5. Our population
We serve a
population of more
than 424,000 in
Medway and Swale
1 in 4 people in
Medway has a mental
health problem
19 per cent of adults aged
18 years and over are
current smokers…and
alcohol is the leading
cause of death among
15 to 49 years
The proportion of older
people experiencing
income deprivation is
15.1 per cent
More than two thirds
of adults aged 18
years and over are
overweight or obese
6. Recognition of improvements
• The CQC’s report into Urgent and Emergency
services at the Trust was published in June 2022.
• The CQC noted significant improvements since its
previous inspection in December 2020 and rated
the service as ‘Good’ overall. The service had
previously been rated as ‘Inadequate’
• A separate review of the Medical and Older
People’s services, and Children and Young
People’s service also led to improved ratings in
these areas.
• Our Maternity services also retained their ‘Good
rating’
7. A moment to reflect
• We were proud to open a new
outdoor space for colleagues to
remember, reflect and rejuvenate.
• The fully blocked-paved Reflection
Garden, which has pergolas, raised
beds, privacy screens, seating and a
stunning water feature, was made
possible thanks to generous funding
from Medway NHS Foundation Trust,
The Medway Hospital Charity and
The Medway League of Friends.
8. One year of Patient First
• This year we celebrated the first
anniversary of the launch of Patient First.
• We introduced Patient First to move
ourselves away from a culture of fire-
fighting. We knew that working reactively
‘in the moment’ meant we were not able
to take a step back and focus on how we
could do things differently to avoid these
situations in future.
• Patient First is now helping us do that.
9. Virtual Hub
• We were excited to introduce our
new Virtual Hub, located in Eliot
ward, an area which has been
designed to support new ways of
working.
• This has allowed the Trust to offer
more virtual consultations for our
patients, providing more
accessibility and reducing the
need for travel, therefore lowering
expenses and CO2 emissions.
10. New breast screening machine
• Thanks to generous donations from
the public, Medway NHS Foundation
Trust, The Medway Hospital Charity
and The Medway League of
Friends we were able to purchase a
new Tomosynthesis machine
for the Breast Care Unit.
• Tomosynthesis is a special type of
mammogram that is used as a
screening tool for early detection of
breast cancer by creating a high
definition 3D image of the breast.
11. Improving care for patients with hip
fractures
• We were delighted to improve the
experience and outcome for some of our
most vulnerable patients who arrive at
our Emergency Department (ED),
through our relaunched Accelerated Hip
Fracture Pathway.
• The pathway begins from the patient’s
home with the ambulance service
informing our Associate Practitioners in
ED. Colleagues will know the patient’s
name on arrival and ‘drive’ them through
the pathway, ensuring all best practice
indicators are met.
12. Ralph’s legacy
• A state-of-the-art simulator for trainee
surgeons to practise the skills needed to
carry out orthopaedic arthroscopic joint
surgery was opened at the hospital
thanks to a £1 million legacy.
• Ralph Barrett, a retired BBC engineer,
had a serious motorbike accident during
the Second World War and underwent
14 operations to save his leg. He was so
thankful for the outstanding care he
received that he left this incredible gift in
his will to the orthopaedic department
at the Trust.
13. Phase Two of Electronic Patient
Records goes live!
• The Trust took another step forward on
digital transformation as we went live with
Electronic Prescribing and Medicines
Administration (EPMA), and Electronic
Discharge Notification (EDN) in Sunrise
EPR. The Emergency Department also
went live with Sunrise
• Once EPR is fully in place across the
hospital, all information about a patient’s
medical history and treatment will be
available electronically, on screen, at any
location, at any time.
14. Recognition for Oliver Fisher Unit
• Following an assessment in August,
the unit received stage two
accreditation in Unicef’s Baby
Friendly Initiative.
• This initiative, in collaboration with
the World Health Organisation
(WHO), was created to try to improve
the culture of breastfeeding, where
rates in the UK are among the lowest
in the world.
15. Celebrating five years of robotic
surgery
• We were proud to celebrate five
years of robotic surgery at the
Trust.
• We were ahead of the robotic
curve when we introduced the
programme in 2017 and we were
one of the early adopters of the da
Vinci Xi technology.
16. Launch of our new medical model
• We were delighted to launch our
new acute medical model at the
Trust.
• The initiative is supported by NHS
England and brings a new model
to the Trust for patients with an
acute medical need.
• Following the introduction of the
model, we saw an immediate
improvement in ambulance
handover times.
17. Excelling in Research
• We are the leading Trust in Kent, Surrey and
Sussex for patients taking part in research
studies and have been recognised at
national and international levels
• By taking part in research, we offer our
patients new and up-to-date treatments.
• In November, we were proud to support the
‘Your Path in Research’ campaign which
aims to promote careers in research.
Excelling in research
18. Disposable head coverings for
theatre staff
• We were proud to introduce new
disposable head coverings for
staff within our operating theatres,
helping to improve safe practice
and inclusivity for colleagues.
• Thanks to this new initiative, head
coverings are now routinely
available in a disposable format,
adding to the standard operating
theatres hat.
19. Call 4 Concern
• To help prevent the clinical
deterioration of patients on our
wards, the Trust adopted a new
patient safety service in December.
• Call 4 Concern enables patients and
families to call a dedicated number
24/7 for immediate help and advice
directly from a member of our Acute
Response Team if they have ongoing
concerns about their own or their
loved one’s changing condition.
20. Promoting dignity, respect and
compassion at the end of life
• In December, we introduced the
Dandelion Scheme in our theatre
department and recovery areas.
• The dandelion compassion sign is
displayed when a person is expected to
die in the next few hours or days, or
when a person has just died.
• The aim is to promote
dignity, respect and compassion at the
end of life by encouraging a quiet
atmosphere for the patient and their
relatives at a very difficult time.
21. New ward space
• During the year we were pleased to transfer
patients and staff from Wakeley Ward to the
new and improved Keats Ward which
underwent a £1.4 million makeover
• The 26-bedded ward, which is now under the
care of Acute Frailty, provides a clinically
suitable and comfortable environment for
patients to receive acute inpatient care and
treatment
• More recently, our newly refurbished Harvey
Ward opened after a £1.74 refit, providing 25
beds for trauma and orthopaedic patients.
22. Providing care closer to home
• We were pleased to open our
new Sheppey Frailty Unit
at Sheppey Community Hospital
in Minster in January
• The unit allows us to provide care
closer to home for frail patients
in Sheppey and Sittingbourne,
while also increasing capacity at
the Trust to treat more elective
patients.
23. Helping children prepare for surgery
• Dr Samantha Black had the
brilliant idea of creating an
online Beano comic strip to help
children who need to have an
operation understand what it’s
like to have a general
anaesthetic and help reduce
their anxiety about surgery.
24. Namaste Care Service
• Medway has become the first
acute Trust in the UK to
introduce a Namaste care
service in a hospital setting
• Namaste care, which means
‘honouring the spirit within’, is
an alternative holistic treatment
for patients living with advanced
dementia or who are actively
dying.
25. Trust receives Veteran Aware accreditation
• In March the Trust was
successfully accredited as a
Veteran Aware Trust
• The accreditation recognises our
hard work in demonstrating the
Trust's commitment to the Armed
Forces Covenant
• This accreditation recognises the
Trust as an exemplar of the best
standards of care for the armed
forces community.
26. Awards success
• Deteriorating patient project team
• Communications and Engagement and
EPR Project Team
• Eloise Brett – Learning Disability Nurse
27. Challenges
• We know there is still much more to do to
consistently provide the level of care that our
community deserves, but improvements in
performance in a number of areas are making a
real difference
• We require a continued focus on discharge to help
improve flow and alleviate the pressures placed on
our very busy Emergency Department
• We also need to continue to improve waiting times
for treatment – this is especially challenging within
the context of ongoing industrial action.
28. Thank you!
• Thanks to the commitment and hard work
of our brilliant staff, we have had a
successful year and I would like to thank
them from the all that they have done for
our community
• Thank you to all those providing invaluable
support for the Trust, including our
wonderful volunteers, The Medway
League of Friends, Oliver Fisher Trust and
the Medway Hospital Charity
• Thank you to our community for their
ongoing support.
31. Quality Account
Purpose of the Quality Account
A key mechanism to enhance the Trust’s accountability to the public and its
commissioners, providing demonstrable evidence of measures taken in improving the
quality of the Trust’s services, and what further improvement is required. Quality accounts
are therefore both retrospective and forward looking.
• The purpose of the Trust’s Quality Account is to;
• promote quality improvement across the NHS
• increase public accountability
• allow the Trust to review the quality of care provided through its services
• demonstrate what improvements are planned
• respond and involve external stakeholders to gain their feedback including patients and the
public
• Account published 30 June 2023
32. Quality Priorities 2022/23
Progress against the Quality Priorities 2022/23
Safe: Reducing harm and creating a culture of safety
Action: Description: Achievement:
1 95% of incidents reported are no and low harm
• Across the year the Trust achieved 99.0% of incidents being reported as no and low harm, an improvement from the previous year where
we achieved 98.5%.
• The Trust has worked to revise its internal incident reporting system which has enabled improved functionality and better capturing of the
details surrounding incidents
• Implementing a patient safety team daily review, whereby every incident reported is checked for quality and accuracy and
immediately escalated where appropriate. This ensures better consistency of reporting, and enables a shorter time between the
incident being reported and learning and improvement being captured and implemented.
• Creating an open and transparent culture of incident reporting for the benefit of learning and improvement by improving feedback
processes following an incident being reported, to improve the sharing of learning and provide greater reassurance to those
involved that the incident is sufficiently reviewed and improvements are made as a result.
33. Quality Priorities 2022/23
Progress against the Quality Priorities 2022/23
Safe: Reducing harm and creating a culture of safety
Action: Description: Achievement:
2 50% reduction of cardiac arrest calls (2222)
• The total number of avoidable 2222 calls reported this year was 83, an increase from 42 the previous year. For the first half of the year (April-September) the
average monthly avoidable call rate was 7.3 compared to the second half (October-March) (when interventions were in place) where the average monthly
avoidable rate was 6.5, suggesting the improvement measures are beginning to have a positive effect.
• Collaborative A3 meetings between our resuscitation, outreach, emergency, and acute medical multidisciplinary teams, a root cause analysis identified our
primary causes a failure to recognise, failure to escalate, and gaps in clinical planning.
• We established weekly huddles attended by clinicians and executives to review performance and drive continuous improvement, supported by more detailed A3
meetings with wider groups of frontline teams.
• Using a Quality Improvement methodology we process mapped and undertook an audit of the responses to high national early warning scores (NEWS),
undertook a qualitative thematic analysis of incident reports, and performed a root cause analysis to triangulate causes of avoidable 2222 calls.
• To eliminate some human factors delays in escalation, we modified our existing EPR system to display a tracking board of patients with a high NEWS score so
that our outreach team could directly monitor this, and then could “trigger” and treat unwell patients early.
• With 15% of ambulance handover delays taking over 30mins we introduced the acute medical model which prioritises ambulance handovers, enables rapid
transfer of acute medical patients from the ED to wards, and promotes early consultant reviews.
• We launched an initiative called “Call 4 Concern,” which encourages patients and relatives to activate an outreach review when they feel a patient’s clinical
condition has declined or is declining. This service has already shown success in escalating deteriorating patients early when used in other trusts as it
recognises service users as assets (a core principle of co-production), and utilises their knowledge, skills, and time to help identify deteriorating patients.
• We have also developed a safety culture of continuous improvement by introducing annual NEWS training and ward based, twice daily safety huddles,
discussing high NEWS patients and their escalation status. This has resulted in frontline, staff led changes, including ward safety huddles, electronic track and
trigger of high NEWS, patient co-produced “Call 4 Concern”, and an acute medical model reducing delayed ambulance handovers from 15% to 4%.
34. Quality Priorities 2022/23
Progress against the Quality Priorities 2022/23
Effective: Evidence based and best practice
Action: Description: Achievement:
3 Reduction in the number of patients waiting longer than 40 weeks on the
RTT pathway
• The total number of patients waiting over 40 weeks from referral to treatment in 2022/23 was 2,726; an increase from 1,663 in the
previous year.
• The Trust executive has made the reduction in patients waiting over 40 weeks a key business objective as part of the Patient First
programme. This has included weekly performance meetings with the divisional leadership teams and the chief operating officer with the
support of the Trust’s transformation team.
• As a result there have been significant improvements in waiting times for first outpatient appointments in most specialities.
• Although many specialities have seen a reduction in both first appointment and treatment waiting times, the total number of patients
waiting over 40 weeks has unfortunately increased. This is largely a result of capacity versus demand on the services (ENT, and
Rheumatology) and diagnostic capacity in Endoscopy (Gastroenterology, Colorectal/General Surgery).
• Improvement plans are underway to address the individual challenges in these services in 2023/24 and weekly performance meetings
will continue with support from the Trust’s transformation team
35. Quality Priorities 2022/23
Progress against the Quality Priorities 2022/23
Effective: Evidence based and best practice
Action: Description: Achievement:
4 Increase in the number of patients treated within four hours within the
emergency care department
• The average compliance with the Emergency Care four hour performance in 2022/23 was 66.9%, a reduction against the 75.5%
achieved the previous year.
• This is largely due to the challenged performance in the first six months of the year.
• Four hour performance stabilised in January and then achieved consistent incremental improvements thereafter. There has been
significant work undertaken to achieve this improvement and ensure it is both sustainable and incremental.
• We have achieved de-escalation of our PAHU attendance unit, our Discharge Lounge, and our Frailty Assessment unit as escalation
wards, in addition to redesigning and relaunching our CDU pathway. All of this enables improved flow throughout the department,
ensuring patients are seen in the right place, by the right person, first time.
• April 2023 saw the highest average four hour performance total for more than 12 months at 76% and May performance indicates even
further improvement at over 78% putting us regularly in the top 5 performers in the region.
• Further improvement work will continue over 2023 and include the redesign of our mental health pathways, a deep-dive focus on full
utilisation of our streaming pathways, and a renewed focus on our Type 3 pathways
36. Quality Priorities 2022/23
Progress against the Quality Priorities 2022/23
Patient Experience: Best experiences of care for our patients, families and carers
Action: Description: Achievement:
5 95% FFT- Patient experience recommend rate
• The average FFT recommend rate in 2022/23 was 82.7%, which was a reduction from the 84.2% achieved the previous year, however
there has been an increase in the recommend rate to 86.5% in the last five months of the year (November-March).
• The way in which data was collated and utilised changed in October 2022 with the implementation of a new system that allows easier
processing of issues, themes and trends from patients and creation of improvement action plans in clinical areas.
• In order to further improve the response and recommend rate the Trust has implemented a new software system called ‘Gather’ to better
capture and analyse patient feedback. This has allowed the clinical teams to hear the patient voice and dig deeper into the issues that
may concern them whilst in our care. Each area then focuses upon quality improvement projects to address the issues that have been
reflected by patients in their feedback.
• Other areas of improvement the organisation is working on are ensuring consistent information sharing with patients who are waiting
longer than expected in assessment areas and reducing noise at night for patients in open ward areas, again based on feedback
received from patients who were disturbed by lighting and other noise during their stay.
• Up until now, this way of collecting and focussing on the detail of feedback was not available, consequently we were not able to fully
achieve our target recommend rate. There will be further projects to improve areas of care based on patient feedback in real time over
the coming year.
37. Quality Priorities 2022/23
Progress against the Quality Priorities 2022/23
Patient Experience: Best experiences of care for our patients, families and carers
Action: Description: Achievement:
6 5% of patients surveyed say that they were treated with privacy, dignity,
respect and compassion
• Unfortunately the data collated from the friends and family test feedback in 2022/23 has been captured in a different way meaning that a
direct comparison with previous years cannot be made. However, the data shows that between September and March 2022/23 over 95%
of patients said they were treated with privacy, dignity, respect and compassion.
• Over the next 12 months, the organisation is committed to improving patient experience of privacy and dignity whilst under our care with
a number of focussed improvement projects.
• Promoting independence and mobility for frail and elderly patients by rolling out the end PJ paralysis project being one of them. This
initiative aims to ensure patients are out of bed, dressed in their own clothes and moving every day. A pilot has commenced in our frailty
wards with plans to roll this out to other areas of the Hospital over the coming 12 months.
• The Trust has also recently employed a Namaste Practitioner; as the first in the country, this initiative provides patient centred, holistic
care to patients at the end of life and who are living with Dementia. Early indicators suggest not only a large demand for this service but
also that it is having a positive outcome for patients.
38. Quality Priorities 2023/24
What we aim to achieve over the coming year
Domain No. Description How we will measure success
Safe: Reducing harm and
creating a culture of
safety
1 To reduce the number of avoidable 2222 cardiac arrest calls to
no more than 12/year (>1 / month) and the reduce the number
of peri-arrest calls by 30% from 50 calls (22/23) to 35 calls (>3 /
month) by April 2024
Avoidable 2222 call reduction:
Cardiac arrests: >1/month
Peri-arrests: >3 month
2 Improve patient outcomes through having lowest possible
quartile mortality rate
An improvement in the depth of coding
audits. Return to expected ranges for
SHMI and HSMR.
Effective: Evidence
based and best practice
3 All patient referral to treatment (RTT) pathways to be
completed within 65 weeks
0 patients waiting >65 weeks
4 Work with ePR and PAS to review and redesign clinical
systems, to enable a patient to be taken off the clock correctly.
Improved performance against
previous year
Patient Experience:
Best experiences of care
for our patients, families
and carers
5 FFT- Percentage of Patients who would recommend 95% FFT- Patient experience
recommend rate.
95% of patients surveyed say that
they were treated with privacy, dignity,
respect and compassion
39. Quality Priorities 2023/24
National & Local Priorities
Priority Description
Patient Safety Incident
Response Framework
(PSIRF)
In addition to the Trust’s 2023/24 quality priorities Medway FT is committed to fully implementing the NHS’s
approach to developing and maintaining effective systems and processes for responding to patient safety incidents
for the purpose of learning and improving patient safety known as PSIRF. This is a fundamental shift in how the
organisation will respond to patient safety incidents for learning and improvement and will require Trustwide
commitment.
Learning from Patient
Safety Events (LFPSE)
n accordance with the requirements of the NHS’s patient safety strategy Medway FT will also transition to the new
national NHS service for the recording and analysis of patient safety events that occur in healthcare - known as
LFPSE. The switch to recording patient safety events using LFPSE will help to identify areas for improvement and
improve learning for the organisation.
Kent & Medway
Integrated Care Board
Priorities
Through attendance at the Kent & Medway ICB System Quality Group the Trust has participated in the
development of the ICB 3 year priorities;
• Reduce the risk of avoidable deterioration of physical and mental health in people in K&M receiving care in their
home, community or hospital setting
• Frontline staff and carers in all settings have the skill and confidence in using professional curiosity in all aspects
of their work, to keep people safe and their needs met in full
• We support children and young people up to the age of 25 to recognise and address their physical and mental
health and well-being needs
To which the Trust is committed to supporting.
41. Quality Strategy
Core Principles of the Strategy;
• Alignment to;
• Clinical Strategy
• Patient Experience Strategy
• Patient First True North Objectives
• Integrated Care Board (ICB) and Health and Care Partnership (HaCP) quality objectives
• Quality Account Priorities
• Acknowledge the need to ‘get the basics right’
• Engage staff, patients, the public and healthcare partners in agreeing our
priorities
• Moving to Good and Beyond
• Development of a detailed delivery plan
42. Quality Strategy
Delivery Plan;
Year 1
• Back to basics
• Recover from
CV19 backlogs
• Improve systems &
processes
• Improved
performance &
regulatory
compliance
Year 2
• Moving to Good
• Sustained Quality
Performance &
Improvement
Year 3
• Preparing to
move beyond
• Developing
innovation and
leading the way
43. Aim
Breakthrough
Objective
Key Initiatives Measurement of success
Safe
Reduce harm and
create a culture of
safety
Excellent outcomes,
ensuring no patient
comes to harm and
no patients dies who
should not have
Recognising, escalating and
acting on deteriorating
patients
Reduce the number of avoidable 2222 cardiac arrest
calls to no more than 12/year (>1 / month) and the
reduce the number of peri-arrest calls by 30% from
50 calls (22/23) to 35 calls (>3 / month) by April
2024
Reducing unwitnessed falls
Reducing hospital acquired /
deteriorating pressure
damage
Timely review, escalation
and action on diagnostic
tests
National Requirement: To Implement the Patient Safety
Incident Response Framework (PSIRF) and Learning from
Patient Safety Events (LfPSE)
10% reduction in the total number of
unwitnessed in–patient falls per financial year.
Reduce the total number of hospital acquired
category 2 and above pressure damage by 10%
each financial year
Reduce the total number of incidents where
failure to follow up on a diagnostic tests has led
to an adverse outcome for a patient or where a
misdiagnosis has been made
PSIRF and LFPSE launched in line with
national deadlines
44. Aim
Break Through
Objective
Key Initiatives Measurement of success
Patient
Experience
To provide the
best experiences
of care for our
patients, families
and carers and
respond
appropriately
when we get this
wrong
Providing
outstanding,
compassionate care
for our patients and
their families every
time
Reduce the number of open
and breached complaints
No more than 80 complaints open at any one time.
Year on year reduction in the number of breached complaints,
achieving the Trust 95% target in 2024/25
Reduce the number of
complaints received
Reduce complaints related to
staff attitude
Improve the management of
dying patients and of the
bereaved
Year on year reduction in the number of complaints received
between 23/24 – 26/27
60% reduction in the number of complaints received that
reference staff attitude by 2026/27
Year on year improvement in the National Audit of Care at the
End of Life (NACEL) summary scores between 2024 - 2027
45. Aim
Break Through
Objective
Key Initiatives Measurement of success
Clinical
Effectiveness
and Outcomes
To provide
evidence based
and best practice
care
Excellent outcomes,
ensuring no patient
comes to harm and
no patients dies who
should not have
Reduce the backlog of
outstanding NICE Guidance
Year on year improvement in the percentage of NICE guidance
that is reviewed within 90 days
Improve the implementation
of National Audit
Recommendations
Improve the management of
local audits and the
associated learning
Improve Prison Health Care
Provision
National Requirement: GIRFT
95% of all applicable NCA report recommendations have an
associated improvement action by 2026/27
90% of local clinical audits are aligned to a MFT priority
Develop plans for the improvement of prisoner health and
access to acute and secondary care with a view to reducing
admissions from prisions
95% of all GIRFT programme national specialty report
recommendations actioned
46. Aim
Break Through
Objective
Key Initiatives Measurement of success
Continuous
Quality
Improvement
To develop,
implement and
monitor quality
improvement
plans
Excellent outcomes,
ensuring no patient
comes to harm and
no patients dies who
should not have
Implement a systems
learning approach
Staff to be trained in SEIPS (Systems Engineering Initiative for
Patient) methodology and PSIRF (Patient Safety Incident
Response Framework) to be embedded.
Collaborative working across
the HCP
Improving data quality
Review and implement
improved Quality IT Systems
and Solutions
Embed the HCP Governance arrangements and explore options
for integration such as the appointment of joint Patient Safety
Partners, and Patient Safety Investigations
Reliable and easy access to clinical data at Trust, division, care
group and ward level via Business Intelligence sources
Introduction of a new integrated quality management system by
2024/25
National TOMs (Themes, Outcomes & Measures)
framework to evaluate social value (the added value
organisations bring to the economy, community life, the
health of the local population and the environment)
Develop plans for long term initiatives within the Integrated
Governance, Quality and Patient Safety sphere which generate
social value
48. 2022/23 key points
While at the start of the year all elective work was due to be paid on a ‘volume x tariff’ basis, during the year this
transitioned back to a fixed block sum, from which the Trust benefitted.
Despite submitting a breakeven plan, ie no surplus or deficit, the Trust finished the year with a £6million deficit.
Positives
• Continued significant capital investment in hospital infrastructure and services
• Strong cash position
• Head of internal audit opinion: “Significant assurance with minor improvements”
• External audit accounts opinion: “Unqualified”
Areas for improvement
• Pay continues to grow at rates over and above the pay award settlement values. This is particularly prevalent
in medical pay
• Delivery against our efficiency programme
• External audit value for money opinion: “Significant weakness” in respect of the “planned deficit of £15million
for 2023/24 which is predicated on delivery of £27million of savings which have not yet been identified”.
49. Statement of comprehensive income
for the year ended 31 March 2023
Key points
• Deficit of £6.2m (2021/22: surplus of £0.05m)
• Staff costs (within operating expenses) increased by c£26m,
reflecting the pay award (£13.6m), service developments - such
as Sheppey Frailty Unit, Community Diagnostic Centres and
Virtual Wards - and increased activity year-on-year
• Notable growth in other operating costs came from drugs
(£4.5m) and premises/energy costs (£2.1m), mainly as a result
of activity and inflation. Depreciation also increased notably (by
£3.7m) arising from significant capital investment in recent
years.
• The Trust benefitted from the receipt of support funding from
NHSE and the ICB during the year. This was in recognition of
the operational pressures faced in non-elective care which also
had a knock-on impact on elective activity.
2022/23 2021/22
£000 £000
Operating income from patient care activities 397,443 370,315
Other operating income 34,801 30,160
Operating expenses (431,098) (393,469)
Operating surplus from continuing operations 1,146 7,006
Finance income 844 44
Finance expenses (26) (21)
PDC dividends payable (8,168) (6,976)
Net finance costs (7,350) (6,953)
Surplus/(Deficit) for the year (6,204) 53
50. Balance sheet for the year ended 31
March 2023
Key Points:
• £26m of asset investment and an upwards revaluation of c£21m has
increased the value of property, plant and equipment, with a reduction of
c£15m due to depreciation
• Cash balance maintained, although there has been growth in both
receivables and payables
• Trade and other payables have increased due to high levels of capital
payables and accruals (arising from the timing of the capital expenditure),
social security and taxes being paid before the year end in 2022 and due
to the pay award settlement accrual at the 2023 year end.
31 March
2023
31 March
2022
£000 £000
Non-current assets
Property, plant and equipment 271,810 239,695
Right of use assets 928 0
Receivables 780 600
Total non-current assets 273,518 240,295
Current assets
Inventories 6,374 5,996
Receivables 29,086 13,889
Cash and cash equivalents 34,742 33,455
Total current assets 70,202 53,340
Current liabilities
Trade and other payables (50,285) (28,147)
Borrowings (953) (136)
Provisions (519) (763)
Other liabilities (800) (1,353)
Total current liabilities (52,557) (30,399)
Total assets less current liabilities 291,163 263,236
Non-current liabilities
Borrowings (1,950) (2,025)
Provisions (1,031) (1,248)
Total non-current liabilities (2,981) (3,273)
Total assets employed 288,182 259,963
Financed by
Public dividend capital 475,198 461,656
Revaluation reserve 64,406 43,525
Income and expenditure reserve (251,422) (245,218)
Total taxpayers' equity 288,182 259,963
51. Key Points:
• The CRL – Capital Resource Limit – for 2022/23 was
£26.9m (2020/21: £22.8m)
• Capital spend against this was £25.9m (2020/21: £22.8m)
• The £1m slippage related to the externally managed CDC
works
• £11.0m of schemes were funded from Trust resources, with
a further £14.9m funded by Public Dividend Capital
Key projects:
• Electronic Patient Records - £3.4m
• Endoscopy equipment - £2.2m
• Replacement MRI - £3.0m
• Gamma camera - £1.0m
• Community Diagnostic Centres - £3.1m
• Teletracking: digital bed management - £1.0m
Capital Expenditure 2022/23
Programme £000
Backlog maintenance 1,376
Routine maintenance 375
Fire safety 2,505
IT 6,222
New build 2,774
Plant, machinery, equipment, fittings, etc. 9,948
Other 2,729
Total 25,929
52. Unqualified Audit Statements
• The Trust Independent Auditor 's judgment is that the Trusts financial statements are fairly and
appropriately presented, without any identified exceptions.
Value for money
• In addition to their opinion on the financial accounts, the external auditors also provide an
opinion on whether the Trust has processes in place and has delivered value for money.
• Whilst there were no concerns over the overall efficiency of the Trust, the auditors did express
concerns over the planned deficit for 2023/24 and the scale of the efficiency programme
(£27million) required to deliver that deficit.
• Consequently, the opinion was: “Significant weakness identified”.
Audit Outcomes 2022/23
53. Forward View 2023/24
Current Performance
• Systems receive a funding allocation; from that allocation the providers are given a block income contract
for non-elective activity and a ‘volume x tariff’ contract for elective work.
• Additional income can be earned through the Elective Services Recovery Fund – early indications are that
nationally this is proving difficult, although adjustments are being made in light of industrial action.
• £27.0million efficiency programme – several “cross-cutting schemes”, ie large, complex projects impacting
multiple services; executive-led support teams wrapped around these.
• 2023/24 financial performance at month 4 is £5.0million adverse to plan; pressures and emerging risks
include medical pay, nursing pay and efficiencies delivery.
Long Term Financial Sustainability
• The Trust produced and agreed a Financial Recovery Plan in August 2022, which was also approved by
the Integrated Care Board and NHS England
• This is undergoing a refresh and has strengthened its links to Patient First.
55. Avoidable cardiac arrest
calls and creating a learning
culture with Patient First
Aranghan Lingham, Darzi Fellow, ST7 Orthopaedic Registrar
Vimbai Bayonne, Medway Patient with Lived Experience,
Diabetic Specialist Nurse
Representing the avoidable 2222 team at Medway
56.
57. Three principles based on
Patient First
•Measure what matters
•Listen to learn
•Iterate to improve
