who are permanently

pensionable pay for death in service,

death after retirement is payable.

For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full amount of the liability for the additional costs is charged to the employer.

Members can purchase additional service in the NHS Scheme and contribute to money purchase AVC’s run by the Scheme’s approved providers or by other Free Standing Additional Voluntary Contributions (FSAVC) providers.

1.5 Expenditure on Other Goods and ServicesExpenditure on goods and services is recognised when, and to the extent that they have been received, and is measured at the fair value of those goods and services. Expenditure is recognised in operating expenses except where it results in the creation of a non-current asset such as property, plant and equipment.

1.6 Property, Plant and Equipment1.6.1 RecognitionProperty, plant and equipment is capitalised where: - It is held for use in delivering services

or for administration purposes;- It is probable that future economic

be provided to the Trust;- It is expected to be used for more than

- the cost of the item can be measured reliably.

and where they :a.Individually have a cost of at least

£5,000; orb.Form a group of assets which

collectively have a cost of at least £5,000 and individually have a cost of more than £250, where the assets are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are under single managerial control; or

c.Form part of the initial equipping and setting-up cost of a new building or refurbishment of a ward or unit, irrespective of their individual or collective cost; or

d.Form part of an IT network which collectively has a cost more than £5,000 and individually have a cost more than £250. However, small individual purchases are expensed.

Where a large asset, for example a building, includes a number of

asset lives e.g. plant and equipment, then these components are treated as separate assets and depreciated over their own useful economic lives.

1.6.2 MeasurementValuationAll property, plant and equipment assets are measured initially at cost, representing the costs directly attributable to acquiring or constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner intended by the management. All assets are measured subsequently at fair value.

Tangible property, plant and equipment assets are stated at the lower of replacement cost and recoverable amount. The carrying values of property, plant and equipment are reviewed for impairment in periods if events or changes in circumstances indicate the carrying value may not be recoverable.

construction of the asset are not capitalised but are charged to the income and expenditure account in the year to which they relate.

All land and buildings are revalued using

A three yearly interim valuation is also carried out.

Valuations are carried out by

accordance with the Royal Institute of Chartered Surveyors (RICS) Appraisal and Valuation Manual.

In March 2009 all land and buildings were revalued to a Modern Equivalent Asset (MEA) basis by the District Valuer and this was accounted for on 31 March 2009. In March 2012 the District Valuer revalued all land and buildings

for the three year interim valuation and this was accounted for on 31 March 2012. In March 2010, March 2011 and March 2013 the trust undertook annual impairment reviews and commissioned the District Valuer to revalue all land and buildings in a desktop exercise.

In March 2014 all land and buildings were revalued by the District Valuer and this was accounted for on 31 March 2014.The valuations are carried out primarily on the basis of depreciated replacement cost for specialised operational property and existing use value for non-specialised operational property.

The value of land for existing use purposes is assessed at existing use value. For non-operational properties including surplus land, the valuations are carried out at open market value.

Additional alternative open market values are only supplied for operational assets scheduled for imminent closure and subsequent disposal. These assets are

Assets in the course of construction are valued at cost and are valued by

three-yearly valuation or when they are brought into use.

Operational equipment is valued at depreciated historic cost which is deemed to represent fair value.

Subsequent ExpenditureSubsequent expenditure relating to an item of property, plant and equipment is recognised as an increase in the carrying amount of the asset when it is probable

or service potential deriving from the cost incurred to replace a component of

the cost of the item can be determined reliably. Where a component of an asset is replaced, the cost of the replacement is capitalised if it meets the criteria for recognition above. The carrying amount of the part replaced is de-recognised. Other expenditure that does not generate

service potential, such as repairs and maintenance, is charged to the Statement of Comprehensive Income in the period in which it is incurred.

DepreciationItems of property, plant and equipment are depreciated over their remaining useful economic lives in a manner consistent with the consumption of

Freehold land is considered to have an

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Property, plant and equipment which

Sale” ceases to be depreciated upon

construction are not depreciated until the asset is brought into use.

Property, plant and equipment assets are depreciated at rates calculated to write them down to estimated residual value on a straight-line basis over their estimated useful lives. No depreciation is provided on assets surplus to requirements.

depreciated on their current value over the estimated remaining life of the asset as assessed by the NHS Foundation Trust’s professional valuers. Leaseholds are depreciated over the primary lease term.

Equipment is depreciated on current cost evenly over the estimated life of the asset using the following lives:

YearsEngineering plant and equipment 5-15Furniture & Fittings 5-10Information Technology 3-8Set-up costs in new buildings 5-10Vehicles 7

Revaluation gains and losses Revaluation gains are recognised in the revaluation reserve, except where, and to the extent that, they reverse a revaluation decrease that has previously been recognised in operating expenses, in which case they are recognised in operating income.

Revaluation losses are charged to the revaluation reserve to the extent that there is an available balance for the asset concerned, and thereafter are charged to operating expenses.

Gains and losses recognised in the revaluation reserve are reported in the Statement of Comprehensive Income as an item of ‘other comprehensive income’.Impairments

In accordance with the FT ARM, impairments that are due to a loss of

in the asset are charged to operating expenses. A compensating transfer is made from the revaluation reserve to the income and expenditure reserve of an amount equal to the lower of (i) the impairment charged to operating expenses; and (ii) the balance in the revaluation reserve attributable to that asset before the impairment. An impairment arising from a loss of

reversed when, and to the extent that, the circumstances that gave rise to the loss are reversed. Reversals are

recognised in operating income to the extent that the asset is restored to the carrying amount it would have had if the impairment had never been recognised. Any remaining reversal is recognised in the revaluation reserve. Where, at the time of the original impairment, a transfer was made from the revaluation reserve to the income and expenditure reserve, an amount is transferred back to the revaluation reserve when the impairment reversal is recognised.

Other impairments are treated as revaluation losses. Reversals of ‘other impairments’ are treated as revaluation gains.

1.6.3 De-recognitionAssets intended for disposal are

the following criteria are met: The asset is available for immediate sale in its present condition subject to terms which are usual and customary for such sales;

- management are committed to a plan to sell the asset;

a buyer and complete the sale;- the asset is being actively marketed at

a reasonable price;- the sale is expected to be completed

within twelve months of the date of

- the actions needed to complete the plan indicate it is unlikely that the plan

made to it.

measured at the lower of their existing carrying amount and their ‘fair value less costs to sell’. Depreciation ceases to be charged and the assets are not revalued, except where the ‘fair value less costs to sell’ falls below the carrying amount. Assets are de-recognised when all material sale contract conditions have been met.

Property, plant and equipment which is to be scrapped or demolished does not qualify for recognition as ‘Held for Sale’ and instead is retained as an operational asset and the assets economic life is adjusted. The asset is de-recognised when scrapping or demolition occurs.

1.6.4 Donated AssetsDonated and grant funded property, plant and equipment assets are capitalised at their fair value on receipt. The donation/grant is credited to income at the same time, unless the donor imposes a condition that the future economic

donor, in which case the donation/grant is deferred within liabilities and is carried

extent that the condition has not yet been met.

The donated and grant funded assets are subsequently accounted for in the same manner as other items of property, plant and equipment.

1.7 Private Finance Initiative (PFI)The Trust does not have any Private Finance Initiative transactions.

1.8 Intangible Assets 1.8.1 RecognitionIntangible assets are non-monetary assets without physical substance which are capable of being sold separately from the rest of the Trust’s business or which arise from contractual or other legal rights. They are recognised only where it

provided to, the Trust and where the cost of the asset can be measured reliably. They must have a useful life of more than one year and a cost of at least £5,000.Internally Generated Intangible AssetsInternally generated goodwill, brands, mastheads, publishing titles, customer lists and similar items are not capitalised as intangible assets.

Expenditure on research is not capitalised.Expenditure on development is capitalised only where all of the following can be demonstrated:

- the project is technically feasible to the point of completion and will result in an intangible asset for sale or use;

- the Trust intends to complete the asset and sell or use it;

- the Trust has the ability to sell or use the asset;

- how the intangible asset will generate probable future economic or service

a market for its output, or where it is to be used for internal use, the usefulness of the asset;

resources are available to the Trust to complete the development and sell or use the asset; and

- the Trust can measure reliably the expenses attributable to the asset during development.

SoftwareSoftware which is integral to the operation of hardware e.g. an operating system, is capitalised as part of the relevant item of property, plant and equipment. Software which is not integral to the operation of hardware e.g. application software, is capitalised as an intangible asset.

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1.8.2 MeasurementIntangible assets are recognised initially at cost, comprising all directly attributable costs needed to create, produce and prepare the asset to the point that it is capable of being operated in the manner intended by management.

Subsequently intangible assets are measured at fair value. Revaluation gains and losses and impairments are treated in the same manner as for property, plant and equipment.

Intangible assets held for sale are measured at the lower of their carrying amount or ‘fair value less costs to sell’.

AmortisationIntangible assets are amortised over their expected useful economic lives in a manner consistent with the consumption

1.9 Government GrantsThe Trust has not received any Government grants during the current or prior year.

1.10 Inventories Inventories are measured at the lower of cost and net realisable value. The cost of inventories is measured using the First In First Out (FIFO) method or the weighted average cost method. However, the Trust does not recognise inventories as the value is immaterial.

1.11 Leases Finance LeasesWhere substantially all the risks and rewards of ownership of an asset are borne by the Trust, the asset is recorded as property, plant and equipment and a corresponding liability is recorded. The value at which both are recognised is the lower of the fair value of the asset or the present value of the minimum lease payments, discounted using the interest rate implicit in the lease.

The asset and liability are recognised at the commencement of the lease. Thereafter the asset is accounted for as an item of property plant and equipment.

The annual rental is split between the

cost so as to achieve a constant rate

to Finance Costs in the Statement of Comprehensive Income. The lease liability, is de-recognised when the liability is discharged, cancelled or expires.

Operating LeasesOther leases are regarded as operating leases and the rentals are charged to operating expenses on a straight-line basis over the term of the lease.

Operating lease incentives are added to the lease rentals and charged to operating expenses over the life of the lease.

Leases of land and buildingsWhere a lease is for land and buildings, the land component is separated from the

for each is assessed separately.

1.12 ProvisionsThe Trust recognises a provision where it has a present legal or constructive obligation of uncertain timing or amount; for which it is probable that there will be a

and a reliable estimate can be made of the amount. The amount recognised in the Statement of Financial Position is the best estimate of the resources required to settle the obligation. Where the effect

are discounted using the discount rates published and mandated by HM Treasury.

Clinical negligence costsThe NHS Litigation Authority (NHSLA) operates a risk pooling scheme under which the Trust pays an annual contribution to the NHSLA, which in return, settles all clinical negligence claims. Although the NHSLA is administratively responsible for all clinical negligence cases, the legal liability remains with the Trust. The total value of clinical negligence provisions carried by the NHSLA on behalf of the Trust is disclosed at note 14 but it is not recognised in the NHS Foundation Trust’s

Non-clinical risk poolingThe Trust participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both are risk pooling schemes under which the Trust pays an annual contribution to the NHS Litigation Authority and, in return, receives assistance with the costs of claims arising. The annual membership contributions, and any ‘excesses’ payable in respect of particular claims are charged to operating expenses when the liability arises.

1.13 ContingenciesContingent assets (that is, assets arising from past events whose existence will

events not wholly within the entity’s control) are not recognised as assets, but

Contingent liabilities are not recognised, but are disclosed in note 17 unless the probability of a transfer of economic

“Possible obligations arising from past

only by the occurrence of one or more uncertain future events not wholly within the entity’s control; or Present obligations arising from past events but for which it is not probable that

or for which the amount of the obligation

reliability.”

1.14 Public Dividend Capital (PDC)Public dividend capital (PDC) is a type

the excess of assets over liabilities at the time of establishment of the predecessor NHS Trust. HM Treasury has determined

within the meaning of IAS 32.

utilised by the Trust, is payable as public dividend capital dividend. The charge is calculated at the rate set by HM Treasury (currently 3.5%) on the average relevant

year. Relevant net assets are calculated as the value of all assets less the value of all liabilities, except for (i) donated assets, (ii) average daily cash balances held with

the Government Banking Services and National Loans Fund ( NLF) deposits, excluding cash balances held in GBS accounts that relate to a short- term working capital facility

(iii) for 2013/14 only, net assets and liabilities transferred from bodies which ceased to exist on 1 April 2013 (Herefordshire PCT asset transfer ), and

(iv) any PDC dividend balance receivable or payable.

In accordance with the requirements laid down by the Department of Health (as the issuer of PDC), the dividend for the year is calculated on the actual average relevant net assets as set out in the pre-audit’ version of the annual accounts. The dividend thus calculated is not revised should any adjustment to net assets occur as a result of the audit of the annual accounts

1.15 Value Added Tax Most of the activities of the Trust are outside the scope of VAT and, in general, output tax does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included

assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT.

1.16 Corporation Tax The Trust is a Health Service Body

144

within the meaning of s519A ICTA 1988 and accordingly is exempt from taxation in respect of income and capital gains within categories covered by this. There is a power for the Treasury to dis-apply

activities of a Foundation Trust (s519A (3) to (8) ICTA 1988). Accordingly, the Trust is potentially within the scope of corporation tax in respect of activities which are not related to, or ancillary to, the provision of healthcare, and where

annum.

The Trust has determined that it has no corporation tax liability as it does not carry out any applicable commercial activities.

1.17 Foreign ExchangeThe functional and presentational currency of the Trust is sterling.

A transaction which is denominated in a foreign currency is translated into the functional currency at the spot exchange rate on the date of the transaction.The Trust has no assets or liabilities denominated in a foreign currency at the Statement of Financial Position date.

1.18 Cash and Cash EquivalentsCash is cash in hand and deposits with

penalty on notice of not more than 24 hours. Cash equivalents are investments that mature in 3 months or less from the date of acquisition and that are readily convertible to known amounts of cash

1.19 Third Party AssetsAssets belonging to third parties (such as money held on behalf of patients) are

in them. However, they are disclosed in a

in accordance with the requirements of the HM Treasury Financial Reporting Manual.

1.20 Financial Instruments and LiabilitiesThe Trust may hold any of the following

Financial assetsInvestmentsLong-term trade receivablesShort-term trade receivablesCash at bank and in hand

Financial liabilitiesLoans and overdraftsLong-term trade payablesFinance lease obligationsShort-term trade payablesProvisions arising from contractual arrangementsRecognition

which arise from contracts for the

(such as goods or services), which are entered into in accordance with the Trust’s normal purchase, sale or usage requirements, are recognised when, and to the extent which, performance occurs i.e. when receipt or delivery of the goods or services is made.

respect of assets acquired or disposed

and measured in accordance with the accounting policy for leases described in note 1.14.

liabilities are recognised when the Trust becomes a party to the contractual provisions of the instrument.

De-recognition

from the assets have expired or the Trust has transferred substantially all of the risks and rewards of ownership.Financial liabilities are de-recognised when the obligation is discharged, cancelled or expires.

Financial assets are categorised as loans and receivables.

Loans and ReceivablesLoans and receivables are non-derivative

payments which are not quoted in an active market. They are included in current assets.

The Trust’s loans and receivables comprise: cash and cash equivalents, NHS receivables, accrued income and other trade receivables.

Loans and receivables are recognised initially at fair value, net of transaction costs, and are measured subsequently at amortised cost, using the effective interest rate method. The effective interest rate is the rate that exactly discounts estimated future cash receipts

asset or, when appropriate, a shorter period, to the net carrying amount of the

Interest on loans and receivables is calculated using the effective interest rate method and credited to the Statement of Comprehensive Income.

initially at fair value, net of transaction costs incurred, and measured

subsequently at amortised cost using the effective interest method. The effective interest rate is the rate that exactly discounts estimated future cash payments through the expected life of the

shorter period, to the net carrying amount

They are included in current liabilities except for amounts payable more than 12 months after the Statement of Financial

long-term liabilities.

amortised cost is calculated using the effective interest method and charged to the income and expenditure account.Determination of fair value

liabilities carried at fair value, the carrying amounts are determined from quoted market values.

At the Statement of Financial Position date, the Trust assesses whether

held at ‘fair value through income and expenditure’ are impaired. Financial assets are impaired and impairment losses are recognised if, and only if, there is objective evidence of impairment as a result of one or more events which occurred after the initial recognition of the asset and which has an impact on the

cost, the amount of the impairment loss is measured as the difference between the asset’s original effective interest rate. The loss is recognised in the Statement of Comprehensive Income and the carrying amount of the asset is reduced directly.

1.21 Losses and Special PaymentsLosses and special payments are items that Parliament would not have contemplated when it agreed funds for the health service or passed legislation. By their nature they are items that ideally should not arise. They are therefore subject to special control procedures compared with the generality of payments. They are divided into different categories, which govern the way each individual case is handled.

Losses and special payments are charged to the relevant functional headings in the income and expenditure account on an accruals basis, including losses which would have been made good through insurance cover had NHS Foundation Trusts not been bearing their own risks (with insurance premiums then being included as normal revenue expenditure). However note 21, the

145

losses and special payments note, is compiled directly from the losses and compensations register which reports on an accrual basis with the exception of prvisions for future losses.

1.22 Reserves

over by the Trust at inception and the

debt.

1.23 Transfers of Functions to / from other NHS bodies / local government bodies.For functions that have been transferred to the Trust from another NHS / local government body, the assets and liabilities transferred are recognised in the accounts as at the date of transfer. The assets and liabilities are not adjusted to fair value prior to recognition. The

net gain/loss corresponding to the net assets/ liabilities transferred is recognised within income / expenditure but not within operating activities. The net gain corresponding to the new assets transferred from Herefordshire PCT is recognised within the income and expenditure reserve.

For property, plant and equipment assets and intangible assets, the Cost and Accumulated Depreciation/Amortisation balances from the transferring entity’s

statements. Where the transferring body recognised revaluation reserve balances attributable to the assets, the Trust makes a transfer from its income and expenditure reserve to its revaluation reserve to maintain transparency within

For functions that the Trust has

transferred to another NHS/local government body, the assets and liabilities transferred are de-recognised

the date of transfer. The net loss/gain corresponding to the net assets/liabilities transferred is recognised within expenses/income, but not within operating activities. Any revaluation reserve balances attributable to assets de-recognised are transferred to the income and expenditure reserve.

1.24 Accounting Standards issued but not yet adoptedNeither the Treasury FReM nor Monitor’s ARM requires the following standards to be applied in 2013/14. Their application would

Change published Published by IASB appliesIFRS 9 Financial Instruments Oct-10 Uncertain. Not likely to be adopted by the EU

instruments project.IFRS 10 Consolidated Financial Statements May-11 Effective date of 2014/15*IFRS 11 Joint Arrangements May-11 Effective date of 2014/15*IFRS 12 Disclosure of Interests in Other Entities May-11 Effective date of 2014/15*

IFRS 13 Fair Value Measurement May-11 Effective date of 2013/14 but not yet adopted by the EU.

IAS 27 Separate Financial Statements May-11 Effective date of 2014/15*IAS 28 Associates and joint ventures. May-11 Effective date of 2014/15*

Jun-11 Effective date of 2013/14 but not yet adopted by the EU.

IAS 32 Financial Instruments: Presentation - amendment Dec-11 Effective date of 2014/15

1.25 Prior Period AdjustmentsThere were no prior year adjustments.

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2 GoinG ConCern and Liquidity riskThe Trust’s business activites, together with the factors likely to affect it’s future development, performance and position are set out in the Strategic Report. In the addition, notes 1 to 22 to the financial statements include the Trust’s policies and processess for managing it’s capital; its financial risk management objectives; details of its financial instruments; and its exposures to credit risk and liquidity.

At the Audit Committee in April 2014 the Committee received the annual assessment of the Trust’s Going Concern status. The Committee concluded that the Trust has sufficient resources and the future projections indicate the Trust should break even or generate surpluses and achieve Monitor’s financial risk ratings of 4 over the next five financial years. As a consequence, the Audit Committee believe that the Trust is well placed to manage its business risks

successfully despite the current uncertain economic outlook. The Audit Committee is confident that the Trust has adequate resources to continue in operational existence for the foreseeable future. Thus they continue to adopt the going concern basis of accounting in preparing the annual financial statements.

£000 £000 Operating income of discontinued operations 0 7,442Operating expenses of discontinued operations 0 (6,520)Gain on disposal of discontinued operations 0 0(Loss) on disposal of discontinued operations 0 0total 0 922

3 disContinued operations

At 31st March 2013, the Trust stopped providing Integrated Drug Treatment services and General Medical services to HMP Gloucester following the closure of the prison on 31st March 2013. The full year contract was £2.4m and involved 45 employees.

The Trust received the following transfer from Herefordshire PCT£000

Property, plant and equipment 6,417Current Trade and other receivables 16Current Trade and other payables (338)

6,095

4 Business ComBinations invoLvinG the trust and another entity within the whoLe of Government aCCounts (wGa) Boundary

As a result of the reorganisation of the NHS on 1 April 2013 the Trust is the recipient of the transfer of assets and liabilities from Herefordshire PCT. Since the trust recognises the transfer directly from a body which ceases to exist on 1 April 2013, modified absorption accounting applies.

5 CritiCaL aCCountinG JudGements and key sourCes of estimation unCertainty

In the application of the Trust’s accounting policies, management is required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. Actual results may differ from those estimates and the estimates and underlying assumptions are continually reviewed. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period or in the period of the revision and future periods if the revision affects both current and future periods.

Critical judgements in applying accounting policies

The following are the critical judgements, apart from those involving estimations (see below) that management has made in the process of applying the Trust’s accounting policies and that have the most significant effect on the amounts recognised in the financial statements.

The Trust believes the use of the Modern Equivalent Asset (MEA) basis to value land and buildings to fair value is the methodology with least risk of material uncertainty.

The Trust must ensure that the fixed asset register holds each asset separately and by components. The Trust believes that a threshold of £800,000 is reasonable, above which owned property assets will be accounted for as structures, engineering and external works components.

key sources of estimation uncertainty The following are the key assumptions concerning the future, and other key

sources of estimation uncertainty at the end of the reporting period, that have a significant risk of causing a material adjustment within the next financial year.

With regard to valuing provisions the methodology to determine best estimate differs according to the class of provision.

An accrual for annual leave was estimated by requesting from all budget holders a list of staff with leave outstanding at the end of 31st March 2014. The remaining leave was valued at the appropriate pay band for each member of staff. Annual leave outstanding for medical staff was calculated differently as their annual leave year does not run from 1st April to 31st March but annually from their start date. The actual date of the individual’s leave year has been factored into the calculation for determining the outstanding leave and applied to their actual pay.

The transfer relates to 5 properties and their equipment in Herefordshire, the major site being Stonebow, from which the Trust runs mental health services. The current receivable and current payable transactions all related to the transferred assets. A breakdown of the property, plant and equipment is shown in note 10.3

147

12 Months to 31 March

2014£000

12 Months to 31 March

2013£000

Cost and volume contract income 1,343 2,167Block contract income 93,885 100,015Clinical partnerships providing mandatory services (including S75 agreements) 2,268 1,811Clinical income for the secondary commissioning of mandatory services 0 0Other clinical income from mandatory services 4,018 3,343

101,514 107,336

Other Operating Income12 Months

to 31 March 2014£000

12 Months to 31 March

2013£000

Research and development 731 94Education and training 416,1 116,1Received from NHS charities: Other charitable and other contributions to expenditure 4 0Non-patient care services to other bodies 677 844,1Other * 086,1 856,1Gain on disposal of assets held for sale 0 61Reversal of impairments of property, plant and equipment 804 31Rental revenue from operating leases 0 0Income in respect of staff costs where accounted on gross basis 287 449

104,5 937,5

Total Operating Income 106,915 113,075

Of which:Related to continuing operations 106,915 105,633 Related to discontinued operations 0 244,7

For details of discontinued operations see note 3

* ‘Other’ includes supporting people services of £1,275,985 (£1,361,764 for 2012/13), sale of goods & services £37,884 (£64,722 for 2012/13), Local Authority non healthcare £2,753 (£2,176 for 2012/13), rental income £90,689 (£136,302 for 2012/13), and insurance claim reimbursement £12,366 (£2,505 for 2012/13).

6.2 Income from Activities (By Commissioner)

12 Months to 31 March

2014£000

12 Months to 31 March

2013£000

NHS Foundation Trusts 1,379 1,375NHS Trusts 54 68Strategic Health Authorities 0 0CCGs and NHS England 95,390 0Primary Care Trusts 0 103,576Local Authorities 3,966 1,894Department of Health - grants 0 0Department of Health - other 0 0NHS other 0 0Non NHS: private patients 0 0Non-NHS: overseas patients (non-reciprocal) 2 0NHS injury scheme 0 0Non NHS: other 723 423

101,514 107,336

The Trust does not generate private patient income.

6 OPERATING INCOME6.1 Income from Activities

148

6.3 Operating Lease Income12 Months

to 31 March 2014£000

12 Months to 31 March

2013£000

Operating lease incomeRental revenue from operating leases - minimum lease receipts 0 0Rental revenue from operating leases - contingent rent 0 0Rental revenue from operating leases - other 0 0Total operating lease income 0 0

Future minimum lease payments due not later than one year 0 0

0 00 0

Total 0 0

149

7 Operating Expenses7.1 Operating expenses comprise

12 Months to 31 March 2014

£000

12 Months to 31 March 2013

£000 Services from NHS Foundation Trusts 728,2 543,3Services from NHS Trusts 141 201Services from PCTs 0 254Services from CCGs and NHS England 65 0Services from other NHS bodies 0 0Purchase of healthcare from non NHS bodies 005,4 274,3Executive directors’ costs 229 639Non-executive directors’ costs 141 741Staff costs 75,325 76,870 Supplies and services - clinical (excluding drug costs) 175 760,1Supplies and services - general 419 192,2Establishment 789 082,1Research and development (pay) 141 851Research and development (Other) 56Transport 622,1 581,1Premises 382,4 587,3Increase / (decrease) in bad debt provision (for impairment of receivables) 534 731Increase in other provisions 801 152,1Drug costs 256,1 964,2

0 0Rentals under operating leases 926 237Depreciation on property, plant and equipment 231,2 099,1Amortisation on intangible assets 462 003Impairments of property, plant and equipment 1 773Impairments of intangible assets 0 0

0 0Impairments of investment property 0 0Impairments of assets held for sale 47 0Audit fees - statutory reporting 83 85Audit fees - regulatory reporting 0 0Other auditors remuneration 0 0Clinical negligence 211 791Loss on disposal of investments 0 0

0 0Loss on disposal of land and buildings 7 0Loss on disposal of other property, plant and equipment 0 0Loss on disposal of assets held for sale 0 9Legal fees 981 962Consultancy costs 723 071Training, courses and conferences 683 313Patient travel 41 621Car parking & security 88 281Redundancy 0 03Early retirements 73 0Hospitality 2 4Publishing 0 0Insurance 521 79Other services, e.g. external payroll 0 0Grossing up consortium arrangements 0 0Losses, ex gratia & special payments 7 71Other * 009,4 309,4

103,617 108,721 Of which:Related to continuing operations 103,617 102,201 Related to discontinued operations 0 025,6

For details of discontinued operations see note 3

* ‘Other’ includes Social Services placement costs of £4,466,517 (£4,137,049 in 2012/13) 150

The Trust has contributed £72,958 to pension schemes in respect of directors in 2013/14 (£74,278 in 2012/13). None of

credits have been made to directors by the Trust, nor have any guarantees been entered into on their behalf.

7.2 Operating leases

7.2.1 Operating expenses include:12 Months to 31

March 2014£000

12 Months to 31 March 2013

£000 Minimum lease payments Buildings 841 761Minimum lease payments Lease Cars 184 565

926 237

7.2.2 Annual commitments containing operating leases are:

On buildings leases expiring:Future minimum lease payment due

12 Months to 31 March 2014

£000

12 Months to 31 March 2013

£000 Within 1 year 311 721Between 2 and 5 years 51 5After 5 years 0 0

821 231

On other leases ( Lease Cars) expiring:Future minimum lease payment due Within 1 year 612 282Between 2 and 5 years 251 432After 5 years 0 0

863 615

7.3 Limitation on auditor’s liability2013/14

£000 2012/13

£000 Limitation on auditor’s liability 1,000 1,000

7.4 The late payment of commercial debts (interest) Act 19982013/14

£000 2012/13

£000

Amounts included within other interest payable arising from claims made under this legislation

0 0

Compensation paid to cover debt recovery costs under this legislation

0 0

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8 STAFF COSTS AND NUMBERS8.1 Staff costs

12 Months to 31 March 2014 12 Months to 31 March 2013Total Permanent Other Total Permanent Other

£000 £000 £000 £000 £000 £000

Salaries and wages 59,982 55,604 873,4 62,274 57,277 799,4Social security costs 017,4 744,4 362 839,4 865,4 073

plans (employers’ contributions to NHS Pension Scheme)

183,7 229,6 954 876,7 692,7 283

Pension cost - other contributions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 99 99 0 0 0 0

Agency/contract staff 472,4 0 472,4 491,3 0 491,3Costs capitalised as part of assets (21) (21) 0 (90) (44) (46)

76,425 67,051 473,9 77,994 69,097 798,8Recoveries from DH Group bodies in respect of staff cost netted off expenditure

0 0 0 0 0 0

Recoveries from Other bodies in respect of staff cost netted off expenditure

0 0 0 0 0 0

76,425 67,051 473,9 77,994 69,097 798,8

The costs associated with bank staff are included within the salaries and wages category.The costs associated with non executive directors are excluded from staff costs.

8.2 Average number of persons employed (WTE basis)12 Months to 31 March 2014 12 Months to 31 March 2013Total Permanent Other Total Permanent Other

Medical and dental 104 67 37 97 65 32Ambulance staff 0 0 0 0 0 0Administration and estates 403 383 20 390 364 26Healthcare assistants and other support staff

54 52 2 56 52 4

Nursing, midwifery and health visiting staff

830 802 28 894 856 38

Nursing, midwifery and health visiting learners

1 1 0 0 0 0

staff 253 239 14 273 246 27

Social care staff 81 49 32 51 51 0Agency and contract staff 75 0 75 148 0 148Bank staff 108 0 108 0 0 0Other 0 0 0 0 0 0

1,909 1,593 316 1,909 1,634 275

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8.5 Other compensation schemes

Number of Compulsory

Redundancies

Cost of Compulsory

Redundancies

Number of Other

Departures Agreed

Cost of Other

Departures Agreed

Total Number

of Exit Packages

Total Cost of Exit

Packages

Number of Departures

where Special

Payments have been

made

Cost of Special

Payment Element included

in Exit Packages

Exit package cost band (including any special payment element)

Number £000s Number £000s Number £000s Number £000s

<£10,000 0 0 0 0 0 0 0 0

£10,001 - £25,000 0 0 0 0 0 0 0 0

£25,001 - 50,000 0 0 1 37 1 37 0 0

£50,001 - £100,000 0 0 1 62 1 62 0 0

£100,001 - £150,000

0 0 0 0 0 0 0 0

£150,001 - £200,000

0 0 0 0 0 0 0 0

>£200,001 0 0 0 0 0 0 0 0

Total 0 0 2 99 2 99 0 0

Number of Compulsory

Redundancies

Cost of Compulsory

Redundancies

Number of Other

Departures Agreed

Cost of Other

Departures Agreed

Total Number

of Exit Packages

Total Cost of Exit

Packages

Number of Departures

where Special

Payments have been

made

Cost of Special

Payment Element included

in Exit Packages

Exit package cost band (including any special payment element)

Number £000s Number £000s Number £000s Number £000s

<£10,000 0 0 0 0 0 0 0 0

£10,001 - £25,000 0 0 0 0 0 0 0 0

£25,001 - 50,000 0 0 0 0 0 0 0 0

£50,001 - £100,000 0 0 0 0 0 0 0 0

£100,001 - £150,000

0 0 1 102 1 102 0 0

£150,001 - £200,000

0 0 0 0 0 0 0 0

>£200,001 0 0 1 230 1 230 0 0

Total 0 0 2 332 2 332 0 0

8.3 Retirements due to ill-health2013/14 2012/13

No. of early retirements on grounds of ill health 6 3Cost of early retirements on grounds of ill health (£000) 298 82

2013/14 2012/13No of Cases 2Cost of Cases (£000s) 99

153

8.6 Exit packages : other (non compulsary) departure payments 2013/14

Payments Agreed2013/14

Total value of Agreements

Number £000sVoluntary redundancies including early retirement contractual costs 0 0Mutually agreed resignations (MARS) contractual costs 0 0

1 37Contractual payments in lieu of notice 1 62Exit payments following Employment Tribunals or court orders 0 0Non-contractual payments requiring HMT approval 0 0Total 2 99

9. FINANCE INCOME AND FINANCE EXPENSES9.1 Finance income - interest receivable

12 Months to 31 March 2014

£000

12 Months to 31 March 2013

£000 Interest receivable 88 99

12 Months to 31 March 2014

£000

12 Months to 31 March 2013

£000 Finance leases 26 82

154

10. INTANGIBLE AND TANGIBLE NON-CURRENT ASSETS10.1 Intangible assets

2013/14Total Software

Licences (Purchased)

Information Technology

(Internally Generated)

Assets Under Construction

£000 £000 £000 £000 Gross cost at 1 April 403,1 642 850,1 0Impairments 0 0 0 0Reversal of impairments 0 0 0 0

0 0 0 0Revaluation surpluses 0 0 0 0Additions - purchased 0 0 0 0Additions - donated 0 0 0 0Transferred to disposal group as asset held for sale

0 0 0 0

Disposals 0 0 0 0Gross cost at 31 March 403,1 642 850,1 0

Amortisation at 1 April 466 461 005 0Provided during the year 462 72 732 0Impairments recognised in the income and expenditure account

0 0 0 0

Reversal of impairments recognised in the income and expenditure account

0 0 0 0

0 0 0 0Revaluation surpluses 0 0 0 0Transferred to disposal group as asset held for sale

0 0 0 0

Disposals 0 0 0 0

Amortisation at 31 March 829 191 737 0

Net book value Purchased at 1 April 640 28 855 0Donated at 1 April 0 0 0 0Total as at 1 April 640 28 855 0

Net book value Purchased at 31 March 673 55 321 0Donated at 31 March 0 0 0 0Total as at 31st March 376 55 321 0

155

2012/13Total Software

Licences (Purchased)

Information Technology

(Internally Generated)

Assets Under Construction

£000 £000 000£ £000 Gross cost at 1 April as previously stated 658 051 607 0Prior period adjustments 0 0 0 0Gross cost at 1 April restated 658 051 607 0Impairments 0 0 0 0Reversal of impairments 0 0 0 0

844 69 253 0Revaluation surpluses 0 0 0 0Additions - purchased 0 0 0 0Additions - donated 0 0 0 0Transferred to disposal group as asset held for sale

0 0 0 0

Disposals 0 0 0 0Gross cost at 31 March 403,1 642 850,1 0

Amortisation at 1 April 463 531 922 0Prior period adjustments 0 0 0 0Amortisation at 1 April 463 531 922 0Provided during the year 003 92 172 0Impairments recognised in the income and ex-penditure account

0 0 0 0

Reversal of impairments recognised in the in-come and expenditure account

0 0 0 0

0 0 0 0Revaluation surpluses 0 0 0 0Transferred to disposal group as asset held for sale

0 0 0 0

Disposals 0 0 0 0Amortisation at 31 March 466 461 005 0

Net book value Purchased at 1 April 294 51 774 0Donated at 1 April 0 0 0 0Total as at 1 April 294 51 774 0

Net book value Purchased at 31 March 046 28 558 0Donated at 31 March 0 0 0 0Total as at 31st March 046 82 558 0

The Trust has no commitments to purchase intangible assets.

156

Intangible Valuations Software Licences (Purchased)

Information Technology (Internally

Generated)

Assets Under Construction

Method of determining fair valueYear of revaluationCarrying amount of revalued assets at 31 March 2013 (£000)

Management Review2007/08

55

Management Review2013/14

321

Held at CostN/A

0

The Trust’s Software Licences have a market value and an established economic life and are required in connection with the

assets will be amortised is reasonable.

Note 10.2 Economic life of intangible assets Min Life Years Max Life Years

10.2.1 Intangible assets - internally generatedInformation technology 0 0Development expenditure 0 2Other 0 0

10.2.2 Intangible assets - purchasedSoftware 0 3Licences & trademarks 0 2Patents 0 0Other 0 0Goodwill 0 0

157

10.3 Tangible Property, Plant and EquipmentTangible property, plant and equipment at the balance sheet date comprise the following elements:

2013/14Total Land Buildings Assets

Under Construction

Plant and Machinery

Transport Equipment

Information Technology

Furniture &

Fittings£000 £000 £000 £000 £000 £000 £000 £000

711,76 16,645 43,784 212,2 496,1 33 947,2 0 714,6 513,1 169,4 0 22 2 98 82

Transfer by absorption Normal 0 0 0 0 0 0 0 0Additions purchased / internally generated

094,1 0 659 614 811 0 0 0

Additions grants/donations of cash to purchase assets

0 0 0 0 0 0 0 0

Impairments charged to operating expenses

0 0 0 0 0 0

Impairments charged to revaluation reserve

(302) (302) 0 0 0 0 0 0

Reversal of impairments credited to operating income

0 0 0 0 0 0 0 0

Reversal of impairments credited to the revaluation reserve

0 0 0 0 0 0 0 0

0 185,1 621 (1,704) 51 0 0 (18) 0 0 0 0 0 0 0 0

Revaluations 372,5 77 691,5 0 0 0 0 0Transferred to disposal group as asset held for sale

(175) (60) (115) 0 0 0 0 0

Disposals 0 0 0 0 0 0 0 0Cost or valuation at 31 March 2014

79,819 19,255 54,908 429 948,1 53 838,2 01

709,2 0 012 0 660,1 33 895,1 0 0 0 0 0 0 0 0 0

Transfer by absorption Normal 0 0 0 0 0 0 0 0Provided during the year 231,2 0 256,1 0 061 1 813 1Impairments charged to operating expenses

0 0 0 0 0 0 0 0

Impairments charged to revaluation reserve

0 0 0 0 0 0 0 0

Reversal of impairments credited to operating income

(408) 0 (408) 0 0 0 0 0

Reversal of impairments credited to the revaluation reserve

0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Revaluation surpluses 0 0 0 0 0 0 0 0Transfer to disposal group as asset held for sale

0 0 0 0 0 0 0 0

Disposals 0 0 0 0 0 0 0 0Accumulated depreciation at 31 March 2014

136,4 0 454,1 0 622,1 43 619,1 1

Net book value Purchased at 31 March 74,425 19,255 52,691 429 326 1 229 9Finance lease at 31 March 063 0 063 0 0 0 0 0Donated at 31 March 304 0 304 0 0 0 0 0Total as at 31st March 75,188 19,255 53,454 429 326 1 229 9

158

As a result of the reorganisation of the NHS on 1 April 2013 the Trust was the recipient of the transfer of assets and liabilities from Herefordshire PCT. Since the trust recognised the transfer directly from a body which ceased to exist on 1 April 2013, modified absorption accounting applies. The Trust received £6,417k property, plant and equipment assets.

As a result of the five yearly revaluation of land and buildings by the District Valuation Office, the Trust’s overall land and buildings value increased by £5,378,000 ;

• Some properties incurred an impairment totalling £303,410 of which £302,500 was credited against revaluation reserve and an impairment of £910 was charged to operating expenses.

• Other properties experienced an increase in value totalling £5,681,000 of which £5,273,000 was debited to revaluation reserves and £408,000 was credited to the operating income as a reversal of previous years impairments against operating expenses.

159

Impairment of Assets (Property, Plant and Equipment and non-current assets for sale Assets):2013/14 2012/13

Net impairments

£000 Impairments

£000 Reversals

£000

Net impairments

£000 Impairments

£000 Reversals

000£Impairments charged to operating

Loss or damage from normal operations

0 0 0 0 0 0

0 0 0 0 0 0Abandonment of assets in course of construction

0 0 0 70 70 0

Unforeseen obsolescence 0 0 0 0 0 0Loss as a result of catastrophe 0 0 0 0 0 0Other 0 0 0 0 0 0Changes in market price (333) 75 (408) 294 307 (13) Total Impairments charged to (333) 75 (408) 364 377 (13)

Impairments charged to the revaluation reserve

302 302 0 843 843 0

Total Impairments (31) 377 (408) 1,207 1,220 (13)

160

2012/13Total Land Buildings Assets

Under Construction

Plant and Machinery

Transport Equipment

Information Technology

Furniture &

£000 £000 £000 £000 £000 £000 £000 £000 Cost or valuation at 1 April 2012 69,810 17,025 47,543 739,1 284,1 011 317,1 0Prior period adjustments 0 0 0 0 0 0 0 0

69,810 17,025 47,543 739,1 284,1 011 317,1 0 0 0 0 0 0 0 0 0

Transfer by absorption Normal 0 0 0 0 0 0 0 0Additions purchased / internally generated

386,2 0 964 312,2 1 0 0 0

Additions grants/donations of cash to purchase assets

0 0 0 0 0 0 0 0

Impairments charged to operating expenses

0 0 0 0 0 0 0 0

Impairments charged to revaluation reserve

(843) (130) (642) (71) 0 0 0 0

Reversal of impairments credited to operating income

0 0 0 0 0 0 0 0

Reversal of impairments credited to the revaluation reserve

0 0 0 0 0 0 0 0

(278) 0 433 (1,867) 912 0 630,1 0 0 0 0 0 0 0 0 0

Revaluations 831 0 831 0 0 0 0 0Transferred to disposal group as asset held for sale

(474) (250) (224) 0 0 0 0 0

Disposals (85) 0 0 0 (8) (77) 0 0Cost or valuation at 31 march 2013 70,951 16,645 47,618 212,2 496,1 33 947,2 0

Accumulated depreciation at 1 April 2012

274,4 0 480,2 0 219 011 663,1 0

Prior period adjustments 0 0 0 0 0 0 0 0 274,4 0 480,2 0 219 011 663,1 0 0 0 0 0 0 0 0 0

Transfer by absorption Normal 0 0 0 0 0 0 0 0Provided during the year 099,1 0 695,1 0 261 0 232 0Impairments charged to operating expenses

773 0 773 0 0 0 0 0

Impairments charged to revaluation reserve

0 0 0 0 0 0 0 0

Reversal of impairments credited to operating income

(13) 0 (13) 0 0 0 0 0

Reversal of impairments credited to the revaluation reserve

0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Revaluation surpluses 0 0 0 0 0 0 0 0Transfer to disposal group as asset held for sale

0 0 0 0 0 0 0 0

Disposals (85) 0 0 0 (8) (77) 0 0Accumulated depreciation at 31 March 2012

147,6 0 440,4 0 660,1 33 895,1 0

Net book value Purchased at 31 March 63,443 16,645 42,807 212,2 826 0 151,1 0Finance lease at 31 March 693 0 693 0 0 0 0 0Donated at 31 March 173 0 173 0 0 0 0 0Total as at 31st March 64,210 16,645 43,574 212,2 826 0 151,1 0

10.4 Economic life of property, plant and equipmentMin Life

YearsMax Life

Years

Land 0 0Buildings excluding dwellings 0 64Dwellings 0 0Assets under construction 0 0Plant & machinery 0 13Transport equipment 0 2Information technology 0 6

0 6

10.5 Non-current assets for sale and assets in disposal groups2013/14

£000 2012/13

£000

NBV of non-current assets for sale and assets in disposal groups at 1 April 474 495Transfers by absorption 0 0

175 474Less assets sold in year (175) (495)Less Impairment of assets held for sale (74) 0Plus reversal of impairment of assets held for sale 0 0

0 0NBV of non-current assets for sale and assets in disposal groups at 31 March 400 474

.

As a result of an impairment review of land and buildings by the District Vto operating expenses.

162

11 TRADE RECEIVABLES AND OTHER RECEIVABLES31 March 2014

£000 31 March 2013

£000 31 March 2012

£000

Current: NHS receivables - revenue 841,2 849,2 376,3NHS receivables - capital 0 0 0Other receivables with related parties - revenue 416 365 647Other receivables with related parties - capital 0 0 0Provision for impaired receivables (899) (553) (420) Deposits and advances 0 0 0Prepayments (non-PFI) 633 952 133Accrued income 0 453 5Interest receivable 2 41 41Corporation tax receivable 0 0 0Finance lease receivables 0 0 0Operating lease receivables 0 0 0PDC dividend receivable 07 031 06VAT receivable 59 14 16Other receivables - revenue 032 081 443Other receivables - capital 0 0 0Total current trade and other receivables 695,2 639,3 418,4

Non Current:NHS receivables - revenue 0 0 0NHS receivables - capital 0 0 0Other receivables with related parties - revenue 0 0 0Other receivables with related parties - capital 0 0 0Provision for impaired receivables 0 0 0Deposits and advances 0 0 0Prepayments (non-PFI) 61 11 5Accrued income 0 0 0Interest receivable 3 0 0Corporation tax receivable 0 0 0Finance lease receivables 0 0 0Operating lease receivables 0 0 0VAT receivable 0 0 0Other receivables - revenue 0 0 0Other receivables - capital 0 0 0Total non current trade and other receivables 91 11 5

Total trade and other receivables 516,2 749,3 918,4

11.1 Provisions for impairment of trade receivables31 March 2014

£00031 March 2013

£000

As at 1 April 355 024Increase in provisions 464 602Amounts utilised (89) (4) Unused amounts reversed (29) (69) As at 31 March 998 355

Provisions for impairment of trade receivables include £855,515 in respect of bodies considered related parties (£510,877 at 31 March 2014)

163

Ageing of impaired receivables

31 March 2014Trade

Receivables£000

31 March 2014Other

Receivables£000

31 March 2013Trade

Receivables£000

31 March 2013Other

Receivables£000

0 - 30 days 33 0 0 030 - 60 days 66 0 0 060 - 90 days 86 0 0 090 - 180 days (was “In three to six months”) 031 0 81 0180 - 360 days (was “over six months”) 855 44 394 24Total 558 44 115 24

Ageing of non-impaired receivables past their due date0 - 30 days 394,1 715 837,2 18630 - 60 days (11) 42 36 1060 - 90 days 11 5 52 190 - 180 days (was “In three to six months”) (230) 0 722 15180 - 360 days (was “over six months”) (84) (9) 67 53Total 971,1 735 921,3 562

No collateral is held as security against any impaired receivables. There are also no credit enhancements or changes in the fair value of any impaired receivables.

11.3 Finance lease receivables

12 Current Asset Investments31 March 2014

£000 31 March 2013

£000

Cost or valuation at 1 April 0 0Additions 96,000 58,000 Disposals (96,000) (58,000) Revaluations 0 0Cost or valuation at 31 March 0 0

The Trust used the Bank of England (National Loans Fund), Royal Bank of Scotland, Barclays and Santander for short term investments which were not greater than 3 months in duration.

11.2 Analysis of impaired receivables

164

13 TRADE AND OTHER PAYABLES13.1 Trade and other payables at the balance sheet date are made up of:

31 March 2014£000

31 March 2013£000

1 April 2012£000

Current Receipts in advance 0 0 0NHS payables - capital 0 0 0NHS payables - revenue 134,1 507,2 1,747NHS Payables - early retirement costs payable within one year 0 0 0Amounts due to other related parties - capital 0 0 0Amounts due to other related parties - revenue 844,1 346,1 1,840Other trade payables - capital 982 281 824Other trade payables - revenue 535,1 976,1 1,458Social Security costs 863,1 774,1 1,516VAT payable 0 0 0Other taxes payable 0 0 0Other payables 495 064,2 492Accruals 983,4 682,1 1,903PDC dividend payable 0 0 0

0 0 0Total current trade and other payables 450,11 234,11 9,780

Non-currentReceipts in advance 0 0 0NHS payables - capital 0 0 0NHS payables - revenue 0 0 0Amounts due to other related parties - capital 0 0 0Amounts due to other related parties - revenue 0 0 0Other trade payables - capital 0 0 0Other trade payables - revenue 0 0 0VAT payable 0 0 0Other taxes payable 0 0 0Other payables 0 0 0Accruals 0 0 0Total non-current trade and other payables 0 0 0

An accrual for annual leave was estimated by requesting from all budget holders a list of staff with leave outstanding at the end of 31st March 2014. The remaining leave was valued at the appropriate pay band for each member of staff. Annual leave outstanding for medical staff was calculated differently as their annual leave year does not run from 1st April to 31st March but annually from their start date. The actual date of the individual’s leave year has been factored into the calculation for determining the outstanding leave and applied to their actual pay.

Accruals for staff travel, telephones and utility invoices were estimated having analysed the invoices paid and the period unpaid.

165

13.2 Other liabilities31 March 2014

£000 31 March 2013

£000 Current Deferred income grants 0 0Deferred income goods & services 653 436Deferred income rent of land 0 0Other deferred income 0 0Total other current liabilities 653 436

Non-currentDeferred income grants 0 0Deferred income goods & services 0 0Deferred income rent of land 0 0Other deferred income 0 0Total other non current liabilities 0 0

13.3 Borrowings31 March 2014

£00031 March 2013

£000Current Bank overdrafts - Government Banking Service 0 0Bank overdrafts - commercial banks 0 0Drawdown in committed facility 0 0Loans from Foundation Trust Financing Facility 0 0Loans from Department of Health 0 0Other Loans 0 0

63 43Obligations under PFI contracts 0 0Total current borrowings 63 43

Non-currentLoans from Foundation Trust Financing Facility 0 0Other loans 0 0

793 234Obligations under PFI contracts 0 0Total other non current liabilities 793 234

166

The prudential borrowing code requirements in section 41 of the NHS Act 2006 have been repealed with effect from 1 April

required.

13.5 Finance lease obligations31 March 2014

£000 31 March 2013

£000

Gross buildings lease liabilities- not later than one year; 95 95

632 632 952 513

Gross buildings lease liabilities 455 016

(121) (144) Net buildings lease liabilities 334 664

Net lease liabilities payable:- not later than one year; 63 43

961 851 822 472 334 664

of the date from which the term is calculated.

13.4 Prudential Borrowing Limit

167

14 PROVISIONS31 March 2014

Other legal claims

£000

Other legal claims

£000

As at 1 April 997,1 904Change in the discount rate 0 0Arising during the period 647 345,1Utilised during the period (430) (160)

0 0Reversed unused (381) (2) Unwinding of discount 0 9At 31 March 437,1 997,1

- not later than one year; 086,1 967,1 31 31 14 71

At 31 March 437,1 997,1

The provision for other legal claims is stated subject to uncertainty about the outcome of legal proceedings.The Trust has made provisions for some employment and supplier issues in accordance with International Accounting Standard 37. No individual provision is over £800,000. (Nil in 2012/13)

The NHS Litigation Authority held provisions of £2,129,028 at 31 March 2014 in respect of clinical negligence liabilities of the NHS Foundation Trust (£260,000 in 12/13).

168

15 CASH AND CASH EQUIVALENTS31 March 2014

£000 31 March 2013

£000

At 1 April 27,645 20,301 Net change in year 367,2 443,7At 31 March 30,408 27,645 Broken down into:Cash at commercial banks and in hand 63 13Cash with the Government Banking Service 18,372 27,614 Other current investments 12,000 0Cash and cash equivalents as in SoFP 30,408 27,645 Bank overdraft - GBS & commercial 0 0Cash and cash equivalents as in SoCF 30,408 27,645

15.1 Third Party Assets31 March 2014

£000 31 March 2013

£000 Third party assets held by the Trust 80 111

Third party assets held by the Trust relate to cash at bank and in hand held by the Trust on behalf of patients. This has been

16 COMMITMENTS

16.1 Capital Commitments

Commitments under capital expenditure contracts at 31 March were as follows:

31 March 2014£000

31 March 2013£000

Property, plant and equipment 1300 5541300 554

16.2 Other Financial Commitments

The Trust is not committed to any non-cancellable contracts (which are not leases, PFI contracts or other service concession arrangements) with any related party or other organisation at 31 March 2014

17 CONTINGENCIES31 March 2014

£000 31 March 2013

£000 Gross value of contingent liabilities 0 0Amounts recoverable against contingent liabilities 0 0Net value of contingent liabilities 0 0

Net value of contingent assets 9 42

Net contingent assets relate to personal injury claims.Contingent liabilities relate to obligations arising from past events such as legal claims. They are not recognised as provisions either:- because it is not probable that any expenditure will be incurred, or- because the expenditure cannot be measured reliably

169

The Department of Health and Monitor (the independent regulator of NHS Foundation Trusts) are regarded as related parties.

for which these bodies are regarded as the parent departments. Those entities with transactions or balances totalling more than £500,000 are listed below:

Entity Income £’000

Expenditure£’000

Receivables £’000

Payables£’000

Berkshire Healthcare NHS Foundation Trust 237Gloucestershire Hospitals NHS Foundation Trust 381,1 387,3 396Wye Valley NHS Trust 036NHS Gloucestershire CCG 76,425 NHS Herefordshire CCG 16,020 Health Education England 685,1NHS England 922,2

In addition, the Trust has had a number of material transactions with other government departments and other central and local government bodies. Those entities with transactions or balances totalling more than £500,000 are listed below:

Entity Income £’000

Expenditure£’000

Receivables £’000

Payables£’000

Gloucestershire County Council 405,1 369,2 756,1Herefordshire Council 919,3 690,1NHS Pension Scheme 892,7 530,1HM Revenue and Customs 386,4 383,1

18 RELATED PARTY TRANSACTIONS

2gether NHS Foundation Trust is a corporate body established by order of the Secretary of State for Health.During the year none of the Board members or members of the key management staff or parties related to them has undertaken any material transactions with the Trust.

The Chief Executive, Shaun Clee, is married to the Head of Older Peoples Services for Midland Heart, a social housing provider who bid for and are in partnership with NHS providers for care support services. The individuals concerned have not been involved in any negotiations or material transactions.

The Medical Director, Paul Winterbottom, is married to a director of Gloucestershire Hospitals NHS Foundation Trust. The individuals concerned have not been involved in any negotiations or material transactions. Paul is also a Trustee of Gloucestershire Young Carers and a Director of Active GloucestershireA Non Executive Director, Joanna Newton, has recently became Chair of the Worcester Acute Programme Board. This role has not involved any negotiations or transactions related to the Trust.

A Non Executive Director, Richard Szadziewski, has his own business, RSZ Consulting Ltd. This business does work with other public sector organisations but

has never contracted with the Trust for services.

A Non Executive Director, Martin Freeman, is a Director and Trustee of Carers Gloucestershire. This role has not involved any negotiations or transactions related to the Trust.

The Board of Governors has two nominated roles held by Duncan Smith and Faye Henry:

Duncan Smith is a Cheltenham Borough Councillor.

Faye Henry is nominated by the Learning Disabilities Partnership Board.

2gether NHS Foundation Trust is the corporate trustee of the 2gether NHS Foundation Trust Charitable Fund, registered with the Charity Commission, registration number 1097529. (Further details in note 19.1)

staff of 2gether NHS Foundation Trust Charitable Fund are members of the Board of 2gether NHS Foundation Trust or its employees. During 2013/14 none of the trustees or members of key management staff or parties related to them undertook any material transactions with the 2gether NHS Foundation Trust Charitable Fund. During the year, the 2gether NHS Foundation Trust Charitable Fund did not use any resources to

executive Directors of the Trust Board

share the responsibility for ensuring

a corporate trustee in managing the charitable funds.

Since 11th December 2013 2gether NHS Foundation Trust became the corporate trustee of the New Highway Charity, registered with the Charity Commission, registration number 1063888. (Further details in note 19.2)

During 2013/14 none of the trustees or members of key management staff New Highway Charity or parties related to them undertook any material transactions with 2gether NHS Foundation Trust or 2gether NHS Foundation Trust Charitable Fund. During the year, the New Highway Charity did not use any resources to

19 CHARITABLE FUNDS WHERE 2GETHER NHS FOUNDATION TRUST IS THE CORPORATE TRUSTEE

The Treasury agreed to apply IAS 27 to NHS organisations from 1 April 2013 therefore from 2013/14, foundation trusts must consolidate any charitable funds where it is the corporate trustee and effectively has the power to exercise control unless the impact on the accounts would not be material.

2gether NHS Foundation Trust is the corporate trustee of the 2gether NHS Foundation Trust Charitable Fund, registered with the Charity Commission, registration number 1097529.

Since 11th December 2013 2gether NHS Foundation Trust has been the corporate

170

trustee of the New Highway Charity, registered with the Charity Commission, registration number 1063888.

The Trust has assessed the transactions and balances of its linked charities ‘2gether NHS Foundation Trust Charitable Funds’ and ‘New Highway’ Charity and has decided that these are not material, in the context of the NHS Trust accounts, and they do not require consolidation.

The Trust will produce Annual Accounts and Trustee Reports for both charities in accordance with the Charity Commission Requirements. Further details of the charities are given in section 19.1 and 19.2

19.1 2gether NHS Foundation Trust Charitable FundThe funds are held on trust under paragraph 16c of schedule 2 of the NHS and Community Care Act 1990.

At 31st March 2014 the funds held by the charity were £367,000. £30,084 was spent on patient welfare and amenities, and £2,810 on staff welfare and amenities. Patient welfare expenditure included £6,290 on music sessions; £2,290 on dancing and movement sessions:£600 on rugby tickets £2,170 on a football project; £1170 on story telling sessions:£1,175 on a potters wheel; £3,847 on gardening projects. Staff welfare expenditure included £847 on a conference attended by service users.

19.1.1 From Charity’s Statement of Financial Activities

12 Months to 31 March 2014

£000

12 Months to 31 March 2013

£000 Total Incoming Resources 1 2Resources Expended with this NHS body (1) (1)Resources Expended with other NHS foundation trusts (2) (2) Resources Expended with NHS Trusts 0 0Resources expended with NHS England & CCGs 0 0

Resources Expended with bodies outside the NHS (37) (21) Total Resources Expended (40) (24) Net (outgoing) / incoming resources before transfers (39) (22) (Losses) / gains on revaluation and disposal 0 0Other fund movements 0 0Net movement in funds (39) (22)

19.1.2 From Charity’s Balance SheetAt 31 March 2014

£000 At March 2013

£000 At 1 April 2012

£000Investments 0 0 0

0 0 0 0 0 0

Cash 173 014 234Other Current Assets 0 0 0Current Liabilities (4) (4) (4) Creditors due after one year 0 0 0Net assets / liabilities 763 604 824

Restricted / Endowment funds 12 22 22Unrestricted funds 643 483 604Total Charitable Funds 763 604 824

19.1.3 Restricted / Non-Restricted Analysis12 Months to 31

March 201412 Months to 31

March 201412 Months to 31

March 2014Total charitable

funds £000

Restricted / Endowment

£000

Non-restricted

£000Opening Balance 406 22 384Net (outgoing) / incoming resources (39) (1) (38)(Losses)/gains on revaluation and disposal 0 0 0Transfers to FT charities (where parent trust is Authorised) 0 0 0Transfers to/from other bodies 0 0 0Other movements 0 0 0Closing Balance 367 21 346

171

19.2 New Highway CharityAt 31st March 2014 the funds held by the charity were £98,469.93. £50,780 was spent on patient welfare projects in line with the Charitable Objects of the charity and donations of £218,200 were made to other local charities.

The Trust became the corporate trustee of the New Highway Charity on 11th December 2013 and have no responsibility for

19.2.1 From Charity’s Statement of Financial Activities11 Months to 31

March 2014£000

13 Months to 30 April 2013£000

Total Incoming Resources 04 742,1Resources Expended with this NHS body 0 0Resources Expended with other NHS foundation trusts 0 0Resources Expended with NHS Trusts 0 0Resources expended with NHS England & CCGs 0 0Resources Expended with bodies outside the NHS (51) (1,329) Total Resources Expended (51) (1,329) Net (outgoing) / incoming resources before transfers (11) (82) (Losses) / gains on revaluation and disposal 0 0Other fund movements (228) 0Net movement in funds (239) (82)

19.2.2 From Charity’s Balance SheetAs 31 March 2014 At 30 April 2013

£000 £000 Investments 0 0

0 0 0 0

Cash 89 443Other Current Assets 0 51Current Liabilities 0 (22) Creditors due after one year 0 0Net assets / liabilities 89 733

Restricted / Endowment funds 0 (18) Unrestricted funds 89 553Total Charitable Funds 89 733

19.2.3 Restricted / Non-Restricted Analysis11 Months to 31

March 201411 Months to 31

March 201411 Months to 31

March 2014Total charitable

funds£000

Restricted / Endow-ment£000

Non-restricted£000

Opening Balance 337 (18) 355Net (outgoing) / incoming resources (11) 18 (29)(Losses)/gains on revaluation and disposal 0 0 0Transfers to FT charities (where parent trust is Autho-rised)

0 0 0

Transfers to/from other bodies (228) 0 (228)Other movements 0 0 0Closing Balance 98 0 98

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20 FINANCIAL INSTRUMENTSFinancial Reporting Standard IFRS 7 requires disclosure of the role that

the period in creating or changing the risks an entity faces in undertaking its activities. Because of the continuing service provider relationship that the Trust has with local Primary Care Trusts and the way those Primary Care Trusts

risk faced by business entities. Also

limited role in creating or changing risk than would be typical of the listed companies, to which the reporting standards mainly apply.

The Trust’s treasury management operations are carried out by the Finance Department, within parameters formally

Financial Instructions and policies agreed by a committee of the Board. Trust treasury activity is subject to review by the Trust’s internal auditors.

Currency riskThe Trust is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The Trust has no overseas operations. The Trust therefore has low exposure to currency

Interest rate risk

market deposits with the National Loans Fund and a small number of banks and building societies with a maximum period of three months. The Trust limits its investment in any one organisation, limits the time of the investment and regularly monitors interest rates in the market. The Trust therefore has low exposure to

Credit riskThe majority of the Trust’s income comes from contracts with other public sector bodies. The Trust has low exposure to credit risk. The maximum exposures as at 31 March are in receivables from

customers, as disclosed in the trade and other receivables note.

market deposits with a small number of banks and building societies. The Trust manages counterparty credit risks by monitoring credit ratings from three agencies and by only investing in organisations with a very strong credit rating and by investing for short periods only. At the 31st March there were no amounts invested in short term deposits.

Liquidity riskThe Trust’s operating costs are incurred under contracts with Primary Care Trusts,

voted annually by Parliament. The Trust funds its capital expenditure from retained surpluses and capital disposals. The Trust is not, therefore, exposed to

£8 million in cash and short term deposits to ensure the liquidity position.

20.1 Financial assets by category Loans and Receivables

Assets at Fair Value through

the I&E

Held to Maturity

Available for Sale

Total

£000 £000 £000 £000 £000 Financial Assets as per Statement of Financial Position:At 31 March 2014Embedded derivatives 0 0 0 0 0Trade and other receivables excluding non 011,2 0 0 0 011,2

Other investments 0 0 0 0 0 0 0 0 0 0

Non current assets held for sale and assets held 0 0 0 0 0

Cash and cash equivalents at bank and in hand 30,408 0 0 0 30,408 Total as at 31 March 2014 32,518 0 0 0 32,518

At 31 March 2013Embedded derivatives 0 0 0 0 0Trade and other receivables excluding non 436,3 0 0 0 436,3

Other investments 0 0 0 0 0 0 0 0 0 0

Non current assets held for sale and assets held 0 0 0 0 0

Cash and cash equivalents at bank and in hand 27,645 0 0 0 27,645 Total as at 31 March 2013 31,279 0 0 0 31,279

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20.2 Financial Liabilities by categoryOther

Financial Liabilities

Liabilities at Fair Value

through the I&E

Total

Liabilities as per Statement of Financial Position: £000 £000 £000At 31 March 2014Embedded derivatives 0 0 0

0 0 0 334 0 334

Obligations under PFI contracts 0 0 0 686,9 0 9,686

0 0 0Provisions under contract 437,1 0 437,1

0 0 0Total as at March 2014 11,853 0 358,11

At 31 March 2013Embedded derivatives 0 0 0

0 0 0 664 0 664

Obligations under PFI contracts 0 0 0 459,9 0 459,9 0 0 0

Provisions under contract 897,1 0 897,1 0 0 0

Total as at March 2013 12,218 0 12,218

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2013/14 2012/13Losses: Numbers Value

£’000Numbers Value

£’0001. Losses of cash due to: a. theft, fraud etc. 0 0 0 0b. overpayment of salaries etc. 81 51 91 28c. other causes 0 0 4 12. Fruitless payments and constructive losses 0 0 0 03. Bad debts and claims abandoned in relation to: a. private patients 0 0 0 0b. overseas visitors 0 0 0 0c. other 1 0 22 14. Damage to buildings, property etc. due to: a. theft, fraud etc. * 0 0 1 47b. stores losses 0 0 0 0c. other 0 0 1 0Total losses 91 51 74 851

Special payments: 5. Compensation under legal obligation 0 0 0 06. Extra contractual to contractors 0 0 0 07. Ex gratia payments in respect of: 0 0 0 0a. loss of personal effects 31 2 11 2b. clinical negligence with advice 0 0 0 0c. personal injury with advice 1 01 5 31d. other negligence and injury 0 0 0 0f. Other employment payments 0 0 0 0g. Patient referrals outside the UK and EEA guidelines 0 0 0 0h. other 0 0 1 1

3 5 0 0

8. Special Severance payments 0 0 0 09. Extra statutory and regulatory 0 0 0 0Total special payments 71 71 71 61

Total losses and special payments 63 23 46 471

* An empty site was broken into and pipework and cabling were stolen resulting in an impairment of £74,000.

22 POST BALANCE SHEETS EVENTSThere are no Events after the Balance Sheet Date that need reporting .

21 LOSSES AND SPECIAL PAYMENTS

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We have audited the financial statements of 2gether NHS Foundation Trust for the year ended 31 March 2014 which comprise the Statement of Comprehensive Income, the Balance Sheet, the Cash Flow Statement, the Statement of Changes in Taxpayers’ Equity and the related notes 1 to 22. The financial reporting framework that has been applied in their preparation is applicable law and the accounting policies directed by Monitor – Independent Regulator of NHS Foundation Trusts.This report is made solely to the Board of Governors and Board of Directors (“the Boards”) of 2gether NHS Foundation Trust, as a body, in accordance with paragraph 4 of Schedule 10 of the National Health Service Act 2006. Our audit work has been undertaken so that we might state to the Boards those matters we are required to state to them in an auditor’s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the trust and the Boards as a body, for our audit work, for this report, or for the opinions we have formed.

Respective responsibilities of the accounting officer and auditorAs explained more fully in the Accounting Officer’s Responsibilities Statement, the Accounting Officer is responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view. Our responsibility is to audit and express an opinion on the financial statements in accordance with applicable law, the Audit Code for NHS Foundation Trusts and International Standards on Auditing (UK and Ireland). Those standards require us to comply with the Auditing Practices Board’s Ethical Standards for Auditors.

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

Independent Auditor’s Report to the Board of Governors and Board of Directors of 2gether NHS Foundation Trust

Opinion on financial statementsIn our opinion the financial statements:

give a true and fair view of the state of the trust’s affairs as at 31 March 2014 and of its income and expenditure for the year then endedhave been properly prepared in accordance with the accounting policies directed by Monitor – Independent Regulator of NHS Foundation Trustshave been prepared in accordance with the requirements of the National Health Service Act 2006.

Opinion on other matters prescribed by the National Health Service Act 2006In our opinion:

the part of the Directors’ Remuneration Report to be audited has been properly prepared in accordance with the National Health Service Act 2006the information given in the Strategic Report and the Directors’ Report for the financial year for which the financial statements are prepared is consistent with the financial statements.

Matters on which we are required to report by exceptionWe have nothing to report in respect of the following matters where the Audit code for NHS Foundation Trusts requires us to report to you if, in our opinion:

the Annual Governance Statement does not meet the disclosure requirements set out in the NHS Foundation Trust Annual Reporting Manual, is misleading or inconsistent with information of which we are aware from our audit. We are not required to consider, nor have we considered, whether the Annual Governance Statement addresses all risks and controls or that risks are satisfactorily addressed by internal controlsproper practices have not been observed in the compilation of the financial statements; or the NHS foundation trust has not made proper arrangements for securing economy, efficiency and effectiveness in its use of resources.

CertificateWe certify that we have completed the audit of the accounts in accordance with the requirements of Chapter 5 of Part 2 of the National Health Service Act 2006 and the Audit Code for NHS Foundation Trusts.

Ian Howse (Senior Statutory Auditor)For and on behalf of Deloitte LLPChartered Accountants and Statutory AuditorCardiff, United Kingdom28 May 2014

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Independent auditor’s report to the council of governors of 2gether NHS Foundation Trust on the quality reportWe have been engaged by the council of governors of 2gether NHS Foundation Trust to perform an independent assurance engagement in respect of 2gether NHS Foundation Trust’s quality report for the year ended 31 March 2014 (the “quality report”) and certain performance indicators contained therein.

This report, including the conclusion, has been prepared solely for the council of governors of 2gether NHS Foundation Trust as a body, to assist the council of governors in reporting 2gether NHS Foundation Trust’s quality agenda, performance and activities. We permit the disclosure of this report within the Annual Report for the year ended 31 March 2014, to enable the council of governors to demonstrate they have discharged their governance responsibilities by commissioning an independent assurance report in connection with the indicators. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Council of Governors as a body and 2gether NHS Foundation Trust for our work or this report, except where terms are expressly agreed and with our prior consent in writing.

Scope and subject matterThe indicators for the year ended 31 March 2014 subject to limited assurance consist of the national priority indicators as mandated by Monitor:

Minimising delayed transfer of careAdmissions to inpatient services had access to crisis resolution home treatment teams.

We refer to these national priority indicators collectively as the “indicators”.

Respective responsibilities of the directors and auditorsThe directors are responsible for the content and the preparation of the quality report in accordance with the criteria set out in the NHS Foundation Trust Annual Reporting Manual issued by Monitor.

Our responsibility is to form a conclusion, based on limited assurance procedures, on whether anything has come to our attention that causes us to believe that:

the quality report is not prepared in all material respects in line with the criteria set out in the NHS Foundation Trust Annual Reporting Manualthe quality report is not consistent in all material respects with the sources specified in the NHS Foundation Trust Annual reporting Manual

2013/14 limited assurance report on the content of the quality reports and mandated performance indicators

the indictors in the quality report identified as having been the subject of limited assurance in the quality report are not reasonably stated in all material respects in accordance with the NHS Foundation Trust Annual Reporting Manual and the six dimensions of data quality set out in the Detailed Guidance for External Assurance on Quality Reports.

We read the quality report and consider whether it addresses the content requirements of the NHS Foundation Reporting Manual, and consider the implications for our report if we become aware of any material omissions.

We read the other information contained in the quality report and consider whether it is materially inconsistent with:

board minutes for the period April 2013 to March 2014papers relating to quality reported to the board over the period April 2013 to March 2014feedback from the Commissioners dated 12 and 13 May 2014feedback from local Healthwatch organisations dated 12/5/2014the trust’s complaints report published under regulation 18 of the Local Authority Social Services and NHS Complaints Regulations 2009the national patient survey 2013the national staff survey dated 25/2/2014Care Quality Commission quality and risk profiles dated 31/03/2014The Head of Internal Audit’s annual opinion over the trust’s control environment dated May 2014.

We consider the implications for our report if we become aware of any apparent misstatements or material inconsistencies with those documents (collectively the “documents”). Our responsibilities do not extend to any other information.

We are in compliance with the applicable independence and competency requirements of the Institute of Chartered Accountants in England and Wales (ICAEW) Code of Ethics. Our team comprised assurance practitioners and relevant subject matter experts.

Assurance work performedWe conducted this limited assurance engagement in accordance with International Standard on Assurance Engagements 3000 (Revised) – “Assurance Engagements other than Audits or Reviews of Historical Financial Information” issued by the International Auditing and Assurance Standards Board (“ISAE 3000”). Our limited assurance procedures included:

Evaluating the design and implementation of the key processes and controls for managing and reporting the indicators.

178

Making enquiries of management.Testing key management controls.Limited testing, on a selective basis, of the data used to calculate the indicator back to supporting documentation.Comparing the content requirements of the NHS Foundation Trust Annual Reporting Manual to the categories reported in the quality report.Reading the documents.

A limited assurance engagement is smaller in scope than a reasonable assurance engagement. The nature, timing and extent of procedures for gathering sufficient appropriate evidence are deliberately limited relative to a reasonable assurance engagement.

LimitationsNon-financial performance information is subject to more inherent limitations than financial information, given the characteristics of the subject matter and the methods used for determining such information.

The absence of a significant body of established practice on which to draw allows for the selection of different, but acceptable measurement techniques which can result in materially different measurements and can affect comparability. The precision of different measurement techniques may also vary. Furthermore, the nature and methods used to determine such information, as well as the measurement criteria and the precision of these criteria, may change over time. It is important to read the quality report in the context of the criteria set out in the NHS Foundation Trust Annual Reporting Manual.

The scope of our assurance work has not included governance over quality or non-mandated indicators which have been determined locally by 2gether NHS Foundation Trust.

ConclusionBased on the results of our procedures, nothing has come to our attention that causes us to believe that, for the year ended 31 March 2014:

the quality report is not prepared in all material respects in line with the criteria set out in the NHS Foundation Trust Annual Reporting Manualthe quality report is not consistent in all material respects with the sources specified in the NHS Foundation Trust Annual Reporting Manualthe indicators in the quality report subject to limited assurance have not been reasonably stated in all material respects in accordance with the NHS Foundation Trust Annual Reporting Manual.

Deloitte LLP Chartered AccountantsCardiff28 May 2014

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Contact UsIf you would like to contact the Trust you can:

Trust SecretaryRikenelMontpellierGloucesterGL1 1LY

john.mcilveen@glos.nhs.uk 01452 894000

Communicating with GovernorsMembers of the trust may contact Governors by:

trustgovernor@glos.nhs.uk

Freepost RLYA-XAKR-HABZ2gether NHS Foundation TrustRikenelMontpellierGloucesterGL1 1LY

The Assistant Trust Secretary on:

01452 894165

There is also a feedback form on the Trust website at:

www.2gether.nhs.uk/feedback-form

Information in other languages/formats

The 2gether NHS Foundation Trust Annual Report and Accounts 2010/11 describe the activities of the Trust during the 2010/11 financial year.

If you would like the Annual Report in large print, Braille, audio cassette tape or another language please telephone

01452 894000 2gether.comms@glos.nhs.uk

To become a member of 2gether NHS Foundation Trust

MembershipRikenelMontpellierGloucesterGL1 1LY

www.2gther.nhs.uk/membership 01452 894000

Contact Us