Our Annual Report is presents an opportunity to reflect on the year that has passed and the challenges faced, and developments and improvements we have made at University Hospitals Plymouth NHS Trust.
The full report can be read in pdf format, we are proud to present a summary version below:
The year has been a challenging one for the NHS generally and for Devon and Plymouth in particular, as demand for our services continues to grow and we focus on recovering full capacity following the pandemic. It will take time to sustainably improve but we are on a journey of improvement which we are executing as rapidly as possible.
The challenges of the wider system which are so apparent in our Emergency Department are quite rightly the focus of the Trust’s leadership and our stakeholders but should not overshadow the amazing achievements of colleagues in so many parts of our Trust. It is incumbent on all of us to celebrate these successes as well as focus on those parts of our service which require ongoing improvement.
The improvements are set out in more detail within the full report but just to highlight a few:
These are the numbers but, as Chairman, I am privileged also to receive so much positive feedback from members of our communities about the kind and compassionate care they have received from our wonderful staff; no surprise therefore that our Trust is rated outstanding by the CQC for being caring and I have great pride in being Chairman.
I am delighted with the achievements over the last 12 months in terms of recruitment and retention of staff and supporting colleagues to return from sickness. There is still much work to be done, however, not only in these areas but also in supporting staff to work to the top of their capability and to ensure
they feel as valued as they truly are.
There have been a number of changes to your Board. I would like to thank Jacky Hayden, Liz Kay and Helen Teague who stepped down as Non-Executive Directors during the year having made significant contributions to the Trust. Most of all, however, I would like to thank Ann James who stepped down as Chief Executive of the Trust at the end of the year. Ann led significant improvement in the Trust during a period of significant challenge as an exemplary values-driven leader. Her dedication to public service and the communities we serve is humbling. We welcome Mark Hackett who has joined us since the end of the year as Interim CEO and for the leadership he is providing.
Finally, on behalf of the Board a huge ‘thank you’ to all our colleagues and colleagues at Livewell Southwest and our other partners for your incredible contribution to the health and wellbeing of the populations we serve.
James Brent
Chairman
Our Trust is continuing to respond to the demands of a post-COVID environment and we have made many improvements in a short space of time for patients and their families.
Our staff have responded to the needs of the local population, delivering more than half a million episodes of care in the past 12 months, across a range of settings: outpatient, inpatient and working in partnership with our community services partner, Livewell Southwest, in the community.
There remains much more to do in the future years to improve the quality
and effectiveness of services, particularly around our emergency care which needs widespread investment, change and focus to achieve high quality care consistently and reliably.
Our investment in new facilities is impressive with circa £80m invested in 2023/24.
We have made real progress in areas such as cancer treatment, stroke care and care for patients awaiting planned operations. But we know that in an emergency, patients have faced waits which have been too long, in ambulances, in our Emergency Departments and in our assessment areas – waiting to get to the right place for their care. This isn’t acceptable and we are determined, working with our partners, to change that.
We are now focused, via a single plan, on improving the quality of service we provide to patients who come to us needing urgent and emergency care. The plan is built around three pillars which you can read more about on page 11, or in the full annual report.
Delivering this plan will improve the safety of care patients receive, their experience and outcomes, as well as the experience of staff and our ‘orange army’ of volunteers. It will enable us to become a high quality organisation which our patients, funders, public and taxpayers deserve.
The Trust continues to work with Devon Integrated Care System to develop a medium term financial recovery plan to restore financial sustainability. The Trust will also continue to develop and implement its Clinical Strategy to improve services for patients by reducing delays leading to higher cost treatments and ensure increased use of community services to provide treatment close to home avoiding acute hospital admissions at more efficient cost.
I will finish by formally thanking our staff and volunteers for all that they do. As this report outlines, they make a huge difference to people’s lives through their skill, commitment and compassion.
Mark Hackett
Chief Executive
Together with our partners we will develop nationally leading integrated health and care, unlocking better outcomes and reducing inequalities, and develop UHP as a regional specialist centre to improve lives across Plymouth, Devon and Cornwall.
UHP has a unique role, one of few trusts in the country to fulfil four distinct roles in the health and care system, spanning community and social care, mental health, acute and through to specialist and tertiary services
At University Hospitals Plymouth NHS Trust we are responsible for providing care across the widest of spectrums: from within people’s homes and, working with our voluntary sector partners, in local communities to offer the most specialist hospital care available in our regional centre.
The south west peninsula geography gives our Trust a secondary care catchment population of 475,000 with a wider peninsula population of almost 2,000,000 people who can access our specialist services.
The population is characterised by its diversity – the rural and the urban, the wealthy and pockets of deprivation, and wide variance in health and life expectancy.
We provide services for patients at the following main sites as well as through clinics at other local hospitals and care centres:
Supporting digital citizenship and inclusion
As part of the The Plymouth Health and Care Digital Citizen Working Group, from our rolling replacement program, 265 laptops were donated to 4 local charities supporting digital citicenship in the local population.
Grand Opening
The new REI (Royal Eye Infirmary) celebrated a grand opening on 18 October 2023. People with eye conditions in Devon, Cornwall
and the surrounding areas can now access the brand-new state-of-the-art facility.
Expanding Same Day Emergency Care
Building on the success of the Same Day Emergency Care (SDEC) service, which treats and discharges around 40-45 patients needing emergency care every day, University Hospitals Plymouth NHS Trust is expanding the service. This will allow space for an additional 75 people to be treated each week and improve ‘flow’ throughout the hospital.
National spotlight on our stroke care service
We were delighted to welcome Professor Sir Stephen Powis, NHS England National Medical Director, Dr David Hargroves (National Clinical Director for Stroke Medicine), Dr Nigel Acheson (Devon ICB Medical Director), Dr Michael Marsh and members of the South West Regional Medical Directorate to visit in February to look at the Stroke Care we provide for the people of Plymouth and the peninsula in the first of a number of national visits.
Teledermatology service for patients with suspected skin cancer
With skin cancer on the rise in the south west, our skin cancer team saw a huge increase in referrals for suspected skin cancer. In August 2023 a new service was launched, with Healthcare Assistants (HCAs) trained to use special magnifying cameras to take images of suspected skin cancers, alongside a new patient questionnaire being sent to patients ahead of their appointment to capture the necessary information from each patient. These images are then reviewed separately by a consultant, and then a diagnosis and treatment plan can be drawn up for the patient if required.
Virtual wards – helping patients receive care in their own home
Since the launch of virtual wards in December 2022, hundreds of patients have been cared for by the team and benefit from consultant-led care delivered in the comfort of their own home. On a virtual ward, patients are provided with digitally enabled smart devices to monitor heart rate, blood pressure and temperature. They receive daily calls and are given a tablet device and Wi-Fi router which sends their vital statistics back to the clinical team looking after them.
UHP uses world’s smallest artificial heart pump to provide life-saving treatment
A patient has received life-saving care thanks to a revolutionary treatment used by the Cardiology team at University Hospitals Plymouth NHS Trust (UHP).
Read more of our highlights in the full annual report.
Looking to the future
The above is by no means an exhaustive list of the building developments currently taking place and planned as part of the Trust’s vision for our future hospital. View our key projects
We published our Clinical Strategy in early 2024, which covers our ten year ambition for the organisation. This has been clinically led, developed and co-designed working closely, in collaboration with our clinical teams across all our individual clinical specialties.
NHS Clinical Activity 2023 - 2024
Elective Spells: 68,402
Emergency Spells: 64,425
Outpatient Attendances: 577,422
Emergency Department Attendances: 103,028
REI Emergency Department Attendances: 2,305
Minor Injury Unit Attendances: 48,731
Babies Delivered: 3,525
NHS Clinical Activity 2022 - 2023
Elective Spells 66,033
Emergency Spells 54,281
Outpatient Attendances 546,980
Emergency Department Attendances 93,018
REI Emergency Department Attendances 2,200
Minor Injury Unit Attendances 48,003
Babies Delivered 3,646
There is considerable work to do to meet the needs of patients requiring emergency care, as we have been the worst hospital in the country for ambulance handover delays. We are working on a single improvement plan which we will improve the quality of care, patient
experience and outcomes, as well as the experience of our staff. This Improvement is built around three pillars:
Our Patient Council provides the ‘patient voice’ for all aspects of the Trust’s operations and planned developments.
Members have been involved with: the revised Patient Experience Committee; the Charity Operational Group; the Quality Assurance Group; the promotion of the carers support notably though membership of the Cornwall and Plymouth Carers Partnership Boards; the Derriford User Group for people with learning disabilities; the Future Hospital Projects Steering Group; reviewing tenders for a new electronic patient record system; the Sustainability sub-committee; the Sustainable Environment Group; attendance at staff network meetings, notably DAWN, Faith & Belief and LGBT+; taking part in PLACE assessments; the Garden of Life Project; and representing the patient perspective on interview panels for new members of staff.
In addition, many of the Patient Council are also general volunteers providing support in the Emergency Department, the League of Friends, for ‘meet-and-greet’, PALS and in the discharge lounge. This year also saw the appointment of Dr Rebecca Baines as the new Patient Experience & Engagement Manager which, moving forward, will facilitate a more co-ordinated approach to the involvement of Patient Council members in Trust activities.
Professor James S Griffiths, Chair, Patient Council
Over the last 12 months following the enactment of the Health & Care Act 2022, there have been further changes to the way that NHS and Local Authority services are commissioned and delivered.
The ‘One Devon’ ICS continues to operate in a challenging environment as it sets the framework for the integration of services that supports the local population be it primary care (GP’s, dentists, pharmacies and opticians), hospitals, mental health, community or social care services.
As services continue to become more integrated, it remains equally as important to listen to patient feedback to ensure that patient journeys and treatment are positive and meet expectations of patients. Healthwatch have been able to support UHP by sharing patient feedback identifying what is working well or not so well.
Healthwatch Plymouth looks forward to continuing to be a ‘critical friend’ to the Trust, ensuring that the patient voice remains at the centre of processes that look to further develop and integrate services for the future.
Tony Gravett MBE
Manager Healthwatch Plymouth
We are so grateful for the support and hours our volunteers continue to dedicate to us at UHP.
Following another successful year of volunteering, we have seen our services strengthen and grow, with more volunteering roles being developed to help support and improve our patients’ experiences.
Our volunteers kindly dedicated 27,330 hours of their time to their roles
Our longest volunteer has actively been volunteering with us for over 46 years!
We are proud that in May 2023 we were awarded the Bronze Standard for deaf awareness through the National Deaf Children’s Society. We now have 46 deaf awareness trained volunteers who will act as buddies to support the volunteering opportunities we are working to introduce for our deaf community.
Some of our volunteers year in numbers:
Patient experience has been described as the cornerstone of healthcare, recognising its vital importance in shaping the delivery, effectiveness and outcomes of healthcare services. By viewing patient experience in this way, we aim to co-create environments where patients and carers feel valued, empowered, and supported throughout their healthcare journey.
Listening, learning and responding to patient and carer experiences is paramount in enhancing our services. We will continue to prioritise active listening and meaningful engagement throughout every step of the care journey and beyond, recognising there is always more that we could be doing. We firmly believe there is no better way to enhance our services than by attuning ourselves to the thoughts, emotions, and experiences of the individuals and communities we serve.
We are committed to enhancing our transparency, accountability, celebrations, necessary actions and improvements following the analysis of patient and carer experience. Our Patient Experience Committee, serves as a vital conduit for identifying emerging themes and issues derived from patient feedback. Patient and carer experiences including themes identified in PALS and complaints are also
shared on a weekly basis in our Patient Safety Incident Response Group (PSIRG), also attended by our fantastic volunteer patient safety partner. Moreover, we provide a diverse array of avenues for patients, carers, and families to share their experiences and narratives, ensuring that the feedback shared is not only valued, but also acted upon.
The various channels we currently collect feedback from includes:
Compliments
We received 46 formally recorded compliments. Following staff feedback, we have also recently introduced a new compliments inbox – plh-tr.compliments@nhs.net to better capture and record compliments and thanks received at UHP.
Complaints
We received 456 complaints from patients and relatives between April 2023 and March 2024. This represents an 18.75% increase from the previous twelve-month period. One complaint was formally re-opened following the receipt of a response letter and subsequently closed following further investigation.
Katrina Wright was the first ever patient to use #MeetTheMatron “I am so pleased my comments were listened to. I think it is so important that we all do what we can to help and improve the patient journey. Sometimes good outcomes can be achieved from giving patients the opportunity to feedback on their experience.”
Staff numbers by staff group (as at 31 March 2024)
Nursing and Midwifery Registered - 2677
Administrative and Clerical - 2095
Additional Clinical Services - 1921
Medical and Dental - 1388
Estates and Ancillary - 761
Allied Health Professionals - 559
Add. Professional, Scientific and Technical - 319
Healthcare Scientists - 283
New recruits by staff group (as at 31 March 2024)
Nursing and Midwifery Registered - 486
Administrative and Clerical - 339
Additional Clinical Services - 519
Medical and Dental - 425
Estates and Ancillary - 192
Allied Health Professionals - 119
Add. Professional, Scientific and Technical - 55
Healthcare Scientists - 19
Our aim is simple: to value our people by creating the best place to work.
In the last 12 months we have:
We have improved Staff Survey results, seeing a significant improvement on all People Promise domains in the staff survey in 2023.
In particular, 57.8% of colleagues would recommend UHP as a place of work. This is up from 2022.
Nationally, this score is 60.52%.
Of our staff, 59.92% would be happy with the standard of care provided to a friend or loved one. This is up from 2022. Nationally, this score is 63.32%.
The Trust’s financial position, along with other NHS Acute Trust’s, remains challenged.
The Trust continues to attempt to balance the costs of minimising patient risks from increased urgent care demand and increased elective waiting lists following the pandemic with a sustainable financial position. There has also been pressure from industrial action and cost inflation during the year. The combination of these pressure has meant that the Trust remains in a financial deficit position.
During 2023-24 the Trust has continued to receive block payments from commissioners, introduced at the start of the pandemic, adjusted for inflation and efficiency and including a ‘Top-Up’ to cover historical deficits and covid costs. However, there were reductions in this funding in 2023-24 compared to 2022-23 to converge this funding towards historical level, and also a reduction in income for the annual tariff efficiency requirement. There were also pressures from non-recurrent actions and funding that supported the financial position in 2022-23 not being available in 2023-24. Additional pressures included inflation costs above allocated funding and the full year impact of cost increases from 2022-23. Although there has been additional Elective Recovery Funding (ERF) and Urgent Care Discharge & Capacity (D&C) funds made available to support recovery of elective activity and ease operational pressures on non-elective and emergency attendances, the Trust required a financial improvement plan of £39.5m (4.5%) to meet its deficit plan for the year of £33.6m agreed with NHS England.
Against this planned deficit of £33.6m the Trust delivered an adjusted financial performance deficit of £32.8m. The Trust’s full reported deficit for the year was £44.4m, this included £11.5m of impairment costs and £0.1m of excess costs relating to donated assets and personal protective equipment which are adjusted out of the position to give the adjusted financial performance deficit of £32.8m.
Although the adjusted financial performance of £32.8m deficit was £0.8m favourable to plan, this was position was achieved due to additional national funding mitigating the impacts of a number of adverse variances to plan, the most significant of which include:
Although the Trust fell short of delivering the full £39.5m efficiency saving target significant cost improvements were made, with £30.9m of savings delivered in year. This was despite significant challenges from continuing industrial action and operational pressures.
