1. Annual General Meeting 2017

2. Welcome Gordon Johns Chair
I am delighted to welcome you here tonight and present our Annual Report and Quality Account. Both are available on our website and there are a limited number of hard copies available at this meeting.

3. Looking back
An overview of our year
Stephen Conroy
Chief Executive

4. We provided care for a population of approximately 270,000
Our year in numbers
We have 360
general and Acute beds
We provided care for a population of approximately 270,000
We invested
£4.9m
into our
infrastructure
We employ
2,672 staff
including…
332
doctors
884
Nurses &
Midwives
688
Clinical
Support staff
501
admin &
Clerical
We delivered 310,352
outpatient
attendances
We treated
54,616
inpatients
73,082
patients attended
the A&E department
(which averages
at 1,405 a week)
19,216
Patients arrived
by ambulance
We had
22,139
emergency
admissions
We undertook
27,872
elective
procedures
2,861
babies were
born here
19,216
Patients arrived
by ambulance
Our income
for 2016/17
was
£ M
We ended the year with a deficit of £8.3M
We served
2,000
freshly prepared meals a day to patients & staff

5. A good year for the Trust…
Despite one of the most challenging periods in NHS history the Trust worked hard to ensure our patients continued to receive high quality care in a safe environment.
Our staff have been fantastic throughout.

6. Review of 2016/17: Activity Significant bed pressures:
- increased emergency admissions (especially frail and elderly)
- delayed discharges
Good partnership working with health and social care organisations
Increased demand on A&E - The number of attendances and admissions were the highest on record.
Activity information
2016/17
A&E attendances
73,079
Emergency admissions via A&E
21,989
Elective day cases
24,843
First outpatient attendances
87,276
Follow-up OP attendances
223,256
Births
2,861

7. Performance
Service activity
National standard
2016/17
A&E waits (less than four hours)
95%
91.5%
Two week referrals for suspected cancer
93%
94.53%
Cancer patients receiving treatment within one month of decision to treat (31 day)
96%
98.17%
Cancer patients receiving treatment within two months of urgent GP referral (62 Day)
85%
83.36%
RTT 18 Weeks incomplete pathways
92%
93.40%
Diagnostic waits (within six weeks)
99%
99.58%
Despite these pressures we met the majority of our non-urgent care national targets, for example routine diagnostic waiting times and 18-week referral to treatment (RTT) times Although we did not achieve the 4 hour A&E target we were still in the top quartile of Trusts.

8. Quality and safety of care
We continue to improve quality and safety:
Our Infection Prevention rates remain strong and we have finished the year in the top three hospitals in the region.
Hospital acquired infections remain low and we were under our C.Diff ceiling for the year with the Trust reporting eight cases 8
hospital acquired category 4 pressure ulcers, and a reduction in category 3
This year has seen a 30% reduction in Serious Incidents, from
55 to 38

9. 4500 compliments, gifts and donations
Patient feedback
The positive feedback we get from our patients has increased and our complaints have halved.
4500 compliments, gifts and donations
125 complaints. (A reduction of 50%)
“Your staff have shown nothing but kindness and wonderful levels of care and commitment”
“Thank you so much for looking after me. such an amazing team of people.”
“Every single member of staff from all the amazing midwifes, student midwifes, maternity care assistants and the canteen staff were worth their weight in gold!”
“Absolutely amazing staff and treatment. A total credit to the NHS. Forever grateful.”
NHS Choices website:
“Very efficient, good knowledge staff, couldn't want more from an A&E”

10. Some highlights
Established our Ambulatory Emergency Care Unit (AECU) with a dedicated medical, nursing and administration team.
Harpur and Elizabeth wards received the Elder Friendly Quality Mark
Our new Primrose Unit opened by HM Lord-Lieutenant of Bedfordshire, Helen Nellis.
Thanks to Bedford Hospitals Charity.
Announced as one of the lead partners to deliver training for new Nursing Associate role

11. Recognition from NHS Improvement
Our performance and improvement work during the year has not gone unnoticed by our regulator (NHS Improvement), which has moved the Trust from segment 3 to segment 2 (with one being the highest or best category)
This reflects the reduced level of support and oversight that they consider we require moving forward in order to attain CQC ratings of ‘Good’ or ‘Outstanding’.

12. Damian Reid Director of Finance

13. Financial position We ended the year with a deficit of £8.3m
This is £1.9m better than our forecast deficit plan of 10.2m
Making us one of the Trusts to successfully meet our 2016/17 planned financial control target
There are a number of factors driving the financial performance in 2016/17, including:
Increased non-elective activity that resulted in some elective activity being displaced.
Increased non-elective activity resulted in additional costs as additional beds were opened and staffed safely at premium costs.
Income loss through the application of business rules, penalties and the marginal rate adjustment
Pay pressure due to national shortages in medical and nursing posts and increases in establishment to deliver safe staffing standards. 
However, good control has been maintained in terms of nursing agency spend, with the Trust marginally exceeding the agency cap imposed by NHS Improvement of £7.1m.

14. Financial breakdown 2016/17 (£000s) 2015/16 2014/15 Income 192,502
2016/17
(£000s)
2015/16
2014/15
Income
192,502
174,407
164,307
Pay costs
118,350
114,504
109,388
All other costs
87,423
77,926
75,154
Net surplus/ (deficit)
-13,271
-18,023
-20,235
Technical adjustment (see below for explanation)
4,971 83
481
Adjusted net surplus/ (deficit)
-8,300
-17,940
-19,754
* technical adjustment – impact of asset valuation

15. Investments
The Trust invested £4.9m in 2016/17 in estates developments, service developments, IM&T and medical equipment. Key projects include:
Pharmacy robot and IT system replacement: £0.5m
Radiology and A&E processors: £0.2m
A&E and Endoscopy monitoring systems: £0.2m
E prescribing system for Chemotherapy: £0.1m
IM&T equipment and systems: £1.4m
This was in addition to funding provided by the Bedford Hospitals Charity, which included support for redevelopment of the Primrose unit: £0.6m.

16. Pharmacy Transformation 16/17
Kandarp Thakkar
Chief Pharmacist
Divisional Clinical Director
5th July 2017
Trust Annual General Meeting
5th July 2017

17. What happened?
Business Case (c. £ 1 million) approved by Trust Executive in May 2015
Staffing establishment reconfiguration and restructure
5 year Medicines Optimisation Strategy
7-day working Consultation
Building works started January 2016
Project completed January 2017
Total refurbishment
New IT system
New robot
Automated controlled drugs
Prescription Tracking Service

19. Recognition by NHS Improvement
So what?
35%  in opening hours
 Clinical Pharmacy
 Medication errors (moderate/high)
Tracking of prescriptions
 50% in discharge turnaround times
Better use of controlled drugs
Recognition by NHS Improvement

20. What next? Further increase in clinical Pharmacy service
Pharmacist prescribers
Increase work at interface
Improved drug storage/security
Full ‘go live’ of chemotherapy electronic prescribing
Innovation in improving discharge patient experience

21. Stephen Conroy Chief Executive
Looking forward
Stephen Conroy
Chief Executive

22. Challenges Staffing Workforce recruitment & retention Staff survey
CQC rating – ‘Requires Improvement’
Financial deficit
Rising demand for our services
IT cyber security
STP and sustainability

23. Looking forward New MRI scanner
Cauldwell Medical Centre - with plans to move in further GP surgeries shortly
New children’s play area in Riverbank Ward

24. BLMK STP – Five priorities identified
Two ‘behind the scenes’ priorities
Three ‘front line’ priorities
Technology
Prevention
Transform our ability to communicate with each other, e.g by having shared digital records that can be easily accessed, using mobile technology for better co-ordinated care.
Encourage healthy living and self care, supporting people to stay well and take more control of their own health and wellbeing.
Primary, community and social care
System redesign
Build high quality, resilient, integrated primary, community and social care services across BLMK.
Improving the way we plan, buy and manage health and social care services across BLMK to achieve a joined up approach that puts people’s health and wellbeing at the heart of what we do.
Sustainable secondary care
Make our hospital services clinically and financially sustainable by working collaboratively across the three hospital sites, building on the best from each and removing unnecessary duplication.

25. Thank you for listening
Any questions?