Aintree University Hospitals

Where quality matters

NHS Foundation Trust

review
2009/10

Contents
Section
1 2 3 4

Title

Page 3 5 6 7 7 13 16 20 21 21 21 22 24 25 26 28 28 29 31 32

Chairman and Chief Executives Foreword Strategic Framework Trust Profile A Summary of 2009/10: Our Key Objectives Our Performance - Operational Our Performance - Quality and Safety Our Performance - Financial

Our People: Staff Engagement Equality and Diversity

6 7 8 9 10

Patient and Public Involvement Raising Standards Sustainability Service Developments How we are Governed: Board of Directors Board of Governors Membership

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Our Accounts

The Trust has been shortlisted in the Acute Organisation of the Year category of the 2010 Health Service Journal Awards. Judges visited the Trust to meet staff and discuss our progress on quality and safety. The awards are announced on Monday, 29th November 2010.
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Chairman & Chief Executives Foreword

This past financial year has been a period of many positive developments for the Chairman Chris Baker congratulating organisation, despite a series of challenges. Jenny Hurst, Assistant Director of Nursing, on her Emerging Leader Award One of the biggest, most visible changes to the organisation has been to the physical environment, with The 1.5m the completion of Health, Work and several major capital Well-being Centre, developments on the one of eleven national University Hospital pilots, now houses Aintree site. These are our occupational enabling us to provide health services. our services from These provide a single site, which support to to more supports our clinical than 20,000 NHS James Birrell, Chief Executive, presenting strategy. a cake to Ward 1 staff for going a year staff across the North without C.diff West, as well as The 2009/10 financial providing help to local year saw us complete small and medium one of our most sized businesses. ambitious buildings project of recent years, the 34m Elective Care Centre (ECC). The ECC The opening of our Combined Heat and Power will house most of the services which have unit will help us reduce our carbon emissions. been provided from Walton Hospital, including The unit re-uses heat which was previously lost, day case surgery and outpatients services. In and it will pay for itself within a few years. addition, it will have one of the best Endoscopy units in the country. With more patients and Through investing in IT, we have taken staff using the Aintree site, we have built a new significant steps towards introducing the most 1,250 space multi-storey car park. The car park advanced Electronic Patient Record in the North will also serve other organisations based here, West, with links to primary care systems and the providing easier access for patients, visitors and regional map of medicine. staff.
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Welcome to this review, which tells you about some of the key developments, challenges and successes at Aintree University Hospitals NHS Foundation Trust in 2009/10

This will increase the safety and quality of our services, while also saving clinicians time and making it much easier for them to access patient information. Quality is a theme that runs through all our work, whether in the design or provision of care. Our new Quality Strategy commits us to saving more lives, reducing serious harm and having more satisfied patients. One of the great successes has been the Medical Emergency Team (MET). Since its launch in November 2009 the MET has already responded to hundreds of calls, and has reduced cardiac arrests by one-third. The team have already won a high profile safety award and are attracting enquiries from other hospitals across the country. We expect this to continue as the team goes from strength to strength.

Although our new developments will drive up quality and safety standards, we should not forget that our staff are already working very hard to ensure high levels of care. Through their hard work and dedication, we were able to meet key access standards for both planned and unplanned care, including the four-hour emergency care standard and the 18 week referral to treatment standard. We achieved all this despite the harshest winter for years. Staff commitment to providing a safe, clean environment for our patients also significantly reduced cases of C. difficile and MRSA. Our mortality rates already compared well to our peer Trusts, but they improved even further, with 363 more lives saved this year than predicted. While the NHS may be facing a period of significant change going forward, we are confident that we can meet the challenges that lie ahead. We will complete our radiotherapy upgrade, build our new Diabetes Centre and extend our physiotherapy department before the end of 2010. We are planning an ambitious investment programme to upgrade wards in the Tower Block and create stronger theatre linkages. We will complete an upgrade of the University Hospital Aintree outpatients department by the end of November 2010. All of this will help us achieve our vision of being a provider of high quality, patient-centred healthcare with a first class local, national and international reputation. Finally, we would like to take this opportunity to thank every member of staff, volunteer, Governor and member who has played their part in making Aintree University Hospitals NHS Foundation Trust the organisation it is. Although this foreword mentions many of our accomplishments, it is the successes in the every day delivery of care in which we hold the greatest sense of pride. We hope that you enjoy this review.

Christopher Baker MBE Chairman

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James Birrell Chief Executive

Strategic Framework

The Trust Board developed our Strategic Framework, which brings together our Vision, Key Objectives, Values and Behaviours. We constantly look to our Strategic Framework to help inform our decisions.

Trust Profile

Aintree University Hospitals NHS Foundation Trust runs University Hospital Aintree and Walton Hospital, serving a population of around 330,000 residents in the North Liverpool, South Sefton and Kirkby areas.

Our new 34m Elective Care Centre will help us become a single site by the end of 2010, supporting our Clinical Strategy

University Hospital Aintree is a large teaching hospital providing a wide range of acute and non-acute specialties. Walton Hospital provides outpatient and day surgery services. Services are currently being moved from Walton Hospital to University Hospital Aintree in a transfer which will be complete by December 2010. The Trust is a teaching hospital of the University of Liverpool and a tertiary centre providing specialist services to a much wider population of around 1.5 million in Merseyside, Cheshire, South Lancashire and North Wales. Specialist services are provided in Respiratory Medicine, Rheumatology, Maxillofacial and Liver Surgery. The population served by Aintree includes some of the most socially deprived communities in the country, with high levels of illness creating a high demand for hospital-based care. Merseyside has some of the worst rates for
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heart disease and cancer in the UK, and has also been associated with a culture among patients of low empowerment over their health status and a reliance on the availability of hospital care. The University of Liverpool School of Clinical Sciences has a major presence at University Hospital Aintree, with a number of Professorial Units within the divisions of Infection and Immunity, Metabolic Medicine and Surgery and Oncology situated exclusively on the Aintree site. The Trust is a recognised centre for multidisciplinary health research and enjoys close collaboration with the University of Liverpool, Edge Hill University, Liverpool John Moores University and other NHS Trusts.

A Summary of 2009/10

OUR KEY OBJECTIVES

Following a review of our Strategic Framework in 2009/10, the Trust adopted five key objectives:
l

Provide high quality, safe healthcare Improve performance and productivity

l Attract the best l

l Invest wisely

l Optimise Foundation Trust status

Throughout the year, the work of our staff resulted in significant developments against all of these objectives. Provide

A series of developments ensured continued improvement in the quality of our services, and of the patients experience in our hospitals. Our Hospital Standardised Mortality rate continued to fall, with 363 fewer deaths than expected at our hospitals. Trust staff continued to drive down infection rates for C.difficile and MRSA, while ensuring that other infections were also being monitored. This year saw staff both reduce rates and then maintain their focus to keep them down. Laboratory staff provided additional testing, so that suspected infections could be confirmed more quickly. MRSA screening has been introduced for both elective and non-elective patients.
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High Quality, Safe Healthcare

Wards are now given certificates when they achieve periods of 50, 100 and 150 days without a C.difficile case, and the first wards also passed the mark of a year without a C.difficile case. The Trusts Quality strategy was launched, with the aims of saving a further 300 lives over three years, reducing moderate or severe clinical incidents by 20% and increasing the number of patients rating their experience as good or excellent by 20%. The workstreams as part of our Quality Improvement Project are:
l Reducing hospital-acquired infections

l Introducing a Medical Emergency Team to

support deteriorating patients. The team started work in November 2009, becoming the first 24/7 team of doctors and nurses of its kind in the region

l Implementing key quality improvements

to the stroke service, in line with national guidance

Ensuring all inpatients have nutritional screening and are appropriately treated to tackle the risk of malnourishment Ensuring inpatients receive correct thrombolysis treatment, cutting the risk of Venous Thrombo-embolism (blood clots), which is responsible for the death of 25,000 patients in hospitals nationally each year

l Ensuring that inpatients with diabetes are given appropriate care

l Reducing the number of falls in hospital

l Progressing the Advancing Quality project,

which is lead by NHS North West, the Strategic Health Authority, to drive up the quality of care in specific clinical areas creating a collaborative group to improve our national inpatient survey scores

l Improving patient experience through

Partnership working with Johns Hopkins Hospital in Baltimore, USA, continued through the year. Johns Hopkins has an international reputation as one of the safest hospitals in the
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world. Trust staff visited Johns Hopkins and teams from the American hospital visited the Trust for joint learning sessions. Following from these visits, a work programme was developed to pilot patient safety initiatives in the Trust. The Trusts regulator, Monitor, recognised the need for patient safety to sit as a priority at Board level and invited the Trust, along with three other Foundation Trusts, to take part in a Trust Board safety programme. This work will build on the other safety and quality initiatives already underway. The Trust achieved Level 3 of the NHS Litigation Authoritys risk management standards, becoming one of just 11 Trusts in the country to hold this level of accreditation. The Trust successfully transferred our palliative care ward to Woodlands Hospice, which is co-located on our site. This means that patients receiving palliative care are now cared for in a purpose-built ward in the hospice environment. The Trusts Patient Environment Action Team ratings for the year were Good for Environment, Excellent for Food and Hydration, and Excellent for Privacy and Dignity. The increase in the Privacy and Dignity score from last year reflects the investment in single sex accommodation. A computerised touchscreen questionnaire which gives patients with cancer a choice of issues to discuss at clinic appointments was commended in the National Health and Social Care Awards North West regional finals. The Patient Concerns Inventory system was developed by Professor Simon Rogers, the Trusts IT team and Trust volunteers. It helps identify needs during a patients post-operative recovery and allows for improved holistic patient and carer support. Work on reducing patient falls was shortlisted in the Patient Safety in Clinical Practice section of the 2010 Patient Safety Awards. Matron Shirley Brady gave a presentation on the progress to judges in the event.

We gained Top Healthcare 100 Employer status for the second year running in 2009/10. The Trust was the second-placed teaching Trust nationally. This prestigious award, which is open to any NHS or private healthcare organisation, is supported by the Nursing Times and Health Service Journal. The review of the Strategic Framework involved a significant engagement programme to develop Behaviours in support of our Values. A total of 600 staff, at all levels, and in all roles, were involved in this work. A new appraisal system called COMPASS was also developed, and has gone live. Mr Graeme Poston, who jointly built up the Liver Specialist Unit at the Trust, was awarded the Stanford Cade Medal by the Royal College of Surgeons of England in recognition of a lifetimes achievement in cancer surgery. The medal, which was first awarded in 1977, is bestowed on cancer surgeons who have distinguished themselves in their careers. It is awarded every three years. Two consultants in the Trusts Head and Neck service were confirmed as taking up prestigious external positions. Mr Andrew Swift will be the President of the Laryngology and Rhinology section of the Royal Society of Medicine, taking up the post in November 2011. Mr Terry Jones has been appointed to a Readership in Head and Neck Surgery/Otolaryngology in the School of Cancer Studies at the University of Liverpool. Dr Arpan Guha, Clinical Director of the Cheshire and Merseyside Simulation Centre, which is based at University Hospital Aintree, won the Training and Educational Materials category of the 2009 North West NHS Innovation Awards for an End of Life and Organ Donation training course. Dr Anil Sharma, Consultant in Stroke Medicine, received an Honorary Fellowship from the University of Central Lancashire in recognition of his contribution to acute stroke care through developing research and excellence in practice.

Christine McQuillian, Transfusion Department Manager

The transfusion teams simple blood questionnaire which aims to ensure appropriate use of Fresh Frozen Plasma has been identified by the national transfusion service as best practice guidance. The Trust launched a new comprehensive weight management service, which is being delivered locally in partnership with the Brownlow Group Practice. It is anticipated that around 1,500 new patients will be assessed in community settings each year, receiving individually tailored two-year programmes which involve support from multi-disciplinary teams. Attract the Best The Trusts new 1.5 million Health, Work and Well-being Centre was officially opened by Dr Steve Boorman, lead reviewer of the independent NHS Health and Welfare Review. The purpose-built centre offers significantly improved facilities for staff, and also serves other organisations across the region. In addition to offering support to around 20,000 NHS staff, including the 4,500 employed by the Trust, the centre is one of just 11 NHS Plus occupational health centres nationally which are in a pilot programme to support local businesses. The Trust re-launched its Black and Minority Ethnic Staff Network, which supports our objective of becoming the employer and provider of choice through ensuring culturally sensitive services and equality of opportunity and best practice.

James Birrell, Chief Executive, presents the Team of the Year Award to the Department of Medicine for the Elderly team, for their work on improving Infection Prevention and Control

The Trusts work with apprentices was recognised with the launch at the Trust of a national 25 million investment programme to create 5,000 NHS apprentice places across the country by March 2010. The Trusts volunteers service has been featured as a best practice case study in the national Strategic Vision for Volunteering in Health and Social Care, which was launched this year. The strategy document noted how many of those who had volunteered at the Trust had moved on to access training for careers in the NHS. More than 700 former volunteers have trained as nurses since 2003, and 400 have gained other work at the Trust. Trust staff serving with the Territorial Army in the 208 (Liverpool) Field Hospital (Volunteers) were presented with a large print of a picture called Safe Return by Commanding Officer Colonel Peter Jackson in gratitude for their efforts in overseas missions. Volunteers include doctors, nurses, biomedical scientists and other staff. Their roles include flying directly into battle areas to give emergency treatment to wounded soldiers.
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Patients have high expectations around performance and access to services, and the Trust is committed to ensuring the best possible use of resources to support efficient patient care. Key access standards were met for patients requiring both planned and unplanned treatment, despite a very severe winter which saw the worst snows in the country for decades. These include the four hour 98% emergency care standard, which saw a run of 18 days where 100% of patients were treated within the four-hour period, the best performance by Trust teams against this standard. The Trust was the first in the region to install a new electronic information system for ambulance patients. The joint work with the North West Ambulance Service saw the time taken to transfer patients reduced by around one-third. The system is now being rolled out to other hospitals in the region.

Improve Performance and Productivity

Clinical teams across the Trust were heavily involved in putting plans to cope with Swine Flu cases in place. If significant numbers of extra patients had to be admitted then this would have had a major impact on services, productivity and performance. A major staff communications and engagement programme was held, and staff were given extra training in the use of masks and other personal protective equipment. In addition, a high profile and very successful staff immunisation programme was held for both seasonal flu and Swine Flu. In the event, very few patients were admitted with Swine Flu. Invest Wisely The Trust has invested nearly 90 million in capital developments over the last nine years, and there was significant progress in key projects this year, both in our facilities and in our IT systems. The Elective Care Centre (ECC) will enable the Trust to provide all of its services from a single site. The ECC will hold the day surgery unit and outpatients services, as well as having one of the most advanced Endoscopy units in the country. Construction of the ECC and the linked multi-storey car park progressed well through the year. The ECC saw its first patients in June 2010, when the outpatients services from University Hospital Aintree temporarily transfered there to enable a 2.5 million upgrade to the current department. Day surgery and outpatient services will transfer from Walton Hospital to the ECC or other areas of University Hospital Aintree through the Autumn, with most services due to move in October and November 2010. The final services are due to move in December 2010. The Trust Board confirmed investment in upgrading the Diabetes Centre and the physiotherapy department, to support the transfer of services from Walton Hospital. Involvement of clinical teams in planning is designed to ensure the best possible facilities for patients. Construction of the new radiology department continued, with state-of-the-art equipment

enabling clinicians to improve the services we offer to patients. The new Health, Work and Well-being Centre and the Combined Heat and Power (CHP) unit were both completed during the year. The CHP is helping create a cleaner environment while saving taxpayers an estimated 500,000 a year in fuel costs. Annual CO2 emissions will be reduced by around 1,600 tonnes the equivalent of a family car driven for seven million miles or 280 times around the world. An Enhanced Ward Upgrade Programme was approved by the Trust Board, which will see work taking place between 2010 and 2020 in all wards in the Tower Block. The upgrades will provide improvements for both patients and staff.

An artists impression of the new Diabetes Centre of Excellence

The Trust also continued with its progress towards introducing an Electronic Patient Record, ending the use of paper-based records. The Trust is on track to be the most advanced in the region in its use of IT systems before the end of 2010. The Electronic Prescribing and Medicines Administration system was successfully piloted on two wards, and is now being rolled out in four wards each month. Electronic whiteboards are also now operational throughout the Trust, giving clinical staff easy access to information about patients. The system increases effective management of the Trusts beds, making sure that patients receive the right treatment in the right place.
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review

2009/10

The financial freedoms offered by Foundation Trust status have supported the investment programme set out above. In addition, the Trust wants to maximise its engagement with members and the broader community. This year saw a range of initiatives and workstreams designed to support this. Governors began a series of engagement events, including giving presentations to health support groups, aimed at encouraging membership applications. Attendance at membership evenings increased, supported by additional publicity and media support for the events. The Annual Members Meeting was used to provide information on Swine Flu, promoting simple steps which members could take to limit the risk to them and their families. More than 100 members, Governors and staff attended. Foundation Trust members took part in a special event aimed at designing patient systems for the Elective Care Centre. This included discussing patient information and advice. The Trusts new Health, Work and Well-being Adviceline for small businesses was officially launched by Department for Work and Pensions Minister Lord McKenzie. The Adviceline is one of just seven national pilots, and will support small businesses across Merseyside.

Optimise Foundation Trust Status

Mr Graeme Poston, recipient of the Stanford Cade medal

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OUR PERFORMANCE - OPERATIONAL

Waiting Times
At the end of 2009/10 the Trust:
l Achieved the 18-week referral to

treatment target (RTT). This target is for at least 95% of non-admitted patients and 90% of admitted patients to wait less than 18 weeks from referral to treatment.

l Delivered the Accident and Emergency Target for 98% of patients to be treated, admitted or discharged within 4 hours.

The Trust has met the four key cancer targets as shown below.
Cancer wait targets April 2009 - March 2010

Cancer Targets

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Inpatients and Day Cases

Total admissions fell by 3.8% during 2009/10 to 74,400. Of these, 38,148 patients were admitted for an elective procedure (2008/09: 40,195), of which just under 80% were treated as daycases. Non elective episodes of care decreased by 2.3% to 36,252 (2008/09: 37,126).

Outpatients

The number of patients attending outpatient clinics continued to grow, increasing by 4.9% during 2009/10 to 318,858 in total (2008/09: 303,862). Of this, 41,764 were outpatient procedures, which includes activity previously recorded as outpatient new attendances. This is reflected in the slight fall in numbers under these two categories. Outpatient procedures also includes some work previously recorded as daycase activity. This shift of recording from daycase to outpatient procedure explains the drop in daycase activity reported above.
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Emergency Services

For the Trust, 86,899 patients attended the Accident and Emergency Department (AED) in 2009/10 a slight increase on 2008/09 (86,672). Of these, 24,362 patients were admitted to hospital, an increase from 2008/09 when 23,828 patients were admitted following AED attendance, but closely linked to the increase in AED attendances between the two years. A total of 98.2% of patients waited less than 4 hours from arrival to admission, transfer or discharge at Aintree. Including Primary Care walk-in centres, the performance for the wider health economy was 99.0% for the year, achieving the national target of 98.0%.

during the year than would have been predicted against this benchmark. Readmission - The readmission rate is the percentage of patients that were readmitted to hospital as an emergency within 28 days of discharge. The rate of readmissions fell by 0.2% to 11.8% over the year, but remains an area for improvement. Hospital Acquired Infections and Hospital Cleanliness - The Trust reduced MRSA bacteraemia and C. difficile infections during 2009/10 and achieved the annual target for both areas.

Planning for Emergencies The Trust continues to work successfully alongside key stakeholders and other agencies to ensure that emergency plans are in place, reviewed and updated. The Trust will continue to join multi-agency exercises to test our plans and help train our staff in responding to different scenarios. Clinical Effectiveness Based on data from Dr Foster Intelligence, our Hospital Standardised Mortality Ratio for 2009/10 was 75.8. This is against a benchmark rating of 100. This performance means that we had 363 more lives saved at the hospital

Actors joined Trust and other NHS staff for an emergency planning exercise

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OUR PERFORMANCE - QUALITY AND SAFETY

The Trust developed the strapline Where quality matters in 2009/10. Every member of staff working at Aintree, whatever their role, is committed to providing our patients with a quality service. The Trusts focus on quality and safety of services supports our Vision, which is to be a provider of high quality, patient-centred healthcare, with a first class local, national and international reputation. This section tells you about our progress in 2009/10 and our future plans. It supplements our Quality Account, a formal document the Trust submits to Monitor, our regulator. The Quality Account is part of our formal Annual Report and Accounts which is available at www.aintreehospitals.nhs.uk

Progress Against Quality Strategy

Our Quality Strategy sets out aims for three key areas which we will deliver by 2012. Each of these overarching aims is supported by a range of targets which we need to achieve in order to deliver the aim.

Patient Safety
Patient safety incidents reported per month have reduced by 15% in 2009/10.

Our overarching aims are:

l

Patient safety to save an extra

300 lives

Clinical effectiveness to reduce moderate or severe clinical incidents by 20% Patient experience increasing
the number of patients rating our services as good or excellent by 20%

Infection Prevention and Control

Our aim: We are aiming to reduce
bloodstream infections by better care of cannula and improved assessment of patients with large wounds or who have invasive devices such as peripheral or central lines.

Each aim has a number of separate, linked projects which support it. These are led by clinical and managerial staff. Some of the key points from this year are highlighted below.
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What we have achieved: Working in partnership, we reduced C.difficile infections by 70% and MRSA infections by one third in 2009/10. We passed the national target to reduce MRSA infections in 2009/10.

Nutrition

Our aim: We aim to improve the overall health

of the 40% of patients who are malnourished on admission by improving identification, assessment and treatment.

Clinical Effectiveness Advancing Quality

This Strategic Health Authority scheme sets standards for specific treatments and financially rewards Trusts for achieving these. The Trust has focussed on four areas of clinical effectiveness based on diagnosis:
l l l l

new, simplified electronic diet referral form and screening tool which give real time information broken down by ward. This improved monitoring allows us to give better nutritional care.

What we have achieved: We introduced a

Falls
2012.

Heart attack* Heart failure Pneumonia Hip and knee replacement

Our aim: We want to reduce falls by 30% by

reduced by 6.6% following the introduction of a new risk assessment for patients.

What we have achieved: Falls have been

For each of these areas the Trust aims to put in place a care bundle to improve both patient experience and outcome. Since Advancing Quality, all areas have improved, meaning fewer readmissions, and a shorter length of stay in hospital.

Focus Area

Heart Attack*

93.33% 96.7% h3.37% 87.35%

Heart failure 82.20% 77.6% i4.46% 65.34% Pneumonia 73.72% 80.82% h7.10% 78.41% Hip & Knee 92.04% 92.04% h1.04% 75.67%

* Acute Myocardial Infarction

Attainment Threshold
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Difference

Year One Score

Year Two Score

Nursing Care

Aintree is also committed to focussing on compassion and dignity. As part of this the Trust is aiming to measure the quality of patient care against a range of areas: l Pain management
l l l l l l

Patient observations Infection control Nutrition Tissue viability Falls management, and Medicines management
The Medical Emergency Team have reduced cardiac arrests by one third

Our aim: We aimed to ensure, as part of this

area of work, that a needs assessment was carried out on all wards.

Patient Experience Quality and Patient Experience

25% of wards were undertaking an assessment. By October of that year 100% of wards were carrying out the assessment. The next phase will link results to patient experience surveys.

What we have achieved: In early 2009 only

Our aim: In line with the Department of

Our aim: To establish a Medical Emergency

Team (MET). The MET is a 24 hour, 7 day a week critical care service consisting of doctors and nurses that responds to the needs of acutely ill patients, wherever they may be in the hospital.

Healths Making Experience Count report, the Trust wanted to merge the long established Patient Advice and Liaison Service (PALS) with the Complaints Department, helping ensure that patient experience is captured and is acted on.

What we have achieved: The MET is the only multi-disciplinary rapid response team in the Merseyside and Cheshire region, and one of only a few in the UK. Since its introduction, in November 2009, there has been a one-third reduction in cardiac arrest calls.
The MET, along with the out-of-hours care team, won the NHS North West Junior Doctors Advisory Team Safe Care Out of Hours Award 2010. In addition, several other NHS hospitals are looking at adopting our model.

What we have achieved: The Customer Services Department has now been established. We have also held a series of health and well-being days for patients, including the opportunity to take part in Reiki, hand massage and Indian head massage.
A library service every Tuesday, along with monthly entertainment sessions on the elderly wards, are contributing to a better patient experience for those in our care.

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Patient and Customer Excellence

Our aim: We aim to use real-time
patient feedback to design and implement improvements to our quality of care.

What we have achieved: We have developed patient information manuals for each ward, and have produced welcome letters which are placed on a patients bed at the start of their stay. Our aim: To develop a Trust-level Patient Experience Questionnaire. In addition to national surveys, the Trust wanted to develop its own in-house questionnaire to enable a monthly survey of patient views.
was introduced in June 2009. The Trust now receives automatic analysis of patient feedback broken down by ward to allow better action planning and monitoring. As the year has progressed, staff have become increasingly responsive to patient needs and keep them better informed about their care. The results show that 90% of patients would recommend Aintree to a relative or friend.

Stroke audit: An audit focussing on the quality of stroke care was conducted last year. The Stroke Sentinal Audit showed that between 2006 2008 the Trust had improved in ten areas of stroke care; up to 83 from 73 two years previously, making us the best in the North West. This demonstrates an improvement in the quality of stroke care provided. The results of the 2010 audit will be available at the end of February 2011. Fractured Neck of Femur: The Trust had two positive results in this area of surgery.
l

In April 2009, 83% of fractured neck of femur patients were operated on within 24 hours. By February 2010 this had increased to 94%. In April 2009, 87% of fractured neck of femur patients were operated on within 48 hour. By March 2010 this had increased to 100%.

What we have achieved: The survey

These improvements, which marked us out as being the best in the North West and third best in the country, ensure that patients received swift operations, which gives better results and means they have shorter stays in hospital.

CQUIN

Commissioning for Quality and Innovation (CQUIN) is an initiative aimed at improving quality and innovation in NHS services. The Trust receives additional financial rewards if we meet these standards, which are set by local Primary Care Trusts. Last year Aintree met all its quality improvement goals. Below is an overview of some of our key achievements.

Our Commitment to Research

MRSA screening: In October 2009, 37%

Research is a vital component of delivering quality healthcare it helps the NHS understand the best ways of delivering treatment and care to patients. Last year over 1,700 patients took part in clinical research at the Trust, an increase on previous years. The Trusts increasing level of participation in clinical research demonstrates our commitment to improving the quality of care we offer and contributing to wider health improvement. You can read more about our research work on page 24.

of all patients were screened for MRSA on admission. By March 2010 this had increased to 88% of all patients. The MRSA screening programme has contributed to a significant reduction in MRSA cases during 2009/10.

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OUR PERFORMANCE - FINANCIAL

Income

Income and Expenditure

Overall, taking into account both income and expenditure, the underlying financial health of the Trust continued to grow through 2009/10 which provides a firm basis as we move into 2010/11 (see pages 32 and 33 for more information). Breakdown of 2009/10 Income:

During 2009/10 the Trust invested 39.7 million Elective Income in improving our facilities for patients, which is by far the largest and most ambitious capital programme to date. Non-Elective Income The capital programme was predominantly financed from the Trusts own internally generated resources, supported by a small loan Outpatient Income from the Foundation Trust Financing Facility, which lends money to Foundation Trusts at preferential rates of interest.
A&E Income This is one of the benefits afforded by being a Foundation Trust. Non PBR Activity Income Research & Development Elective Care Centre

Capital Investment

Capital Plan 2009/10 000 27,260

Actual 2009/10 000 27,338 3,562 2,119 1,275 629 1,161 498 2,635 501 39,718

Income m

Radiology Education & Training 5,714 Expansion Energy Centre 2,919 Project SLAs for Non-Patient Medical Equipment to Other 1,849 Care, Services Bodies Information 1,341 Technology Other Income Occupational Health Electronic Document System Infrastructure Investments Other Total 1,025 500 4,161 731 45,500

Non-Elective Non PBR Activity Elective Outpatient Education & Training SLAs for Non-Patient Care, Services to Other Bodies Other A&E Research & Development
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72.5 66.8 38.6 38 13 9.8 7.8 7.6 0.3

Our People
The chart below shows a breakdown of our workforce by staff group: %
Nursing

Staff Engagement Our aim is to continue to work in a way that encourages and promotes engagement so that our staff will have a positive attitude and pride in the Trust and the quality of our services. We recognise the value of the contribution of our staff in helping the Trust achieve its aims and objectives and we want staff to feel able to express their opinions and views and contribute to decisions taken within the Trust. Equality and Diversity Equality and Diversity and Human Rights are the cornerstone of the Trusts vision and are fully supported by the Executive Team and the Board of Directors. Our aim is to translate this commitment into tangible service delivery benefits for patients and carers as well as encouraging our present and potential staff to see us as an Employer of Choice. We support a person-centred approach to Equality, Diversity and Human Rights which means carrying out our commitment to delivering our services to meet specific and diverse needs of our patients and carers, including our employees.

Admin & C

Prof/Tech/S Ancillary Medical

Note: % Nursing (1531.70) Admin & Clerical (848.12) Prof/Tech/Scientific (832.92) Ancillary (418.31) Medical (365.51) Clin/Specialist Manager (62.74) General Manager (54.10) Maintenance (53.03) 72.5 20 20 10 9 2 1 1

Clin/Specia Manager General Ma

Maintenanc

In partnership with ABILITY, a local disability network, the Trust hosted Disability Matters, a successful conference. At the conference the Trusts Disability Advisory Network, made up of members of the disabled community, was launched. Work is progressing in establishing a Disabled Staff Network. The age profile of our workforce demonstrates a well-balanced distribution across the age bands.

The above analysis does not include Bank and Agency staff.

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Patient & Public Involvement

As planned, the merger of the PALS and Complaints Departments has now been undertaken to form the newly named Customer Services Department. Throughout 2010 there will be initiatives for raising awareness of the team throughout the hospital to both patients and staff alike.

The Trust commissioned the Picker Institute to conduct two patient surveys during 2009, the Adult Inpatient Survey and the Adult Outpatient Survey. The results for the Inpatient Survey, which were published in February 2010, demonstrated that the Trust had improved significantly since the 2008 survey in relation to the following:
l Doctors:

washing their hands between touching patients touching patients clear way

l Nurses: washing their hands between l Surgery: results being explained in a

The report evidenced that, in addition to the above, results were significantly better than the Picker average in relation to the following:
l

Planned admission: speed of admission

nursing staff The results for the Outpatient Survey, which were published in November 2009, demonstrated that the Trust had improved significantly since the 2007 survey in relation to the following:
l

l Nurses: confidence and trust in

Being offered a choice of hospitals examined or treated

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l Being given complete privacy when being

 l Being told clearly why tests are needed

test results The Patient Information Group meets monthly and 75 leaflets have been reviewed from a range of specialties. Specific leaflets developed have been reviewed for the following specialties:
l Infection Control l Pharmacy l Speech and Language Therapy l Physiotherapy

l Being told how the patient will find out

Chief Executive James Birrell and AED consultant Rob Jones at Everton FC, helping promote mens health

l Nutrition and Dietetics The Trust has also established a Patient Experience Collaborative whose overarching aim is to improve the patients experience to ensure the Trust is the local healthcare provider of choice.

During 2009/10 the PALS Volunteers gave directions to 16,698 visitors, answered 4,013 enquiries, escorted 384 visitors and referred 162 cases to the PALS staff. The Patients Council The Patients Council met on ten occasions. Members attended a total of 35 Trust meetings as members of the public and conducted 86 ward visits with a Senior Manager, continuing to use the overall traffic light scoring system.

PALS Volunteers Desk Activity

Terry Owen, Volunteers Departmental Head, sat on the group which shaped the national strategic vision for volunteering in health and social care. Norma Barrowcliff, Volunteer Disability Manager continues to manage the project which includes 140 disabled volunteers, and Gail Bruen, Volunteer Development Manager, organises more than 500 students annually from 103 schools across Merseyside.

Aintree Volunteer Scheme

Nurse Chrisy Skuriah, who had previously volunteered in the Trust, with Volunteers Departmental Head, Terry Owen

23

Raising Standards

Risk Management
The Trust is involved with Edge Hill University in developing a patient safety module, the first of this kind in the United Kingdom. At the same time, plans are at an advanced stage in the planning and implementation of a Patient Safety Officer and team within the organisation. Following the publication of the Francis Report into the Mid-Staffs Inquiry, the Trust is currently undertaking a review of its own practice against the 18 recommendations made in the report. Research and Development There have been important developments in research and development (R&D) over the past year. We hosted a routine visit by the Medicines and Healthcare Products Regulatory Authority (MHRA) with great success.

The MHRA inspectors were impressed with the new R&D structure and endorsed the developments that have been established. There are now some 230 active studies (60 on the national NIHR research portfolio) and a potential 70 more under consideration. Our activity has attracted significant funding with more than 1 million provided and support from other external bodies to help us deliver our research.

24

Sustainability

Aintree University Hospitals NHS Foundation Trust recognises the part it can play in contributing to improving the sustainability of the wider city region and how this can help to reduce health inequalities. The Board of Directors has approved a Sustainability Strategy to provide a framework to support its objectives in this area.
The following key areas are being targeted to significantly reduce our carbon footprint:
l Energy and carbon management

Trust staff sent old equipment to a hospital in Zimbabwe

l Procurement and food l Travel and transport l Water l Waste

2010/11 will see the launch of our new green Travel Plan and the completion of our Carbon Management Implementation Plan. Supported by The Carbon Trust, and as part of the Liverpool Carbon Collective, we are working with Liverpool City Council and other NHS Trusts locally to reduce our combined carbon impact. Hospital Chef Jimmy Cameron - we are sourcing more ingredients locally

review

2009/10
25

Service Developments
l We are now producing significantly less

The Trust is entering into an exciting period which will see the culmination of years of planning to change Aintree University Hospitals NHS Foundation Trust into a single site Trust by the end of 2010.
During 2009/10 we have completed several major projects including:
l The Health, Work and Well-being Centre

carbon dioxide following the completion of our 3.5 million combined heat and power unit improving our green credentials and saving money improving the environment, privacy and dignity on many of our wards

l We have invested over 1 million

Several landmark projects were also completed during 2010:

l The flagship 34 million Elective Care

costing 1.5 million. The Centre is now providing Occupational Health services to many local organisations including our own Outpatients Suite has allowed further investments to commence in this key service

Centre investment will provide outpatients and day care services in a state-of-the-art modern environment campus were alleviated by the opening of our 8 million multi-storey car park providing approximately 1,250 spaces including numerous disabled spaces

l The creation of a 3.5 million Radiology

l The problems of parking on the Aintree

Dignity cards are being used to help assess patients wishes for their care

26

 l We are also about to complete the final

The final phase of the consolidation of services on the Aintree site will be completed with the delivery of three further key projects by the end of 2010:
l Our Physiotherapy Department is

phases of the overhaul and expansion of our Radiology Departments with over 6.5 million being spent, including five new state-of-the-art CT and MR scanners

being extended at a cost of 1.75 million will be created on site

l A new 1.75 million Centre for Diabetes l Our existing Outpatients Departments will

be given a 2.5 million face lift to ensure all patients receive excellent care in a high quality environment

We do not intend to stand still though, and the next five years will see us make continuous improvements to the buildings and services we provide in them. Already we are considering plans to:
l Upgrade all of our Tower Block wards

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2009/10

to improve the quality of inpatient care still further to allow the expansion of the Accident & Emergency Department (AED) that we can better cope at times of high demand

l Create a new purpose built Fracture Clinic

l Reconfigure and enlarge our AED so

l Rationalise and reconfigure our theatre

accommodation to improve efficiency and the environment for staff and patients to ensure we provide the highest care possible whenever needed

l Increase the size of our Critical Care Unit

l Review and consolidate our cardiology

services into purpose built accommodation

l Invest in our infrastructure to ensure the

site can continue to meet the growing demands of a modern hospital

These developments will help support the provision of high quality, safe services.
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10

How we are Governed

As of 31st March 2010

The Board of Directors

The Board of Directors comprises seven Non-Executive Directors, including the Chairman and up to six Executive Directors, including the Chief Executive. The Board of Directors has overall responsibility for strategic development, approving policy and monitoring performance.

Christopher Baker MBE

Chairman

James Birrell
Chief Executive

Director of Nursing

Jill Byrne

Director of Estates & Facilities

Paul Fitzpatrick

Dr Gary Francis
Medical Director

Michael Frayne
Chief Operating Officer

Margaret Jackson
Director of Human Resources

Director of Communications

Fin McNicol

Ward Priestman
Director of Informatics

Director of Finance & Business Services

Steve Warburton

Independent Non- Executive Director

Rayna Dean

Patrick Hackett

Independent Non- Executive Director

George Marcall
28

Frank McKenna

Independent Non- Executive Director

Independent Non- Executive Director

Sally Merriman
Independent Non- Executive Director

Maureen Murphy
Independent Non- Executive Director

The Board of Governors

The Board of Governors holds the Trust Board to account. The Board of Governors is responsible for representing the interests of patient, public and staff members, and local partner organisations in the governance of the Trust and has specific responsibility for the appointment of the Chairman and NonExecutive Directors, and the Trusts auditors. The Board of Governors also approves the appointment of the Chief Executive, the remuneration and terms of office of the Chairman and Non-Executive Directors, and receives the Trusts annual report and accounts and gives views and advice on the forward plans of the Trust. The Board of Governors consists of the Chairman of the Trust and 31 elected and appointed Governors (list as 2009/10). Mrs Pamela Peel was elected by the Governors as the Deputy Chair of the Board of Governors and Lead Governor with effect from 1st August 2009, taking over from Mr George Sands who had held this position since April 2005. Mrs Phyllis Bretherton sadly died in January 2010.

Public Governors (14 Seats)

Mrs Phyllis Bretherton Mr Alan Corkish Mr David Cowan Mr Ronald Denton Mr Norman Falder Mr Gordon Harrison Ms Diane Hart Mr Arthur Jones Ms Olwen Jones Mr Tony Kneebone Mr Brian Lawlor Mr Peter Mayne Mr Tony McLure Mrs Pamela Peel Mr John Rimmer Mr George Sands Mr Brian Worster-Davis

Staff Governors (5 Seats)

Mrs Pamela Black (AHP/Scientists) Mrs Lorraine Brinkley (Nursing) Dr Robert Thompson (Medical Staff) Mrs Terry Owen (All Other Staff) Mr Ranjit Bisnauthsingh (Nursing Staff) Ms Jeanette Wilding (Nursing Staff)

Patient Governors (3 Seats)

Mrs Annette Barnes Mrs Doreen Brown Mr Barry Cave Mr Gerry Hill

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review

2009/10

Foundation Trust Governors and members worked with Trust staff to develop patient pathways for the Elective Care Centre

Appointed Governors
Mr Ian Davies (Knowsley PCT) Cllr Jayne Aston (Knowsley MBC) Cllr Dave Hanratty (Liverpool City Council) Mrs Leonie Beavers (Liverpool PCT) Cllr Barry Griffiths (Liverpool PCT) Dr Leigh Griffin (Sefton PCT) Ms Mair Ning (Edge Hill University) Professor Robert Moots (University of Liverpool) Mrs Renee Brenner (Woodlands Hospice)

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Membership
Membership of the Trust is open to anyone who is either a resident of the North West of England, a patient of the Trust and/or their carer, who is aged 16 and above, and all members of staff. Membership Numbers (31st March 2010)

Constituency
Public Patient Medical Staff Nursing Staff Allied Health Professionals/ Clinical Scientists All Other Staff Total

Membership Numbers
5715 1577 384 2097 939 1954 12666

If you would like to join Aintree University Hospitals NHS Foundation Trust as a member, please email: governors@aintree.nhs.uk or visit the Foundation Trust pages of our website: www.aintreehospitals.nhs.uk Membership is free and gives you the opportunity to find out more about the work we do and to help shape development of our services.
31

11

Our Accounts

A full set of the audited Annual Report and Accounts of Aintree University Hospitals NHS Foundation Trust can be obtained via our website.

Statement of Comprehensive Income for the Year Ended 31st March 2010
Operating Income Operating Expenses OPERATING SURPLUS FINANCE COSTS Finance Income Finance Expense - Financial Liabilities PDC Dividends Payable NET FINANCE COSTS SURPLUS FOR THE YEAR Other Comprehensive Income Revaluations Losses and Impairment Losses on Purchased Property, Plant and Equipment Revaluations Losses and Impairment Losses on Donated Property, Plant and Equipment Increase in the Donated Asset Reserve Due to the Receipt of Donated Assets Reduction in the Donated Assets Reserve in Respect of Depreciation of Donated Assets TOTAL COMPREHENSIVE ExPENSE FOR THIS PERIOD

2009/10 000
258,464 (251,190) 7,274

2008/09 000
241,802 (236,834) 4,968

119 (16) (4,691) (4,588) 2,686

1,669 (11) (5,019) (3,361) 1,607

(8,521) 0 38 (122) (5,919)

(4,030) 11 3 (142) (2,554)

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Statement of Financial Position as at 31st Marchof Financial Position as at Statement 2010 31st March 2010
NON-CURRENT ASSETS
Intangible Assets Property, Plant and Equipment Trade and Other Receivables Total Non-current Assets

31st March 2010 000

31st March 2009 000

1st April 2008 000

0 171,382 1,043 172,425

0 146,312 1,210 147,522

161 142,637 1,059 143,857

CURRENT ASSETS
Inventories Trade and Other Receivables Cash and Cash Equivalents Total Current Assets 979 8,988 11,457 21,424 835 10,035 30,918 41,788 899 9,008 37,777 47,684

CURRENT LIABILITIES
Trade and Other Payables Borrowings Provisions Tax Payable Other Liabilities Total Current Liabilities (19,141) (227) (2,077) (3,484) (6,272) (31,201) (16,794) (73) (1,786) (3,214) (5,625) (27,492) (19,624) (73) (2,054) (2,951) (6,271) (30,973)

Total Assets Less Current Liabilities NON-CURRENT LIABILITIES

Borrowings Provisions Other Liabilities Total Non-Current Liabilities

162,648

161,818

160,568

(5,943) (725) (901) (7,569)

(161) (783) (1,032) (1,976)

(234) (1,048) (1,334) (2,616)

Total Assets Employed FINANCED BY

Public Dividend Capital Revaluation Reserve Donated Asset Reserve Income and Expenditure Reserve

155,079

159,842

157,952

113,434 25,479 1,842 14,324

112,278 34,000 1,926 11,638

107,834 38,133 2,057 9,928

TOTAL TAxPAYERS EQUITY

155,079

159,842

157,952
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The Trusts Employees of the Month 2009/10

Year
April 2009 Carol Bermingham Healthcare Assistant, Coronary Care Unit May 2009 Diane Jeffers June 2009 Kerry Tither
Staff Nurse, Ward 17

Medical Secretary, Ophthalmology

July 2009 Jean Brown Healthcare Assistant, Endoscopy Unit

August 2009 Paul Prescott

Healthcare Assistant

September 2009 Dave Williams

Clerical Officer, Prosthetic and Wheelchair Centre

October 2009 Dawn Woolsgrove

Radiology Department Assistant

November 2009 Debbie Clark

Breast Care Nurse

December 2009 Shirley Brady

Matron, Thoracic Medicine and Haemotology

January 2010 June Carr

34 Outreach Co-ordinator, Critical Care

February 2010 Vanessa Beattie and Maria Guerin

Thoracic Medicine

March 2010 Shiney Paul

Staff Nurse, Ward 6

The Trust was named as a Top Healthcare 100 Employer for the second year in a row, and has been placed second Teaching Trust nationally.

This document is available in other formats upon request.

Aintree University Hospitals NHS Foundation Trust University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL

Telephone: 0151 525 5980 Email: info@aintree.nhs.uk Website: www.aintreehospitals.nhs.uk

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2009/10