Annual General Meeting Tuesday 17 th September 2013

Annual General Meeting Tuesday, 17 th September 2013

Annual General Meeting TUESDAY, 17 TH SEPTEMBER 2013, COMMENCING AT 6 PM AGENDA 1. Welcome & Announcements - Christopher Langley, Interim Chairman 2. Annual Report and Accounts for 2012/13 • Michael Morgan, Interim Chief Executive • John Somers, Chief Financial Officer • Trisha Bain, Acting Executive Health Informatics Officer • Clare Partridge, Director KPMG LLP - Looking Back and to the Future Annual Accounts Quality Accounts Annual Audit Letter 3. Council of Governors - Jean Dearden, Lead Governor • Elections 2013 4. Review of Service 5. Questions from the floor on matters relating to the business of the meeting - Christopher Langley, Interim Chairman By Order of the Board Alan Lambourne Interim Company Secretary

Looking Back and to the Future Michael Morgan Interim Chief Executive

Looking Back • Difficult year due to Finances and Electronic Patient Records System (EPR) problems • Monitor declared Trust in Significant Breach of Authorisation – Finance, EPR, and Board Governance Issues • Number of Changes at Board Level • Action/Recovery Plan drawn-Up and agreed with Monitor • Subsequent progress made with Action Plan

Recovery plan progressing well Key results • Reconnecting the executive with clinical / front line staff • Interim CEO: participative and inclusive management style • Rebuilding functioning executive team • Restructuring clinical service units to reduce from 11 to 4 • Replacement interim CEO to be recruited • Reconnecting with commissioners and the local health economy • Fixing electronic patient record system • Renegotiated contract (£ 8 m savings in future years) • Rapidly reducing the cost base in a safe way and managing liquidity • Corporate overhead reduced by £ 5 m (£ 22 m in FY 13 to £ 17 m in FY 14) • Tactical controls saving up to £ 1. 6 m annually • As at month 4, £ 1. 5 m ahead of plan • KPMG: External review of recovery plan 5

On track with Monitor requirements • Regular meetings & on-going communication • Recovery plan submitted • On track with focus areas: • • • Finance • Governance • Electronic patient records system Future deliverables: • Revised 18 month forecast submit by 1 st October • Strategic plan submit by 31 st December Additional work stream: • Zero based budgeting (bottom up budgeting, based on agreed data and assumptions with clinical involvement) completed and approved by December 6

Next steps Aug Sept Oct A B Board Monitor Reforecast & Zero Based Budgeting Nov Dec Jan C D E F Board Monitor • Reforecast Option 0 ZBB Strategic Planning • Review Option 0 • High Level Option 1 • Detailed Option 1 • Confirm long list short list • High level Options 2 – 3 Option development is based on commissioning intentions and changes to clinical delivery • Review fully worked up Options 0 – 3 • Confirm plan for preferred option • Final options / plan based on Nov board feedback • Ready for Monitor submission 7

Annual Accounts 2012 -13 John Somers Chief Financial Officer

Financial Overview 2012/13 • The Trust generated an underlying deficit of £ 0. 7 m, excl. restructuring costs and impairments (2011/12 £ 4. 8 m surplus); deficit of £ 6. 5 m including restructuring costs and impairments • Operating income £ 234. 2 m v plan £ 225. 5 m: – £ 1. 5 m (0. 6%) increase on 2011/12 – £ 8. 7 m (3. 9%) above plan • Operating expenditure £ 237. 8 m; £ 232. 0 m excl. restructuring costs and impairments v plan £ 219. 2 m: – £ 7. 1 m (3. 2%) above 2011/12 (excl. restructuring costs and impairments) – £ 12. 8 m (5. 8%) above plan (excl. restructuring costs and impairments) • Non-operating costs £nil above 2011/12 and £ 0. 2 m below plan (reduced public dividend capital payment)

Financial Overview 2012/13 T & O Surplus / (Deficit) £ 12 £ 10 £ 8 £ 6 Income / Cost £ 4 £ 2 £ 0 Operating Income -£ 2 Non-operating expenditure Impairment Operating Expenditure -£ 4 -£ 6 -£ 8 Cost Classification Restructuring Surplus / Deficit

Financial Overview 2012/13 • Of total operating income (£ 234. 2 m): 10% patient related activities; of which circa 80% from NHSR £ 211. 9 m from non-patient activities £ 22. 3 m 90% • Of total operating expenditure (£ 232. 0 m excl. restructuring costs and impairments): 2% 3% 5% 2% Employee costs £ 152. 4 m 3% Drug and clinical supply costs £ 33. 1 m 5% Premises costs £ 10. 8 m Depreciation and amortisation £ 7. 5 m 14% Other supplies, services, transport & establishment costs £ 7. 1 m 66% Services from other NHS bodies £ 5. 7 m Clinical negligence claims premium (insurance) £ 4. 1 m Other £ 11. 3 m

Financial Overview 2012/13 • Cash and cash equivalents at year end of £ 15. 8 m (2011/12 £ 17. 3 m) • Circa £ 8. 6 m of cash generated from operating activities: – £ 0. 9 m servicing of finance – £ 2. 6 m loan repayments – £ 4. 4 m capital investment (EPR, mortuary) – £ 1. 9 m PDC dividends • Borrowings outstanding £ 21. 8 m, against a year-end Prudential Borrowing Limit of £ 32. 6 m, at year-end • Monitor Financial Risk Rating of 2 at year-end

Consolidated trading results (Month 4 YTD)

Forecast outturn for FY 2014

Quality Accounts 2012 -13: Overview of Performance Dr Patricia Bain Acting Executive Health Informatics

Section 1: Patient Experience • Increasing number of complaints, reduced severity • Themes: National and Local Surveys

Staff Experience: Local Surveys Response Category 2012/13 2011/12 Feeling valued 7. 2 Learning and Development 5. 4 6. 0 Performance/Stress* 5. 6 6. 1 Higher National Health & Wellbeing 7. 4 7. 3 Communication from Managers 6. 4 6. 6 Job Satisfaction 5. 6 5. 7 Conflict resolution* 7. 1 7. 0 Lower National Overall Score 6. 4 6. 5

Section 2: Improvement 1 a: NHS Safety Thermometer Benchmarking Falls with harm All Pressure Ulcers (new & old) 1, 6% 12, 0% 1, 4% 10, 0% 1, 2% 8, 0% 1, 0% 0, 8% 6, 0% 0, 6% 4, 0% 0, 4% 2, 0% 0, 0% апр-12 100, 0% 0, 2% июн-12 авг-12 Nationwide окт-12 дек-12 Nof. E SHA cluster фев-13 апр-13 TRFT июн-13 0, 0% апр-12 окт-12 дек-12 Nof. E SHA cluster фев-13 апр-13 TRFT июн-13 ‘Harm Free Care’ (overall) 94, 0% 92, 0% 80, 0% 90, 0% 70, 0% 88, 0% 60, 0% 86, 0% 50, 0% 84, 0% апр-12 авг-12 Nationwide VTE Assessment & Prophylaxis 90, 0% 40, 0% июн-12 82, 0% июн-12 авг-12 окт-12 Assessment Nationwide Assessment TRFT Prpphylaxis Nof. E SHA cluster дек-12 фев-13 апр-13 июн-13 Assessment Nof. E SHA cluster Prophylaxis Nationwide Prophylaxis TRFT 80, 0% апр-12 июн-12 авг-12 Nationwide окт-12 дек-12 Nof. E SHA cluster фев-13 апр-13 TRFT июн-13

Improvements continued: 1 b: Medications Management To ensure that all Trust medicine management systems and processes adhere to The Royal Pharmaceutical Society Safe and Secure Storage and Handling of Medicines guidance (2005): • • Significant improvements have been made in most areas 30 -40% across 6 areas Improvement remains in terms of locking drugs trolleys and fridges, location of Drug Disposal Unitscontinued assessment ward accreditation 1 c: Liverpool Care Pathway Increasing compliance to 65% for 5 key measures of the Liverpool Care of the Dying Pathway (LCP) by April 2013: • • Very significant improvement evident for the application of the 5 key measures, against 2011 -12 performance Areas where improvement needed : application of medication on a PRN (as required) basis

1 d: Dementia F. A. I. R To deliver the locally agreed improvement targets for early identification of patients with dementia – Find, Assess/Investigate and Refer (F. A. I. R. ) • • • Results did not achieve target TRFT generated their own ‘stretch’ target in relation to this, for achievement for the 65+ age group Recruitment of Dementia Lead • Continues to be a CQUIN this year 1 e: Health Assessments for Looked After Children Increasing the number of assessments carried out for looked after children and young people, from the April 2012 baseline • Data quality issues affected baseline • Changes to the data flow process implemented utilising Systm. One • Staff recruitment issues – difficulties still remain • Increase in assessments not met - continues to be a target for this year

Section 2 b: National Mandate • National Quality Board Indicators • Zero Rule 43 notices from the coroner • Zero ‘Never Event’ • CQC risk profile positive and no enforcements • IG Toolkit not met – training compliance • Quality Improvement Programmes 2013/14: • Intra-operative/ward fluid management • Dementia • Death certification process • Data Quality

The Rotherham NHS Foundation Trust Annual Audit Letter 2012/13 Presentation to the Council of Governors 17 September 2013 Clare Partridge Director, KPMG LLP

Scope and Audit Approach Financial Statements Audit Use of Resources Quality Report Annual Audit Letter © 2013 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. KPMG and the KPMG logo are registered trademarks of KPMG International Cooperative, a Swiss entity. 23

Key issues arising • Unqualified opinion • 2 audit differences reported – neither material to the financial statements Financial • Statement s Audit • • Only a number of minor disclosure changes required Annual Report is consistent with financial statements 5 control recommendations raised – 0 classed as high risk © 2013 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. KPMG and the KPMG logo are registered trademarks of KPMG International Cooperative, a Swiss entity. 24

Key issues arising • Qualified opinion provided following the Trust’s position of “significant breach” as at 31 July 2013. Use of • The Annual Governance Statement Resources reflects our understanding of the Trust’s operations and risk management arrangements © 2013 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. KPMG and the KPMG logo are registered trademarks of KPMG International Cooperative, a Swiss entity. 25

Consistency of the Quality Report with information specified by Monitor • CQC quality and risk Are significant matters included? Quality Report Are significant assertions supported? profile • Board minutes and papers • Head of Internal Audit’s annual opinion • Feedback from commissioners • Feedback from governors • Quality reports to the Board • Complaints report • Monitor best practice © 2013 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. KPMG and the KPMG logo are registered trademarks of KPMG International Cooperative, a Swiss entity. 26

Key issues arising • Achieved limited assurance opinion on content of Quality Report • Limited assurance opinion achieved on two mandated indicators (clostridium difficile and 62 day cancer) © 2013 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. KPMG and the KPMG logo are registered trademarks of KPMG International Cooperative, a Swiss entity. 27

Key issues arising • No opinion required this year on local Quality Report indicator (incidents resulting in severe harm). However, we concluded that we would be unable to provide an opinion in future years. • Two (low priority) recommendations raised and agreed with management © 2013 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. KPMG and the KPMG logo are registered trademarks of KPMG International Cooperative, a Swiss entity. 28

Areas for consideration 2013/14 Audit Risk Financial Statements Issues influencing our audit • Delivery of year one recovery plan • Valuation of EPR asset • Successful actions against Monitors requirements Use of Resources Quality Report to remove the Trust from position of significant breach • Achievement of cost improvement plans • Achievement of national & local targets • Compliance with Monitor’s new regulatory regime • Quality Governance Framework • Impact of Francis & Keogh reports © 2013 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. KPMG and the KPMG logo are registered trademarks of KPMG International Cooperative, a Swiss entity. 29

Council of Governors Jean Dearden Public Governor Wentworth South & Lead Governor

Council of Governors During 2013 the following were elected to the Council of Governors: Public Governors Rother Valley West - Jeffrey Gudgeon Rotherham North - Sylvia Bird (re-elected) Rotherham South - Terry Barker Wentworth North - Ann Ashton Wentworth Valley - Gordon Forster & Abul-Abbas Zaidi & Cynthia Shaw (re-elected)

Staff Governors Other Health Professionals - Catherine Ripley Other Staff - Sandra Lewis On behalf of Council of Governor colleagues I would like to say thank you to those outgoing Governors in 2013 for their contribution and support.

The Rotherham NHS Foundation Trust Community Continence Service Joanne Mangnall Clinical Nurse Specialist Continence / Service Lead

Continence. . . • Toilet related activities are rarely discussed and are a source of embarrassment, often coped with through the use of humour. • However continence is arguably the biggest threat to individual dignity, the ability to maintain bladder and bowel continence is an elemental part of who we are

Rotherham leads the way! • Over 1, 000 people in Rotherham require prescriptions for items such as catheters • Was anything wrong with the way it was done before? • Not really, but we knew if we were given the opportunity we could do it better

A new way of working • Prescribing responsibilities transferred from GPs to Specialist Nurses • New model offers the opportunity to provide clinical advice and support each time the patients contacts the service to request a prescription • Patients speak to staff who have extensive product knowledge

Benefits • Patients now have rapid access to specialist clinical advice and support • Effective product prescribing has reduced costs • Costs savings have been re-invested in the service • Reduces attendance at A&E • Frees up GP time

Why is the model successful? • The service model is responsive to patient needs • How do we know that? • Our patients have played a key role in the re-design process

Service User Group • Meets quarterly • Discuss service related issues • Bring new ideas to the table – Hospital to Home Pack • Hold awareness raising events • Contract monitoring from an end user perspective

National Recognition for the group • Nursing Times Awards • Members of the group attended the award ceremony

What next? • Adapting the model for patients who required prescribed stoma appliances • Partnership working with Infection Prevention & Control team to reduce catheter associated infections • Research projects to improve product design

Thank you

Questions from the floor