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ann

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200910 Providing high quality care for patients through your

local hospitals

The Pennine Acute HospitalsNHS Trust

2 ANNUAL REPORT 2009-10

ANNUAL REPORT 2009-10 3

Page No. Introduction 4 About the Trust 5 Local health inequalities 6 Top ten facts 7 Chairman’s Report 8 - 9 Chief Executive’s Report 10 - 11 Mission, values & corporate objectives 12 - 14 Service reconfiguration 15 Key achievements 16 - 19 High quality care for patients 20 Quality Accounts 2009/10 21 Statement on Quality on Behalf of the Board 24 Priorities for improvement 24 Review of quality performance - Safety 14 - 32 Review of quality performance - Effectiveness 33 - 36 Review of quality performance - Patient Experience 37 - 40 Service improvements 41 - 45 Participation in clinical audit 46 - 49 Research and development 50 Participation in CQUINs 51 Advice, Liaison and Complaints 52 Data quality 53 Care Quality Commission Statement 54 Conclusion to the Quality Accounts 56 - 57 Protecting personal data 58 Sustainability 59 Valuing People 60 - 63 Foundation Trust 64 Looking forward 65 Financial Report and Annual Accounts 66 - 107 Remuneration Report 108 - 109 Charitable Funds 110 Glossary 111 - 113 Trust Board 114 - 116 Contacting the Trust 118 - 119

Contents

Intr

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ion Welcome to the 2009/10 Annual Report and Financial

Accounts of The Pennine Acute Hospitals NHS Trust. This year we have focused on improving patient safety, quality of care and the patient experience through strong clinical leadership and our involvement in national initiatives such as Advancing Quality and the National Patient Safety First campaign.

This focus on quality has enabled us to make a declaration of full compliance with the Care Quality Commission (CQC) Standards and our CQC rating for 2008/09 improved to ‘Good’ for both Quality of Services and Financial Management. We have continued to reduce healthcare acquired infections, such as MRSA and Clostridium Difficile, across all your hospitals and in reducing our mortality rate.

This year we have been pleased to open the new children’s A&E department and children’s services at North Manchester General Hospital and have continued to work to progress the development of the new £32m purpose built children’s, maternity and neonatal units on the same hospital site, which opened in June 2010.

We have also begun implementing service changes as part of the Healthy Futures and Making it Better reconfiguration programmes to improve care to patients by developing centres of excellence for patients needing specialist treatment.

Providing high quality care for patients through your local hospitals

The Trust manages four main hospitals across the north east sector of Greater Manchester. These include North Manchester General Hospital, The Royal Oldham Hospital, Fairfield General Hospital in Bury and Rochdale Infirmary, along with services at Birch Hill Hospital.

As the largest NHS Trust in the North West and one of the largest in the country, we employ around 10,000 staff and provide high quality general and specialist hospital services to around 800,000 residents living across Bury, Oldham, Middleton, Rochdale, Heywood, Prestwich and North Manchester.

The Trust works with four PCTs – NHS Manchester, NHS Bury, NHS Oldham and NHS Heywood, Middleton and Rochdale - to plan, develop and commission healthcare services for local people.

We provide services to residents across the four PCTs and the corresponding local authority boundaries. Many people come for treatment from outside the PCT boundaries. We make great effort to ensure that

we fulfill our responsibility in both the delivery of health care and ensuring that we also play our part in promoting good health and avoiding illness.

Our clinical services are organised within four divisions: surgery, medicine, women and children’s, and diagnostic and clinical support which work together to provide integrated care across our five hospitals. Each division is managed by a divisional director. Specialist clinical areas within each division are overseen by one of nineteen consultants who are senior doctors appointed as clinical directors responsible for managing their own services.

A range of support services, such as human resources, education and training, IT, research and development, finance and governance, facilities, estates and catering, are all essential for your hospitals to run smoothly and effectively.

About the Trust



The local communities we serve are geographically and culturally diverse, but remain largely characterised by their industrial past. This has contributed to significant health inequalities among residents. The higher populated areas, in particular, have contributed to historically poor provision and access to healthcare.

Today, the north east of Greater Manchester, which we serve, continues to face challenging health issues. Many areas suffer high levels of deprivation. Rates of obesity, smoking, cancer and heart disease related to poor general health and poor nutrition are significantly higher than the national average, whilst life expectancy at birth in some areas is the one of the lowest in England. Perhaps more starkly, within certain communities across Greater Manchester, there is a gap in life expectancy of almost six years between the poorest and most affluent areas.

Other issues facing our communities include proportionately larger numbers of younger and older people, large and growing ethnic minority populations whose health and access to healthcare have been poor, heavy reliance on public transport and low levels of personal car ownership.

Local health inequalities


Top Ten Facts

In 2009/10 the Trust: invested £47 million

on capital programmes and in maintaining and improving the physical estate and on smaller

projects to develop front line clinical services.

spent over half a billion pounds (£544,860,000) before impairments on providing healthcare

services for local people through your hospitals – over £1.4m a day).

saw 306,602 accident and emergency cases

(up 10.5% on last year including attendance at the new Children’s A&E

at North Manchester General Hospital which opened in June 2009).

spent £10 million on medical and scientific equipment to support

front line clinical services.

saw 82,220 day cases

(up 2.4%).

delivered 10,404 babies.

laundered over 4 million

kilograms of linen (equivalent weight of 245 double-decker

buses).

saw 739,022 outpatients (up 2.9%).

saw 128,675 inpatients (up 3.7%).

provided 1.83 million meals.

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This year’s Annual Report is a combined report with the first set of Quality Accounts published by the Trust. Publication of Quality Accounts is a new requirement on NHS Trusts and for staff across this Trust is a timely opportunity to showcase how they have improved the quality of service for all of our patients.

Quality has always been at the heart of everything the 10,000 staff within the Trust set out to do. Our mission statement - “To provide the very best care for each patient on every occasion” reflects this. Throughout the year major pieces of work have ensured that patient safety is the first priority for all our staff. This is reflected in a year on year reduction in our mortality rates, achieving continued reductions in the number of hospital – acquired MRSA bacteraemia infections (by 10% last year) and hospital-acquired Clostridium Difficile infections (by 26%) to levels below the targets set and the introduction of World Health Organisation pre-surgical checklists and briefings in our theatres. Reducing patient falls and the number of hospital acquired pressure sores have been major priority areas for the Trust. The Trust Board agendas have been reorganised to make sure that patient safety is the first item to be discussed at each meeting. The Trust Board remain determined to ensure that its work is directly connected to patient care and that the link from the bedside to the Board room is well made. Further work in 2010/11 will see arrangements put in place so that examples of real patient stories and experiences, both good and bad, are brought to the Board room table. The reports into the quality of care provided by the Mid-Staffordshire NHS Foundation Trust were considered in detail by the Trust Board who reviewed the outputs of divisional work over several meetings to ensure that similar failings could not occur within Pennine.

The Annual Report and Quality Accounts list many of the achievements of Trust staff throughout the year. Following the closure of Booth Hall Children’s Hospital in June 2009 many of the services transferred successfully to North Manchester General Hospital into a new permanent children’s Accident & Emergency Department and a range of other new interim accommodation including two inpatient wards. All the staff have been looking forward with keen anticipation to the opening in June 2010 of the new £32 million women and children’s building at North Manchester General Hospital which will see the children’s inpatient wards, along with the existing maternity services at North Manchester move into new state of the art accommodation and facilities.

The innovative “Christie at Pennine” development at The Royal Oldham Hospital opened in March 2010 ensuring that patients from across the north-east of Greater Manchester can now receive radiotherapy services without the need travel to the south of the city. This development will provide the very best of Christie’s cancer care in the heart of Pennine. New inpatient wards for Pennine haematology and surgical services will open on the upper floors of the £17million building in June 2010.


The achievements of our staff were recognised during the year through a number of awards. Laura Dobson, a student nurse and former cadet at Rochdale Infirmary, won the Catherine Barrett Young Achievers’ Award. Helen Taylor, a staff nurse at North Manchester General Hospital, won a national Dignity in Care award for her exceptional care and dignity towards patients. The Intensive Care Unit at The Royal Oldham Hospital won a Pride in Oldham award organised by the Oldham Evening Chronicle. Staff on Ward 14 at Fairfield General Hospital won the national NHS Institute for Innovation “People’s Choice” award as voted by healthcare professionals across the country for their work on the productive ward programme. A new barcode labelling system for pathology tests developed by staff at The Royal Oldham Hospital won a NHS North West Regional Innovation award. Helen Hindle, Senior Midwife at The Royal Oldham Hospital won a Royal College of Midwives’ national award for her work on signs of deterioration and collapse amongst women during pregnancy and childbirth.

The Trust continues to have a strong financial position and achieved all its financial targets in 2009/10, including making a modest surplus before impairments. The quality of care which we all aspire to provide for our patients is underscored by solid financial foundations.

While achieving the vast majority of targets, the Trust recorded 96.6% against the four hour emergency access target that 98% of patients should be treated, admitted, transferred or discharged within four hours of arrival at an Accident and Emergency department. After securing support from the national Emergency Care Intensive Support Team, clinical staff and managers throughout the Trust now have a wide range of plans in place, under the slogan of “Saving Lives with Timely Care – it’s the way we do things at Pennine” to ensure that this target is achieved in 2010/11. A crucial part of this work is linking with our colleagues in Primary Care Trusts to manage demand and ensure that there are other opportunities for people to receive treatment and advice for more minor conditions in the community, thus reserving accident and emergency departments for the most seriously ill and injured people. Other work with colleagues in the community has focused on, and will continue to focus, on making sure that patients can be discharged more quickly after an admission to hospital, while receiving

any back up and support services they need either in their own home or in a nursing or residential care home.

Our application for Foundation Trust status saw the public consultation period take place over the winter of 2009/10. The overall response from the public and our staff was positive and a number of helpful comments have now been included in our proposals for both public and staff Governors to ensure that we fully reflect our local communities and staff.

During the year the Board saw some changes in its membership. John Battye retired after serving as a Non-Executive Director for seven years and prior to that as a Non-Executive Director of The Royal Oldham Hospital Trust. Edward Ahmad joined the Board in his place. I should like to record my personal thanks to John for all his work and also to welcome Edward to the Trust at this very important time in our development. Simon Payler, Director of Operations, left the Trust and was replaced by Hugh Mullen who took up post in May 2010. In the interim period Robert Chadwick, Director of Finance, became Acting Director of Operations, and Barbara Herring, Associate Director of Finance, became Acting Director of Finance.

Each and every one of our 10,000 staff, our 800 volunteers and all those throughout our communities who raise money for the Trust’s charity and support us in so many other ways contribute to our overall mission and our over-riding priority to improve patient safety and improve quality of care. None of what we set out to achieve is possible without the commitment and dedication of all of these individuals and I wish to record, on behalf of the Board, our appreciation of their valuable contribution to provide the very best care for each patient on every occasion.

John JeskyChairman

Quality has always been at the heart of everything the 10,000 staff within the Trust set out to do

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I concluded last year’s Annual Report by stating that the Trust was in a stable financial position with a clear development plan and a committed workforce. All of that remains true one year on. In last year’s Annual Report I also stated that the Trust was well placed for the challenges ahead of increasing regulation, financial uncertainty and pursuing our application to become a Foundation Trust. Trust staff have once again risen to those challenges while at the same time caring for an increasing number of patients. This year’s Annual Report demonstrates how we have done that.

This year has seen the first stages of reconfiguring services across the north east of Greater Manchester as outlined in the Healthy Futures and Making it Better programmes.

As part of the Healthy Futures programme, from November 2009 Orthopaedic trauma patients from Rochdale and Oldham have their surgery at The Royal Oldham Hospital while the vast majority of pre-planned day cases have taken place at Rochdale Infirmary. Outpatient clinics have continued at both hospitals. This change has allowed us to bring together specialist resources in each location to concentrate on providing the best possible care while also making sure that appointments and follow ups can take place locally. In January 2010 our centralised specialist cancer service for patients with suspected Ear Nose and Throat (ENT) cancer started at North Manchester General Hospital. In June 2010 a centralised clinical haematology service opened in the brand new accommodation at The Royal Oldham Hospital.

As part of the Making it Better programme the new dedicated children’s A&E, x-ray department, observation and assessment unit and inpatient wards opened in June 2009 at North Manchester General Hospital following the closure and transfer of services from Booth Hall Children’s Hospital. The brand new £32m women and children’s building at North Manchester General Hospital opened in June 2010 providing a new permanent home for the maternity and children’s services in North Manchester and in 2011 for the services transferring from Fairfield General Hospital.

We have also continued to invest in new equipment such as our new automated pharmacy robot at Oldham, digital mammography machines at North Manchester and Oldham and over £10m in medical, scientific and computer equipment to support front line clinical services.

The Christie at Oldham – the new purpose built radiotherapy centre at The Royal Oldham Hospital - opened in March 2010 and immediately began treating its first patient – a 73 year old Rochdale man who had recently been diagnosed with prostate cancer. The centre is the first in a planned network of Christie radiotherapy centres where patients will be able to access first class radiotherapy treatment closer to home. The new facility demonstrates a close partnership and joint venture between the Trust and The Christie.


Plans put in place to prepare for a possible H1N1 (swine flu) pandemic did not, thankfully, need to be activated. The planning has put the Trust in a good position to respond appropriately in the event of other emergencies and this was demonstrated when the Trust was able to maintain services during the short period of unusually severe weather at the turn of the year.

The many developments and improvements that have been put in place during the year are recorded elsewhere in annual report, and in particular in the Quality Accounts. Production of Quality Accounts is a new requirement on the NHS this year and we have taken the decision to fully integrate the Quality Accounts with this Annual Report. While there are many successes and service improvements, regrettably the Trust is stalling in some aspects of performance, in particular in consistently meeting the national 4 hour Emergency Access standard and some of the cancer waiting time standards. As a Trust we must redouble our efforts to meet these standards.

The Trust’s ambition to become an NHS Foundation Trust is progressing well. We see real strength in local people and all our staff becoming members of the Foundation Trust. All members of the Foundation Trust will have a vote to elect a Governors’ Council which will hold the Trust Board to account on behalf of local people. Listening to and working with local people and our staff is important in making sure our services are fit for the future. I would encourage you to join up as a member of our Foundation Trust. You can complete the form in this annual report or join up on line by visiting the Trust web site at www.pat.nhs.uk/foundationtrust

Both the previous and the present government have indicated that all public services, including the NHS, face tough financial challenges over the next few years. The Trust, like other Trusts across the country will not be immune from these pressures. The Trust is in an excellent position to meet these challenges, having once again met its financial duties to the Department of Health. Nevertheless, difficult decisions will have to be taken and new ways of working will need to be adopted. Across the North West the health service will work together and with other partners to meet growing demand whilst maintaining the quality and safety of care and delivering best value.

The Trust Board and all Trust staff are committed to providing high quality services and to making a real difference to our patients. Through a programme of constant improvement, we strive to be the first choice hospital for local people and to be regarded as a valuable asset for the communities we serve. We continue to focus on quality and patient safety first. By getting our performance right for our patients we will ensure we live up to our mission statement “to provide the very best care for each patient on every occasion”.

John SaxbyChief Executive

10 June, 2010

...to providing high quality services and to making a real difference to our patients

Mis

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ives Mission statement

The Trust’s mission statement is a statement of purpose of what our patients can expect from our staff across your hospitals.

“To provide the very best care for each patient on every occasion”

Our mission statement is enshrined within our organisational values:

Values

Patient care is at the centre of everything we do. We work together to deliver a high quality service to provide the best possible outcome for patients.

Accountability, honesty and integrity are keys to our success both individually and across the Trust.

Treating everyone with respect and promoting good working relationships will support individuals in reaching their full potential.


The strategic aims of the Trust are:

• to provide secondary healthcare services

• to provide a number of specialist services and continue to develop these in line with demand

• to develop services in primary care where this makes clinical and financial sense

• to build upon its brand as an NHS provider

The Trust has ambitious plans to improve and develop the quality of services it provides by:

• improving patient experience, mortality outcomes, quality and safety

• focusing on key performance areas such as reducing waiting times, length of stay and healthcare acquired infections i.e. MRSA/C. Difficile

• creating centres of excellence, particularly in surgery

• driving efficiencies through the organisation

• modernising the estate - improve North Manchester General Hospital estate

• transfer services into the community and work with partners to develop effective integrated patient pathways with community services.


We said we would How did we do?

Achieve “good” and “good” in the care quality commission ratings Achieved

Achieve level 3 in the Auditors Local Evaluation Achieved

Achieve all our financial targets Achieved

Ensure that 90% of admitted patients and 95% of non admitted patients received treatment within 18 weeks of referral Achieved

Ensure that 98% of patients attending A&E would be seen, treated and admitted, transferred or discharged within 4 hours of arriving Achieved 96.6%

Ensure that less than 0.8% of patients had their operations cancelled. 1.26% of patients had their operations cancelled (98.74% went ahead as planned)

Achieve targets to reduce MRSA and C. Difficile infections Achieved

Improve in all areas covered by the national annual patient survey

There was a mixed picture, with improvements in some areas but not in others. New “real time” patient surveys are being undertaken to find out patient views and address these more quickly.

Eliminate mixed sex accommodation except where clinically necessary Achieved

Develop methods to capture patient experience in real time while they are receiving care

Introduced hand held electronic feedback machines and have started to survey patients while they are still in hospital.

Improve the speed with which calls to switchboard are answered Achieved

Reduce the number of the most severe pressure sores

It is likely that the number of pressure sores has been under-reported in the past. When the target was set and the profile of this activity raised we have found that more pressure sores have been reported and recorded. We are now carrying out detailed work to establish the true baseline so that we can plan realistic reductions.

Reduce mortality Achieved

Deliver plans to maintain and redevelop our estate Achieved

Launch our Foundation Trust application Achieved

Complete plans for reconfiguring services We have completed our plans and these are described throughout this report

Ensure that 90% of staff have objectives set and an appraisal in the year Achieved 80%

Corporate objectives

The Department of Health guidance within ‘The Operating Framework 2009 - 10’ entitled High Quality Care for All set out the national priorities the government expected the NHS to deliver during the year.

For the third year, the five national NHS priorities are:

• improving cleanliness and reducing healthcare associated infections;• improving access through meeting 18-week referral to treatment pledge;• keeping adults and children well, improving health and reducing health inequalities;• improving patient experience, staff satisfaction and engagement; and• preparing to respond in a state of emergency such as an outbreak of pandemic flu; learning lessons from

recent experience of swine flu (H1N1).

Each year the Trust sets itself an ambitious set of corporate objectives against which it judges its performance for the year. The Trust’s corporate objectives for 2009-10 took account of the Operating Framework and set out 10 corporate objectives, each with performance indicators which could be measured. Regular reports are provided to the Trust Board on progress against corporate objectives and at the end of each year an assessment is made of the Trust’s achievements against those objectives.

The corporate objectives for 2009/10 are set out in the Table below together with the Trust’s achievements against each objective.


Following full public consultation and the Secretary of State’s decision in 2007 to support major reconfiguration of clinical services across Greater Manchester, the Trust has been in the process of implementing major service change to improve the quality of care and patient safety. The reconfiguration of services is being implemented under two strategic initiatives which are clinically led.

The plans for reconfiguration of services, which was scrutinised and subsequent recommendations made to the Secretary of State by The Independent Reconfiguration Panel (IRP), is currently being implemented under two strategic initiatives which are clinically led.

- Healthy Futures involves changes to services for adults in the north east sector of Greater Manchester covering the areas served by the Trust and your hospitals.

- Making It Better covers women and children’s services across the whole of Greater Manchester. The reconfiguration programme involves the modernisation and improvement of services, as well as centralising some inpatient services. The implementation is now well under way and is due to complete in Summer 2012.

Service reconfiguration

Key Achievements

The Trust has an ambitious development programme which involves the reconfiguration and modernisation of healthcare services across your hospitals. The achievements over the past year are described briefly below:


The new £32m women and children’s development at North Manchester General Hospital opened in June 2010

In June 2009, Booth Hall Children’s Hospital, a specialist hospital for children located in Blackley, North Manchester, closed after 100 years and many of the services were relocated to North Manchester General Hospital.

The Trust has made a significant investment and opened a dedicated children’s A&E department, observation and assessment unit and children’s services at North Manchester General Hospital. The Trust is now able to treat sick and injured children, aged between 0 - 16 years, in appropriate child-friendly environment at your hospital at North Manchester. As part of the new services, the Trust has over the last year recruited 10 new consultant paediatricians and 82 nurses. Of these, 63 nurses have transferred from Booth Hall, meaning familiar faces for children who attend the services regularly.

In addition, a brand new purpose-built development to accommodate children’s, neonatal and maternity services has completed at North Manchester General Hospital and opened in June 2010. The £32m development will accommodate the existing children’s inpatient service at North Manchester. The new facilities will also receive patients who will transfer from Fairfield General Hospital in Bury as a result of the reconfiguration and the planned transfer of inpatient paediatric, obstetric and neonatal services in September 2011 as part of the Making it Better programme.


... recruited 10 new consultant paediatricians and 82 nurses

Children’s services at North Manchester General Hospital


The Trust has made significant investment in creating additional bed capacity at The Royal Oldham Hospital. In June 2010 the Trust’s specialist clinical haematology services transferred to a brand new dedicated unit on the first floor of The Christie at Oldham build. The unit will create a centre of excellence for the clinical haematology service, providing 22 inpatient beds. The second floor will accommodate 45 beds for vascular surgery patients, allowing centralisation of vascular surgery to provide a more sustainable, robust and safe service for patients.

The ground floor accommodates a new radiotherapy facility which is operated by The Christie Hospital – one of Europe’s leading cancer centres. The facility, the first of its kind in the UK, opened to patients in March 2010 and means that patients who require radiotherapy will no longer have to travel to South Manchester to receive their treatment.

In 2010 the Trust invested nearly £1m in new digital mammography equipment for the North Manchester and Oldham sites. This investment has enabled diagnostic images to be stored and transferred electronically enabling patients to receive results much more quickly than they would otherwise have done. Digital mammography is regarded as being the gold standard for the diagnosis of breast cancer and Pennine is the only Trust in Greater Manchester that is fully digital in this service. In addition, the Trust invested over £10m in medical and scientific equipment to support front line clinical services.

Capital ExpenditureThe Trust’s Capital Programme for 2009/10 totalled £47m. In addition to the major schemes outlined above, the Trust invested in maintaining and improving the physical estate and on smaller capital projects to develop front line clinical services. For example, £500,000 investment was made in head and neck cancer services at North Manchester General Hospital to establish a specialist centre. This enables services to patients to be improved and also ensures the Trust maintains the standards expected in delivering this important service.

Additional capacity and radiotherapy at The Royal Oldham Hospital

Medical equipment

The Trust’s Capital Programme for 2009/10 totalled £47m.



High quality care for patients

Last year was a pivotal year for the NHS as the third stage of the Government’s reform agenda of the NHS. The first stage of reform focused on increased capacity and investment across the NHS. The second stage introduced levers to enable reform: choice, contestability, more freedom for providers and better financial systems. The third stage was about transforming services to deliver high quality care for patients and value for money.

The Operating Framework 2009/10 defined quality in three areas: safety, effectiveness and patient experience. The three quality areas are reflected within the Trust’s corporate objectives.

Successful organisations need to pay attention to both quality assurance and meeting standards and national targets that are expected from regulatory bodies. Services must be delivered through safe and reliable systems and processes.

Quality Accounts are annual reports to the public from NHS providers about the quality of services they provide.

The aim is to enhance public accountability by listening to and involving the public and partner agencies and, most importantly, acting on the feedback we receive, both during the process and following the publication of this report.

Risks

The management and mitigation of risk is one of the key responsibilities of managers at all levels and the Board. The key in year risks which the organisation faced in the year were:

• Achievement of national targets – this was mitigated through robust action plans and with the backing of national support teams;

• Increasing demand – this was mitigated through close links, liaison and provision of service level information to primary care trusts.

• Managing the financial demands of the current economic climate – this was mitigated through the robust financial planning and monitoring arrangements the Trust has built up over several years.

The key future risk facing the organisation is managing the financial demands of the current economic climate – the robust financial and workforce planning to be undertaken, closely linked to work with Primary Care Trusts on demand management, will be the key method of mitigating this risk.

A comprehensive review of the Risk Register and Assurance Framework process was carried out during the year. The new arrangements which ensure a closer link with the operational objectives of the Trust, will be implemented during 2010.

The following chapters 11–22 are the first Quality Accounts to be published by The Pennine Acute Hospitals NHS Trust.

Quality Accounts 2009-10Quality Accounts are annual reports to the public from NHS providers about the quality of services they provide.

The aim is to enhance public accountability by listening to and involving the public, partner agencies and, most importantly, acting on the feedback we receive, both during the process and following the publication of this report.

National Context

The Next Stage Review carried out in England set out to build on the progress made in delivering the vision set out in the NHS Plan (Department of Health, 2000) and the Government’s reform agenda, to identify the way forward for a 21st Century NHS.

The High Quality Care for All: The ‘NHS Next Stage Review’ final report was published on the 30th June 2008; it made quality of care a central organising principle for the NHS. Professor Lord Darzi, Parliamentary Under Secretary of State at the Department of Health, defined quality across three dimensions:

• Patient Safety• Clinical Effectiveness• Patient Experience

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The Department of Health promised to strengthen and maintain the focus on quality by:

• Establishing a National Quality Board• Requiring Trusts to measure quality including

“real time” feedback to monitor patients’ experience

• Including data from patients’ experience surveys in the “vital signs” that comprise the NHS Operating Framework and National Indicator Set for national and local use

• Introducing routine application of patient-reported outcome measures (PROMs)

• Establishing quality observatories in every NHS region

• Rewarding high quality performance through Commissioning for Quality and Innovation (CQUIN)

In the report, a key component of the new Quality Framework was the requirement for all providers of NHS services to publish Quality Accounts: annual reports to the public on the quality of the health care services they deliver.

High quality care should be as safe and effective as possible, with patients treated with compassion, dignity and respect. As well as clinical quality and safety, quality means care that is personal to each individual.

Professor Lord Darzi, Parliamentary Under Secretary of State at the Department of Health, 2008

The Trust’s mission statement is: “to provide the very best care to each patient on every occasion”. To achieve this, quality and the patient experience must be at the heart of everything we do.

Successful organisations need to pay attention to both quality assurance and meeting national standards that are expected from regulatory bodies. Services must be delivered through safe and reliable systems and processes.

The Trust has developed a Quality Improvement Strategy which makes explicit our commitment to patient safety, clinical effectiveness and patient experience. We will set goals that demonstrate our ambition to be the Acute Trust provider of choice delivering high quality healthcare services across North Manchester and the boroughs of Oldham, Rochdale and Bury.

The Trust takes all aspects of patient care very seriously. Patient safety, in particular, is our top priority. During 2009/10 the Trust has continued to focus its attention on improving patient safety and the patient experience.

Patient Safety reports are now presented monthly to the Trust Board by the Trust’s Medical Director. The Trust has also signed up to both the national Patient Safety First campaign (PSF) and the Safer Care programme – Leading Improvement in Patient Safety (LIPS).A new Quality Framework has also been approved by the Trust Board; this came into effect in April 2010. The framework clarifies individual responsibilities for quality and establishes a new committee structure to ensure appropriate performance monitoring against the Quality Improvement Strategy.

The Quality Framework takes into account the Next Steps management restructuring programme that took effect across the Trust in September 2009. The cornerstone to the new management structure has been the appointment of 19 clinical directors. Each clinical director is responsible for the full management of their clinical directorate and all elements of service delivery including performance, governance, patient safety, service quality, staffing and finance.

Local Context

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Clinical Governance and Quality Committee

Clinical Effectiveness Committee

Patient Safety Steering Group

Patient Experience Committee


Our aim is to provide the very best care to each patient on every occasion. This is our mission statement. It is central to everything we strive to achieve; a statement of what our patients expect, of what we want our services to be, and what we expect our staff to deliver day in day out across our hospitals and all of our services. To achieve this, improving patient safety and quality and the patient experience continue to be the Trust’s top priority. Our fundamental purpose continues to be to provide ever better quality healthcare services for our patients and communities.

Good progress has been made in many areas, particularly in our efforts to reduce healthcare acquired infections across all our hospitals and in reducing our mortality rate which has seen a steady improvement year on year. Our Care Quality Commission rating for 2008/09 was ‘Good’ for both Quality of Services and Financial Management. The Care Quality Commission, in introducing the new registration scheme across England, registered the Trust with no conditions for 2010/11.

Many Trust staff have been involved in developing this report, and our community partners have had the opportunity to comment on its contents. I am satisfied that the information contained within these Quality Accounts is accurate and I commend it to you.


Statement on Quality on Behalf of the Board

Priorities for improvement The Trust Board has approved its objectives for 2010/11 and in doing so has identified priorities for improvement in the following areas:

Patient safety

• Mortality – to reduce hospital standardised mortality by 5% by the final quarter of 2010/2011.

• Healthcare acquired Infections – to ensure all elective inpatients are screened for MRSA and to reduce further the incidence of MRSA (maximum 14 cases) and Clostridium Difficile (maximum 362 cases).

• Patient falls – to achieve a 2% reduction in the number of patient falls.

• Pressure sores – to achieve a 50% reduction in the number of pressure sores on 3 pilot wards and to expand this improvement programme.

Patient experience

To develop a system to capture patient views of their hospital experience as they are receiving it and to demonstrate improvements to services as a result of their feedback.

All patients, except where clinically necessary, will be cared for in an environment which complies with the Department of Health’s ‘Delivering Same Sex Accommodation’ programme.

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Hospital Standardised Mortality Ratios (HSMR) compare an NHS Trust’s actual number of deaths with its expected (or predicted) number of deaths. This prediction takes account of factors such as the age and sex of patients, their primary diagnosis and complicating factors, and their length of stay in hospital.

The HSMR is a complex indicator which is reviewed and a new base rate set on an annual basis. Standardisation of mortality rates allows comparison between different hospitals serving different communities.

If the Trust has an HSMR of 100, this means that the number of patients who died is exactly as it would be expected. A Trust’s HSMR above 100 means that more patients died than would be expected; one below 100 means that fewer patients than expected died.

Our objective for 2009 was a reduction in our standardised mortality of 5%. Our mortality index using CHKS at the 2008 standard is shown in the graph below. The Trust has experienced a year on year improvement in standardised mortality since 2005.

Review of quality performance – Safety

Mortality rates

The Trust is an active member of a new North West regional mortality collaborative set up to improve clinical practice and combined understanding among clinicians to reduce avoidable deaths. The collaborative comprises nine NHS Trusts across the region. The Steering Group is supported by AQuA, the Advancing Quality Alliance (NW Observatory) which network and supports activities across the North West to deliver six core quality improvement goals across the quality domains of safe, effective and experience, as well as supporting organisations in the delivery of their own determined priorities.


The Patient Safety First Campaign is a national campaign whose aim is to have no avoidable deaths and no avoidable harm in hospital settings. The campaign comprises specific ‘interventions’ relating to leadership, the management of the deteriorating patient, critical care, perioperative care and high risk medicines. Membership of the campaign by NHS organisations is voluntary and the Trust was awarded a certificate of progress in September 2009.

The leadership intervention requires the establishment of executive management ‘walk-rounds’ across all hospital sites and wards that focus on patient safety. They are an opportunity for front line staff to raise patient safety issues with Trust Board directors. Directors will respond to the local team within 48 hours on the main areas discussed and actions to be undertaken. These commenced at the Trust in October 2009 and progress is monitored and reported to the Trust Board. By April 2010, over 50 ‘executive walk-rounds’ have taken place across the Trust.

Patient Safety First Campaign Case study – Patient falls

Patient falls are the most common patient safety incident reported to the National Patient Safety Agency (NPSA).

Falls are most common in older patients. The causes are complex due to a combination of underlying medical and physical conditions, as well as possible side effects of medications. Poor eyesight, memory and continence problems also significantly increase the risk for a patient who is out of their normal environment.

Due to the complexities of the underlying causes of falls, there is not a simple solution to reduce the incidence of falls in hospitals. It is widely recognised that a multi-faceted approach is required focusing on individual patient intervention i.e. how do we stop this patient from falling?

The Trust’s Strategic Group for Prevention of Falls focuses on reducing falls within the organisation. A number of specific measures have been put in place as part of the group’s work, for example:

• At North Manchester General Hospital movement alarms are used in selected wards with high fall rates. Two randomised control trials are being carried out.

• Low rise beds and, in exceptional circumstances, individual supervision are being used in the case of patients who experience several falls. At Rochdale Infirmary, for example, education boards have been developed for local staff training and these are to be reviewed and adapted for Trust-wide use.

The Trust intends to reduce the number of patient falls. Significant progress has already been made and data for 2008 and 2009 shows an overall reduction of 5.7% for patient falls and a reduction of 13.5% in in-patient falls. The Trust aims to reduce these by a further 2% in 2010/11.

Chief Executive, John Saxby, receiving his seasonal flu jab

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The World Health Organisation (WHO) Safe Surgery Saves Lives Checklist was created by an international group of experts with the goal of improving the safety of patients undergoing surgical procedures around the world. The 19-item surgical checklist involves the coordination of the operating team – the surgeons, anaesthesia providers, and nurses – to discuss key safety checks prior to specific phases of perioperative care. It has been demonstrated to reduce complications and mortality associated with a variety of surgical procedures by greater than 30 per cent. It is currently in active use in operating rooms around the world. The surgical check list and Patient Safety First Briefing have been implemented across the Trust.

• At the beginning of February 2010 all surgical theatres at Rochdale Infirmary were using the approved check list and briefing. Ophthalmology services at Birch Hill Hospital were rolled out in February 2010.

• At The Royal Oldham Hospital most theatres are now using both the WHO checklist and briefing.

• At Fairfield General Hospital all theatres began using both the WHO surgical check list and Patient Safety First Briefing in February 2010.

• At North Manchester General Hospital all theatres are using the checklist. The roll-out of the briefing aspect began in March 2010.

The National Patient Safety Agency (NPSA) issues alerts to organisations based on national learning derived from the reporting of patient safety incidents into a national reporting system.

The Trust takes the implementation of the NPSA alerts very seriously and has robust policies and systems in place across all our hospitals for reporting and recording alerts, and in taking the necessary action to address any issues or concerns. All patient safety alerts are scrutinised by the Trust’s Clinical Governance Committee, chaired by the chief executive and whose membership includes doctors, nurses and senior managers. There were no alerts outstanding at 1 April 2010.

Perioperative care NPSA Alerts

Clean Hands Save Lives

This Alert was issued in September 2008 and applies to all providers (direct and commissioned) of NHS care in all healthcare settings in England and Wales.

Improving the hand hygiene of healthcare staff at the point of patient care will reduce healthcare associated infection (HCAI). Hands are a repository for microorganisms that can cause infection. Healthcare staff in all healthcare settings have the greatest chance of transferring these as they move between patients, or different care activities for the same patient.

The Alert highlights the following key points:

1. The role of hand hygiene by healthcare staff in preventing and controlling infection

2. The point of care as the crucial moment for hand hygiene3. The appropriate placement of alcohol handrub products4. Advice on which hand hygiene products to use and when5. The current recognised standard for hand hygiene products6. Management of risks including ingestion, storage and skin

irritation

NPSAA L E R T

Example NPSA alert


The Trust employs a private contractor to provide domestic cleaning services on all five hospital sites.

The required standard set for the contract is that over a 13 week assessment period an overall score over 85% is achieved. Penalties for poor performance can be imposed.

There has been variation in cleaning scores across a number of wards in the Trust. In particular, problems have been identified at both North Manchester General Hospital and Rochdale Infirmary. The cleaning contractor is addressing this by:

• Recruiting additional healthcare cleaning assistants

• Reviewing the training of individual healthcare cleaning assistants

• Monitoring the performance of cleaning staff

• Reviewing working patterns particularly at weekends and evenings

Following a visit by the independent healthcare regulator, the Care Quality Commission (CQC), in October 2009 a full review of cleaning responsibilities has been undertaken. As well as publishing the domestic services cleaning schedules, the nursing cleaning schedules are published on each ward.

In a recent survey of patients’ experience, 98.1% of patients were satisfied with the standard of cleanliness in the ward areas where they were first admitted.

The Government requires annual Patient Environment Action Team (PEAT) inspections to be carried out every year. The PEAT inspections check NHS hospitals in England for their standards in three areas of concern to patients – ‘Environment’, ‘Food’ and ‘Privacy and Dignity’. Unannounced inspection teams review issues such as cleanliness, hand hygiene and the quality of accommodation and food from the perspective of a patient. PEAT Inspections took place at the Trust in January and February 2010.

The inspections have highlighted some excellent standards with scores of 5 (excellent) for the A&E and X-Ray departments and Outpatient department A at North Manchester General Hospital and Rochdale Infirmary Medical Emergency Unit. The Trust’s overall PEAT score came out as ‘Good’, a score rating of 4. The relatively small number of issues identified as needing improvements have been listed out on an action plan; the vast majority have now been remedied. Work continues with the improvement programme.

Cleanliness

...inspections have highlighted some excellent standards at your hospitals ...

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In 2009/10 The Trust met its agreed targets for the reduction of Methicillin Resistant Staphylococcus Aureus (MRSA) and Clostridium Difficile (CDT).

MRSA bacteraemia

The Trust has successfully reduced MRSA bacteraemia from 105 in 2006/07 to 36 in 2009/10 (20 post-48 hours, 16 pre-48 hours). Our target for 2009/10 was to have no more than 38.The trajectory target for 2010/11 is to have no more than 14 post 48 hour cases. This is a very challenging target that requires a further 63% reduction and a maximum of 1 hospital-acquired MRSA bacteraemia per month.

Clostridium Difficile (CDT)

The Trust reported 262 Clostridium Difficile infections in 2009-10 compared to 472 in 2008-9. We therefore achieved both the national target for 2009/10 of no more than 398 hospital-attributable cases (post-72 hours) and the Strategic Health Authority’s stretch target of no more than 320 cases. The trajectory target for 2010/11 is to have no more than 362 hospitable attributable cases but the Trust intends to reduce the number of cases by even more.

Healthcare Associated Infection (HCAI) reduction strategies

A series of actions to support the continued reduction of both MRSA and CDT are being implemented. The Trust will continue to aim to deliver quality healthcare services safely with infection prevention at its core. The following actions continue during 2009/10:

MRSA

• Standardised nursing care plans/ care pathways, including protecting against infection during care of invasive urinary devices.

• Education and assessment programme for ANTT (aseptic non-touch technique) and aseptic wound care standards.

• Audit of High Impact Interventions to assess compliance with standards of practice for hand hygiene; care of IV and urinary catheter devices.

• Audit of compliance with the integrated nursing care plan for MRSA and CDT patients.

CDT

Although the Trust remains under target for CDT cases, investigation of all CDT cases continues. The following actions have been implemented:

• Wards identified with cases of CDT have undergone a full clean and disinfection

• Hand hygiene audits - random checks

• Commode audits - random checks

• Increased cleaning resources to high risk areas such as the Medical Admissions Unit.

Further work is underway to promote antibiotic stewardship among medical staff at The Royal Oldham Hospital, and a retrospective audit is to be carried out by the pharmacy department. CDT cases reported at The Royal Oldham Hospital during the last six months will be investigated to identify antibiotic prescribing prior to patients being identified with CDT and compliance with the antibiotic policy.

Reducing healthcare acquired infections


During 2009/10 the Trust set itself a target to reduce the number of hospital acquired grade 3 and 4 pressure ulcers by 20%. Whilst this target has not been achieved, several new measures have been taken and implemented to improve standards of pressure ulcer prevention and management. These include:

• The appointment of a project nurse to measure pressure ulcer prevention and management standards across the Trust

• Pressure ulcer documentation and ‘staff knowledge audits’ undertaken across the Trust

• An annual prevalence survey undertaken to identify trends in our pressure ulcer patient population

• Pressure ulcer study days for healthcare workers

• A Trust-wide training programme run by the Trust’s Tissue Viability Service to improve internal awareness among staff and routinely request that an incident report is generated following receipt of a pressure ulcer patient referral

• Additional training for staff to enhance the appropriate identification of pressure damage and minimise confusion with other skin lesions

• A new clinical reference tool which staff can use at the patient’s bedside to help staff develop their skills in correctly grading pressure ulcers.

Pressure Sores

The graphs below show the number of patients with hospital acquired Grade 3 and Grade 4 pressure ulcers.

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All patients with pressure ulcers grade 2 and above are now reported as a clinical incident and photographed in line with the National Institute for Health and Clinical Excellence (NICE) requirements. Nurses’ skills in pressure ulcer grading are now measured prior to and following training sessions.

The frequency of mattress condition audits has been increased from annually to bi-annually to comply with Medicines and Healthcare Products Regulatory Agency guidance in the maintenance of pressure reducing foam hospital mattresses. A pressure reducing cushion inventory and condition audit has also taken place. The Trust is also working with Salford Royal NHS Foundation Trust on a Patient Safety Node Collaborative focusing on pressure ulcers.


The 4 hour urgent and emergency care access target was introduced in emergency departments by the Department of Health in 2004. At least 98% of patients are now required to be seen, treated, admitted to a ward, transferred or discharged within four hours of attending an A&E department.

The Trust performed below this national standard in 2009/10. In November 2009 the Department of Health’s Emergency Care Intensive Support Team (ECIST) was invited to conduct a review of the Unscheduled (Emergency) Care pathway across the north east sector of Greater Manchester in response to under-performance against the national 4-hour emergency access standard.

The ECIST team visited all Pennine hospitals as well as conducting interviews with key stakeholders. The feedback was presented to key stakeholders from across the north east sector health economy in February 2010.

The key challenges for the Trust and local health economy are to:

• improve the flow of patients through A&E departments

• improve the flow through hospital wards

• improve the discharge flow of patients

• reduce avoidable demand on hospital services

In response to the ECIST proposals, the Trust has established action plans for each of its four main hospitals to improve patient flow, patient safety and to help reduce waiting times for patients attending emergency departments. In March 2010 the ECIST team was invited back to the Trust to undertake a series of ‘Clinical Challenge Events’ working with senior managers and clinical staff. The focus of the ECIST work within the Trust is to improve patient safety through improving patient flow.

Action plans are currently being implemented, including:

• The introduction of expected date of discharge (EDD) across all inpatient settings.

• The introduction of daily board/ward rounds for all inpatient medical wards.

• The development and introduction of Internal Professional Standards (IPS) across the clinical workforce to include Emergency Medicine, Emergency Assessment Units, Short Stay facilities, General Medicine, Specialties, General Nursing, Therapists and Diagnostics. The standards are explicit statements about what each professional group will do to ensure safe and efficient patient flow through secondary care services.

• The development of fast flow wards with the aim of providing a focused environment for patients with an expected date of discharge of less than 72 hours.

• Agreed metrics and management of the performance for these metrics for the emergency departments and emergency assessment units.

• Clear discharge plans available in every patient’s medical records.

• Proactive management of all patients with a length of stay greater than 14 hospital bed nights.

• Review and improvements to bed management support services.

Improving patient safety by improving patient flow

Getting patients better faster and safer

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Advancing Quality

The Trust has been participating in the North West regional Advancing Quality (AQ) Programme since October 2008. The programme measures how well 24 north west NHS Trusts adhere to evidence-based clinical pathways and enables Trusts within the north west to benchmark their outcomes with one another.

The aim of the programme is to improve the quality of care offered across the region in the treatment of five major health conditions. There are four clinical pathways of care applicable to the Trust:

• Acute Myocardial Infarction (AMI) – heart attacks

• Heart Failure

• Community-Acquired Pneumonia (CAP)

• Hip and Knee replacement

A Trust steering group has been set up to oversee the implementation of the programme and disease specific working groups have been formed to improve performance across the pathways.

Key work areas include:

• Raising awareness of AQ criteria across the Trust.

• Improving the provision of smoking cessation advice at ward level and increasing referrals to the smoking cessation team.

• Improving documentation and provision of discharge instructions to patients with a diagnosis of Heart Failure.

Community-Acquired Pneumonia

The Trust was ranked 5th out of the 23 NHS Trusts involved in the Advancing Quality programme for our high standard of care delivered to people with pneumonia coming into A&E departments in 2009/10. The AQ performance indicators for providing services for pneumonia patients are as follows:

• Percentage of patients who received an oxygenation assessment within 24 hours prior to or after hospital arrival

• Initial antibiotic selection

• Blood culture collected prior to first antibiotic administration

• Antibiotic timing, percentage of pneumonia patients who received first dose of antibiotics within six hours after hospital arrival

• Smoking cessation advice/counselling

The key area for improvement that the Trust has targeted has been around smoking cessation counselling. Although the levels achieved are in the top 25% in the north west, improvement is needed to continue to deliver this effective health intervention.

The Trust was ranked 15th for acute myocardial infarction, 19th for heart failure and 18th for hip and knee elective and non-elective surgery.

Review of quality performance - Effectiveness


Stroke affects up to 12,000 people per year in the north west and is the third biggest cause of death in the UK.

The Trust’s Stroke Unit at Fairfield General Hospital is one of two specialist Primary Stroke Centres which form a co-ordinated approach to stroke care across Greater Manchester; the other is at Stepping Hill Hospital in Stockport. Together with Salford Royal NHS Foundation Trust (the Comprehensive Stroke Centre), the two Primary Centres offer the very specialist elements of stroke care, such as the ‘clot busting’ thrombolysis treatment, which is one of the biggest advances in minimising disability caused by Stroke. The Trust also provides clinical stroke services across its other three main hospitals.

For 2009/10 the Trust was set nine Key Indicators for its stroke services to evidence performance on a month by month basis against nine key indicators:

• 80% of patients to receive a swallowing assessment within 12 hours of admission

• 80% of patients should receive a ‘Malnutrition Universal Screening Tool’ (‘MUST’) Assessment within 24 hours of admission

• 80% of patients should receive a CT Brain Scan within 24 hours of admission

• 80% of patients should receive Aspirin within 48 hrs of admission

• 80% of patients should receive a physiotherapy assessment within 72 hours of admission

• 80% of patients should have Rehabilitation Goals agreed by the MDT

• 80% of patients should be weighed once during their hospital stay

• 80% of patients should receive an Occupational Therapy assessment within 4 days of admission

• 70% of patients should spend 90% of their admission within a stroke unit

Because of the demanding nature of the standards expected, a whole scale reform of how we deliver stroke services has been undertaken across the Trust. Improvements have been evidenced, month on month, with action plans developed and shared with Primary Care Trusts for all nine indicators. At the end of March 2010, the Trust achieved an overall average of 86% and ‘Commissioning for Quality and Innovation’ payments (CQUINs) of £615,000 have been secured. The Trust has also undertaken a patient and carer survey of Stroke patients. A summary of the results of this survey is as follows:

• The overall standard of care within the Trust is high with 87% of respondents rating their care as good-excellent.

• 90% of patients stated that their Stroke was diagnosed quickly and that they were admitted to hospital quickly.

• Information given on discharge from hospital needs improving. A significant number of patients reported that they were not given information on diet, exercise and medications on discharge from hospital. A trust-wide Stroke Information Booklet covering all of these aspects has now been produced and the first Annual Stroke Improvement Workshop was held in April 2010.

• Care following hospital discharge appears to be fragmented with a lack of support for issues such as emotional and therapy requirements. Our Primary Care Trusts are addressing these aspects of the survey results.

Stroke

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The Trust has a proactive approach to treating Transient Ischaemic Attack (TIA) (or mini strokes). The standard requires 45% of high risk TIA patients to be seen within 24 hrs and all other TIA patients within 14 days. By March 2010 Stroke Services had seen 93% of high risk TIA patients within 24 hours and all other TIA patients within 14 days.

The Trust continues to develop stroke research studies covering hyper-acute, acute stroke care, rehabilitation and out-patient clinics. In June 2009 the Trust, with the support of The National Institute of Health Research, recruited more patients for a trial of a new treatment aimed at lowering blood pressure in stroke patients than any other Trust in the country. A person with a normal blood pressure is at lower risk of having a stroke and the Trust’s consultants are keen to find out if blood pressure should be artificially controlled immediately after a stroke. The trial took place at Fairfield General Hospital and used special glycerl trinitrate patches as a method of lowering blood pressure. In the longer term, this treatment method could replace the existing anti-hypertensive medication, which patients often struggle to swallow.

Transient Ischaemic Attack services

The Trust continues to develop stroke research studies...


‘Releasing Time to Care’, also known as the ‘Productive Ward’ programme, was launched in January 2008 by the NHS Institute for Innovation and Improvement after research studies showed that ward-based nurses spend on average less than 40% of their time on direct patient care.

The initiative aims to make better use of nursing time by offering a systematic way of improving the way ward teams work together in delivering safe, quality care to patients.

The Trust is fully signed up to the initiative and has already seen overwhelming evidence of the benefits to staff and patients across its four pilot wards within its hospitals.

The pilot wards currently involved in the initiative include ward C4 (medical) at North Manchester General Hospital, ward 14 (surgical) at Fairfield General Hospital, ward G1 (rehabilitation/stroke) at The Royal Oldham Hospital and paediatric wards at Rochdale Infirmary.

Early indicators from the pilot wards have shown how minor alterations and changes have released more time to be invested back into direct patient care. For example, direct patient care time measured through activity following a staff nurse on one surgical ward has shown an increase from 39% in March 2009 to 53% in June 2009. On another ward, direct patient care time increased by 29% after 11 weeks and time spent in motion decreased from 17% to 11%.

The Trust is rolling out phase three of its ‘Productive Ward’ initiative involving a further 11 wards. The programme at the Trust will be implemented into all wards over the next two years in seven phases.

In December 2009 staff on Ward 14 at Fairfield General Hospital won a major national healthcare award after being chosen by their peers for successfully freeing up time to enable nurses to increase time spent on direct patient care. The surgical ward received the ‘People’s Choice’ award which was voted for by healthcare professionals from across the country at the Lean Healthcare Academy’s annual awards for excellence.

Productive ward

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Real time patient experience capture

There is a need to engage with and listen to patients to establish their perception of the services offered by NHS Trusts. The requirement to gather feedback from patients, carers and users of services has increased significantly – both locally and nationally.

The Trust gathers information from a variety of sources, including the patient advice and liaison service, performance, equality and diversity, patient surveys, the complaints department and incident forms.

It is accepted that surveys get more honest responses than face-to-face interviews. Electronic patient survey devices afford a flexible alternative to paper-based surveys with the advantage that the results are easily analysed.

Electronic device pilot

A pilot of an electronic system was undertaken for two weeks in September 2009, supported by Customer Research Technology Ltd (CRT). Features considered to be important and available on CRT devices were:

• Simplicity • Multi-language features (up to 20

languages) • Larger font and design • Light, flexible and transportable

Some of the benefits of using this approach are:

• Unrestricted flexible survey design and unlimited surveys

• Fast effective automated reporting on results

• Effectively targeting of hard to reach groups

• Free text question available • Increased response rates• Reduced research costs • Reduced demands on staff

Two different formats were piloted across North Manchester General Hospital and The Royal Oldham Hospital. The devices used as part of the pilot were:

Tablet

These are designed to be accessed by the patient or visitor personally via a small laptop. Trust volunteers supported users during the pilot. This ensured that demands were not placed on staff. The volunteers were also able to support any patient who had difficulties using the technology.

Touch screen

This is a substantial piece of fixed equipment, designed to remain in one place and may be secured to the wall. The lack of staff support required and ability to fix the device to the wall makes it more suitable for use in outpatient departments.

Outcome

The Trust has invested in 12 electronic data capture devices, to support the collection of real time patient experience data. A 12 month programme of “experience capture” is planned for 2010/11, which will meet primary care trust commissioning requirements, inform internal service development needs, and bring improvements in service quality. Quarterly reports will be presented to the Trust Board. This methodology will allow the Trust to collect patient feedback at the point of their experience. It is anonymous and ensures accurate responses, together with high response rates from all age groups.

Review of quality performance - Patient experience


The Trust has also bought 16 hand-held devices to capture patient experience for a number of clinical services as part of the North West regional Advancing Quality (AQ) Programme.

Collecting patient experience for these conditions links directly back to the data collected from the patient’s case notes. Work is currently being undertaken to compare what the Trust delivers in terms of treatment with what the patient feels they have experienced regarding their care. By undertaking this piece of work we can ensure that any changes made in services or treatments will be more patient-focused.

Carers UK, the national charity for carers, estimate that there are around 6 million carers in the UK who provide unpaid care by looking after an ill, frail or disabled family member, friend or partner.

The Trust recognises that many of our patients and a number of our staff have caring responsibilities. Many, however, will not see themselves as carers and are unaware of the information and support that is available. It is important that carers are recognised and supported.

During the last 12 months the Trust has worked with local organisations to improve the experience of carers who use Trust services or are employed by the Trust. A Carers’ Strategy and Carers’ Charters for staff and patient carers have been developed.

The Trust’s new ‘Carers’ Strategy’ has been developed in conjunction with carers’ representatives and the four councils in Bury, Manchester, Oldham and Rochdale, carers’ centres and primary care trusts and outlines the Trust commitment to both staff and patient carers.

A ‘Staff Carer Charter’ and a ‘Patient Carer Charter’ provide information and is a commitment by the Trust on how carers can expect to be supported by the Trust. The Patient Charter is available on all wards and outpatient departments. The Staff Charter was sent to all staff in December 2009 and has been promoted internally.

The Trust has also set up a Staff Carers’ Network. This is a new initiative to provide staff carers with a forum to provide mutual support and exchange information and ideas; help the Trust understand staff’s experience and needs as a carer and look to improve working life for all members of staff with caring responsibilities.

The Trust is piloting a ‘Key to Caring’ scheme at North Manchester General Hospital and Fairfield General Hospital. A yellow key shaped key fob will be given to carers with information about carers contacts on it. A carer’s handbook for the Trust is also under development.

Advancing Quality patient experience Carers’ strategy

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The new Standard NHS Contract for Acute Services, introduced in April 2008, included a requirement to report on patient-reported outcome measures (PROMs). The Trust has been actively collecting this information and is expecting a report on the results in 2010.

PROMs are used to collect information for elective NHS patients undergoing hip or knee replacements, groin hernia surgery or varicose vein procedures. PROMs involves conducting short, self-completed questionnaires which measure the patient’s health status or health-related quality of life at a single point in time.

PROMs provide a means of gaining an insight into the way patients perceive their health and the impact that treatments or adjustments to lifestyle have on their quality of life. These questionnaires can be completed by a patient about themselves, or by others on their behalf. The Trust is keen to know more about the clinical outcomes of NHS services from the patients’ perspective. PROMs allow the Trust to gain this information.

The potential benefits of routine collection of PROMs data, and measures of care, include the following:

• Supporting clinicians and managers to benchmark their own performance

• Supporting reduction of inequalities, and

• Strengthening audit and research.

Patient choice over treatment and care is a central principle of the NHS. Patients’ experience of treatment and care is a major indicator of quality and PROMs are one of the tools the Trust is using to ensure that services are to the highest quality.

Patient Reported Outcome Measures (PROMs)

Benefits for patients


The Trust was one of the first NHS Trusts in the country to be officially accredited as a quality provider of health and social care information by the Department of Health’s Information Standard. The Information Standard is a new scheme for public and patient information.

The Information Accreditation Scheme has two aims:

• to provide an effective way for people to make judgements about information to support decisions regarding their lifestyle and care

• to support information producers in raising the general standard and reliability of information they provide to the public.

The accreditation demonstrates that the Trust has a robust policy and the necessary process in place to ensure its patient information meets the rigorous quality criteria of The Information Standard.

The Trust’s Patient Information and Review Group, comprising staff and voluntary patient representatives, ensures that all written patient information material is regularly assessed before it is published. All leaflets go through a strict editorial process to ensure the information material is accurate, user friendly, clear to understand and complies with all relevant guidance.

The Department of Health’s Delivering Same-Sex Accommodation (SSA) programme aims to eliminate mixed sex accommodation from hospitals in England by 2010. It is a visible affirmation of the NHS’s commitment to delivering safe care with privacy and dignity.

All providers of NHS-funded care were required to make a same-sex accommodation (SSA) declaration of compliance by 31 March 2010. Following a peer review visit on 11 March, the Trust has confirmed that mixed sex accommodation has been eliminated in all our hospitals.

Patients who are admitted to our hospitals will only share the room where they sleep with members of the same sex, and same sex toilets and bathrooms will be close to their bed area. Sharing with members of the opposite sex will only happen in emergency situations or by exception based on clinical need, for example, where patients need specialist equipment such as in critical care areas.

Information Standard Same Sex Accommodation

Protecting patients’ privacy and dignity is an essential part of delivering high quality care. Sharing accommodation with the opposite sex can undermine privacy and dignity at a time when patients are already feeling vulnerable. The work being undertaken across our hospitals reflects the critical importance we place on privacy and dignity as factors influencing the patients’ perception of the quality of care that they receive. The eradication of mixed sex accommodation is crucial to improving patients’ experience, and will continue to be a priority for 2010 and beyond.”

Marian Carroll, Director of Nursing

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Malnutrition can be both a cause and consequence of ill health. It is most common in older people and those with long term medical conditions.

The consequences of malnutrition include vulnerability to infection, delayed wound healing, impaired function of heart and lungs, decreased muscle strength and mood depression. Surgical patients who have malnutrition have more postoperative complications and a greater risk of death than well nourished patients. If dietary intake is extremely poor or an inability to eat persists for weeks, the resulting malnutrition can be life threatening in itself.

The need for nutritional support is essential when patients are unable to feed themselves or experience swallowing difficulties or intestinal failure. Unfortunately providing nutritional support in such cases is not without risk and decisions on how to feed are complex. Oral supplementation in patients with swallowing difficulties can cause pneumonia. Enteral tube feeding and parenteral (intra venous) nutrition can cause gastro intestinal problems, infection, metabolic upset and trauma. These risks must be discussed if possible with the patient and family.

Service improvementsNutrition


NICE Nutrition Support in Adults – Clinical Guideline 32

Best practice guidance recommended by the National Institute for Clinical Excellence (NICE) has been implemented across the Trust. A Nutrition Steering Group, chaired by the Trust’s medical director, has been established and an operational sub group has developed an action plan to implement the Trust’s Nutrition Strategy. The strategy aims to promote nutrition awareness and develop and oversee a programme of audit relating to nutrition practice and compliance with Trust policies and procedures.

Progress to date

Best practice guidelines relating to nutrition status assessment, enteral tube feeding, parenteral feeding, refeeding syndrome and management of patients with dysphagia (swallowing problems) have been produced.

Nursing quality indicators relating to nutritional assessment of all patients have been developed and are monitored and reported monthly. Meal time volunteers have been recruited to help to feed elderly and disabled patients and protected mealtimes are in place. Nurses have been trained to carry out swallowing assessments on patients with dysphagia so that the risks of aspiration pneumonia or delayed feeding are minimised.

Poor nutritional care can threaten the safety of patients in acute hospitals. Staff need to be aware of the risks and the action they can take to improve care. The Trust is committed to delivering the ‘10 key characteristics of good nutritional care’ as recommended by the Royal College of Nursing and the National Patient Safety Agency (NPSA).

Mission Nutrition

The Trust’s department of Nutrition and Dietetics have recently launched ‘Mission Nutrition’, a rolling programme of internal education and training for the multidisciplinary team, including ward staff, doctors, nurses, healthcare assistants and housekeepers across the Trust.

Following training, nursing staff should be:

• able to undertake MUST screening (Malnutrition Universal Screening Tool) accurately.

• select appropriate care plans and deliver nutritional care actions.

• be aware of the procedure for ordering nutritional supplements and enteral feed.

Patients admitted to the Trust are screened to identify those who are malnourished or at risk of becoming malnourished and nutritional support plans are put in place as required. Services are designed to ensure that patients have access to food and beverages at all times and food choices designed to meet medical, religious, cultural or personal preference are available.

Services are designed to ensure that patients have access to food and beverages at all times and food choices designed to meet medical, religious, cultural or personal preference are available.

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The Cytology department at The Royal Oldham Hospital provides cytology services to the Trust’s four main hospitals and screening departments at local primary care trusts in Oldham, Rochdale and Bury.

In 2008 the department was successful in its application to become one of ten national pilot sites to use the adoption of ‘Lean Management’ practices to ensure that laboratory test results were received by women within the national 14 day standard deadline for cervical cytology following routine cervical smear tests.

Cytology is the study of cells. Smear tests are taken at GP surgeries, tested at the Trust’s Cytology department and then the results of the samples are sent to women via a letter in the post. Last year the Trust reported approximately 45,000 samples.

Baseline data was collected for the pathway as a whole and for individual elements of the pathway. The average length of time that a specimen took to being reported was between 27-29 days. There was significant variation in the time taken to report specimens. This variation suggested a poorly controlled process. The Trust is now able to achieve an average total turnaround time of 7 days, with 41% of cases being reported within seven days and 99.4% reported within the Department of Health’s 14 day target.

In November 2009, new specialist services for trauma and orthopaedic patients were established at The Royal Oldham Hospital and Rochdale Infirmary. This was the second major service change to be delivered through the Healthy Futures modernisation and improvement programme.

Anyone from the Rochdale borough who requires an operation on badly broken bones will be referred from Rochdale Infirmary’s emergency department to a specialist emergency surgery team based at The Royal Oldham Hospital.

Oldham patients who require day surgery for orthopaedic complaints, such as knee and shoulder conditions, will see their consultant at The Royal Oldham Hospital, but may have their planned operation at Rochdale Infirmary. All follow-ups for these patients will be at their local hospital, but some patients who have had emergency surgery may be asked to see the surgeon who operated on them, which could involve travel between Oldham and Rochdale, or vice versa.

The reshaped service delivery will see equal numbers of patients moving between Rochdale and Oldham to receive the trauma and orthopaedic treatment they need.

The plans to reshape and improve the way specialist trauma and orthopaedic services are delivered have been clinically driven by surgeons and other NHS specialists to concentrate key clinical expertise, equipment and other resources into the two hospitals to create a more focused approach in the quality and delivery of patient care whilst driving improvements in the efficiency of our services.

As part of the new service, the Trust has introduced two trauma co-ordinators, a new role in the Trust, who play an essential role in the care of patients both pre and post-operatively and in conjunction with the medical team ensure that trauma sessions and acute beds are fully and appropriately used.

Plans for the future include developing specialist foot and ankle services at Rochdale Infirmary.

Cervical cytology screening Trauma and orthopaedic services


In June 2009, new paediatric services opened at North Manchester General Hospital following the planned closure of Booth Hall Children’s Hospital in Blackley.

The new services are specially designed to meet the needs of children and young people, aged 0-16, and are provided in an appropriate child-friendly environment. These include a new children’s A&E department and Emergency and Observation and Assessment Unit, two paediatric inpatient wards (one medical, one surgical), a paediatric outpatient department, as well as a dedicated paediatric radiology department.

As part of the new services, the Trust has over the last year recruited 10 new consultant paediatricians and 82 nurses. Of these, 63 nurses have transferred from Booth Hall, meaning familiar faces for children who attend the service regularly. Other staff have also been recruited as part of the new service, including radiographers, secretaries and porters.

In June 2010, the Trust opened its new purpose-built children’s, neonatal and maternity facilities at North Manchester General Hospital.

The new building will complete around £35 million worth of investment at North Manchester General Hospital, delivered as part of Making it Better, the Greater Manchester-wide programme of improvements to services for pregnant women, children and babies. It will include state-of the art equipment and allow the co-location of maternity, neonatal and paediatric services.

The new paediatric services at North Manchester are expected to see and treat approximately 21,000 emergency attendances, 6,000 inpatients and 2,000 day case patients annually. When the service is fully open in 2011 there will be 20 paediatric beds (of which 1 will be high dependency), 6 day case beds and 6 Observation and Assessment beds. An additional service highlight was the introduction of ‘Dr Loo Loo’ a clown doctor provided by the Theodora Children’s Trust. Dr Loo Loo attends the hospital for 4 hours every Thursday, and visits all of the paediatric areas. This service is funded by the charity MedEquip4Kids. Dr Loo Loo provides a positive and fun atmosphere for the children who are in hospital.

As the services develop and complete, quality of care provided at these new services will be monitored closely in line with the three indicators of quality chosen by the Trust Board; safety, effectiveness and patient experience.

Paediatric services at North Manchester General Hospital

In June 2010, the Trust opened its new £32m purpose-built children’s, neonatal and maternity facilities at North Manchester General Hospital.

Charlie Wilkinson, ward manager with the Lord Mayor of Manchester, Councillor Mark Hackett

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Clinical audit is a way of improving the quality of care we provide to patients. The definition of clinical audit endorsed by the National Institute for Clinical Excellence is as follows:

“Clinical audit is a quality improvement process that seeks to improve patient care and outcomes through the systematic review of care against explicit criteria and the implementation of change. Aspects of the structure, processes and outcomes of care are selected and systematically evaluated against explicit criteria. Where indicated, changes are implemented at an individual, team or service level and further monitoring is used to confirm improvement in healthcare delivery.”

National Clinical Audit

Involvement in the National Clinical Audit Programme is high on the Trust’s clinical audit agenda and we aim to participate in all applicable national clinical audits which form part of the National Clinical Audit and Patient Outcomes Programme.

During 2009/10, 28 national clinical audits and 5 national confidential enquiries covered NHS services that the Trust provides.

The Trust participated in all of the national clinical audits and national confidential enquiries in which it was eligible to participate.

The national clinical audits and national confidential enquiries the Trust was eligible to participate in during 2009/10 are as follows:

National Audit Trust Participation

Continuous audit of all patients

NNAP: neonatal care Yes

NDA: National Diabetes Audit Yes

ICNARC CMPD: adult critical care units Yes

National Elective Surgery PROMs: four operations Yes

NIAP: Adult cardiac interventions; coronary angioplasty Yes

NJR: hip and knee replacements Yes

Renal Registry: renal replacement therapy Yes

NLCA: lung cancer Yes

NBOCAP: bowel cancer Yes

DAHNO: head and neck cancer Yes

MINAP: AMI & other ACS Yes

Heart Failure Audit Yes

NHFD: hip fracture Yes at FGH

TARN: severe trauma Yes

NHS Blood & Transplant: potential donor audit Yes

VSGBI VSD Vascular Society Database Yes

Participation in clinical audit

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National Audit Trust Participation

Audit requiring intermittent samples of patients

National Kidney Care Audit Yes

National Sentinel Stroke Audit Yes

National Audit of Dementia Yes

National Falls and Bone Health Audit Yes

National Comparative Audit of Blood Transfusion: changing topics Yes

British Thoracic Society: respiratory diseases Yes

College of Emergency Medicine: pain in children Yes

College of Emergency Medicine: asthma Yes

College of Emergency Medicine: fractured neck of femur Yes

One-off audits; all patients

National Mastectomy and Breast Reconstruction Audit Yes

National Oesophago-gastro Cancer Audit Yes

RCP Continence Care Audit Yes

Other national audits not contained within the list provided by the National Clinical Audit Advisory Group (NCAAG).

Trust Participation

National Re-Audit of the Care of the Dying Pathway 08/09 Yes

National Pain Audit Yes

National Audit of Cardiac Rehabilitation Yes

National confidential enquiry Trust Participation

National Confidential Enquiry into Patient Outcome and Death (NCEPOD)

Deaths in Acute Hospitals: Caring to the End?

Yes

Acute Kidney Injury: Adding Insult to Injury Yes

Parenteral Nutrition Yes

Elective & Emergency Surgery in the Elderly Yes

Centre for Maternal and Child Enquiries (CMACE) Yes


The national clinical audit and national confidential enquiries that the Trust participated in, and for which data collection was completed during 2009/10, are listed below alongside the number of cases submitted to each audit or enquiry as a percentage of the number of registered cases required by the terms of that audit or enquiry.

Project title % of required cases submitted

College of Emergency Medicine: pain in children All sites - 100%

College of Emergency Medicine: asthma All sites - 100%

College of Emergency Medicine: fractured neck of femur All sites - 100%

RCP Continence Care Audit

100% Organisational questionnaires returned

NMGH 68%

FGH 100%

TROH 53%

RI 57%

National Re-Audit of the Care of the Dying Pathway 08/09

NMGH 100%

FGH 100%

TROH 100%

RI 57%

National Mastectomy and Breast Reconstruction Audit All sites - 100%

National Oesophago-gastro Cancer Audit All sites - 90%

NCEPOD Acute Kidney Injury: Adding Insult to Injury

48% Clinical questionnaires returned

100% Case-notes returned

100% Organisational questionnaires returned

NCEPOD Deaths in Acute Hospitals: Caring to the End? Awaiting info from NCEPOD

NCEPOD Parenteral Nutrition Awaiting info from NCEPOD

NCEPOD Elective & Emergency Surgery in the Elderly Awaiting info from NCEPOD

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The reports of a number of national clinical audits were reviewed by the Trust in 2009/10. Below are examples of actions taken to improve the quality of care provided to our patients in response to several of these national audits. Further information on the Trust’s response to National Clinical Audit findings will be detailed in the Trust’s 2009/10 Clinical Audit Annual Report.

National Sentinel Stroke Audit Changes made across the Trust’s hospitals include: North Manchester General Hospital:Improvements have been made in the number of patients weighed during admission. This has increased from 84% to 100%. The Trust’s occupational therapy lead and occupational therapist leads from across the Trust’s local health area have agreed a common set of documentation. This has now been agreed and is being rolled out. The Royal Oldham Hospital:A stroke bleep system, held by a senior nurse on the stroke unit at all times, has been established and is operational on three sites. The Trust has also created stroke assessment areas on each of the three sites to ensure more timely access to the acute units. Clear lines of communication between the stroke unit, emergency admissions unit and the bed managers are now in place. This will assist in meeting the requirement that 70% of patients spend at least 90% of their stay on a stroke unit. Fairfield General Hospital & Rochdale Infirmary:A direct admissions policy at core times now operates ensuring patients are accessing specialist stroke care at the earliest possible opportunity. Work has been carried out to improve the percentage of patients for which rehabilitation goals have been agreed by a multi-disciplinary team.

Older People National Audit of the Organisation of Services Provided to Older People for Falls Prevention and Bone Health 2008/09 Following this audit and in response to the NPSA guidance, site based inpatient falls groups have been set up across the Trust reporting to a Trust-wide Falls Group. The groups are implementing the following actions:

• A Trust-wide Falls Policy • Ward specific falls risk assessments are being piloted • Falls prevention equipment is being trialled • The use of falls and bedrail risk assessments are being audited throughout the Trust • The development of patient stories in relation to multiple fallers • Better use of incident data to raise awareness and identify areas of concern • Slippers Audit and trial of new product • Local validation of falls assessment tool

Local clinical audit

The Trust undertakes a programme of local clinical audit activity.

The reports of approximately 150-200 local clinical audits were reviewed by the organisation in 2009/10. Actions planned and undertaken by the organisation in response to the audit findings will be detailed in the Trust’s 2009/10 Clinical Audit Annual Report.


The Trust is committed to research as a driver for improving the quality of care and patient experience.

The number of patients receiving NHS services provided or sub-contracted by the Trust in 2009/10 that were recruited to participate in National Institute for Health Research (NIHR) studies approved by a research ethics committee was 2460. This figure is three times more patients than were recruited by the Trust into NIHR studies in the previous year. The Trust recruited more patients into NIHR studies than any other NHS Trust within Greater Manchester. This increasing level of participation in clinical research demonstrates the Trust’s commitment to improving the quality of care we offer and to making our contribution to wider health improvement.

Cancer research performance at the Trust has seen considerable success this year in exceeding all of the research targets set by the National Cancer Research Network (NCRN). Fifteen per cent of the Trust’s cancer/pre-malignant patients participated in a NIHR study. This is the first year that the Trust has achieved its NCRN cancer targets and highlights the Trust’s commitment to supporting high quality cancer studies, helping to improve patient outcomes and experience across the NHS.

The Trust was involved in 76 NIHR clinical research studies. Of these, the NIHR supported 66 studies through its research networks. The Trust used national systems to manage the studies in proportion to risk. Of those studies given permission to start through the NIHR Coordinated System for gaining NHS Permission (NIHR CSP), the average (median) approval time was 84 days; this is better than the national average.

The Trust also has excellent links with industry. In 2009/10 the Trust opened a number of clinical trials that involved collaboration with nine different pharmaceutical companies.

The Trust’s infectious diseases department and diabetes department have particularly strong links with industry, ensuring that patients referred to these departments have access to some of the latest medicines available.

Research and development

The Trust also has excellent links with industry. In 2009/10 the Trust opened a number of clinical trials that involved collaboration with nine different pharmaceutical companies.

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Use of the Commissioning for Quality and Improvement Payment Framework (CQUINs)

‘High Quality Care For All’ included a commitment to make a proportion of providers’ income conditional on quality and innovation, through the Commissioning for Quality and Innovation (CQUIN) payment framework. A proportion of the Trust’s contracted income in 2009/2010 was conditional on achieving quality improvement and innovation goals agreed between the provider and its commissioners (local primary care trusts) through the CQUIN payment framework.

The CQUIN framework forms one part of the overall approach on quality, which includes: defining and measuring quality, publishing information, recognising and rewarding quality, improving quality, safeguarding quality and staying ahead. It is intended to support and reinforce other elements of the approach on quality and existing work in the NHS by embedding the focus on improved quality of care in commissioning and contract discussions.

CQUINs encourage and reward organisations that focus on quality improvement and innovation in commissioning discussions to stretch ourselves, improve quality for patients and innovate. CQUINs build on, but not replace, existing initiatives such as the Advancing Quality (AQ) programme.

In the 2009/2010 Contract the Trust agreed to 13 CQUIN schemes, from reducing falls, pressure sores and medication errors to reducing unnecessary follow ups and patient waits for outpatient medication dispensing.

Two of the larger CQUINs involved increasing the percentage of women who have seen a midwife or a maternity healthcare professional for assessment by 12 completed weeks of pregnancy and establishing a range of best practice indicators for all patients attending following a stroke.

As a result of participation in the CQUIN schemes the Trust has made some significant improvements to both patient experience and outcomes. This includes achieving an overall average of 86% in meeting key performance indicators for our Stroke services and securing £615,000 in CQUIN payments, reducing outpatient waits for pharmacy prescriptions, reducing inpatient falls and reducing maternity assessments.

Participation in CQUINs


The Patient Advice and Liaison Service (PALS) provided advice and support and dealt with 2,361 cases during 2009/10 (a 12% increase). A total of 699 formal complaints were received (a 5% reduction on the previous year). 86% of complaints were responded to within 25 working days.

Key issues raised through the complaints and PALS services related to:

• Communication and provision of information

• Clinical treatment and diagnosis

• Nursing care

• Appointments, delay and cancellations

• Attitude of staff

An updated complaints procedure was introduced during the year with a renewed emphasis on learning from mistakes and putting things right. The complaints department also carried out some benchmarking of the number of complaints and the issues raised against other Trusts. Lessons learned arising from complaints is a critical part of complaints management. The complaints team audited the way in which ‘lessons learned’ and actions taken as a direct consequence of a complaint were recorded and developed a system to record this information electronically so that future data can be analysed and reported in a more meaningful way.

Advice, Liaison and Complaints

...rated the Trust as Good in 2008/09 for the Quality of Services ... and Good for Financial Management

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Good quality information underpins the Trust’s effective delivery of patient care and is essential if improvements in quality of care are to be made.

Improving data quality, which includes the quality of ethnicity and other equality data, will improve patient care and improve value for money.

NHS Number and General Medical Practice Code Validity

The Trust submitted records between October and December 2009 to the Secondary Uses Service for inclusion in the Hospital Episode Statistics which are included in the latest published data. The percentage of records in the published data which included patients’ valid NHS number was 98.7% for admitted patient care; 99.6% for out patient care and 93.1% for accident and emergency care.

The percentage of records in the published data, which included patients’ valid General Medical Practice Code, was 99.8% for admitted patient care; 99.8% for outpatient care and 99.9% for accident and emergency care.

The Trust’s score for October 2009 to December 2009 for Information Quality and Records Management, assessed using the Information Governance Toolkit was at attainment level 3 (highest level of achievement).

Clinical coding error rate

The Trust was subject to the Payment by Results clinical coding audit during the reporting period July 2009 to September 2009 by the Audit Commission and the errors rates reported in the latest published audit (unconfirmed) for that period for diagnosis and treatment coding (clinical Coding) were as follows:

General Medicine (100 records audited)

Primary Diagnosis 12%

Secondary Diagnosis 4%

Primary Procedure 0%

Secondary Procedure 0%

ENT (100 records audited)





Chapter JA - Breast procedures (70 records audited)





FZ13B - General Abdominal disorders without complications (30 records audited)





These results highlighted an inaccuracy in the primary diagnosis coding of patients with Ascites. This has now been addressed through a programme of training workshops for all clinical coders.

Data Quality


Care Quality Commission Statement

The Care Quality Commission rated the Trust as Good in 2008/09 for the Quality of Services (an improvement on the previous year) and Good for Financial Management (the same as the previous year). In the new registration scheme introduced for 2010/11 the Trust was successfully registered without conditions.

During the year, the Care Quality Commission uses national surveys to find out about the experience of patients when receiving care and treatment from healthcare organisations. Between July and October 2009, a questionnaire was sent to patients who had recently attended an outpatient department appointment for each trust in England. Responses were received from 446 Trust patients. The survey found, in general, that the quality services provided by the Trust were comparable with other Trusts.

The CQC also carried out an unannounced inspection on cleanliness. It found evidence that the Trust had failed to use effective arrangements for the appropriate decontamination of instruments and other equipment, but found that in 14 other areas there were no concerns.

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The JHOSC commend the introductory statement that the patient experience must be at the heart of everything the Trust does, in order to achieve the mission statement.

The timing of this report (dictated by the Care Quality Commission) has made it extremely difficult for the JHOSC to comment. Following the local elections, all four councils are in the process of appointing their Members to the JHOSC for the municipal year 2010/11. Consequently, consultation with Members about the content of the commentary has been extremely difficult. Nevertheless, the JHOSC has decided to comment on the areas of the Quality Account that it has scrutinised.

The JHOSC is pleased to see both efforts to reduce Healthcare Acquired Infections (HAIs)and mortality rates as priorities for improvement. The reduction in HAIs is to be commended but the JHOSC acknowledges the challenging targets for the future.

The JHOSC is pleased to see the improvements in stroke services and the action being taken to improve discharge from hospital after a stroke. However, as recommended in its review of Stroke Services, published in April 2009, the JHOSC would still wish to see equity in the provision of treatment and care of stroke patients across the Trust.

The JHOSC commends the productive ward initiative but, as reported in its review of Hospital Nutrition, published in April 2010, the JHOSC would emphasise the importance of using the freed time appropriately to improve patient care and the patient experience.

The JHOSC were impressed by the real time patient experience capture and looks forward to seeing the results and the use made by the Trust of the information gathered from patients.

The JHOSC is pleased that the Trust is accredited as a quality provider of health and social care information by the Department of Health’s Information Standard. However, the Trust has accepted that information given on discharge after stroke is poor and the JHOSC feels that it is important that all patients receive high quality information in an appropriate way.

The JHOSC is pleased to see nutrition as one of the service improvements in the Quality Accounts and hopes that the recommendations made in its review of hospital nutrition , published in April 2010, will be included in this service improvement.

Quality Accounts give organisations the opportunity to work with and report back to staff, patients and the public on the issues that really matter to local people and local partner organisations. In accordance with the

Department of Health guidance, the Trust has shared these Quality Accounts 2009/10 with a range of stakeholders for an opportunity to comment.

NHS Oldham, as Lead Commissioner for the Pennine Acute Hospitals NHS Trust, welcomes this first publication of the Quality Account. This statement has been prepared following receipt of responses to the Quality account from the Associate Commissioners (through their nominated Quality Leads) for the contract. NHS Oldham agrees that the data provided and issues described within the Quality Account is an accurate representation of the quality intelligence reported through

the Contract Management Board. Within the report Pennine Acute Hospital’s Trust clearly identifies their achievements to date, but also areas within their service delivery requiring improvement. NHS Oldham and the associate commissioners to the contract are committed to supporting Pennine Acute Hospital’s Trust in achieving improvement in the areas identified within the Quality Account through existing contract mechanisms and collaborative working.

Joint Health Overview and Scrutiny Committee commentary

Comments received on the Quality Accounts 2009/10

Lead Commissioner commentary


Conclusion to the Quality Accounts

This is the first Quality Accounts report produced by the Trust. It is now a requirement of all providers of NHS services in efforts to strengthen and maintain the focus on quality of care for patients.

During 2009/10 the Trust has continued to focus its attention on improving patient safety, clinical effectiveness and the patient experience. Good progress has been made across all areas of quality.

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The Trust’s mortality rate has seen a year on year improvement since 2005 and a 5% target reduction has been set for the coming year. The Trust has also successfully reduced the number of MRSA bacteraemia from 105 in 2006/07 to 36 (20 post-48 hours, 16 pre-48 hours) in 2009/10 and will continue to seek a further reduction in 2010/11 and beyond.

In efforts to improve its own target for pressure sore reduction and learning from the past year, the Trust has joined a North West Improvement Collaborative to ensure progress is made. The Trust has been participating in the North West Advancing Quality Programme since October 2008. For the first time the programme sets out an assessment criteria for comparing quality of care with all other trusts in the region. The Trust was ranked 5th out of the 23 Trusts involved in the programme for patients with pneumonia. The Trust is beginning to see improvements across all areas but will need to ensure similar progress is made in the other conditions included in the programme.

During 2009/10 the Trust has embarked upon a number of programmes to collate and improve the patient’s experience and is particularly proud of its work in developing a Carers’ Strategy and Carers’ Charters for staff and patient carers.

The Quality Accounts report has highlighted a number of service improvements that have been made during the year, most notably the development of new children’s services at North Manchester General Hospital, the productive ward initiative for realising more nursing time for patient care, and the reduction in the waiting times for results of cervical cytology screening.

The report also details the considerable participation of all our clinical services in National Clinical Audit Programmes enabling us to compare our progress nationally. The Trust is committed to research as a driver for improving the quality of care and the patient experience and this year has exceeded all of the research targets set by the National Cancer Research Network.

The Care Quality Commission rated the Trust as Good in 2008/09 and under the new registration scheme introduced for 2010/11 the Trust was successfully registered without conditions.

The Trust’s mission statement is: “to provide the very best care to each patient on every occasion”. To achieve this, quality and the patient experience must be at the heart of everything we do.

Patient safety and quality continue to be the Trust’s priority and as such are reflected in the objectives the Board has set the organisation for the coming year.

Pers

on

al D

ata Protecting

personal data The Trust regards information security as a very high priority and has a series of safeguards in place.

During 2009-10, the following incidents were reported which involved the loss of potentially-identifiable personal data.

After each incident, processes were reviewed and action taken as required.

Summary of serious untoward incidents involving personal data as reported to the Information Commissioner in 2009 - 10

Date of Incident (month)

Nature of incident

Nature of data involved

Number of people

potentially affected

Notification steps

Nil

Summary of other personal data related incidents in 2009 - 10

Category Nature of Incident Total

ILoss of inadequately protected electronic equipment, devices or paper documents from secured NHS premises

8

IILoss of inadequately protected electronic equipment, devices or paper documents from outside secured NHS premises

6

IIIInsecure disposal of inadequately protected electronic equipment, devices or paper documents

4

IV Unauthorised disclosure 15

V Other 2


The Trust is committed to supporting the NHS carbon reduction and sustainable development agenda and in reducing the Trust’s carbon footprint. Progress has been made during the year in realising these objectives, including:

• working in partnership with the Carbon Trust and introducing automatic lighting controls and variable speed controls for ventilation fans and electric motors to improve energy efficiency and reduce electricity consumption.

• adopting the new BREEAM Healthcare Standard. BREEAM is an environmental assessment method for buildings and sets the standard for best practice in sustainable design for buildings and environmental performance.

• developing a travel and access strategy for each hospital as a means of improving the efficiency of how people travel to and around particular locations. Sustainable travel plans are being developed to include measures to promote cycle purchase and increase walking and cycling which will make for healthy living and reduced emissions.

• reducing the quantity of waste we send to landfill in 2009/10. All electrical equipment, scrap metal and confidential waste is now recycled. All clinical waste from the Trust is incinerated, with the heat produced being recovered and used in place of fossil fuel at The Royal Oldham Hospital.

• Establishing in partnership with national procurement agencies, a policy of sustainable procurement. All contracts for products used by the Trust must comply with sustainable standards. This includes minimising packaging, energy efficiency, and using transport which is as efficient as possible.

Looking forward, in 2010/11 the Trust will publish a sustainable development and carbon reduction strategy to help ensure the Trust meets the targets for reducing carbon emissions in line with the NHS Carbon Reduction Strategy for England.

The Trust has well developed and robust plans in place for dealing with any emergencies and major incidents that may arise, including arrangements to manage a pandemic. Although the swine flu outbreak during the summer of 2009 claimed several lives across the UK and put pressure on some intensive care services locally, thankfully the Trust’s extensive plans did not need to be put into effect. Elements of the planning,

particularly relating to staffing of services, did come into their own during the short but unusually wintry spell at the start of 2010. Major incident planning continues within the Trust and in partnership with other service providers.

Sustainability

Emergency Preparedness


Valuing people

The Trust is committed to engaging with and respecting the differences and needs of our staff and the patients we serve.

NHS Constitution The Trust is fully committed in taking account of the rights and pledges of staff and patients set out in the NHS Constitution. Published in January 2009, the NHS Constitution gives patients the legal rights to access NHS services; drugs and treatments approved by NICE; choice about where they receive their care; and to be treated with dignity and respect. The Constitution also sets out clear expectations about the behaviours and values for all organisations providing NHS care.

As well as patients, the Constitution also ensures that the NHS provides a high quality working environment for staff. It brings together their legal rights, and pledges to provide staff with rewarding jobs that make a difference to patients and communities, support and opportunities to maintain their own health and well-being and the opportunity to give their view on decisions that affect them and the services they provide.


Equality and diversity

• The Single Equality Scheme and Action Plan review has taken place with consultation events held between November 2009 to January 2010 across all sites to enable staff and the public to become more involved in the design of the scheme and resulting actions. A robust action plan has now been developed incorporating all feedback which will allow the Trust to meet its equality commitments for the next 3 years.

• The Trust published a Carers Strategy in December 2009, developed in partnership with local councils, primary care trusts, carers’ centres, service users and carers. The strategy outlines the Trust’s commitment to supporting and working in partnership with carers. A staff charter and a patient charter have also been developed to support the strategy.

• Development of staff support networks for black and minority ethnic communities, lesbian, gay, bisexual and disabled people continues which will help the Trust understand staff’s experience and the needs of services. A staff carer’s network was also launched to support staff carers, meeting monthly across sites. Local carers networks are providing guest speakers to ensure information, advice and support is available.

• The Trust held an Equality Conference in 2009 with the theme of disability, ‘breaking down disabling barriers’. Hosting this event allowed the Trust to demonstrate that supporting and promoting equality, diversity and human rights are key attributes of the organisation. The conference aim was to ensure that disabled people are recognised and included in the opportunities offered by the Trust and that staff from this and other organisations develop a better understanding of the needs of disabled people.

• Bullying and Harassment advisers have been introduced in the Trust this year. These members of staff support staff and enable resolution of any issues. The advisers are across all sites and all levels of the organisation, they have undertaken training to carry out the role, and it is an extension to their normal job.

...and pledgesto provide staff with rewarding jobs that make a difference to patients and communities...

2009/10 saw a further reduction in the Trust’s percentage time lost due to sickness absence. The Trust had set a target of 5.22% and achieved 4.97%. The Trust further aims to reduce the sickness absence rate by 0.25% in 2010/11.

Staff engagement

The Trust has several forums set up to inform and consult with staff representatives. These include the Partnership Forum, Central Joint Negotiating Committee and Joint Local Negotiating Committee. In 2009/10 a proposal was put to the forums that the existing employee relations framework need to be looked at to ensure it was fit for purpose as the Trust moves forward to become an NHS foundation trust. This proposal has been accepted by staff side colleagues on the Central Joint Negotiating Committee and work will begin in May 2010 to start the review process.

The two large service reorganisation programmes: Healthy Futures and Making it Better require the Trust to consult with the majority of its 10,000 employees on a 1:1 basis between 2009 and 2012. This has required the setting up of a consistent system to ensure that timely and meaningful consultation occurs. This system is now in place and has been used as a template for other service reconfigurations outside the above mentioned programmes.

The Trust has developed an Organsational Development Strategy to improve staff engagement. Early work being taken forward include a leadership programme for clinical leaders led by the ‘Advisory Board Academies’ and the launch of a Pennine Annual Staff Awards event to recognise staff who have demonstrated excellence in their work.

The Trust’s most important asset is its people and it is committed to providing learning and development to all staff. The Trust continues to provide a high standard of continuing professional development, lifelong learning and mandatory training. A total of 53,975 episodes of learning activities were provided in-house during 2009/10.

The Trust achieved the highest number of Apprenticeships within the NHS in the north west. It has also worked in partnership with local job centres and colleges to develop pre-employment programmes to enable our local community to gain access to employment.

Working Time Directive

The Trust met the 2009 European Working Time Directive compliance targets. To ensure the ongoing compliance with targets and reduce the need for locum speciality doctors, the Trust carried out an international recruitment exercise and successfully recruited six specialist doctors to anaesthetics. The Trust has invested in innovative changes to deal with changing demand and move towards consultant delivered care by introducing resident consultant posts in paediatrics and obstetrics and gynaecology.


Sickness absence Learning and development

The Trust’s most important asset is its people and it is committed to providing learning and development to all staff

The results of the 2009 annual NHS Staff Survey were published in April 2010. 850 surveys were randomly circulated to a sample of staff across the Trust and 396 were completed. Our results were compared with other Trusts. The survey found that:

- 74% of staff felt satisfied with the quality of work and patient care they are able to deliver.

- 91% of staff agreed that ‘their role makes a difference to patients or service users’, ‘they felt work pressure’, and ‘they used flexible working options’

- further improvements are needed in some areas, including ‘quality of job design’, ‘feeling valued by work colleagues’ and ‘working in a well structured team environment’.

- The Trust is below average when compared with other trusts on percentage of staff experiencing discrimination at work in last 12 months’, but above average on ‘believing the Trust provides equal opportunities for career progression and promotion.’

Last year, we increased the take up of performance development reviews (PDRs) for staff across the Trust so that 80% of staff had received a PDR during the year. We want to improve this further this year with a target of 90%.

Additional surveys have also been carried out with staff this year, including ‘Healthcare 100’ and surveys on key topics. The surveys have provided more feedback from staff and better information about our staff satisfaction levels. An action plan has been developed to address the issues raised.


Annual staff survey

Fou

nd

atio

n T

rust

During 2009/10 the Trust has been preparing its application to become an NHS foundation trust hospital (FT). NHS foundation trusts are a new type of organisation as part of the Government reform of the NHS. Although they are still firmly part of the NHS, they are more accountable to the local communities they serve rather than to central government. This makes them more responsive to the needs and wishes of local people.

As an NHS Foundation Trust we will have more freedom to work together with you to better understand what you want and need from your local hospitals. NHS Foundation Trusts also have other freedoms such as the ability to use financial surpluses and borrow money to quickly develop new hospital buildings and services that will benefit their local communities. Local patients, public and staff can become members of the Trust and also stand for election as Governors.

By becoming an FT we believe this will help us continue the improvements we have made, provide better and faster services for our patients, their carers and families and local people, and bring better working arrangements and advantages for our staff. Our formal public consultation document called ‘Your Hospitals, Your Choice – Your Voice’, was officially launched on 3 November 2009 and closed on 29 January 2010.

The main difference about Foundation Trusts is that local people and staff can become a member, have a vote and a say in the future of your hospitals. Membership is free. Members can be as involved as much or little as they wish. You may wish just to receive the Trust’s occasional newsletter, or take part in some surveys or focus groups or special events. Some people may be interested in getting involved in working groups or increase their knowledge in specific areas of interest.

It is planned that the Trust will achieve Foundation Trust status in 2011. Support your local hospitals. Become a member. For more information or to register to become an NHS foundation trust member of the Trust visit online at www.pat.nhs.uk/foundationtrust or contact 0161 918 4283 or email [email protected] for a leaflet and membership form.

By becoming an FT we believe this will help us continue the improvements we have made, provide better and faster services for our patients, their carers and families and local people

Looking forward, the Trust has a number of ambitious aspirations in relation to future investment to improve services within our hospitals. There are also a number of trends and factors which are likely to affect the Trust’s future development, performance and position. The key challenges for the Trust for 2010/11 are set out in the Annual Business Plan and include:

• Improving patient safety by reducing infections, falls, venous thromboembolism and mortality;

• Achieving all the national targets including the 18-week referral to treatment target, the 4 hour Emergency Access target and the cancer targets;

• Improving patient dignity by ensuring same sex accommodation is provided, ensuring high standards of cleanliness and reducing inequalities;

• Delivering on carbon reduction and sustainability targets;

• Improving staff satisfaction, and engagement;• Preparing for Foundation Trust status;• Achieving financial targets;• Maintaining an emphasis on delivering a high

quality service particularly in the areas of safety, effectiveness and patient experience and meeting increasing regulation.

The Trust is forecasting breakeven for 2010/11 (before impairment charges). The main financial risk for 2010/11 is the potential increase in activity despite plans and intentions from commissioners to reduce demand. Addressing these issues will require joint working between all local healthcare organisations.

The Trust is planning to invest £44m in developing new women and children’s services at The Royal Oldham Hospital. The plans, which are currently awaiting final approval from the Department of

Health, will expand and improve maternity, children’s and newborn care facilities across the north east of Greater Manchester. The development will involve a major new 4-storey building on the site, the refurbishment of existing wards in the main hospital and will include new delivery rooms, obstetric theatres, a paediatric theatre, more maternity beds and a brand new Level 3 Neonatal Intensive Care Unit (NICU). It will update accommodation to provide the necessary capacity to serve patients that will be transferred from Rochdale Infirmary when the paediatric obstetrics and neonatal services on that site is reshaped. Once complete, The Royal Oldham Hospital will be one of three regional centres providing the highest level of intensive care to the smallest and most vulnerable babies.

The Trust is aware that parts of its building stock are in need of replacement and over the coming years plans will be developed to ensure that this can happen. A substantial proportion of the accommodation on the North Manchester site was built in the 19th century and despite being upgraded on a number of occasions, this accommodation needs replacing. Over the next three to five years we will develop plans in consultation with our Primary Care Trusts to establish how this replacement can take place. Furthermore, some of the estate at The Royal Oldham Hospital also dates back to the 19th century and will require decommissioning over the coming years.

The arrangements through which community based services will be provided in future is likely to change during 2010 or 2011. The Trust would welcome the opportunity for greater integration of acute and community services. Closer integration will allow organisations to support people in their own homes and prevent un-necessary admission to hospital and ensure speedy discharge when admission does become necessary.

Looking Forward


An

nu

al A

cco

un

tsFinancial Overview

a 2009/10

The Trust’s audited annual accounts outline the financial performance of the Trust for 2009/10 and are included, in full, at the end of this chapter. Please note a glossary of terms is included at the end of the accounts for ease of reference. From 2009/10 all public bodies, including the NHS, have prepared their accounts under International Financial Reporting Standards (IFRS).

The Trust has achieved a surplus of £620,000 (before impairment charges) and a deficit of £22,252,000 (after impairment charges) for the year 2009/10.

Operating expenses includes a net impairment charge (relating to the valuation of property, plant and equipment – PPE) of £22,872,000. Prior to 2008/09 NHS trusts (excluding foundation trusts) received income to cover such costs. From 2008/09, impairment charges are not taken into account when measuring NHS Trusts’ financial performance or performance against the breakeven duty (see note 29.1).

The impairment charge to operating expenses comprises four main elements:

• a change in the valuation basis for the Trust’s buildings (effective 1 April 2009) £14,123,000

• a fall in the value of buildings since 1 April 2009 due to prevailing economic conditions £9,149,000

• reversal of a previous impairment charge (£772,000)• falls in value associated with the completion of newly

constructed/enhanced assets £372,000

From 1 April 2009 the Trust has adopted a modern equivalent asset (MEA) valuation method for buildings in line with guidance from the Department of Health/Treasury. Current valuations are based on a “like for like” basis. The impairment charge to operating expenses is the amount by which the total fall in value for a particular asset exceeds the amount of increases in value held in the revaluation reserve from previous years.

In 2009/10, the Trust met all key financial duties:

• Breakeven taking one year with another (excluding impairment charges) (note 29.1 of the accounts)

• Remain within approved external financing limit (note 29.3)• Maintain capital expenditure within approved limits (note

29.4)• Achieve a 3.5% return on capital employed

(note 29.2)• Achieve 95% compliance with Better Payments Practice

Code (note 12.1)


b 2010/11

The Trust is forecasting a surplus of £2,953,000 for 2010/11 before impairment charges and a deficit of £1,862,000 after impairment charges. An impairment charge of £4,815,000 is included in the 2010/11 plan relating to the estimated fall in value of newly constructed assets. Schemes completing during 2010/11 are the Women and Children’s development at North Manchester General Hospital and additional capacity at The Royal Oldham Hospital. Impairment charges are not taken into account when measuring NHS Trusts’ financial performance or performance against the breakeven duty. The forecast surplus is in line with the integrated business plan submitted to the SHA to support the Trust’s Foundation Trust application.

The forecast surplus is after taking into account forecast cost increases (for example pay, non pay, drugs and clinical negligence), changes in income due to proposed disinvestment of services by Primary Care Trusts (PCTs) and the in year efficiency target set by the Department of Health.

The main financial risks for 2010/11 are: the achievement of efficiency savings whilst maintaining or improving quality; reducing costs as PCTs disinvest in services or deflect demand elsewhere; containing local cost pressures and, avoiding contractual financial penalties.

Revenue

Total revenue in 2009/10 amounted to £557,760,000, of which, revenue from patient care activities was £510,794,000 with other operating revenue of £46,966,000. In total, revenue has increased by 8.6% between years. This increase relates to changes in the payment by results (PbR) tariff structure 2.2%, inflationary uplift 1.7%, Booth Hall transfer 1.7%, contracting for quality and innovation (CQUIN) 0.5%, over performance against plan 2.2% and other 0.3%.

The vast majority of revenue comes from Primary Care Trusts – £504,014,000 (90%).

Operating Expenses

Operating expenses (before impairment) amounted to £544,860,000 and the largest element of this is the pay bill for our staff and directors of £368,662,000 (68%). Overall, operating expenses increased by 9.3% between years.

The increase in operating expenses relates to pay/non pay inflation 3.6%, local pressures/developments 3.8%, cost of net growth 3.2%, Booth Hall transfer 1.7% less efficiencies (3.0%).

Other comprehensive income

Other comprehensive income effectively replaces the former “statement of total realised gains and losses” produced prior to the application of IFRS and shows those gains/losses that are not credited or charged to revenue or expenses. The value of impairments charged to the revaluation reserve (against previous upward revaluations) was £78,171,000. Revaluation gains of £3,292,000 were credited to the revaluation reserve.

The total comprehensive income for the year from all sources was a loss of £97,576,000.

In 2009/10 the Trust spent £46,512,000 on buildings, equipment and information technology, as follows :

£000

Womens & Childrens Development 18,749

Additional Wards/capacity, ROH 8,038

Medical and Scientific Equipment 9,773

Information Technology 3,033

Other building & estate schemes 6,919

Capital investment is heavily influenced by the reconfiguration of services over the next two to four years in response to the Healthy Futures and Making It Better consultations. The Womens & Childrens development and additional wards/capacity development are due to be completed in May/June 2010.

Register Of Declared Interests

A register of declared interests is maintained by the Trust and is available for inspection on application to Mr J Saxby, Chief Executive. There are no company directorships held by directors of the Trust with companies who are likely to, or are seeking to, conduct business directly with the Trust.

External Auditors

The Trust’s Auditors are KPMG. The cost of work performed by the auditor in respect of the 2009/10 reporting period was £306,000 relating to audit services and the requirements of the Audit Commission’s Code of Practice, ie the statutory audit and services carried out in relation to the statutory audit eg reports to the Department of Health. A further £16,000 was paid to KPMG for additional services over and above that required by the Code of Practice.

Auditing standards require the Directors to provide the external auditors with representations on certain matters material to their audit opinion. The Directors have confirmed to KPMG such representations as necessary to the best of their knowledge and belief, having made appropriate enquiries of other Directors and officers of the Trust.


Statement Of Comprehensive Income 2009/10

Capital Expenditure 2009/10

The Trust Board is accountable for internal control. As Accountable Officer, the chief executive of the Board has responsibility for maintaining a sound system of internal control that supports the achievement of the organisation’s policies, aims and objectives. The chief executive also has responsibility for safeguarding the public funds and the organisation’s assets for which he is personally responsible, as set out in the Accountable Officer Memorandum.

As a large Acute Trust with a number of constituent stakeholder organisations, various arrangements and agreements are in place through which the Trust’s performance is monitored. These are set out in the full Statement of Internal Control (included with the Annual Accounts) along with an explanation of the purpose of the system of internal control, information on the capacity to handle risk, the risk and control framework and review of effectiveness.

The Trust’s Annual Accounts for 2009/10 is set out on pages 66 to 113. In addition it should be noted that to comply with legislation governing charities, a separate set of Annual Accounts is maintained for funds held on trust. A full set of these accounts is also available on request.

R ChadwickDirector of Finance and IM&TThe Pennine Acute Hospitals NHS TrustHeadquartersNorth Manchester General HospitalDelaunays RoadManchester M8 5RB


Statement On Internal Control


Page No

Main Statements :

Statement of Comprehensive Income 78Statement of Financial Position 79Statement of Changes in Taxpayers Equity 80Statement of Cash Flows 81

Notes to the Accounts :

1 Accounting policies 82 -892 Operating segments 903 Income generation activities 904 Revenue from patient care activities 905 Other operating revenue 916 Revenue 917 Operating expenses 928 Operating leases 939 Employee costs and numbers 9410 Pension costs note 95 - 9611 Retirements due to ill-health 9712 Better payment practice code 9713 Investment revenue 9714 Other gains and losses 9715 Finance costs 9716 Property, plant and equipment/Intangibles 98 - 10017 Impairments 10018 Capital commitments 10119 Inventories 10120 Trade and other receivables 101 - 10221 Cash and cash equivalents 10222 Trade and other payables 10223 Borrowings 10224 Other liabilities 10225 Provisions 10326 Contingencies 10427 Financial risk management 10428 Events after the reporting period 10429 Financial performance targets incl EFL, CRL 10530 Related party transactions 10631 Third party assets 10732 Intra-government and other balances 10733 Losses and special payments 10734 Transition to IFRS 107

Contents


Statement of Directors’ Responsibilities in respect of the AccountsThe directors are required under the National Health Service Act 2006 to prepare accounts for each financial year. The Secretary of State, with the approval of the Treasury, directs that these accounts give a true and fair view of the state of affairs of the Trust and of the income and expenditure, recognised gains and losses and cash flows for the year. In preparing those accounts, directors are required to:

- Apply on a consistent basis accounting policies laid down by the Secretary of State with the approval of the Treasury;

- Make judgements and estimates which are responsible and prudent;

- State whether applicable accounting standards have been followed, subject to any material departures disclosed and explained in the accounts.

The directors are responsible for keeping proper accounting records which disclose with reasonable accuracy at any time the financial position of the Trust and to enable them to ensure that the accounts comply with requirements outlined in the above mentioned direction of the Secretary of State. They are also responsible for safeguarding the assets of the Trust and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.

The directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing the accounts.

By order of the Board


10 June, 2010

R ChadwickDirector of Finance and IM&T

10 June, 2010


Opinion on the financial statements

We have audited the financial statements of The Pennine Acute Hospitals NHS Trust (“the Trust”) for the year ended 31 March 2010 under the Audit Commission Act 1998. The financial statements comprise the Statement of Comprehensive Income, the Statement of Financial Position, the Statement of Changes in Taxpayers’ Equity, the Statement of Cash Flows and the related notes. These financial statements have been prepared in accordance with the accounting policies directed by the Secretary of State with the consent of the Treasury as relevant to the National Health Service set out therein. We have also audited the information in the Remuneration Report that is described as having been audited.

This report is made solely to the Board of the Trust, as a body, in accordance with Section 2 of the Audit Commission Act 1998. Our audit work has been undertaken so that we might state to the Board of the Trust, as a body, those matters we are required to state to them in an auditor’s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Board of the Trust, as a body, for our audit work, for this report or for the opinions we have formed.

Respective responsibilities of Directors and auditors

The directors’ responsibilities for preparing the financial statements in accordance with directions made by the Secretary of State are set out in the Statement of Directors’ Responsibilities.

Our responsibility is to audit the financial statements in accordance with relevant legal and regulatory requirements and International Standards on Auditing (UK and Ireland).

We report to you our opinion as to whether the financial statements give a true and fair view in accordance with the accounting policies directed by the Secretary of State as being relevant to the National Health Service in England. We report whether the financial statements and the part of the Remuneration Report to be audited has been properly prepared in accordance with the accounting policies directed by the Secretary of State as being relevant to the National Health Service in England.

We also report to you whether, in our opinion, the information which comprises the commentary on the financial performance included within the Operational and Financial Review, included in the Annual Report, is consistent with the financial statements.

We review whether the directors’ Statement on Internal Control reflects compliance with the Department of Health’s requirements, set out in ‘Guidance on Completing the Statement on Internal Control 2009/10’ issued in February 2010. We report if it does not meet the requirements specified by the Department of Health or if the statement is misleading or inconsistent with other information we are aware of from our audit of the financial statements. We are not required to consider, nor have we considered, whether the Directors’ Statement on Internal Control covers all risks and controls. Neither are we required to form an opinion on the effectiveness of the Trust’s corporate governance procedures or its risk and control procedures.

We read other information contained in the Annual Report, and consider whether it is consistent with the audited financial statements. This other information comprises the foreword, the unaudited part of the Remuneration Report, the Chairman’s statement and the remaining elements of the Directors’ Report. We consider the implications for our report if we become aware of any apparent misstatements or material inconsistencies with the financial statements. Our responsibilities do not extend to any other information.

Independent auditors’ report to the Board of Directors of The Pennine Acute Hospitals NHS Trust


Basis of audit opinion

We conducted our audit in accordance with the Audit Commission Act 1998, the Code of Audit Practice issued by the Audit Commission and International Standards on Auditing (UK and Ireland) issued by the Auditing Practices Board. An audit includes examination, on a test basis, of evidence relevant to the amounts and disclosures in the financial statements and the part of the Remuneration Report to be audited. It also includes an assessment of the significant estimates and judgments made by the directors in the preparation of the financial statements, and of whether the accounting policies are appropriate to the Trust’s circumstances, consistently applied and adequately disclosed.We planned and performed our audit so as to obtain all the information and explanations which we considered necessary in order to provide us with sufficient evidence to give reasonable assurance that:

• the financial statements are free from material misstatement, whether caused by fraud or other irregularity or error;

• the financial statements and the part of the Remuneration Report to be audited have been properly prepared.

In forming our opinion we also evaluated the overall adequacy of the presentation of information in the financial statements and the part of the Remuneration Report to be audited.

Opinion

In our opinion:

• the financial statements give a true and fair view, in accordance with the accounting policies directed by the Secretary of State as being relevant to the National Health Service in England, of the state of the Trust’s affairs as at 31 March 2010 and of its income and expenditure for the year then ended.

• the part of the Remuneration Report to be audited has been properly prepared in accordance with the accounting policies directed by the Secretary of State as being relevant to the National Health Service in England.

• information which comprises the commentary on the financial performance included within the Directors’ Report included within the Annual Report, is consistent with the financial statements.

Tim Cutler

Senior Statutory Auditorfor and on behalf of KPMG LLP, Statutory Auditor

Chartered AccountantsSt James SquareManchesterM2 6DS

10 June 2010

“The maintenance and integrity of The Pennine Acute Hospitals NHS Trust web site is the responsibility of the directors; the work carried out by the auditors does not involve consideration of these matters and, accordingly, the auditors accept no responsibility for any changes that may have occurred to the financial statements since they where initially presented on the website.”


1. Scope of responsibility

The Board is accountable for internal control. As Accountable Officer, and Chief Executive of this Board, I have responsibility for maintaining a sound system of internal control that supports the achievement of the organisation’s policies, aims and objectives. I also have responsibility for safeguarding the public funds and the organisation’s assets for which I am personally responsible as set out in the Accountable Officer Memorandum.

As a large Acute Trust with a number of constituent stakeholder organisations there are a range of arrangements / agreements in place through which the Trust’s performance is monitored. These include:

i. Executive Director one to one meetings / contact with their counterparts at the Strategic Health Authority.

ii. Performance management of the Trust overseen by the Strategic Health Authority and devolved to Primary Care Trusts through the Performance Assessment Framework and the Organisational Improvement Plan.

iii. Overview and Scrutiny Committees - one for each local authority area and an overarching committee for the Trust.

iv. Membership of the Local Authority Local Strategic Partnerships.

v. Links with the Primary Care Trusts through:-

- the North East Sector Strategic Board comprising of Trust Chairs, Chief Executives, Medical Directors and PEC Chairs.

- monthly one to one meetings between the Chief Executive and PCT Chief Executives

- at Chief Executive level a commissioning forum comprising the Acute Trust and its constituent Primary Care Trusts.

- service level agreements and contracts detailing commissioning requirements in terms of finance, activity and performance indicators.

- fortnightly meetings with each site and relevant PCT to manage emergency access.

In addition I am supported internally by:

• the Risk Management and Clinical Governance Committees, both sub committees of the Trust Board, established as part of the overall assurance framework.

• the Audit Committee and the established arrangements for External and Internal Audit services. Regular reports are received by the Audit Committee who in turn report to the Board.

• the Medical Director who has Board responsibility for clinical risk.

• the Director of Finance who has Board responsibility for financial management and financial risk.

• the Director of Operations who has Board level responsibility for operational risk

• the Governance Director who has operational responsibility for governance and the strategic development and monitoring of the organisation against specific objectives and assessment criteria.

2. The purpose of the system of internal control

The system of internal control is designed to manage risk to a reasonable level rather than to eliminate all risk of failure to achieve policies, aims and objectives; it can therefore only provide reasonable and not absolute assurance of effectiveness. The system of internal control is based on an ongoing process designed to:

• identify and prioritise the risks to the achievement of the organisation’s policies, aims and objectives,

• evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically.

The system of internal control has been in place in The Pennine Acute Hospitals NHS Trust for the whole year ended 31 March 2010 and up to the date of approval of the annual report and accounts.

3. Capacity to handle risk

Board level responsibility and leadership for the risk management process lies with the Chief Executive who is supported by a Governance Director. Risk Co-ordinators and Health & Safety Advisors, based on the four main hospital sites, in turn support the Governance Director. The year 2009/10 has seen continued progress in ensuring that the Trust’s risk

Statement On Internal Control 2009/10The Pennine Acute Hospitals NHS Trust


management process remains fit for purpose. This has included increasing the frequency with which the risk register and assurance framework are reported to the Trust Board from six-monthly to quarterly. During the year significant work was undertaken to review the Trust’s objectives, risk register and assurance framework. The recommendations from this work will be implemented by management during 2010/11.

The Trust was successful in being re-assessed against the NHSLA Risk Management Standards at Level 1 for the general standards and assessed for the first time at Level 1 for the maternity standard. The Trust achieved an indicative Level 3 against the Auditors Local Evaluation assessment for Internal Control. The Trust declared compliance with the Standards for Better Health for the year. The Trust was successfully registered with the Care Quality Commission without conditions.

A standard risk assessment process is used across the Trust and mandatory training is delivered by the Risk Co-ordinators and Health and Safety Advisors on a rolling programme. As part of the Trust’s two-day general induction programme a half-day is dedicated to the Governance Team ensuring that risk management processes are highlighted to all new staff. Governance, Risk Management and Health and Safety training forms part of the mandatory training cycle for all staff in the Trust. The Trust has a single Accident and Incident Reporting Policy and risk management system (Ulysses). All incidents are recorded on to the system. The Trust has been reporting patient safety incidents to the National Patient Safety Agency (NPSA) National Reporting and Learning System (NRLS) on a voluntary basis since June 2005, well in advance of the mandatory system introduced from 1 April 2010. Reports are provided regularly to governance committees at all levels of the organisation and lessons learned and any good practice identified are communicated through the line management structure.

4. The risk and control framework

The risk and control framework is made up of the following key elements:

• The Governance structure outlined above of which risk management is an integral part.

• The Assurance Framework in which risks are linked to the Trust’s Strategic objectives.

• Divisional risk registers which are regularly reviewed at Divisional Governance Committees

• The Standards for Better Health declaration

The Trust’s Risk Management Strategy and Policy are reviewed annually and were assessed as part of the NHSLA Risk Management Standards Level 1 re-assessment in February 2010. Both the Strategy and the Policy are circulated widely throughout the organisation and clearly describe the process for the identification of risks. A single grading process is in place throughout the Trust. Divisions populate their risk registers and risks are escalated to the corporate risk register via the appropriate Executive Director.

The Risk Management Committee regularly reviews the corporate Risk Register and Assurance Framework. Each risk is graded and the controls in place to minimise the risk identified. Where a significant risk remains a risk treatment plan has been identified along with timescales, resource requirements and responsibility for implementation. Each risk then has a source of review, in many cases this is external, and a residual risk rating which the organisation must consider in terms of its acceptability. Should it not be acceptable a further risk treatment plan must be developed.

The Assurance Framework was initially developed during 2003/04. The Assurance Framework is aligned to the Trust’s Corporate Objectives and is cross referenced to the Risk Register. The Assurance Framework brings together all of the evidence required to support the Statement on Internal Control. No gaps in control or assurance measures have been identified. The Internal Audit Opinion confirms that there is significant assurance that during 2009/10 the Assurance Framework fulfilled its role. During 2009/10 a comprehensive review of how the assurance framework links to the risk register and the objectives of the Trust was carried out in order to build on and further enhance and embed the risk registers and assurance framework within the organisation as key management tools.

The key in year risks facing the organisation are:• Achievement of national targets – this is being

managed through robust action plans and with the backing of national support teams;

• Increasing demand – this is being managed through close links, liaison and provision of service level information to primary care trusts.


• Managing the financial demands of the current economic climate – this is being managed through the robust financial planning and monitoring arrangements the Trust has built up over several years.

The key future risk facing the organisation will remain managing the financial demands of the current economic climate – the robust financial and workforce planning to be undertaken, closely linked to work with Primary Care Trusts on demand management, will be the key method of mitigating this risk.

Risks to data security are managed through policies and procedures and mandatory training. Arrangements are in place to protect confidential information, whilst ensuring that information is released to those who have a right to access. These arrangements include continual review of information security is in place with policy changes and improvements recommended within the information governance structure, and a dedicated Information Governance Manager and Information Security Officer. The Information Governance Group oversees the policy arrangements and reports to the Risk Management Committee. There were no serious untoward data security incidents in the year.

Mitigation of risks to equality issues is integrated into core Trust business by undertaking equality impact assessments on all new and reviewed services, business plans, strategies, policies, procedures and functions. This ensures that the principles of equality, diversity and respect for human rights are at the core of our business planning processes and the implementation of service delivery.

Public Stakeholders are involved in the following ways:-

• Annual General Meeting• Public Trust Board meetings• Overview and Scrutiny Committees• Patients Forums

Control measures are in place to ensure that all the organisation’s obligations under equality, diversity and human rights legislation are complied with.

As an employer with staff entitled to membership of the NHS Pension Scheme, control measures are in place to ensure all employer obligations contained within the Scheme regulations are complied with. This includes ensuring that deductions from salary, employers’ contributions and payments in to the Scheme are in accordance with Scheme rules, and that member Pension Scheme records are accurately updated in accordance with the timescales detailed in the Regulations.

The Trust has undertaken risk assessments and Carbon Reduction Delivery Plans are in place in accordance with emergency preparedness and civil contingency requirements, as based on UKCIP 2009 weather projects, to ensure that this organisation’s obligations under the Climate Change Act and the Adaptation Reporting requirements are complied with.

The Trust is fully compliant with the core standards for better health.

5. Review of effectiveness

As Accountable Officer, I have responsibility for reviewing the effectiveness of the system of internal control. My review is informed in a number of ways. The Head of Internal Audit provides me with an opinion on the overall arrangements for gaining assurance through the Assurance Framework and on the controls reviewed as part of the internal audit work. Executive managers within the organisation who have responsibility for the development and maintenance of the system of internal control provide me with assurance. The Assurance Framework itself provides me with evidence that the effectiveness of controls that manage the risks to the organisation achieving its principal objectives have been reviewed. My review is also informed by the following:-

• Standards for Better Health Declarations• Care Quality Commission Registration• NHSLA Risk Management Standards

Assessment• Data Accreditation / Information Governance

Toolkit• External Audit Reports• Reports provided to the Trust Board and its

sub-committees


I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the work of the Trust Board and its sub-committees. The Trust’s Audit Committee continues to work closely with the Risk Management Committee and the Clinical Governance Committee to ensure that the Trust continuously improves its management of risk. The Head of Internal Audit in providing his Opinion Statement provides further assurance of the processes in place. A major review of the arrangements in place was carried out during 2009/10 and the recommendations from this review, which will further strengthen the arrangements, will be implemented during 2010/11.

There have been no significant control issues and my review confirms that The Pennine Acute Hospitals NHS Trust has a generally sound system of internal control that supports the achievement of its policies, aims and objectives.


10 June, 2010


2009/10 2008/09

NOTE £000 £000

Revenue

Revenue from patient care activities 4 510,794 466,479

Other operating revenue 5 46,966 47,052

Total Revenue 557,760 513,531

Operating expenses 7 (567,732) (498,490)

Operating surplus (deficit) (9,972) 15,041

Finance costs:

Investment revenue 13 88 1,015

Other gains and (losses) 14 (128) (101)

Finance costs 15 (727) (215)

Surplus/(deficit) for the financial year (10,739) 15,740

Public dividend capital dividends payable (11,513) (15,404)

Retained surplus/(deficit) for the year (22,252) 336

Retained surplus/(deficit) for the year (before impairment - see note) 620 533

Other comprehensive income

Impairments and reversals (78,171) (52,527)

Gains on revaluations 3,292 1,014

Receipt of donated/government granted assets 113 93

Reclassification adjustments:

- Transfers from donated and government grant reserves (558) (639)

Total comprehensive income for the year (97,576) (51,723) The notes on pages 82 to 107 form part of these accounts.

Note : Operating expenses includes an impairment charge (relating to the valuation of fixed assets) of £197,000 (2008/09) and £22,872,000 (2009/10). Prior to 2008/09 NHS bodies received income to cover such costs. The Department of Health revised the NHS Finance Manual in 2008/09 to the effect that the impact of all impairments will not be taken into account when measuring NHS Trusts’ financial performance or performance against the breakeven duty (see note 29.1). Without this impairment charge, the Trust would have reported a surplus of £533,000 (2008/09) and £620,000 (2009/10).

STATEMENT OF COMPREHENSIVE INCOME FOR THE YEAR ENDED 31 March 2010


31 March 2010

31 March 2009

1 April 2008

NOTE £000 £000 £000

Non-current assets

Property, plant and equipment 16 329,476 399,409 449,364

Intangible assets 16 4,125 4,144 4,578

Trade and other receivables 20 6,302 9,690 8,294

Total non-current assets 339,903 413,243 462,236

Current assets

Inventories 19 8,132 8,365 7,707

Trade and other receivables 20 26,709 14,005 21,354

Cash and cash equivalents 21 6,776 6,769 6,764

41,617 29,139 35,825

Non-current assets held for sale 0 0 0

Total current assets 41,617 29,139 35,825

Total assets 381,520 442,382 498,061

Current liabilities

Trade and other payables 22 (49,035) (40,012) (39,718)

Other liabilities 24 (89) (81) (70)

DH Capital loan (1,168) 0 0

Provisions 25 (2,548) (3,373) (2,703)

Net current assets/(liabilities) (11,223) (14,327) (6,666)

Total assets less current liabilities 328,680 398,916 455,570

Non-current liabilities

DH Capital loan (26,858) 0 0

Provisions 25 (9,935) (9,453) (10,250)

Total assets employed 291,887 389,463 445,320

Financed by taxpayers’ equity:

Public dividend capital 219,281 219,281 223,415

Retained earnings 4,524 23,777 18,237

Revaluation reserve 63,337 140,087 195,209

Donated asset reserve 4,491 5,679 7,559

Government grant reserve 254 639 900

Total Taxpayers’ Equity 291,887 389,463 445,320

STATEMENT OF FINANCIAL POSITION AS AT 31 March 2010


Public dividend capital (PDC)

Retained earnings

Reval’n reserve

Donated asset

reserve

Gov’t grant

reserve

Total

£000 £000 £000 £000 £000 £000

Balance at 31 March 2008

As previously stated 223,415 18,237 195,209 7,559 900 445,320

Prior Period Adjustment 0 0 0 0 0 0

Restated balance 223,415 18,237 195,209 7,559 900 445,320

Changes in taxpayers’ equity for 2008/09

Total Comprehensive Income for the year:

Retained surplus/(deficit) for the year 0 336 0 0 0 336

Transfers between reserves 0 5,204 (4,964) 0 (240) 0

Impairments and reversals 0 0 (51,102) (1,425) 0 (52,527)

Net gain on revaluation of property, plant, equipment

0 0 944 70 0 1,014

Receipt of donated/government granted assets

0 0 0 93 0 93


- transfers from donated/government grant reserve

0 0 0 (618) (21) (639)

PDC repaid in year (4,134) 0 0 0 0 (4,134)

Balance at 31 March 2009 219,281 23,777 140,087 5,679 639 389,463

Changes in taxpayers’ equity for 2009/10

Balance at 1 April 2009 219,281 23,777 140,087 5,679 639 389,463

Total Comprehensive Income for the year

Retained surplus/(deficit) for the year 0 (22,252) 0 0 0 (22,252)

Transfers between reserves 0 2,999 (2,999) 0 0 0

Impairments and reversals 0 0 (77,043) (751) (377) (78,171)

Net gain on revaluation of property, plant, equipment

0 0 3,292 0 0 3,292

Receipt of donated/government granted assets

0 0 0 113 0 113


- transfers from donated/government grant reserve

0 0 0 (550) (8) (558)

Balance at 31 March 2010 219,281 4,524 63,337 4,491 254 291,887

STATEMENT OF CHANGES IN TAXPAYERS’ EQUITY


2009/10 2008/09

NOTE £000 £000

Cash flows from operating activities

Operating surplus/(deficit) (9,972) 15,041

Depreciation and amortisation 18,557 21,852

Impairments and reversals 22,872 197

Transfer from donated asset reserve (550) (618)

Transfer from government grant reserve (8) (21)

Interest paid (504) 0

Dividends paid (11,513) (15,404)

(Increase)/decrease in inventories 233 (658)

(Increase)/decrease in trade and other receivables (9,315) 5,859

(Increase)/decrease in other current assets 0 11

Increase/(decrease) in trade and other payables 4,564 2,451

Increase/(decrease) in other current liabilities 8 0

Increase/(decrease) in provisions 25 (566) (342)

Net cash inflow/(outflow) from operating activities 13,806 28,368

Cash flows from investing activities

Interest received 87 1,109

(Payments) for property, plant and equipment 16 (41,916) (25,423)

Proceeds from disposal of plant, property and equipment 4 85

Net cash inflow/(outflow) from investing activities (41,825) (24,229)

Net cash inflow/(outflow) before financing (28,019) 4,139

Cash flows from financing activities

Public dividend capital repaid 0 (4,134)

Loans received from the DH 28,750 0

Loans repaid to the DH (724) 0

Net cash inflow/(outflow) from financing 28,026 (4,134)

Net increase/(decrease) in cash and cash equivalents 7 5

Cash/cash equivalents at the start of the financial year 6,769 6,764

Cash/cash equivalents at the end of the financial year 21 6,776 6,769

STATEMENT OF CASH FLOWS FOR THE YEAR ENDED 31 March 2010


1.0 Accounting Policies

The Secretary of State for Health has directed that the financial statements of NHS Trusts shall meet the accounting requirements of the NHS Trusts Manual for Accounts, which shall be agreed with HM Treasury. Consequently, the following financial statements have been prepared in accordance with the 2009/10 NHS Trusts Manual for Accounts issued by the Department of Health. The accounting policies contained in that manual follow International Financial Reporting Standards (IFRS) to the extent that they are meaningful and appropriate to the NHS, as determined by HM Treasury, which is advised by the Financial Reporting Advisory Board. Where the NHS Trusts Manual for Accounts permits a choice of accounting policy, the accounting policy which is judged to be most appropriate to the particular circumstances of the Trust for the purpose of giving a true and fair view has been selected. The particular policies adopted by the Trust are described below. They have been applied consistently in dealing with items considered material in relation to the accounts.

1.1 Accounting convention

These accounts have been prepared under the historical cost convention modified to account for the revaluation of property, plant and equipment, intangible assets, inventories and certain financial assets and financial liabilities

1.2 Acquisitions and discontinued operations

Activities are considered to be ‘acquired’ only if they are taken on from outside the public sector. Activities are considered to be ‘discontinued’ only if they cease entirely. They are not considered to be ‘discontinued’ if they transfer from one public sector body to another.

1.3 Critical accounting judgements and key sources of estimation uncertainty

In the application of the Trust’s accounting policies, management is required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. Actual results may differ from

those estimates and the estimates and underlying assumptions are continually reviewed. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period or in the period of the revision and future periods if the revision affects both current and future periods.

Management has applied accounting policies as outlined in note 1.0 according to the NHS Trust Manual for Accounts and has not made any critical judgements about the application of accounting policies that could have a significant effect on the amounts recognised in the financial statements other than the following:

The Trust ordered a replacement MR scanner in February 2010 which will be delivered in April 2010. The Trust has accrued 95% of the value of the scanner at the end of March following discussion with the supplier. The value of this accrual at the 31 March 2010 is £0.75m.

There are no key assumptions, other than asset values and lives (see note 1.7), concerning the future or key sources of estimation uncertainty at the end of the reporting period, that have a significant risk of causing a material adjustment to the carrying amounts of assets and liabilities within the next financial year.

Other less significant areas of judgement and estimation techniques (e.g. depreciation) have been disclosed in the Trust’s accounting policies and in the notes to the financial statements, as required by IFRS.

1.4 Revenue

Revenue in respect of services provided is recognised when, and to the extent that, performance occurs, and is measured at the fair value of the consideration receivable. The main source of revenue for the Trust is from commissioners for healthcare services. Revenue relating to patient care spells that are part-completed at the year end are apportioned across the financial years on the basis of length of stay at the end of the reporting period compared to expected total length of stay. Such revenue was not considered material prior to 2009/10. However, in keeping with practice across the NHS such revenue will be reported and included within income from 2009/10 irrespective of materiality.

NOTES TO THE ACCOUNTS


Where income is received for a specific activity that is to be delivered in the following year, that income is deferred.

The Trust receives income under the NHS Injury Cost Recovery Scheme, designed to reclaim the cost of treating injured individuals to whom personal injury compensation has subsequently been paid e.g. by an insurer. The Trust recognises the income when it receives notification from the Department of Work and Pension’s Compensation Recovery Unit that the individual has lodged a compensation claim. The income is measured at the agreed tariff for the treatments provided to the injured individual, less a provision for unsuccessful compensation claims and doubtful debts.

1.5 Employee Benefits

1.5.1 Short-term employee benefitsSalaries, wages and employment-related payments are recognised in the period in which the service is received from employees. The cost of leave earned but not taken by employees at the end of the period is recognised in the financial statements to the extent that employees are permitted to carry forward leave into the following period.

1.5.2 Retirement benefit costsPast and present employees are covered by the provisions of the NHS Pensions Scheme. The scheme is an unfunded, defined benefit scheme that covers NHS employers, General Practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as if it were a defined contribution scheme: the cost to the NHS body of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period.

For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full amount of the liability for the additional costs is charged to expenditure at the time the Trust commits itself to the retirement, regardless of the method of payment.

Some employees are members of the Local Government Superannuation Scheme, which is

a defined benefit pension scheme. The scheme assets and liabilities attributable to those employees can be identified and are recognised in the Trust’s accounts. The assets are measured at fair value and the liabilities at the present value of the future obligations. The increase in the liability arising from pensionable service earned during the year is recognised within operating expenses. The expected gain during the year from scheme assets is recognised within finance income. The interest cost during the year arising from the unwinding of the discount on the scheme liabilities is recognised within finance costs. Actuarial gains and losses during the year are recognised in the pensions reserve and reported as an item of other comprehensive income.

1.6 Other expenses

Other operating expenses for goods or services are recognised when, and to the extent that, they have been received. They are measured at the fair value of the consideration payable.

1.7 Property, plant and equipment

1.7.1 Recognition Property, plant and equipment is capitalised if:• it is held for use in delivering services or for

administrative purposes;• it is probable that future economic benefits will

flow to, or service potential will be supplied to, the Trust;

• it is expected to be used for more than one financial year;

• the cost of the item can be measured reliably; and• the item has cost of at least £5,000; or• Collectively, a number of items have a cost of at

least £5,000 and individually have a cost of more than £250, where the assets are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are under single managerial control; or

• Items form part of the initial equipping and setting-up cost of a new building, ward or unit, irrespective of their individual or collective cost.

Where a large asset, for example a building, includes a number of components with significantly different asset lives, the components are treated as separate assets and depreciated over their own useful economic lives.


1.7.2 ValuationAll property, plant and equipment are measured initially at cost, representing the cost directly attributable to acquiring or constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner intended by management. All assets are measured subsequently at fair value.

Land and buildings used for the Trust’s services or for administrative purposes are stated in the statement of financial position at their revalued amounts, being the fair value at the date of revaluation less any subsequent accumulated depreciation and impairment losses. Revaluations are performed with sufficient regularity to ensure that carrying amounts are not materially different from those that would be determined at the end of the reporting period. Fair values are determined as follows:• Land and non-specialised buildings – market value

for existing use• Specialised buildings – depreciated replacement cost

Until 31 March 2008, the depreciated replacement cost of specialised buildings has been estimated for an exact replacement of the asset in its present location. HM Treasury has adopted a standard approach to depreciated replacement cost valuations based on modern equivalent assets and, where it would meet the location requirements of the service being provided, an alternative site can be valued. HM Treasury has agreed that NHS trusts must apply these new valuation requirements by 1 April 2010 at the latest. The Trust adopted the new valuation requirements from the 1 April 2009. As a result, building values reduced by £67.5m and this has been accounted for in the 2009/10 accounts.

The value of land and buildings has fallen during 2009/10 since the last full revaluation (land 31 March 2009, buildings 1 April 2009) due to the prevailing economic conditions. The carrying amounts for land and buildings have been revised at the 31 March 2010 in conjunction with the District Valuer. The District Valuer has reviewed and revalued land and provided BCIS (building cost) indices for the Trust to update building values. As a result, land values have reduced by £5m and building values by a further £25.6m.

Properties in the course of construction for service or administration purposes are carried at cost, less

any impairment loss. Cost includes professional fees but not borrowing costs, which are recognised as expenses immediately, as allowed by IAS 23 for assets held at fair value. Assets are revalued and depreciation commences when they are brought into use.

Until 31 March 2008, plant & machinery and other equipment were carried at replacement cost, as assessed by indexation and depreciation of historic cost. From 1 April 2008 the requirement to index ceased. In 2008/09 the Trust continued to index plant & equipment and other equipment. From 2009/10, plant and machinery will continue to be indexed using a suitable index. Other fixtures and equipment will be written off over their remaining useful lives or carried at depreciated historic cost as this is not considered to be materially different from fair value.

An increase arising on revaluation is taken to the revaluation reserve except when it reverses an impairment for the same asset previously recognised in expenditure, in which case it is credited to expenditure to the extent of the decrease previously charged there. A revaluation decrease is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Gains and losses recognised in the revaluation reserve are reported as other comprehensive income in the Statement of Comprehensive Income.

1.7.3 Subsequent expenditureWhere subsequent expenditure enhances an asset beyond its original specification, the directly attributable cost is capitalised. Where subsequent expenditure restores the asset to its original specification, the expenditure is capitalised and any existing carrying value of the item replaced is written-out and charged to operating expenses.

1.8 Intangible assets

1.8.1 RecognitionIntangible assets are non-monetary assets without physical substance, which are capable of sale separately from the rest of the Trust’s business or which arise from contractual or other legal rights. They are recognised only when it is probable that future economic benefits will flow to, or service potential be provided to, the Trust; where the cost


of the asset can be measured reliably, and where the cost is at least £5000.

Intangible assets acquired separately are initially recognised at fair value. Software that is integral to the operating of hardware, for example an operating system, is capitalised as part of the relevant item of property, plant and equipment. Software that is not integral to the operation of hardware, for example application software, is capitalised as an intangible asset. Expenditure on research is not capitalised: it is recognised as an operating expense in the period in which it is incurred. Internally-generated assets are recognised if, and only if, all of the following have been demonstrated:• the technical feasibility of completing the

intangible asset so that it will be available for use• the intention to complete the intangible asset and

use it• the ability to sell or use the intangible asset• how the intangible asset will generate probable

future economic benefits or service potential• the availability of adequate technical, financial and

other resources to complete the intangible asset and sell or use it

• the ability to measure reliably the expenditure attributable to the intangible asset during its development

1.8.2 MeasurementThe amount initially recognised for internally-generated intangible assets is the sum of the expenditure incurred from the date when the criteria above are initially met. Where no internally-generated intangible asset can be recognised, the expenditure is recognised in the period in which it is incurred.

The amount initially recognised for internally-generated intangible assets is the sum of the expenditure incurred from the date when the criteria above are initially met. Where no internally-generated intangible asset can be recognised, the expenditure is recognised in the period in which it is incurred.

1.9 Depreciation, amortisation and impairments

Freehold land and properties under construction are not depreciated.

Otherwise, depreciation and amortisation are charged to write off the costs or valuation of property, plant and equipment and intangible non-current assets, less any residual value, over their estimated useful lives, in a manner that reflects the consumption of economic benefits or service potential of the assets. The estimated useful life of an asset is the period over which the Trust expects to obtain economic benefits or service potential from the asset. This is specific to the Trust and may be shorter than the physical life of the asset itself. Estimated useful lives and residual values are reviewed each year end, with the effect of any changes recognised on a prospective basis. Assets held under finance leases are depreciated over their estimated useful lives.

At each reporting period end, the Trust checks whether there is any indication that any of its tangible or intangible non-current assets have suffered an impairment loss. If there is indication of an impairment loss, the recoverable amount of the asset is estimated to determine whether there has been a loss and, if so, its amount. Intangible assets not yet available for use are tested for impairment annually.

If there has been an impairment loss, the asset is written down to its recoverable amount, with the loss charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Where an impairment loss subsequently reverses, the carrying amount of the asset is increased to the revised estimate of the recoverable amount but capped at the amount that would have been determined had there been no initial impairment loss. The reversal of the impairment loss is credited to expenditure to the extent of the decrease previously charged there and thereafter to the revaluation reserve.

1.10 Donated Assets

Donated non-current assets are capitalised at their fair value on receipt, with a matching credit to the donated asset reserve. They are valued, depreciated and impaired as described above for purchased


assets. Gains and losses on revaluations and impairments are taken to the donated asset reserve and, each year, an amount equal to the depreciation charge on the asset is released from the donated asset reserve to offset the expenditure. On sale of donated assets, the net book value is transferred from the donated asset reserve to retained earnings.

1.11 Government Grants

Government grants are grants from government bodies other than revenue from NHS bodies for the provision of services. Revenue grants are treated as deferred income initially and credited to income to match the expenditure to which they relate. Capital grants are credited to the government grant reserve and released to operating revenue over the life of the asset in a manner consistent with the depreciation and impairment charges for that asset. Assets purchased from government grants are valued, depreciated and impaired as described above for purchased assets. Gains and losses on revaluations and impairments are taken to the government grant reserve and, each year, an amount equal to the depreciation charge on the asset is released from the government grant reserve to the offset the expenditure.

1.12 Non-current assets held for sale

Non-current assets are classified as held for sale if their carrying amount will be recovered principally through a sale transaction rather than through continuing use. This condition is regarded as met when the sale is highly probable, the asset is available for immediate sale in its present condition and management is committed to the sale, which is expected to qualify for recognition as a completed sale within one year from the date of classification. Non-current assets held for sale are measured at the lower of their previous carrying amount and fair value less costs to sell. Fair value is open market value including alternative uses.

The profit or loss arising on disposal of an asset is the difference between the sale proceeds and the carrying amount and is recognised in the Statement of Comprehensive Income. On disposal, the balance for the asset on the revaluation reserve is transferred to retained earnings. For donated and government-granted assets, a transfer is made to or from the relevant reserve to the profit/loss on disposal account

so that no profit or loss is recognised in income or expenses. The remaining surplus or deficit in the donated asset or government grant reserve is then transferred to retained earnings.

Property, plant and equipment that is to be scrapped or demolished does not qualify for recognition as held for sale. Instead, it is retained as an operational asset and its economic life is adjusted. The asset is de-recognised when it is scrapped or demolished.

1.13 Leases

Leases are classified and accounted for as finance leases when substantially all the risks and rewards of ownership are transferred to the lessee and the value of the asset is greater than £50,000. All other leases are classified as operating leases.

Operating lease payments are recognised as an expense on a straight line basis over the lease term. Lease incentives are recognised initially as a liability and subsequently as a reduction of rentals on a straight line basis over the lease term.

1.14 Inventories

Inventories are valued at the lower of cost and net realisable value using either the first-in first-out (manually recorded inventories) or weighted average (computerised inventories) cost formula. This is considered to be a reasonable approximation to fair value due to the high turnover of inventories.

Manually recorded inventories are counted once a year. Computerised inventories are the subject of rolling counts during the year. Certain inventories on wards and departments (including sterile supplies) are covered by a materials management topping up system. The level of materials management inventories held by wards and departments are estimated using a formula agreed by external audit. Likewise, the value of ward/department drug inventories are estimated using a formula agreed with external audit. From 2009/10, other ward and department inventories with a value less than £10,500 (per ward/department) are not included in the inventories balance.


1.15 Cash and cash equivalents

Cash is cash in hand and deposits with any financial institution repayable without penalty on notice of not more than 24 hours. Cash equivalents are investments that mature in 3 months or less from the date of acquisition and that are readily convertible to known amounts of cash with insignificant risk of change in value.

In the Statement of Cash Flows, cash and cash equivalents are shown net of bank overdrafts that are repayable on demand and that form an integral part of the Trust’s cash management.

1.16 Provisions

Provisions are recognised when the Trust has a present legal or constructive obligation as a result of a past event, it is probable that the Trust will be required to settle the obligation, and a reliable estimate can be made of the amount of the obligation. The amount recognised as a provision is the best estimate of the expenditure required to settle the obligation at the end of the reporting period, taking into account the risks and uncertainties. Where a provision is measured using the cash flows estimated to settle the obligation, its carrying amount is the present value of those cash flows using HM Treasury’s discount rate of 2.2% in real terms.

When some or all of the economic benefits required to settle a provision are expected to be recovered from a third party, the receivable is recognised as an asset if it is virtually certain that reimbursements will be received and the amount of the receivable can be measured reliably.

Present obligations arising under onerous contracts are recognised and measured as a provision. An onerous contract is considered to exist where the Trust has a contract under which the unavoidable costs of meeting the obligations under the contract exceed the economic benefits expected to be received under it. A restructuring provision is recognised when the Trust has developed a detailed formal plan for the restructuring and has raised a valid expectation in those affected that it will carry out the restructuring by starting to implement the plan or announcing its main features to those affected by it. The

measurement of a restructuring provision includes only the direct expenditures arsing from the restructuring, which are those amounts that are both necessarily entailed by the restructuring and not associated with ongoing activities of the entity.

1.17 Clinical negligence costs

The NHS Litigation Authority (NHSLA) operates a risk pooling scheme under which the Trust pays an annual contribution to the NHSLA which in return settles all clinical negligence claims. The contribution is charged to expenditure. Although the NHSLA is administratively responsible for all clinical negligence cases the legal liability remains with the Trust. The total value of clinical negligence provisions carried by the NHSLA on behalf of the Trust is disclosed at note 25.

1.18 Non-clinical risk pooling

The Trust participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both are risk pooling schemes under which the Trust pays an annual contribution to the NHS Litigation Authority and, in return, receives assistance with the costs of claims arising. The annual membership contributions, and any excesses payable in respect of particular claims are charged to operating expenses as and when they become due.

1.19 EU Emissions Trading Scheme

EU Emission Trading Scheme allowances are accounted for as government grant funded intangible assets if they are not expected to be realised within twelve months, and otherwise as other current assets. They are valued at open market value. As the NHS body makes emissions, a provision is recognised with an offsetting transfer from the government grant reserve. The provision is settled on surrender of the allowances. The asset, provision and government grant reserve are valued at fair value at the end of the reporting period.

1.20 Contingencies

A contingent liability is a possible obligation that arises from past events and whose existence will be confirmed only by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the Trust, or a present obligation that is not recognised because it is not probable that


a payment will be required to settle the obligation or the amount of the obligation cannot be measured sufficiently reliably. A contingent liability is disclosed unless the possibility of a payment is remote.

A contingent asset is a possible asset that arises from past events and whose existence will be confirmed by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the Trust. A contingent asset is disclosed where an inflow of economic benefits is probable.

Where the time value of money is material, contingencies are disclosed at their present value.

1.21 Financial assets

Financial assets are recognised when the Trust becomes party to the financial instrument contract or, in the case of trade receivables, when the goods or services have been delivered. Financial assets are derecognised when the contractual rights have expired or the asset has been transferred.

Financial assets are initially recognised at fair value.

Financial assets are classified into the following categories: financial assets at fair value through profit and loss; held to maturity investments; available for sale financial assets, and loans and receivables. The classification depends on the nature and purpose of the financial assets and is determined at the time of initial recognition.

Other than NHS trade receivables, non NHS trade receivables and other receivables (relating to the injury cost recovery scheme) the Trust does not have any other financial assets.

1.22 Financial liabilities

Financial liabilities are recognised on the statement of financial position when the Trust becomes party to the contractual provisions of the financial instrument or, in the case of trade payables, when the goods or services have been received. Financial liabilities are de-recognised when the liability has been discharged, that is, the liability has been paid or has expired.

Loans from the Department of Health are recognised at historical cost. Otherwise, financial liabilities are initially recognised at fair value.

Other than NHS payables, non NHS payables and provisions, the Trust does not have any other financial liabilities.

1.23 Value Added Tax

Most of the activities of the Trust are outside the scope of VAT and, in general, output tax does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in the capitalised purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT.

1.24 Foreign currencies

The Trust’s functional currency and presentational currency is sterling. Transactions denominated in a foreign currency are translated into sterling at the exchange rate ruling on the dates of the transactions. At the end of the reporting period, monetary items denominated in foreign currencies are retranslated at the spot exchange rate on 31 March. Resulting exchange gains and losses for either of these are recognised in the Trust’s surplus/deficit in the period in which they arise.

1.25 Third party assets

Assets belonging to third parties (such as money held on behalf of patients) are not recognised in the accounts since the Trust has no beneficial interest in them. Details of third party assets are given in note 31 to the accounts.

1.26 Public Dividend Capital (PDC) and PDC dividend

Public dividend capital represents taxpayers’ equity in the NHS trust. At any time the Secretary of State can issue new PDC to, and require repayments of PDC from, the Trust. PDC is recorded at the value received. As PDC is issued under legislation rather than under contract, it is not treated as an equity financial instrument.

An annual charge, reflecting the cost of capital utilised by the Trust, is payable to the Department of Health as public dividend capital dividend. The charge is calculated at the real rate set by HM Treasury (3.5%) on the average carrying amount of


all assets less liabilities, except for donated assets and cash balances with the Office of the Paymaster General. The average carrying amount of assets is calculated as a simple average of opening and closing relevant net assets. A note to the accounts discloses the rate that the dividend represents as a percentage of the actual average carrying amount of assets less liabilities in the year. From 1 April 2009, the dividend payable is based on the actual average relevant net assets for the year instead of forecast amounts.

1.27 Losses and Special Payments

Losses and special payments are items that Parliament would not have contemplated when it agreed funds for the health service or passed legislation. By their nature they are items that ideally should not arise. They are therefore subject to special control procedures compared with the generality of payments. They are divided into different categories, which govern the way that individual cases are handled.

Losses and special payments are charged to the relevant functional headings in expenditure on an accruals basis, including losses which would have been made good through insurance cover had NHS trusts not been bearing their own risks (with insurance premiums then being included as normal revenue expenditure). However, the note on losses and special payments is compiled directly from the losses and compensations register which reports amounts on an accruals basis with the exception of provisions for future losses.

1.28 Subsidiaries

Material entities over which the Trust has the power to exercise control so as to obtain economic or other benefits are classified as subsidiaries and are consolidated. Their income and expenses; gains and losses; assets, liabilities and reserves; and cash flows are consolidated in full into the appropriate financial statement lines. Appropriate adjustments are made on consolidation where the subsidiary’s accounting policies are not aligned with the Trust’s or where the subsidiary’s accounting date is before 1 January or after 30 June.

Subsidiaries that are classified as ‘held for sale’ are measured at the lower of their carrying amount or ‘fair value less costs to sell’

For 2009/10, in accordance with the directed accounting policy from the Secretary of State, the Trust does not consolidate the NHS charitable funds for which it is the corporate trustee.

1.29 Accounting standards that have been issued but have not yet been adopted

The following standards and interpretations have been adopted by the European Union but are not required to be followed until 2010/11. None of them are expected to impact upon the Trust’s financial statements.

IAS 27 (Revised) Consolidated and separate financial statements

Amendment to IAS 32 Financial instruments: Presentation on classification or rights issues

Amendment to IAS 39 Eligible hedged items

IFRS 3 (Revised) Business combinations

IFRIC 17 Distributions of Non-cash Assets to Owners

IFRIC 18 Transfer of assets from customers


All of the Trust’s activities are in the provision of healthcare, which is an aggregate of all the individual specialty components included therein, and the large majority of the Trust’s revenue originates with the UK Government. The majority of expenses incurred are payroll expenditure on staff involved in the delivery or support of healthcare activities generally across the Trust together with the related supplies and overheads needed to establish the delivery of healthcare. The activities which earn revenue and incur expenses are, therefore, of one broad combined nature and, therefore, on this basis one segment of ‘healthcare’ is deemed appropriate.

The operating results of the Trust are reviewed monthly or more frequently by the Trust’s chief operating decision maker which is the overall trust board and which includes senior professional non-executive directors. The trust board review the financial position of the Trust as a whole in their decision making process, rather than individual components included in the totals, in terms of allocating resources. This process again implies a single operating segment under IFRS8.

The finance report considered monthly by the Trust board contains summary figures for the whole trust together with divisional budgets and their cost improvement positions. The statement of financial positions (balance sheet) and cashflow forecasts are considered for the whole trust in total only. The board as chief operating decision maker, therefore, only considers one segment of healthcare in its decision making process.

The single segment of ‘healthcare’ has been identified as consistent with the core principles of IFRS8 which is to enable users of financial statements to evaluate the nature and financial effects of business activities and economic environments.

3. Income generation activitiesThe trust undertakes income generation activities with an aim of achieving profit, which is then used in patient care. The following provides details of income generation activities whose full cost exceeded £1m or was otherwise material.

Car Parking Charges Catering - Restaurants

2009/10 2008/09 2009/10 2008/09

£000 £000 £000 £000

Income 1,792 1,672 2,001 1,974

Full cost 1,396 1,340 2,335 2,040

Surplus/(deficit) 396 332 (334) (66)

4. Revenue from patient care activities

2009/10 2008/09

£000 £000

Strategic health authorities 640 609

Primary care trusts 504,014 436,363

Local authorities 0 22

Department of Health 0 23,339

Non-NHS:

Private patients 293 254

Overseas patients (non-reciprocal) 351 252

Injury costs recovery 4,358 4,557

Other 1,138 1,083

510,794 466,479

Injury cost recovery income is subject to a provision for impairment of receivables of 8.6% to reflect expected rates of collection.

2. Operating Segments


2009/10 2008/09

£000 £000

Education, training and research 19,846 19,081

Charitable and other contributions to expenditure 0 41

Transfers from Donated Asset Reserve 550 618

Transfers from Government Grant Reserve 8 21

Non-patient care services to other bodies 16,584 17,597

Income generation 6,989 7,037

Other revenue 2,989 2,657

46,966 47,052

6. Revenue

2009/10 2008/09

£000 £000

From rendering of services 555,763 511,557

From sale of goods 1,997 1,974

5. Other Operating Revenue


2009/10 2008/09

£000 £000

Services from other NHS Trusts 575 1,681

Services from PCTs 2,886 4,537

Services from other NHS bodies 3,679 4,034

Services from Foundation Trusts 3,788 1,981

Purchase of healthcare from non NHS bodies 1,970 1,580

Directors' costs 1,332 1,192

Other Employee Benefits 367,330 332,544

Supplies and services - clinical 80,971 73,788

Supplies and services - general 14,946 14,158

Consultancy services 578 699

Establishment 6,439 6,403

Transport 1,025 1,029

Premises 18,679 18,143

Provision for impairment of receivables 580 153

Inventories write offs 59 73

Depreciation 17,678 20,886

Amortisation 879 966

Impairments and reversals of property, plant and equipment 22,872 197

Audit fees 306 307

Other auditor's remuneration 16 21

Clinical negligence 12,152 6,296

Education and Training 1,109 1,055

Security Services 1,542 1,539

Interpreter fees 514 737

Clinical Waste 642 757

Insurance 466 489

Legal Fees 420 133

Employers liability and injury benefit 854 1,001

Premature retirement provision 833 240

Professional Fees 933 532

Other 1,679 1,339

567,732 498,490

7. Operating Expenses


2009/10 2008/09

£000 £000

8.1 As lessee

Payments recognised as an expense

Minimum lease payments 918 219

Total future minimum lease payments

Payable:

Not later than one year 1,162 89

Between one and five years 1,506 75

After 5 years 0 0

Total 2,668 164

8.1 As lessor

The trust does not have any significant operating leases as lessor

8. Operating leases


9.1 Employee costs 2009/10 2008/09

TotalPermanently

EmployedOther Total

Permanently Employed

Other

£000 £000 £000 £000 £000 £000

Salaries and wages 311,651 281,692 29,959 281,560 262,812 18,748

Social Security Costs 23,683 22,715 968 20,781 19,838 943

Employer contributions to NHS Pension scheme

33,426 32,052 1,374 31,467 30,087 1,380

Termination benefits 7 7 0 11 11 0

Employee benefits expense 368,767 336,466 32,301 333,819 312,748 21,071

Of the total above:

Charged to capital 168 145

Employee benefits charged to revenue

368,599 333,674

368,767 333,819

9.2 Average number of people employed

2009/10 2008/09

TotalPermanently

EmployedOther Total

Permanently Employed

Other

Number Number Number Number Number Number

Medical and dental 1,163 999 164 1,094 977 117

Administration and estates 2,138 2,107 31 2,069 2,034 35

Healthcare assistants and other support staff

727 698 29 738 714 24

Nursing, midwifery and health visiting staff

4,213 3,944 269 4,238 3,914 324

Nursing, midwifery and health visiting learners

47 47 0 89 89 0

Scientific, therapeutic and technical staff

1,085 1,064 21 1,005 986 19

Other 7 7 0 7 7 0

Total 9,380 8,866 514 9,240 8,721 519

Of the above:

Number of staff (WTE) engaged on capital projects

3 3

9. Employee costs and numbers

9.3 Staff sickness absence2009

Number

Total days lost 94,012

Total staff years 8,381

Average working days lost 11.20

In line with Department of Health guidance, the above data relates to the calendar year and comparative data for 2008 is not required. Figures exclude Lead Employer staff.

9.4 Management Costs2009/10 2008/09

£000 £000

Management costs 16,124 15,819

Income 547,259 505,553

2.95% 3.13%


Past and present employees are covered by the provisions of the NHS Pensions Scheme. Details of the benefits payable under these provisions can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions

The scheme is an unfunded, defined benefit scheme that covers NHS employers, General Practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as if it were a defined contribution scheme: the cost to the NHS Body of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period.

The scheme is subject to a full actuarial valuation every four years (until 2004, every five years) and an accounting valuation every year. An outline of these follows:

a) Full actuarial (funding) valuation

The purpose of this valuation is to assess the level of liability in respect of the benefits due under the scheme (taking into account its recent demographic experience), and to recommend the contribution rates to be paid by employers and scheme members. The last such valuation, which determined current contribution rates was undertaken as at 31 March 2004 and covered the period from 1 April 1999 to that date. The conclusion from the 2004 valuation was that the scheme had accumulated a notional deficit of £3.3 billion against the notional assets as at 31 March 2004.

In order to defray the costs of benefits, employers pay contributions at 14% of pensionable pay and most employees had up to April 2008 paid 6%, with manual staff paying 5%.

Following the full actuarial review by the Government Actuary undertaken as at 31 March 2004, and after consideration of changes to the NHS Pension Scheme taking effect from 1 April 2008, his Valuation report recommended that employer contributions could continue at the existing rate of 14% of pensionable pay, from 1 April 2008, following the introduction of employee contributions on a tiered scale from 5% up to 8.5% of their pensionable pay depending on

total earnings. On advice from the scheme actuary, scheme contributions may be varied from time to time to reflect changes in the scheme’s liabilities.

b) Accounting valuation

A valuation of the scheme liability is carried out annually by the scheme actuary as at the end of the reporting period by updating the results of the full actuarial valuation.

Between the full actuarial valuations at a two-year midpoint, a full and detailed member data-set is provided to the scheme actuary. At this point the assumptions regarding the composition of the scheme membership are updated to allow the scheme liability to be valued.

The valuation of the scheme liability as at 31 March 2010, is based on detailed membership data as at 31 March 2008 (the latest midpoint) updated to 31 March 2010 with summary global member and accounting data.

The latest assessment of the liabilities of the scheme is contained in the scheme actuary report, which forms part of the annual NHS Pension Scheme (England and Wales) Resource Account, published annually. These accounts can be viewed on the NHS Pensions website. Copies can also be obtained from The Stationery Office.

c) Scheme provisions

In 2008-09 the NHS Pension Scheme provided defined benefits, which are summarised below. This list is an illustrative guide only, and is not intended to detail all the benefits provided by the Scheme or the specific conditions that must be met before these benefits can be obtained:

Annual PensionsThe Scheme is a “final salary” scheme. Annual pensions are normally based on 1/80th for the 1995 section and of the best of the last three years pensionable pay for each year of service, and 1/60th for the 2008 section of reckonable pay per year of membership. Members who are practitioners as defined by the Scheme Regulations have their annual pensions based upon total pensionable earnings over the relevant pensionable service.

10. Pension costs


With effect from 1 April 2008 members can choose to give up some of their annual pension for an additional tax free lump sum, up to a maximum amount permitted under HMRC rules. This new provision is known as “pension commutation”.

Pensions IndexationAnnual increases are applied to pension payments at rates defined by the Pensions (Increase) Act 1971, and are based on changes in retail prices in the twelve months ending 30 September in the previous calendar year.

Lump Sum AllowanceA lump sum is payable on retirement which is normally three times the annual pension payment.

Ill-Health RetirementEarly payment of a pension, with enhancement in certain circumstances, is available to members of the Scheme who are permanently incapable of fulfilling their duties or regular employment effectively through illness or infirmity.

Death BenefitsA death gratuity of twice their final year’s pensionable pay for death in service, and five times their annual pension for death after retirement is payable.

Additional Voluntary Contributions (AVCs)Members can purchase additional service in the NHS Scheme and contribute to money purchase AVC’s run by the Scheme’s approved providers or by other Free Standing Additional Voluntary Contributions (FSAVC) providers.

Transfer between FundsScheme members have the option to transfer their pension between the NHS Pension Scheme and another scheme when they move into or out of NHS employment.

Preserved BenefitsWhere a scheme member ceases NHS employment with more than two years service they can preserve their accrued NHS pension for payment when they reach retirement age.

Compensation for Early RetirementWhere a member of the Scheme is made redundant they may be entitled to early receipt of their pension plus enhancement, at the employer’s cost.


During 2009/10 there were 12 (2008/09, 17) early retirements from the Trust agreed on the grounds of ill-health. The estimated additional pension liabilities of these ill-health retirements will be £496,340 (2008/09: £904,769). The cost of these ill-health retirements will be borne by the NHS Business Services Authority - Pensions Division.

12. Better Payment Practice Code

12.1 Better Payment Practice Code - measure of compliance

2009/10 2008/09

Number £000 Number £000

Total Non-NHS trade invoices paid in the year 138,423 184,861 134,803 148,405

Total Non NHS trade invoices paid within target 134,099 177,043 132,372 145,840

Percentage of Non-NHS trade invoices paid within target 97% 96% 98% 98%

Total NHS trade invoices paid in the year 5,683 44,945 5,836 38,896

Total NHS trade invoices paid within target 5,482 42,751 5,688 38,404

Percentage of NHS trade invoices paid within target 96% 95% 97% 99%

The Better Payment Practice Code requires the Trust to aim to pay all undisputed invoices by the due date or within 30 days of receipt of goods or a valid invoice, whichever is later.

12.2 The Late Payment of Commercial Debts (Interest) Act 1998

The trust has not incurred any interest charges as a result of the late payment of commercial debts

13. Investment revenue

Interest revenue:

2009/10 2008/09

£000 £000

Bank accounts 88 1015

14. Other gains and losses

Interest revenue:

2009/10 2008/09

£000 £000

Gain/(loss) on disposal of property, plant and equipment (128) (101)

15. Finance Costs

Interest revenue:

2009/10 2008/09

£000 £000

Interest on loans 504 0

Unwinding of discount factor (provisions) 223 215

Total 727 215

11. Retirements due to ill-health


Intangibles

Land Buildings excluding dwellings Dwellings AUC and POA* Plant and machinery Transport equipment Information technology Furniture & fittings Total PPE Computer Software - purchased

2008/09: £000 £000 £000 £000 £000 £000 £000 £000 £000 £000

Cost or valuation at 1 April 2008 112,159 292,049 613 1,942 88,135 1,535 18,749 1,129 516,311 7,181

Additions purchased 0 3,305 0 14,656 3,166 35 1,701 3 22,866 402

Additions donated 0 0 0 0 93 0 0 0 93 0

Reclassifications 0 (1,685) 7 (97) 1,759 0 (137) 23 (130) 130

Disposals other than by sale 0 0 0 0 (4,860) (157) 0 0 (5,017) 0

Revaluation/indexation gains 0 157 0 0 1,319 27 0 23 1,526 0

Impairments (52,527) 0 0 0 0 0 0 0 (52,527) 0

At 31 March 2009 59,632 293,826 620 16,501 89,612 1,440 20,313 1,178 483,122 7,713

Depreciation** at 1 April 2008 0 0 0 0 57,971 963 7,433 580 66,947 2,603

Reclassifications 0 (100) 0 0 83 0 0 17 0 0


Revaluation/indexation gains 0 0 0 0 492 11 0 9 512 0

Impairments 0 197 0 0 0 0 0 0 197 0

Charged during the year 0 12,467 19 0 5,743 101 2,447 109 20,886 966

Depreciation at 31 March 2009 0 12,564 19 0 59,617 918 9,880 715 83,713 3,569

Net book value

Purchased 58,132 278,760 601 16,501 27,708 493 10,433 463 393,091 4,144

Donated 1,500 1,863 0 0 2,287 29 0 0 5,679 0

Government granted 0 639 0 0 0 0 0 0 639 0

Total at 31 March 2009 59,632 281,262 601 16,501 29,995 522 10,433 463 399,409 4,144

2009/10: £000 £000 £000 £000 £000 £000 £000 £000 £000 £000




Reclassifications 0 184 18 (859) 677 1 12 (3) 30 (30)

Disposals other than by sale 0 0 0 0 (10,089) (83) (2,267) (140) (12,579) 0

Revaluation/indexation gains 0 3,216 21 0 55 0 0 0 3,292 0

Impairments (5,026) (73,011) (134) 0 0 0 0 0 (78,171) 0

At 31 March 2010 54,606 215,893 506 44,229 90,479 1,397 20,474 1,149 428,733 8,573



Impairments 0 23,645 0 0 0 0 0 0 23,645 0

Reversal of Impairments 0 (773) 0 0 0 0 0 0 (773) 0



Net book value

Purchased 53,256 183,249 487 44,229 32,371 388 10,283 468 324,731 4,125

Donated 1,350 1,202 0 0 1,925 14 0 0 4,491 0


Total at 31 March 2010 54,606 184,705 487 44,229 34,296 402 10,283 468 329,476 4,125

All assets are owned. * AUC - assets under construction, POA - payments on account. ** amortisation for intangible assets

16. Property, plant and equipment (PPE)/Intangibles


Intangibles

Land Buildings excluding dwellings Dwellings AUC and POA* Plant and machinery Transport equipment Information technology Furniture & fittings Total PPE Computer Software - purchased

2008/09: £000 £000 £000 £000 £000 £000 £000 £000 £000 £000




Reclassifications 0 (1,685) 7 (97) 1,759 0 (137) 23 (130) 130


Revaluation/indexation gains 0 157 0 0 1,319 27 0 23 1,526 0

Impairments (52,527) 0 0 0 0 0 0 0 (52,527) 0

At 31 March 2009 59,632 293,826 620 16,501 89,612 1,440 20,313 1,178 483,122 7,713


Reclassifications 0 (100) 0 0 83 0 0 17 0 0


Revaluation/indexation gains 0 0 0 0 492 11 0 9 512 0

Impairments 0 197 0 0 0 0 0 0 197 0



Net book value

Purchased 58,132 278,760 601 16,501 27,708 493 10,433 463 393,091 4,144

Donated 1,500 1,863 0 0 2,287 29 0 0 5,679 0


Total at 31 March 2009 59,632 281,262 601 16,501 29,995 522 10,433 463 399,409 4,144

2009/10: £000 £000 £000 £000 £000 £000 £000 £000 £000 £000




Reclassifications 0 184 18 (859) 677 1 12 (3) 30 (30)


Revaluation/indexation gains 0 3,216 21 0 55 0 0 0 3,292 0

Impairments (5,026) (73,011) (134) 0 0 0 0 0 (78,171) 0

At 31 March 2010 54,606 215,893 506 44,229 90,479 1,397 20,474 1,149 428,733 8,573



Impairments 0 23,645 0 0 0 0 0 0 23,645 0

Reversal of Impairments 0 (773) 0 0 0 0 0 0 (773) 0



Net book value

Purchased 53,256 183,249 487 44,229 32,371 388 10,283 468 324,731 4,125

Donated 1,350 1,202 0 0 1,925 14 0 0 4,491 0


Total at 31 March 2010 54,606 184,705 487 44,229 34,296 402 10,283 468 329,476 4,125

All assets are owned. * AUC - assets under construction, POA - payments on account. ** amortisation for intangible assets


16.1 Property, plant and equipment

Donated Assets During the year The Pennine Acute Hospitals Charity has donated equipment purchased at a cost of £114,000

Asset RevaluationsIn accordance with HM Treasury guidance the Trust has adopted a Modern Equivalent Asset approach to the valuation of buildings as opposed to the previous like for like method. This review was carried out by the District Valuer and resulted in building values falling by £67.5m as at 1 April 2009, which is reflected in the 2009/2010 accounts.

The value of land and buildings has fallen again during the year due to the prevailing economic conditions. The land values have been formally reviewed by the District Valuer and have reduced by £5 million. The buildings have been reviewed by application of building cost indices which has resulted in a fall in value of £25.6 million

Asset Lives There have been no changes during the year in the lives applied to the Trust assets

Life applied Min Max

Buildings exc Dwellings 5 58

Dwellings 29 34

Plant & Machinery 3 15

Transport Equipment 5 10

Information Technology 5 8

Furniture and Fittings 5 15 There has been no compensation from third parties for assets impaired included in the Trust’s surplus.

Within the land revaluation fall of £5 million as at 31 March 2010 there is an amount of £750,000 relating to Westhulme site. This is held at Open Market Value in anticipation of sale when the economic conditions are more favourable. The Trust has no temporary idle assets

The gross carrying amount of fully depreciated assets still in use is £35,568,022.

16.2 Intangible assets

Asset Revaluations There have been no revaluations to intangible assets during the year and there are no revaluation balances held for intangibles.

For all purchased software the Trust applies a finite life of between 5 and 9 years.

The trust still has fully amortised purchased software in use with a replacement cost of £2,518,254

17. Impairments

During the year there has been a charge to impairments of £14.1 million resulting from the Modern Equivalent Asset building revaluation; the amount held on the revaluation reserve for some assets was insufficient absorb the decrease, that excess was charged to Income and Expenditure as at 1 April 2010.

The subsequent revaluation to buildings as at 31 March 2010, by application of building cost indices resulted in a further charge to impairments of £9.1 million, again whereby the amount held on the revaluation reserve was insufficient to absorb the decrease.

The District Valuer has reviewed newly contructed buildings/enhancements and this has resulted in an impairment charge of £372,484 during the year.

During the year there has only been one reversal of impairment relating to a building on Westhulme site. The planned disposal of the site has been delayed by the current economic downturn and the Trust has allowed another NHS body to temporarily occupy one building. The reversal of £771,622 has been credited to Income and Expenditure Account.


Contracted capital commitments at 31 March not otherwise included in these financial statements:

31 March 2010

31 March 2009

£000 £000

Property, plant and equipment 7,873 33,120 Comprises:Womens and Childrens development at North Manchester £2,693,000 (2008/09 £21,011,000)

Additional capacity/Radiotherapy development at Royal Oldham Hospital £5,180,000 (2008/09 £12,109,000)

19.1. Inventories

31 March 2010

31 March 2009

£000 £000

Drugs 3,432 3,524

Consumables 4,286 4,533

Energy 414 308

Total 8,132 8,365

19.2 Inventories recognised in expenses

31 March 2010

31 March 2009

£000 £000

Write-down of inventories (including losses)

59 73

18. Capital commitments 19. Inventories

20. Trade and other receivables

20.1 Trade and other receivables

Current Non-current

31 March 2010

31 March 2009

31 March 2010

31 March 2009

£000 £000 £000 £000

NHS receivables-revenue 17,114 8,857 0 0

Non-NHS receivables-revenue 197 211 0 0

Non-NHS receivables-capital 0 0 3,226 3,226

Provision for the impairment of receivables (835) (577) (647) (547)

Prepayments and accrued income 2,564 1,086 0 0

VAT 1,297 993 0 0

Other receivables 6,372 3,435 3,723 7,011

Total 26,709 14,005 6,302 9,690

The great majority of trade is with Primary Care Trusts, as commissioners for NHS patient care services. As Primary Care Trusts are funded by Government to buy NHS patient care services, no credit scoring of them is considered necessary.

The trust is the lead employer for doctors in training on behalf of the North West Deanery. The trust is responsible for the employment and payment of almost 2000 doctors in training under the lead employer contract with an annual value of approximately £115m (08/09 £110m). The costs are recharged to the relevant NHS organisation (30) throughout the North West (including Pennine Acute). Only the costs and associated numbers of the Deanery doctors in training to Pennine Acute (approximately 13%) are shown in Pennine Acute’s expenditure account and workforce numbers. NHS receivables includes £8.1m debt (08/09 £1.7m) relating to outstanding recharges to other organisations.

20.2 Receivables past their due date but not impaired31 March 2010 31 March 2009

£000 £000

By up to three months 156 548

By three to six months 24 93

By more than six months 67 357

Total 247 998


20.3 Provision for impairment of receivables31 March 2010 31 March 2009

£000 £000

Balance at 1 April (1,124) (1,461)

Amount written off during the year 222 490

Amount recovered during the year 57 129

(Increase)/decrease in receivables impaired (637) (282)

Balance at 31 March (1,482) (1,124)

23. Borrowings

Current Non-Current

31 March 2010 31 March 2009 31 March 2010 31 March 2009

£000 £000 £000 £000

Loans from:

Department of Health 1,168 0 26,858 0

In 2009/10, the Trust secured a loan of £42.050m over 25 years from the Department of Health to support the Womens & Children development at North Manchester General Hospital and the additional capacity development (above Radiotherapy) at the Royal Oldham Hospital. £28.750m was received in 2009/10 and £0.724m repaid. The balance of the loan (£13.300m) will be received in 2010/11.

24. Other liabilities

Current31 March 2010 31 March 2009

£000 £000

Payments on account 89 81

21. Cash and cash equivalents31

March 2010

31 March 2009

£000 £000

Balance at 1 April 6,769 6,764

Net change in year 7 5

Balance at 31 March 6,776 6,769

Made up of

Cash with Office of HM Paymaster General

6,599 6,604

Commercial banks and cash in hand 177 165

Cash/cash equivalents in statement of financial position

6,776 6,769

Cash/cash equivalents as in statement of cash flows

6,776 6,769

22. Trade and other payables

Current

31 March 2010

31 March 2009

£000 £000

NHS payables-revenue 3,459 3,416

Non NHS trade payables - revenue 2,735 4,287

Non NHS trade payables - capital 9,226 4,765

Accruals and deferred income 22,188 17,557

Social security costs 4,558 4,272

Tax 1,439 371

NHS Pensions 5,222 4,951

Other 208 393

Total 49,035 40,012

A proportion of the tax, social security and pensions creditors £3.1m (08/09 £1.0m) in total relates to the Trust’s contract as lead employer for doctors in training for the North West Deanery (see also note 20.1)


25. Provisions

Current Non-current

31 March 2010

31 March 2009

31 March 2010

31 March 2009

£000 £000 £000 £000

Pensions relating to other staff 313 286 3,721 3,536

Legal claims 252 112 126 56

Restructures 127 230 2,055 1,928

Other 1,856 2,745 4,033 3,933

Total 2,548 3,373 9,935 9,453

Pensions relating to other staff

Legal claims

Restructure Other Total

£000 £000 £000 £000 £000

At 1 April 2008 3,874 294 2,281 6,504 12,953

Arising during the year 152 110 89 2,300 2,651

Used during the year (289) (179) (263) (490) (1,221)

Reversed unused 0 (57) 0 (1,715) (1,772)

Unwinding of discount 85 0 51 79 215

At 1 April 2009 3,822 168 2,158 6,678 12,826

Arising during the year 1,166 305 439 876 2,786

Used during the year (289) (52) (440) (991) (1,772)

Reversed unused (751) (43) (22) (764) (1,580)

Unwinding of discount 86 0 47 90 223

At 31 March 2010 4,034 378 2,182 5,889 12,483

Expected timing of cash flows:

In the remainder of the spending review period to 31 March 2011

313 252 127 1,857 2,549

Between 1 Apr 2011 and 31 Mar 2016 1,563 126 635 1,110 3,434

Between 1 Apr 2016 and 31 Mar 2021 1,518 0 635 997 3,150

Thereafter 640 0 785 1,925 3,350

Other provisions relate mainly to permanent injury benefit payable, contract issues and changes to pay.

£86,230,169 is included in the provisions of the NHS Litigation Authority at 31/3/2010 in respect of clinical negligence liabilities of the Trust (31/03/2009 £75,576,558).


26.1 Contingent liabilities2009/10 2008/09

£000 £000

The trust’s liability to third parties (public and employers) under the scheme operated by the NHSLA

(243) (88)

26.2 Contingent assets The trust does not have any contingent assets.

26. Contingencies

27. Financial risk management

Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating or changing the risks a body faces in undertaking its activities. Because of the continuing service provider relationship that the NHS Trust has with Primary Care Trusts and the way those primary care trusts are financed, the NHS Trust is not exposed to the degree of financial risk faced by business entities. Also financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. The NHS Trust has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks facing the NHS Trust in undertaking its activities.

The Trust’s treasury management operations are carried out by the finance department, within parameters defined formally within the Trust’s standing financial instructions and policies agreed by the board of directors. Trust treasury activity is subject to review by the Trust’s internal auditors.

Currency riskThe Trust is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The Trust has no overseas operations. The Trust therefore has low exposure to currency rate fluctuations.

Interest rate riskThe Trust borrows from government for capital expenditure, subject to affordability as confirmed by the strategic health authority. The borrowings are for 1 – 25 years, in line with the life of the associated assets, and interest is charged at the National Loans Fund rate, fixed for the life of the loan. The Trust therefore has low exposure to interest rate fluctuations

Credit riskBecause the majority of the Trust’s income comes from contracts with other public sector bodies, the Trust has low exposure to credit risk. The maximum exposures as at 31 March 2010 are in receivables from customers, as disclosed in the Trade and other receivables note.

Liquidity riskThe Trust’s operating costs are incurred under contracts with primary care trusts, which are financed from resources voted annually by Parliament . The Trust funds its capital expenditure from funds obtained within its prudential borrowing limit. The Trust is not, therefore, exposed to significant liquidity risks.

28 Events after the reporting period

On the 1 April 2010 the Trust has transferred ownership of certain facilities (buildings and associated land) on Pennine Acute hospital sites to the respective mental health trusts. The facilities were effectively rented to the mental health trusts since the merger that formed Pennine Acute Trust in April 2002. Pennine Acute Trust has no long term plans or strategic interest in these facilities and, therefore, ownership has been transferred.

At North Manchester General Hospital, buildings and associated land with a value of £11.6m have been transferred to Manchester Mental Health Social Care NHS Trust. At Fairfield General Hospital (Bury) buildings and associated land with a value of £2.4m have been transferred to Pennine Care NHS Foundation Trust.


The figures given for periods prior to 2009/10 are on a UK GAAP basis as that is the basis on which the targets were set for those years.

29.1 Breakeven Performance2005/06 2006/07 2007/08 2008/09 2009/10

£000 £000 £000 £000 £000

Turnover 446,095 473,696 499,444 513,531 557,760

Retained surplus/(deficit) for the year 56 (9,170) 9,472 48 (22,252)

Adjustments for Impairments 197 22,872

Break-even in-year position 56 (9,170) 9,472 245 620

Break-even cumulative position 1,690 (7,480) 1,992 2,237 2,857

2005/06 2006/07 2007/08 2008/09 2009/10

% % % % %

Materiality test (I.e. is it equal to or less than 0.5%):

Break-even in-year position as a %tage of turnover 0.0 (1.9) 1.9 0.0 0.1

Break-even cumulative as a %tage of turnover 0.4 (1.6) 0.4 0.4 0.5

The amounts in the above tables in respect of financial years 2005/06 to 2008/09 inclusive have not been restated to IFRS and remain on a UK GAAP basis.

29.2 Capital cost absorption ratePrior to 2009/10 the Trust was required to absorb the cost of capital at a rate of 3.5% of forecast average relevant net assets. The rate is calculated as the percentage that dividends paid on public dividend capital, totalling £11,513,000 bears to the actual average relevant net assets of £328,945,000 that is 3.5% (prior year 3.8%). Explanations were required for material differences between the forecast and actual absorption rate achieved.

From 2009/10 the dividend payable on public dividend capital is based on 3.5% of the actual (rather than forecast) average relevant net assets and, therefore, the actual capital cost absorption rate is automatically 3.5%.

29. Financial performance targets

29.3 External financing The Trust is given an external financing limit which it is permitted to undershoot.

2009/10 2008/09

£000 £000 £000

External financing limit 28,026 (4,134)

Cash flow financing 28,019 (4,139)

Finance leases taken out in the year

0 0

Other capital receipts 0 0

External financing requirement

28,019 (4,139)

Undershoot/(overshoot)

7 5

29.4 Capital Resource Limit The Trust is given a capital resource limit which it is not permitted to exceed.

2009/10 2008/09

£000 £000

Gross capital expenditure 46,512 23,361

Less: book value of assets disposed of (156) (188)

Plus: loss on disposal of donated assets 3 0

Less: capital grants 0 0

Less: donations towards the acquisition of non-current assets

(113) (93)

Charge against the capital resource limit

46,246 23,080

Capital resource limit 46,582 23,094

(Over)/Underspend against the capital resource limit

336 14


During the year no trust board members or members of the key management staff, or parties related to any of them, has undertaken any material transactions with The Pennine Acute Hospitals NHS Trust.

The Department of Health is regarded as a related party. During the year The Pennine Acute Hospitals NHS Trust has had a significant number of material transactions with the Department, and with other entities for which the Department is regarded as the parent Department. These entities are:

Related Party Transaction detailsAmount

£’000

Oldham PCT Income from activities 121,346

North West SHA Other Operating Income 18,829

Manchester PCT Income from activities 81,943

Bury PCT Income from activities 102,628

Heywood, Middleton and Rochdale PCT Income from activities 127,830

East Lancashire PCT Income from activities 15,972

Salford PCT Income from activities 7,404

Tameside and Glossop PCT Income from activities 6,410

Western Cheshire PCT Income from activities 28,902

NHS Litigation Authority Annual contribution to risk pooling 12,529

NHS Business Authority Purchase of goods and services 13,733

NHS Blood and Transport Service level agreement 3,787

NHS Pensions Agency Employers contributions to NHS Pension Scheme 30,571

In addition, the Trust has had a number of material transactions with other government departments and other central and local government bodies. Most of these transactions have been with Bury MBC, Oldham MBC, Rochdale MBC and Manchester City Council.

The trust has also received revenue and capital payments from a number of charitable funds, which include the Pennine Acute Hospitals Charity. The Trust Board is the corporate trustee of the charity.

31. Third Party Assets

The trust held £27,000 cash and cash equivalents at 2009/10 (£48,000 - at 2008/09) which relates to monies held by the NHS Trust on behalf of patients. This has been excluded from the cash and cash equivalents figure reported in the accounts.

30. Related party transactions


Current receivables

Non-current receivables

Current payables

£000 £000 £000

Balances with other Central Government Bodies 1,478 0 11,980

Balances with Local Authorities 0 0 0

Balances with NHS Trusts and Foundation Trusts 16,918 0 2,676

Balances with Public Corporations and Trading Funds 15 0 69

Intra Government balances 18,411 0 14,725

Balances with bodies external to Government 8,298 6,302 34,310

At 31 March 2010 26,709 6,302 49,035

Balances with other Central Government Bodies 413 0 9,922

Balances with Local Authorities 0 0 0

Balances with NHS Trusts and Foundation Trusts 8,818 0 3,035

Balances with Public Corporations and Trading Funds 12 0 53

Intra Government balances 9,243 0 13,010

Balances with bodies external to Government 4,762 9,690 27,002

At 31 March 2009 14,005 9,690 40,012

33. Losses and Special Payments There were 242 cases of losses and special payments (2008/09: 412 cases) totalling £457,563 (2008/09: £577,613) accrued during 2009/10.

34. Transition to IFRSThe following table explains the adjustments made as a result of the introduction of IFRS

Retained earnings

£000

Taxpayers’ equity at 31 March 2009 under UK GAAP: 25,268

Adjustments for IFRS changes:

Private finance initiative 0

Leases 0

Holiday Accrual (1,491)

Adjustments for:

Impairments recognised on transition 0

UK GAAP errors 0

Taxpayers’ equity at 1 April 2009 under IFRS: 23,777

£000

Surplus/(deficit) for 2008/09 under UK GAAP 48

Adjustments for:

Private finance initiative 0

Leases 0

Holiday Accrual 288

Surplus/(deficit) for 2008/09 under IFRS 336

32. Intra-Government and Other Balances


The membership of the remuneration committee comprises the chairman and non-executive directors with the chief executive attending as required. The committee determines on behalf of the Board the remuneration and terms of service arrangements of the chief executive, executive directors and other senior employees, ensuring they are fairly rewarded for their contribution to the Trust. The chairman undertook an assessment of the chief executive measured against achievement of the corporate objectives. The chief executive undertook similar assessments with the other executive directors.

The executive directors are employed on permanent contracts. The chief executive is required to give six months notice of termination of employment and the other executive directors three months.

There are no special guaranteed termination payments or compensation payments for early termination of executives. Executives are subject only to the same redundancy rights as all other employees of the Trust.

Salary and Pension entitlements of senior managers A) Remuneration

Name and Title

2009-10 2008-09

Salary Other

RemunerationBenefits in

KindSalary

Other Remuneration

Benefits in Kind

(bands of £5000) £000

(bands of £5000) £000

£000(bands of £5000) £000

(bands of £5000) £000

£000

J Saxby, Chief Executive 180-185 5 180-185 5

R Chadwick, Director of Finance & IMT *

135-140 115-120

R Jameson, Medical Director 175-180 165-170

M Carroll, Director of Nursing 115-120 105-110

R Pickering, Director of Human Resources

140-145 140-145

J Wilkes, Director of Facilities 105-110 105-110

S Payler, Director of Operations - left 31/12/09

145-150 35-40

B Herring, Acting Director of Finance & IMT - commenced 5/11/09*

40-45 0

J Jesky, Chairman 20-25 20-25

J Battye, Non Executive Director - left 30/11/09

0-05 05-10

E Ahmad, Non Executive Director - commenced 1/12/09

0-05 0

TD Pickstone, Non Executive Director 05-10 05-10

H Griffith, Non Executive Director 05-10 05-10

M Holly, Non Executive Director 05-10 05-10

C Guereca, Non Executive Director 05-10 0-5

F Burke, Non Executive Director 05-10 0-5

* Notes in respect of 2009/10Note 1 : R Chadwick, Director of Finance & IMT from 1/4/09 to 5/11/09 and Acting Director of Operations from 5/11/09 - 31/3/10 Note 2 : B Herring, Acting Director of Finance & IMT from 5/11/09 - 31/3/10

Remuneration Report


B) Pension Benefits

Name and title

Real increase

in pension at age

60

Real increase in lump sum at age 60

Total accrued

pension at age 60 at 31 March

2010

Lump sum at aged 60 related to accrued

pension at 31 March

2010

Cash Equivalent Transfer Value at

31 March 2010

Cash Equivalent Transfer Value at

31 March 2009

Real Increase in Cash

Equivalent Transfer Value

Employers Contribution

to Stakeholder

Pension

(bands of £2500) £000

(bands of £5000) £000

(bands of £5000) £000

(bands of £5000) £000

£000 £000 £000 £000

J Saxby, Chief Executive

(0-2.5) (5-10) 80-85 245-250 N/A 2,013 -

R Chadwick, Director of Finance & IMT *

0-2.5 5-10 50-55 155-160 1,114 972 94

R Jameson, Medical Director

2.5-5 5-10 65-70 205-210 1,540 1,357 116

M Carroll, Director of Nursing

2.5-5 10-15 55-60 165-170 1,277 1,088 135

R Pickering, Director of Human Resources

0-2.5 5-10 5-10 15-20 136 91 40

J Wilkes, Director of Facilities

(0-2.5) (0-5) 25-30 85-90 616 564 24

S Payler, Director of Operations - left 31/12/09

(0-2.5) (0-5) 45-50 135-140 858 771 36

B Herring, Acting Director of Finance & IMT - commenced 5/11/09*

2.5-5 5-10 35-40 115-120 843 634 72

As Non-Executive members do not receive pensionable remuneration, there will be no entries in respect of pensions for Non-Executive members.

A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any contingent spouse’s pension payable from the scheme. A CETV is a payment made by a pension scheme, or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which the disclosure applies. The CETV figures, and the other pension details, include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries.

Real Increase in CETV - This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another pension scheme or arrangement) and uses common market valuation factors for the start and end of the period.


Small Change Big Difference

The Trust operates a registered charity called The Pennine Acute Hospitals Charity and other related charities (Charity Commission registration no 1050197).

People and organisations make donations to the Trust’s charity funds for many different reasons. Sometimes it is to mark gratitude for treatment, sometimes it is to support the service generally and sometimes it is to help remember a family member who worked for the Trust.

These donations range from donations of a few pounds up to six figure sums, but they are all equally welcome – and they are all put to good use. Last year the charity spent £661,000 during the year on patients’ amenities, staff education and welfare and research.

The charity has the Trust Board as the corporate trustee and covers all of our hospitals – Fairfield General, Birch Hill, Rochdale Infirmary, North Manchester General and The Royal Oldham for any charitable purpose relating to the NHS.

The charity received income of £585,000 in the year 2009/10 comprising:

£

Donations 414,000

Legacies 52,000

Investment Income 119,000

£468,000 was spent on patients’ amenities. The majority of expenditure has been on medical equipment for a range of wards and departments across all hospitals. In addition, the hospital arts project management is funded by charitable funds. £133,000 was spent on staff education and welfare. The majority of expenditure is on courses and conferences across a range of designated funds. £28,000 was spent on research during the year.

The trustee of the Pennine Acute Hospitals Charity would like to express their sincere thanks for all the generous donations received over the last year and the charitable work undertaken by all individuals and organisations. Charitable donations contribute greatly in enhancing the services that we are able to provide across the Trust.

More information about charitable funds and activities, as well as making donations on-line, is available on the Trust’s website at www.pat.nhs.uk by clicking on the charity’s logo. Gift Aid enables potential donors to maximise the income to the charity. The taxman adds 25p in the pound for every pound donated by UK taxpayers. Gift Aid information and envelopes are now available on all wards as well as the Cashiers offices at each site.

A full copy of the charity’s annual report and accounts is on the Trust’s website.

Donations to The Pennine Acute Hospitals Charity and other related charities can be received at any of the hospitals’ cashiers’ office, or more information is available from Jan Bolton, Charitable Fundraising Manager on tel: 0161 908 4497.

Charitable Funds


Finance Glossary

Accruals accountingAccruals accounting recognises assets or liabilities when goods or services are provided or received - whether or not cash changes hands at the same time. Also known as ‘the matching concept’, this form of accounting ensures that income and expenditure is scored in the accounting period when the ‘benefit’ derived from services is received or when supplied goods are ‘consumed’, rather than when payment is made.

AmortisationThe process of charging the cost of an asset over its useful life as opposed to recording its cost as a single entry in the income and expenditure account. Usually refers to intangible assets eg computer software. Similar in effect to depreciation.

BreakevenBreakeven is the term used to indicate that an organsiation has balanced its income with its expenditure.

Capital (Property, plant and equipment)Expenditure on the acquisition of land and premises, individual works for the provision, adaptation, renewal, replacement and demolition of buildings, items or groups of equipment and vehicles, etc. In the NHS, expenditure on an item is classified as capital if it is in excess of £5,000.

Capital ChargesCapital charges are a way of recognising the costs of ownership and use of capital assets and comprise depreciation and interest/target return on capital.

Capital Resource Limit (CRL)A control set by DoH onto NHS organisations to limit the level of capital expenditure that may be incurred in year.

Cost of CapitalA charge on the value of assets tied up in an organisation, as a measure of the cost to the economy.

CommissionersCommissioners is a term used to cover those organisations who commission services from NHS trusts or other providers (eg private sector). Primary Care Trusts (PCTs) are the main commissioners in the NHS.

Current AssetsReceivables (debtors), inventories (stocks), cash or similar, whose value is either, or can be converted into cash within the next twelve months.

DepreciationThe measure of the wearing out, consumption or other loss of value of property, plant or equipment whether arising from use, passage of time or obsolescence through technology, and market changes.

External Financing Limits (EFLs)The External Financing Limit (EFL) is a fundamental element of the NHS trusts financial regime. It is a cash based public expenditure control set by DoH and a trust’s access to all sources of external finance. The EFL represents the excess of its approved level of capital spending over the cash a trust can generate internally (mainly surpluses and depreciation), essentially controlling the amount of “externally” generated funding.

Foundation TrustNHS foundation trusts are not-for-profit, public benefit corporations. They are part of the NHS and provide over half of all NHS hospital and mental health services. NHS foundation trusts are a result of the Government’s drive to devolve decision making from central to local organisations and communities. They provide and develop healthcare according to core NHS principles - free care, based on need and not ability to pay.

Foundation trusts are regulated by Monitor. For more information see the website www.monitor-nhsft.gov.uk

ImpairmentsImpairments generally relate to property, plant and equipment and represent the loss of value of property, plant and equipment below that recorded in the accounts of the organisation. Impairment occurs because something has happened to the property, plant or equipment itself or to the economic environment in which it is used.

IndexationA process of adjusting the value, normally of property, plant and equipment to account for inflation.

Glossary


Intangible assetSoftware licence or some other right, which although invisible provides value to the organisation from its use. More commonly includes goodwill or brand values in the private sector.

International Financial Reporting Standards (IFRS)From 2009/10 all public bodies, including the NHS, prepare their accounts under International Financial Reporting Standards (IFRS). Prior to 2009/10, accounts were prepared under UK GAAP (generally accepted accounting principles).

Market Forces Factor (MFF)MFF is a composite index of geographical cost variations in land, buildings, equipment and staff pay (including London weighting). MFF is paid by commissioners as a percentage add-on to the national tariff. This helps to even out the purchasing power of commissioners of NHS services (mainly primary care trusts) and allows the use of a national tariff across the country.

Payment by Results (PbR)Payment by results (PbR) is the system by which trusts are paid for the majority of the work they do. The system is managed by the Department of Health.

Primary Care Trust (PCT)A Primary Care Trust is responsible for commissioning health services for its population and receives its resources annually from the Department of Health. A PCT may also provide some services itself eg community nursing.

ProvisionsProvisions are made when an expense is probable but there is uncertainty about how much or when payment will be required, e.g. estimates for employers or public liability. Provisions are included in the accounts to comply with the accounting principle of prudence. An estimate of the likely expense is charged to the income & expenditure account as soon as the issue comes to light, although actual cash payment may not be made for many years. The expense is matched by a balance sheet provision entry showing the potential liability of the organisation.

Prudential Borrowing Code (PBC)A framework that allows NHS trusts to manage their capital positions within their ability to service the resulting financial obligations. The PBC is based upon a series of financial tests, which determine prudent capital positions relative to their revenues and costs.

Prudential Borrowing Limit (PBL)The PBL is calculated by reference to the rules contained in the PBC and represents the total borrowing (from all sources) that an NHS trust can service based on its current financial performance.

Public Dividend Capital (PDC)PDC is similar to company share capital. It represents the value of the assets employed by a Trust at its formation plus any further issue or repayment of capital in subsequent years from/to the Department of Health.

Statement of comprehensive incomeThe statement of comprehensive income is the IFRS equivalent of the income and expenditure account/statement of totals gains and losses (UK GAAP).

Statement of financial positionThe statement of financial position is the IFRS equivalent of the balance sheet (UK GAAP).

TariffThe tariff is the unit price the Trust is paid for the activity it delivers. For the majority of work a national mandatory tariff is used throughout the NHS. The Department also issues non mandatory tariffs for some activity. Some activity is not covered by either a mandatory or non mandatory tariff in which case a local tariff can be negotiated with commissioners.

Working CapitalWorking capital is the current assets and liabilities (receivables, inventories, cash and payables) required to facilitate the operation of an organisation.


Acute servicesMedical or surgical treatment usually provided in a hospital setting. The organisation running the hospital is called an acute trust.

BoardEach NHS organisation is run by a Board. The Board consists of non-executive directors (who are members of the public) and executive directors (who are NHS employees).

Choose and Book / ChoiceThe system allowing patients to choose from a range of hospitals and a date for their first outpatient appointment.

Department of HealthThe Government department responsible for the NHS.

ElectivePlanned hospital treatment, either with a patient being admitted from a waiting list or by a planned admission.

Healthcare CommissionThe health watchdog for England. (Replaced from April 209 by the Care Quality Commission)

NHSThe National Health Service was set up in 1948 and is now the largest organisation in Europe.

National Institute for Clinical Excellence (NICE)The National Institute for Clinical Excellence is an independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health.

North East sectorThe north east of Greater Manchester, the area served by the Trust. Often referred to within the context of the Trust’s partnership work with the local Primary Care Trusts.

National Patient Safety Agency (NPSA)The National Patient Safety Agency co-ordinates the reporting of patient safety incidents and work to improve patient safety in the NHS.

Patient pathwayThe treatment process for the patient, taking in all contact from any member of clinical staff.

Primary Care Trust (PCT)Primary Care Trusts are organisations which commission (ie fund) most health services for residents in their area. They also provide some community-based services directly such as district nursing, and have public health responsibilities.

Primary CareThe part of the NHS where general Practitioners, community nurses and other community based healthcare professionals work.

Secondary CareSpecialist services usually provided in an acute hospital setting.

Strategic Health Authority (SHA)The Strategic Health Authority links the Department of Health and local NHS organisations. The North West Strategic Health Authority covers the Greater Manchester area.

Tertiary careHighly specialised nature typically provided in one hospital serving an entire region. Referrals to tertiary care are usually made by staff in secondary care hospitals, rather than directly from primary care.

This report contains a number of clinical terms. Plain English versions are available via NHS Direct www.nhsdirect.nhs.uk/encyclopaedia

General Glossary

Tru

st B

oar

d John Jesky, Chairman

Edward Ahmad, Non Executive Director (from December 2009)

John Battye, Non Executive Director (to November 2009)

Haydn Griffith, Non Executive Director

Michael Holly, Non Executive Director

Tim Pickstone, Non Executive Director

Camilla Guereca, Non Executive Director

Fiona Burke, Non Executive Director

John Saxby, Chief Executive

Marian Carroll, Director of Nursing

Robert Chadwick, Director of Finance & IM&T (Acting Director of Operations from November 2009)

Barbara Herring, Acting Director of Finance and IM&T (From November 2009)

Ruth Jameson, Medical Director

Simon Payler, Director of Operations (To November 2009)

Roger Pickering, Director of Human Resources

John Wilkes, Director of Facilities

The Trust Board had 12 meetings in 2008/09 with attendance figures as noted below.

Non Executive Directors

John JeskyEdward Ahmad

John BattyeTim

PickstoneHaydn Griffith

Michael Holly

Camilla Guereca

Fiona Burke

12/12 *3/4 **7/8 11/12 12/12 12/12 12/12 12/12

* Term started 1 December 2009 ** Term ended 30 November 2009

Executive Directors

John SaxbyRobert

ChadwickMarian Carroll

Barbara Herring

Dr Ruth Jameson

Simon Payler

Roger Pickering

John Wilkes

12/12 12/12 11/12 *5/5 11/12 **8/8 12/12 12/12

*Term started 5 November 2009 ** Term ended 4 November 2009


Trust Board

The Board has five sub-committees.

Audit CommitteeMichael Holly (Chair)Edward Ahmad (From December 2009)John Battye (To November 2009)Fiona Burke

The Audit Committee:

• Reviews reports from internal and external audit.

• Reviews compliance with Secretary of State directives for countering fraud.

• Reviews the system of integrated risk, governance and internal control.

• Monitors compliance with standing orders and SFIs.

• Receives and approves annual accounts.

Clinical Governance CommitteeJohn Saxby (Chair)Marian CarrollHaydn GriffithMichael HollyRuth JamesonRoger Pickering

The Clinical Governance Committee:

• Gives direction to and agrees clinical governance policies

• Agrees systems and processes to ensure quality in clinical care

Risk Management CommitteeJohn Saxby (Chair)Robert ChadwickCamilla GuerecaTim PickstoneJohn Wilkes

The Risk Management Committee:

• Oversees the design and effective operation of risk management processes across the Trust, including management and production of the assurance framework.

Remuneration CommitteeJohn Jesky (Chair)Edward Ahmad (From December 2009)John Battye (To November 2009)Fiona BurkeHaydn GriffithCamilla GuerecaMichael HollyTim Pickstone

The Remuneration Committee:

• Determines on behalf of the Board appropriate remuneration and terms of service for the chief executive, executive directors and other senior employees.

• Reviews arrangements for termination of employment and other contractual terms.

Endowment CommitteeJohn Battye (Chair) (To November 2009)Tim Pickstone (Chair) (From December 2009)Edward Ahmad (From December 2009)Robert ChadwickRuth Jameson (From September 2009)John Saxby

The Endowment Committee:

• Ensures operation of the charity within the terms of its governing documents

• Reviews and approves charitable funds and accounts for the year.


The register of interests declared by Board members at May 2010 is noted below:

J Jesky, Chairman Director ‘42’ Business and Product DevelopmentChair of North West Committee and Council Member of Music in Hospitals

E Ahmad, Non executive director Director E & M Associated Ltd, ConsultancyDirector Silver Street CentreTrustee Beam International Charity

F Burke, Non executive director Psychotherapy private practiceDoctoral student, School of Psychology, University of Central Lancashire

C Guereca, Non executive director Chief Executive of Oldham Personal Advocacy Limited

Michael Holly, Non-executive directorCouncillor for South Middleton - Rochdale MBCDeputy Chair and Trustee/Director - Assessment & Qualifications AllianceDirector - Rochdale Lawn Tennis Ground LimitedGovernor – Cardinal Langley High School, MiddletonGovernor – Crossgates Primary School, Milnrow

T Pickstone, Non executive director Councillor, Holyrood Ward, Prestwich Bury MBCChief Executive, Association of Liberal Democrat CouncillorsGovernor, Prestwich Arts CollegeGovernor St Margaret’s Primary School, PrestwichDirector of Birchcliffe Training LimitedDirector of Manchester Pride LimitedDirector of Manchester Pride Events Limited

J Saxby, Chief Executive Audit Surveyor, Health Quality Service (part of CAPITA Group)NHS Management representative, National Institute for Health and Clinical Excellence

M Carroll, Director of Nursing School Governor, Pike Fold Primary School, Blackley

R Jameson, Medical Director Director/Trustee Med Equip4Kids

All Board members have confirmed that they subscribe to the Codes of Conduct and Accountability.

Declaration of Interests


It is important to us that our membership is strong and vibrant and can influence how your hospitals are run.

Membership is free, with no obligation, and is open to anyone aged 14 and over.

For more information, or to register to become a member, visit online at www.pat.nhs.uk/foundationtrust or call 0161 918 4283 or email [email protected]

Find us on YouTube

The Trust has produced a promotional film about its proposals to become an NHS Foundation Trust and to encourage the public to sign up as members to support their local hospitals.

The 5 minute film showcases some of the achievements made by the Trust over the past two years and features interviews with Chief Executive, John Saxby, and a number of staff.

The film is part of the Trust’s membership recruitment campaign and is now available on YouTube and the Trust’s own website.

Foundation Trust - Become a member, support your local hospitals


The Trust welcomes direct feedback from patients about its services.

There are a number of different ways in which you can contact us or give us your views.

If you have an issue which you wish to raise about your care then you should initially discuss this with the ward or departmental staff in the area you are being cared for. Local staff are usually best placed to be able to answer questions about your own care, or those of your relatives. We recognise that in some circumstances patients or relatives may prefer to discuss the matter with someone not directly involved in their care. In those circumstances you can also contact the Patient Advice and Liaison Service, as follows:

• Fairfield General Hospital: 0161 778 2455• North Manchester General Hospital: 0161 720 2707• The Royal Oldham Hospital 0161 627 8678• Rochdale Infirmary: 01706 517354

You can also email: [email protected]

Sharing your feedback

The Trust welcomes all comments on its services. Patients and their families can use the hospital feedback section of the NHS Choices website at www.nhs.uk, the Patient Opinion website at www.patientopinion.org.uk or the feedback sections of the Trust’s own website at www.pat.nhs.uk

Useful Contacts

Switchboard 0161 624 0420

Volunteers co-ordinator 0161 778 5114 [email protected]

Charity 0161 908 4497 [email protected]

Contacting the Trust

Comments on this report

If you have any comments on this annual report or suggestions about future content then please contact the communications department on tel: 0161 918 4284 or email [email protected]

Foundation Trust membership

I am interested in becoming a foundation trust member.

Volunteering

I am interested in volunteering in the Trust.

The Pennine Acute Hospitals NHS Trust Charity

I am interested in raising funds or making a donation to the Charity.

Name

Address

Telephone Number Email

Please return this page toThe Pennine Acute Hospitals NHS TrustCommunications DepartmentTrust HeadquartersNorth Manchester General HospitalDelaunays RoadManchesterM8 5RB

We welcome comments on this annual report or about services provided by the Trust in general. We also welcome enquiries about volunteering or donating to our Charity.

"

Copies of this report, including different formats, are available from the Communications Department.Telephone 0161 918 4284It is also available online at www.pat.nhs.uk

The Pennine Acute Hospitals NHS TrustTrust HeadquartersNorth Manchester General HospitalDelaunays RoadManchesterM8 5RB

ann

ual rep

ort

200910

The Pennine Acute HospitalsNHS Trust

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