Review

of

the

yearA

pril2008

-M

arch2009

It really has been a yearof two halves for theRoyal Bolton Hospital. Forthe first half of the yearwe were a normal NHSTrust. Then in October,we were granted NHSFoundation Trust status.

This was a major achievement forour hospital, but it is just assignificant, if not more so, for ourpatients and the people of Boltonand beyond. Although we are stillgoverned by the NHS, FoundationTrust status means we are nowmore accountable to local people,and local people can have a real sayin decisions on how local servicesshould develop.

David Fillingham Chief Executive Cliff Morris Chairman

We find out these views throughour ‘members’ – ordinary peoplewho sign up to give their viewsabout how their local hospital isrun and how they think we canimprove. And perhaps the mostexciting thing about becoming aFoundation Trust has been the waywe have connected with ourmembers. We now have amembership of over 3,750 staffand around 3,700 members of thepublic and a very enthusiasticCouncil of Governors, whorepresent local people and help usmake key decisions about ourfuture.

We’d like to take this opportunityto thank every one of our membersfor their commitment andinvolvement. This review of the yearreflects some of the highlights andchallenges we’ve faced throughoutthe last 12 months. We’ve madehuge progress in some areas and wewant to continue to build on that inthe next 12 months and comingyears. We hope we can count onyour support in the future.

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Introduction from theChairman and Chief Executive

About us

We want to provide forour patients• Excellent and accessible

emergency care• A range of leading planned

diagnostic and treatmentservices

• Specialist women’s and children’sservices

• Services closely integrated withprimary and community services

• Safety and quality at the mostcompetitive cost

Did you know?• We serve the whole of the

population of Bolton – that’saround 265,000 people. Manypatients choose to come herefrom other locations as well

• Last year, we had 33,204emergency admissions

• 4,445 babies were born at ourPrincess Anne Maternity Unit lastyear

• We have more than 700 beds• We employ around 3,660 staff.• Our turnover for 2008/09 was

£183 million• We were given 'good' ratings by

the Healthcare Commission for2007/08 (latest ratings)

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The Royal Bolton Hospital is amedium sized district generalhospital which offers a wide rangeof services, including emergencycare, specialist surgery andmaternity.

We are one of the busiest acutehospitals in Greater Manchesterwith 28% more ambulancearrivals than any other generalhospital site. And we’re also thebusiest general hospital maternityunit in Greater Manchester witharound 950 more births each yearthan any other district generalhospital in the area.

Our vision is to be thebest hospital in the NHS.We are aiming for:

• Best possible care for ourpatients

• Improved health for ourcommunity

• Joy and pride in work for ourstaff

• Value for money for thetaxpayer.

Performanceagainst key measures

As a publicly accountableorganisation, we have to reporthow we perform on key measuresto our regulators Monitor. This yearwe have achieved all our keymeasures except one – the length oftime people spend in ourAccident and Emergencydepartment before beingadmitted, transferred or discharged.We have been working hard toimprove this and the measures wehave introduced are already takingeffect.

Performance

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Target Must Achieve Achieved Performance

Reducing C Difficile infections

15% reductionwith amaximum of213 cases

178 �

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A maximum of16 cases

15

90% 90.5%

95% 96.6%

98% 96.7%

98% 100%

95% 99.6%

68% 74.2%

98% 99.9%

Reducing MRSA infections

Making sure admitted patientswait no longer than 18 weeksto start their treatmentfollowing referral from a GP

Making sure non-admittedpatients wait no longer than 18weeks to start their treatmentfollowing referral from a GP

Making sure nobody stays inA&E for more than four hours,before going home or beingadmitted, transferred ordischarged

Making sure cancer patientsstart their treatment within 31days of being diagnosed

Making sure cancer patientsstart their treatment within 62days of being urgentlyreferred by a GP

Making sure people sufferinga heart attack receiveclot-busting treatment within60 minutes of 999 call

Making sure nobody waitsmore than two weeks for anoutpatient appointmentfollowing an urgent GPreferral for suspected cancer

Infection control

One of the biggest concerns ofpatients coming into hospital iswhether of not it will be cleanand hygienic and that they willremain infection free. This isanother area in which we arepleased with our progress.2008/9 saw a reduction in MRSAbacteraemias down from 31 toonly 15 together with a 61%reduction in the rates ofClostridium Difficile.

How did we do it?

In the ongoing fight againstinfections we have increased thenumber of MRSA tests we routinelycarry out on patients coming intohospital from 40,000 to about60,000 a year. Senior Matron MarieDigner said: “We already have goodMRSA results. This is another step inthe process and patients can beconfident we are doing everythingwe can to reduce the figures.”

Reduction inhospital deaths

One of our aims for the year was toreduce the hospital’s standardisedmortality ratio (HSMR). HSMR is astatistical calculation that looks atthe numbers of deaths in a hospitalcompared with a national standard.A hospital with a ratio below 100had fewer deaths than would beexpected, and those with a rateabove 100 will have had moredeaths than would be expected.

We have seen a steady decline inHSMR as a result of huge effort toaddress our highest risk systems andprocesses. In orthopaedic trauma,our rate has reduced from amongthe worst nationally, to being 15%better than the national average. Instroke, the rate has also fallen tobelow 100. We achieved areduction in overall rates to102.2 by December 2008, and afull year rate of 109.

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Senior Matron Marie Dignerperforms a nasal swab on a patient

Focus on urgent care

Urgent care includes our Accidentand Emergency Department andemergency admissions to otherhospital units. This year, we saw acontinued rise in levels of urgentcare demand. There was a 1.7%increase in emergency admissionsand a 4.4% increase in A&Eattendances. Our target is to makesure at least 98% of patients areadmitted, transferred or dischargedwithin four hours of arriving atA&E. Our performance howeverwas 95% for the Royal BoltonHospital and 96.7% for the wholeBolton health economy. UntilNovember we were on track toachieve the 98% standard, but along outbreak of norovirus, adiarrhoea and vomiting infection,and a very cold winter resulted inmore admissions and longer stays inhospital, particularly for the elderly.

Since then we have completed amajor review of our urgent careprocesses and made a number ofchanges which have already seenhuge improvements.

out within 24 hours, how much of apatient’s stay was spent on a strokeunit and whether rehabilitationgoals were agreed. Over the lastfew years a great deal of work hasbeen carried out to improve ourstroke services, including theopening of a 20-bed acute strokeunit in 2007.

Stroke care

The Bolton population has a highincidence of cerebrovascular disease(strokes) - around 400 patients ayear are admitted with a stroke.Major work has been carried out toimprove our stroke care in recentyears and this year we weredelighted that a national auditnamed our services among the bestin the country.

Out of 214 hospitals taking part,our results were in the top five –and the second best in the NorthWest region. The audit, by theRoyal College of Physicians, coveredevery eligible hospital in England,Wales and Northern Ireland. Wereceived an average score of 92 percent over nine indicators, comparedto 60 per cent in 2006 when therewere 12 indicators.

We were judged on how quicklyassessments were made - forexample, if a brain scan was carried

Dr Gillian Halstead, aconsultant physician instroke medicine and leadstroke consultant, said:“We are now among thetop hospitals in thecountry and I am verypleased. Our work doesnot end here though. Wewill be continuing to lookat how we can improve.”

page 6Team effort: The Stroke Team celebrates its success

Orthopaedic outpatients

A new orthopaedic X-ray suite wasofficially opened in March reducingwaiting times and bringing manyother benefits for patients.

The suite cost £900,000, includingtwo new digital X-ray machines. Itis being used for outpatients whohave suspected fractures or whomay be having hip or kneereplacements. Currently around30,000 orthopaedic outpatientX-rays a year are taken. Previouslypatients could spend up to 45minutes in the department but now,thanks to the new system whichalso includes high tech digitalimaging, it take as little as tenminutes.

Cancer services

We unveiled a new £90,000extension to our Churchill Unit inMarch. The Churchill Unit openedin 2004 and offers numerous clinicsfor cancer patients every week,including chemotherapy and bloodtests.

The new ‘quiet room’ providespatients with a dedicated areawhere they can go if they receivedifficult news or want to wait inprivacy for chemotherapy or bloodresults. It is a light and airy spacethat has been designed with arelaxing feel for patients duringwhat can be a particularlystressful time.

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The new X-ray machine

Bolton Wanderers captain Kevin Daviesin the new extension

Maternity services

A new midwife-led Birth Suiteopened in July and has nowwelcomed more than 200 babies.The unit provides women withuncomplicated pregnancies theoption of having their babies in acomfortable home-likeenvironment. However back upfacilities are available if needed.

The Birth Suite is in a formerlyunused ward in the Princess AnneMaternity Unit and includes abirthing pool, five separate en suitebedrooms, a lounge, relaxationarea and a place to makerefreshments. The unit can alsosupport family centred care andbirth partners are able to stay inthe birth suite if they wish.

In March we also gavethe go-ahead for a £20million investment in ourservices for women,children and babies.

Under the Making itBetter scheme the RoyalBolton Hospital willbecome a ‘super centre’for this type of care andover the next threeyears we will beexpanding our facilitiesthrough a majorbuilding programme.

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Awards:high praise for our staff

This year the excellenceof our staff has beenrecognised nationallywith a number of highprofile accolades andachievements.

• Consultant physician Dr SimonStacey won an award from the NHSNorth West Leadership Academy inNovember, in the category ‘ServiceImprovement through Leadership’.He was nominated for leadingimprovements for elderlyorthopaedic and other surgicalpatients. Working with colleagues,he has supported the creation of aTrauma Stabilisation Unit which

gives additional support to highrisk patients, greatlyreducing the likelihood ofpost operative complications.

• Our Chief Executive DavidFillingham was named by theHealth Service Journal (HSJ) as oneof the 50 people with the greatestinfluence on NHS managementpolicy and practice in 2008. Hisaward winning work in ‘lean’management has been highlyinfluential in the health service.

• Our Bereavement and DonorTeam was highlighted as anexample to the rest of the NHS inthe Nursing Times Awards, comingsecond in Team of the Year. Theteam has consistently been at theforefront of this type of work andmuch that they have pioneered in

Bolton has been taken upnationally. Working with staffand members of the public theyhave raised awareness about organand tissue donation, giving supportto families at what is often a verydifficult time.

• A project from our Eye Unit andlink workers, which aims to raiseawareness of glaucoma amongstthe Asian population, was selectedas a finalist in the AllergenGlaucoma Awards. The project wasthe development of a leaflet forthe Asian community aboutglaucoma, the first of its type in thecountry. It has proved so successfulthat other hospitals across thecountry are now replicating it.

This year we…..

• Officially opened thepharmacy robot tostreamline dispensingservices

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Our Bereavement and Donor Team

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Informing and involving

We are committed to informingand involving patients, carers, staffand the public on every aspect ofour service. Our patient and publicinvolvement work ensures thattheir voices are heard at every leveland we use that feedback to builda patient focused service.

As part of our patientand public involvementwork we:

• Recruit, inform and engage withour Foundation Trust members.Members are a vital voice inproviding feedback aboutservices.

• Have a Council of Governorsrepresenting our publicmembers. Quarterly Council ofGovernor meetings are held inpublic.

• Keep interested members ofthe public well informed ofdevelopments and newsthrough our website, the mediaand other communicationschannels, including a newsletterfor members.

• Have a Patient Experience Groupwhich meets monthly. The grouphas representatives from bothstaff and patients and was setup to share views and todiscuss how improvements canbe made.

Listening to patients:Using patient feedbackto improve

The views of our patients are vitalin developing our services and helpus know whether we are gettingthings right. We have a number ofways in which we obtain theseviews including taking part innational patient surveys. Wemonitor and respond to patientfeedback on websites includingNHS Choices. We also run acomment card service, issued topatients when they are discharged.As a direct result of comments,many improvements have beenmade this year including theinstallation of handrails in ourcorridors and extra wheelchairsupplies in Accident and Emergency.

We also have an active PatientAdvice and Liaison Service (PALS),ideally located in the main entranceof the hospital. People can contactPALS for information about servicesand advice about problems andPALS staff will do all they can toresolve issues as quickly as possible.

This year we....

• worked withorthopaedic patients tocreate video diaries oftheir experiences,which were then usedto make improvements.

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Our Members

Every member of the public overthe age of 16 can become an FTmember of the Royal BoltonHospital and give their views onhow they think we should developour services. Through our members,we can really get to know what thepublic wants and, more importantly,act on that as our services evolve.

We are committed to building amembership that is representativeof and reflects the localcommunities we serve in terms ofdisability, age, gender, socio-economics, sexuality, ethnicbackground and faith.

Membership of the Trust is open toanyone who lives in England. Thereis a lower age limit of 16 but noupper age limit. Public membersare placed in constituencies basedon where they live. There are 20constituencies representing theelectoral wards of Bolton and oneto represent the rest of England.All our staff are automaticallymembers, unless they choose not tobe.

Our Governors

As a Foundation Trust we have aCouncil of Governors whorepresent our members, includingthe public, our staff and the partnerorganisations we work with. TheCouncil of Governors’ role is tomake sure that members’ views arerepresented when importantdecisions are taken about services,or the future direction of theorganisation. The Council ofGovernors is also responsible forholding the Board of Directors toaccount and for the appointmentof the Trust Chairman and Non-Executive Directors.

The BoltonImproving Care System

Learning through “lean”

The Royal Bolton Hospital is aleader in using "lean thinking" inhealth care. This is a way ofimproving patient services andadding value for patients and staffthrough the removal of wastefulactivity. We have developed ourown Bolton Improving Care System(BICS) using lean thinking.

For more than three years, teamsfrom across the Trust have beenlearning how to use BICS to tackleproblems and improve the way wedo things, so that we can deliver abetter service for patients, betterworking lives for staff and bettervalue for money.

Major benefits for patients this yearinclude the continuation of thework improving care for patients instroke, older people, trauma andophthalmology. New improvementwork started in key areas oftheatres, respiratory, and care ofolder people in hospital.

This year we…..

• Started building ournew £2 million HealthRecords building tohouse more than300,000 files of patientdata.

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Financial Overview

As a busy generalhospital, the Royal BoltonHospital had a turnoverof £183 million in2008/09.

Most of our income, approximately£160 million in the year, comes fromtreating patients and we are paidthis from other NHS bodiesincluding NHS Bolton and theDepartment of Health. We alsoreceive income from other sourcesincluding education and training,staff accommodation and catering.

Our largest expenditure is on ourworkforce. In 2008/09 this was £125million. Other areas of expenseincluded £8 million for drugs and£7.5 million for maintaining andrunning our premises.

It was a challenging year financiallydue to a number of factors

including high levels ofuncontracted activity, additionalwinter pressures, the failure ordelay of some savings schemes andhigher than expected inflation andcosts.

We ended the period with a £3.8mdeficit. This was largely due to twoexceptional items, namely adevaluation of the hospital estateby £4.05 million which was partlyoffset by a profit of £1.8m sale ofFall Birch Hospital.

Our financial plans for 2009/10 havebeen modelled to address thechallenges of the past year but werecognise that the recent economiccrisis will have a significant effecton the NHS in the coming years.

This year we…..

• Completed thefirst round of bowelscreening for thepopulation of Bolton,Salford and Wiganahead of schedule - avital programme whichcan help diagnosecancer earlier. Morethan 1000 peoplehave had colonoscopiesand to date 87 cancershave been detected.

The Bowel Cancer Screening Team

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Looking forward to2009/10

The coming year 2009/10will offer many morechallenges andopportunities for theTrust. We will be workingin the more restrictivenational economicclimate and our PCTcommissioners will belinking our income tomeasures of quality andsatisfaction.

We will also be planning for theimpact of changes in theconfiguration of services in NorthEast Manchester which are likely toincrease the flow of emergencypatients to Royal Bolton Hospital infuture years. And of course theMaking it Better changes forwomen, children and babies willcontinue to gather pace. Followingthe approval of the full businesscase to expand and improveservices, we hope to make majorprogress in the building work whichis ultimately due for completion in2011.

We will be opening a complexcardiac pacing laboratory to fitcomplex pacemakers and InternalCardiac Defibrillators (ICDs) –devices which automaticallyattempt to restart the heart if itstops beating. Bolton, Wigan andSalford area. The new unit willenable us to carry out moreadvanced cardiac-pacing proceduresfor the people of Bolton, Wiganand Salford, which can currentlyonly be carried out at theManchester Heart Centre.

We will also be introducingelectronic ordering for ourradiology and pathology tests,

This year we…..

• Introduced wardachievement boards sothat patients, visitorsand staff can see howwe are performingagainst a number ofstandards.

• Expanded our ExemplarWard Programme, toensure all our wardsmeet the higheststandards of caredelivery, competency,awareness of patientsafety and qualityimprovement.

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which will speed up the process forboth GPs and hospital staff.

The Trust has set its performancegoals for 2009/10. These range fromfurther reductions in death rates toa redesign of urgent care, and arein some cases more demanding thannational mandatory targets andguidelines. Further detail can befound in the Trust's Annual Plan atwww.royalboltonhospital.nhs.uk

This year we…..

• Bought several piecesof equipment includingtwo exercise systemsfor cardiology patients,equipment forradiology and

ultrasound, a cornealsurgery machine and abody plethysmographwhich is used fortesting lung function.

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