Annual Report 2007-08

A message from the Chair and Chief Executive

It is clear that something really significant is happening in the Trust. In the last six months of 2007/08 we have seen a dramatic improvement in performance against national standards, significant improvements in our financial position and a fall in waiting times.

These changes, coupled with very big changes in how services are to be delivered in the latter part of 2008, suggest that the Trust is using all of its resources much better than previously, with notable improvements in quality and productivity. These successes have been achieved by the hard work, commitment and creativity of our staff.

This is just the start and there is much more to do before we have the services that we all want; but progress is being made quickly and visibly.

Improvements are Happening Quickly
  • A&E performance has moved from being amongst the worst in the country to being amongst the best.
  • Hospital acquired infections have been dramatically reduced, particularly MRSA,
  • Turning a £11.4m deficit into a surplus of £2.5 million
  • We are recruiting more permanent staff
  • We are cancelling far less operations than recently, particularly at St Albans
A Period of Change

The Trust entered the 2007/08 year on the back of two consecutive years of being rated by the Healthcare Commission as weak on the use of resources and weak on the quality of services. This double weak rating was a threat to the future of the Trust and significant changes were required. As late as autumn, the indications were that the Trust was still at significant risk of another weak/weak rating. Jan Filochowski joined the Trust at the beginning of November 2007 with the task of making basic performance improvements for the last five months of 2007/08 and to continue to develop the short to medium term priorities.

The Trust's focus therefore changed from November 2007 when the emphasis was on getting the basics right. From thinking that we may have already failed against the Healthcare Commission targets for 2007/08, we now think it is likely that we will be awarded a 'Fair' on use of resources and a 'Fair' on quality of services when the results are announced in October 2008. This is a rapid advance in a relatively short time and will need to be maintained and further improved.

Our People

We recognise it has been a difficult year for staff. We have done some things well, but there has been a lack of clarity around people's roles and responsibilities. The Trust has tried to put that right and emphasised its double focus on:

  • Patient Safety – preventing healthcare infections is our number one focus and priority as safety in all we do is the key.
  • Delivery – ensuring we actually deliver what we promise quickly so we can deliver the very best services for the people of west Hertfordshire
Our performance

In recent years we have not performed at the highest levels, hence the ratings from the Healthcare Commission for 2006/07 assessing our performance as “weak/weak”. If we are to have the future we deserve, this had to change.

A Few Other Headlines
  • C. diff has been brought under control. There has been a remarkable and continuing improvement since the first half of 2007, when levels were very high. MRSA cases are also reducing, but we need to get them down further. The introduction of isolation wards in the Trust has had a real and lasting effect.
  • Our A&E performance moved from being one of the worst in the country in the first six months of 2007/08 to being right up where it should be and we are now consistently seeing more than 98% of patients within the four hour national standard.
  • Keeping people in hospital longer than is necessary, delayed discharges, is a serious problem but we are tackling it with our NHS partners. Numbers are still too high but they are considerably lower than last year.
  • A new centre for patients needing planned surgery was opened at St Albans in September 2007. This is a good facility based upon a good idea, but it ran into major operational difficulties at the start. Getting its problems sorted has been one of our biggest and immediate concerns and significant improvements had been made by the end of March 2008.

Big changes are underway as the Trust reforms and modernises with the opening of an Acute Admissions Unit (AAU) at Watford in early 2009. This unit will herald a real step-change for patients. It will provide excellent medical care, early and accurate assessment of their needs and prompt provision of the right and appropriate care. The effect of all this will be improved quality of services and improved use of resources.

Foundation Trust application

At the October 2007 meeting the Board made the decision to apply for Foundation Trust status. The process to achieve FT status is a long and complex journey. Our five year Integrated Business Plan and Long Term Financial Model were submitted to the Strategic Health Authority (SHA) at the end of January 2008. The process will see the Trust going to public consultation in September of this year and accreditation as an FT in 2009.

And Finally....

There is a sustained and significant improvement happening in the Trust. The improvements recorded in this report have been achieved by the hard work, determination and creativity of people working in and with the Trust. We know that everyone involved has the very difficult task of making improvements for the future whilst running today's services.

Let us end by outlining a couple of final messages

Firstly, nothing is more important for the Trust than preventing and controlling healthcare acquired infections. We have transformed our performance in controlling C.diff. More needs to be done on MRSA, but we are bearing down on this. At the present time, nothing is more important for us and nothing is more important for the patients of west Hertfordshire.

Secondly, we were amongst the worst in the country for waiting times in A&E. Today we are consistently at or above the national target of seeing patients within 4 hours. How long people wait in A&E is one of the main ways in which they judge their local hospitals. That's exactly as it should be.

We intend to ensure we make these improvements permanent and that we become the best Trust we can possibly be for the people of west Hertfordshire. NHS Foundation Trusts are a fundamental part of the current NHS reform programme. They reflect the move from a centrally managed service towards one that is managed locally and is therefore more responsive to patients. Foundation Trusts are authorised and monitored by Monitor – the Government's Independent Regulator of NHS Foundation Trusts.

» next: Operational Review

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