REPORT TO

Enclosure 3
REPORT TO
Board (Open Section)
Date of Meeting
27 May 2010
Name of Report
Annual Report & Accounts 2009/10
Presented By
Mary Leadbeater - Interim Director of Finance
Author
Mary Leadbeater, Colin Groom, Sandra Storey
Primary Purpose
For Decision
Delivering Health No
Approved By
Select...
Summary of the Report
This paper presents the Annual Report and Annual Accounts for 2009/10 for approval
by the Board.
At the time of these papers going out, members of the Audit Committee are considering
this information and will shortly report their recommendations to the Trust Board.
Recommendations
The Board is requested to consider and approve the Annual Report and Trust Accounts
for the year ended 31 March 2010 having taken account of supported documentation.
By approving this report the Board will approve:
The Annual Accounts for the year ending 31 March 2010
The Statement on Internal Control for year ending 31 March 2010
The Remuneration Report for the year ending 31 March 2010.
Relationship with Assurance Framework (Risk, Control & Assurance)
The annual audited accounts provides assurance as to the financial position of the
Trust with the associated audit work providing assurance on the financial controls in
place.
Does this report provide assurance in accordance with Yes
the Register of Assurance?
Relationship to the Trust's Principal Objectives?
Which of the Trust's business priority areas does this
report most relate to?
Governance
Which of the Trust's principal objectives for 2009/10
Select...
does this report most relate to? (up to 3)
Visit http://tinyurl.com/5832ht for a list of the 2009/10
objectives
Select...
Select...
Relationship to the Standards for Better Health
Which of the Standards for Better Health
domains does this report most relate to?
Summary of the Financial Implications of this Report
Presents the Annual Accounts for 2009/10
Validated by the Director of Finance
Has the information about the financial
implications been validated?
Select...
If so, by whom?
Not Required
Summary of the Legal Implications of this Report
Has the information about the legal
implications been validated?
Select...
If so, by whom?
Not Required
Summary of the Involvement, Equality & Diversity Implications of this Report
None.
ANNUAL REPORT AND
SUMMARY FINANCIAL STATEMENTS
2009/10
0
Chairman & Chief Executive’s Message
We are delighted to bring to you the annual report for North Staffordshire Combined
Healthcare Trust for the period for April 1st 2009 – March 31st 2010.
There has been great change over the past few years in the way mental health services are
delivered. Large institutions have been closed and services transferred into the community
which has meant more of our service users being supported and treated closer to home.
This year sees a new era in the provision of mental health services which will see many
more users being supported and treated at home. A new policy document called ‘New
Horizons’ was published by the Department of Health and replaces the 10 year plan for
Mental Health Services (National Service Framework) which has now finished.
We have once again achieved financial balance; were found to be ‘fully compliant’ with all
the Core Standards for Better Health and achieved compliance with the Regulations defined
by the Health and Social Care Act 2008 resulting in us being successfully registered by the
Care Quality Commission. In the Care Quality Commission ratings for 2008/09, we received
a ‘good’ for use of resources but regrettably dropped to ‘fair’ for our quality of services. We
have put action plans in place to address the areas which resulted in the Trust’s ‘fair’ rating
with the aim of significantly improving our ratings in 2010/11.
We are very pleased with our patient survey results which showed a significant improvement
on the previous year’s results.
It has been another challenging year for NHS organisations and we see the next five years
as being equally as challenging. We are being asked to do more with less, so doing what we
have always done in the way in which we have always done it is no longer an option.
During the year we have been revising our five year Integrated Business Plan (IBP) to
ensure that we are well placed to provide quality services through increased productivity
whilst at the same time being mindful that we meet the personalised care needs for every
individual. In addition, we have also been progressing our Foundation Trust (FT) application.
We continue to be actively supported by both of our local commissioners and are working
together to ensure our business plan is aligned and responsive to the local commissioning
intentions and priorities.
We believe that mental health is everyone’s business and are committed to leading the
move to further embed good mental health across the community whilst at the same time
continuing to improve our services. By working together with different agencies we can
address problems as early as possible, combat stigma and put mental health service users
in charge of the support they receive.
Last but by no means least, we wish to take this opportunity on behalf of the Board to thank
our staff for their incredible professionalism, hard work and dedication they have in providing
care to our service users.
We hope that you enjoy reading this report and thank you for your continued support.
SIGNATURES TO BE ADDED HERE
1
OPERATING AND FINANCIAL REVIEW
The Annual Report and Summary Financial Statements may not contain sufficient
information for a full understanding of the Trust’s financial position and performance. A copy
of the Trust’s full accounts can be obtained by contacting the Trust Board Secretary in
writing, or by telephone at:Mrs S Storey
Trust Board Secretary
Harplands Hospital
Hilton Road
Stoke on Trent
Harpfields
Stoke on Trent
ST4 6TH
Tel: 01782 275105
2
Section 1
Our Population, Our Organisation and
Our Partners
North Staffordshire Combined Health NHS Trust was established as a Trust in 1994 and are
responsible for providing mental health and specialist learning disability care to people living
in the city of Stoke on Trent and North Staffordshire county and sometimes from outside of
these areas. We currently work from both hospital and community based premises.
We provide services to people of all ages with a wide range of mental health and learning
disability needs. Sometimes our service users need to spend time in hospital, but much
more often we provide care in outpatients, community resource settings and in people’s own
homes.
We also provide specialist mental health services such as parent and baby mental health
services, mentally disordered offenders and psychological therapies and until September
2009 we provided care for older people with physical health needs, when this service was
transferred to the management of a more appropriate community health care provider North Staffs Community Healthcare. Our 1,967 clinical and support staff see around 380,500
people each year and we have an inpatient bed occupancy rate of around 87%. We have an
annual budget of c£86million.
Our Population
We service a population of around 463,000 people from a variety of diverse communities.
The area is very mixed, and ranges from prosperous suburban communities to areas of
severe deprivation in the city of Stoke on Trent. Like residents of many industrial cities the
people of Stoke have a poorer standard of health on average than the country as a whole.
Our Partners
Our main NHS partners are the two local Primary Care Trusts (PCTs) – NHS Stoke on Trent
and NHS North Staffordshire. We also work very closely with the local authorities in these
areas. In addition, we provide a range of clinical and non clinical services to University
Hospital of North Staffordshire NHS Trust and a range of support services such as estates,
health and safety and health informatics to the two PCTs.
We have also forged closer links with the two local universities, University of Staffordshire
and Keele University. The organisation has been a partner in the development of the Keele
University Medical School.
We also work closely with agencies which support people with mental health problems, such
as North Staffs Users Group (NSUG), Approach, ASIST, Brighter Futures, Changes,
EnGAGE, North Staffs Huntington’s Disease Association, MIND, North Staffs carers
Association, Rethink, Richmond Fellowship.
3
Section 2
Our Purpose, Vision & Values
Mental Health Services are Changing
2009/10 has seen the completion of the 10 year plan of the National Service Framework
(NSF) in respect of Mental Health services. The NSF has been replaced with the policy
document entitled ‘New Horizons’ which marks a new era in the provision of mental health
services. This policy sets out a dynamic new approach to improving the well-being for the
whole population. The policy combines service improvement with a new partnership and
means we will be working more closely with our local partners in health and social care in
future.
More focus will go on identifying illness and treatment much earlier and far more of our
service users are being supported and treated at home. Our centre of attention is shifting to
wellbeing and recovery whilst at the same time ensuring we provide timely early intervention
in the treatment of illness. As we enter the next decade, our services need to become much
more personalised to allow service users to make decisions about their treatment, monitor
their own condition and tell the professionals what it is they want to help get their life back on
track.
What Matters to Us.
We want to be a leading provider of mental health services. We aim to offer:
•
•
•
•
•
•
An improved care environment and high quality services
A recovery based approach
A sufficient, competent and motivated workforce – ‘the right people in the right place at
the right time’.
More choice for and meaningful engagement of service users and carers.
A well-run, financially viable and sustainable organisation
An environment which puts the service user first and which provides privacy and
dignity.
•
We believe that how we go about achieving our aims are critical, and being values-led
matters to us.
Of course clinical excellence is centrally important, but our ultimate aim is to enable our
service users to live their lives to the full, play their part in the community and maintain their
independence.
To do this will require more than just first rate clinical care. It means treating people with
respect and giving them choices, providing practical support (for example with housing and
employment), ensuring we deliver our services in the community wherever we can, and
above all avoiding lengthy stays in hospital by keeping people mentally healthy.
The diagram below illustrates our purpose, vision and values and how they link to our
strategic goals and the strategies that will help us realise our aims.
4
Our purpose, vision and values underpin our business plans and have been developed in
response to themes arising from our market assessment and feedback from our
stakeholders. This strong alignment will enable the Trust to adapt and manage current
challenges and future change.
We Want to Become a Foundation Trust
The Trust is committed to becoming an NHS Foundation Trust in 2010. We strongly believe
this is in the best interests of our service users, their carers, local people and our staff. It will
give them a greater say in how we continue to improve our services. Becoming a Foundation
Trust is not an easy process, but we are confident we have what it takes to do so.
As a Foundation Trust we will still be part of the NHS but we will have more independence
from Government and more financial freedoms to run our own affairs. As a Foundation Trust,
5
we will have greater control over our decision-making. Service users, carers, our local
community and our staff will have more say in the decisions we make too.
The first step in the process was to submit our five year business plan to the Strategic Health
Authority (StHA) at the end of March 2010 as the first stage of their assurance process in
respect of our Foundation Trust application. When advised by the StHA we will then
undertake a public consultation on our proposals before it is submitted to MONITOR who are
the governing body for Foundation Trust’s for formal consideration of our application.
We view communication as a vital element of our relationship with our membership and
intend to ensure that we engage more effectively with members whether or not we become a
Foundation Trust.
6
Section 3
Our Priorities and Performance
Our Priorities
The Operating Framework for the NHS for the next five years (2010-2015) was published
last autumn and sets out the need for change in the way services are delivered as a
consequence of the pressures that public sector funding will face during this period. This
means that we will need to become far more efficient and productive in how we deliver
services and our own five year business plan (IBP) concentrates on how we can reshape
services to ensure better quality of care. However this change cannot be achieved in
isolation and more than ever it is important that we work in partnership with all our
stakeholders, particularly social services.
Building on Lord Darzi’s vision set out in the ‘Next Stage Review’ the challenges we are
facing means we do have to ensure far more meaningful engagement with our service users
and their carers as well as investing in developing strong effective leadership within the
trust. Mindful of these challenges, our commitment for the future is to ensure the Trust is
focused on Quality, Innovation, Productivity & Prevention (QIPP) in the planning and delivery
of services. Locally we have made this QIPPPp – to include Partnership and people.
We will not be able to achieve the changes required without the input of our service users or
our staff (people). The planning and delivery of services is one in which we are firmly
committed to working in close partnership with all our local stakeholders, in order that we
can make a strong contribution to the promotion of the wellbeing and health of our local
community.
It is important that we focus more on the outcomes of care, rather than on the inputs – this
way we provide services which are evidence based and benchmarked nationally that will
ensure we deliver best practice for our service users. More than ever the principles of strong
clinical leadership, system alignment, collaboration and cooperation become even more
important in the way we execute our business, in order to remain successful as the provider
of choice in the future.
During 2009 the Trust continued to:
•
•
Redesign core services in response to changing local demand and alignment with
our local commissioner requirements.
Progress our response to the national dementia strategy
The Next Five Years
In response to the NHS Operating Framework, we have developed our own five year
Integrated Business Plan (IBP). In this plan longer term assumptions have been made about
the development of services in response to our vision, commissioner’s requirements and
market opportunities. To support this plan we have developed long term strategies for
Estates, Workforce, Information Technology, Clinical, Customer Focus and Innovation.
A full copy of the IBP can be found on our website at www.combined .nhs.uk
7
We have also developed a robust integrated workforce, leadership and organisation
development (OD) strategy to ensure we effectively manage change, build capacity and
improve capability across the Trust.
Quality Accounts – 2010 onwards
High Quality Care for All - published in June 2008, is the first report by Lord Darzi who was
appointed by the Government to look at the whole of the NHS and report how it could work
more effectively and efficiently. It set an ambitious goal of putting quality at the heart of the
NHS by making it its organising principle.
The Report highlighted the importance of measuring what we do in order to drive
improvements in the quality of care, but it is how we use this information and the changes
we make as a result which are key to successful improvement and high quality services.
By 30 June 2010 all organisations are required to develop and publish a Quality Account
which will be our yearly report to the public about the quality of services we provide and will
demonstrate that the Trust Board regularly scrutinises each and every one of our services.
The Trust’s Quality Account will be our yearly report to the public about the quality of
services we provide. In the coming years we hope our organisation and the general public
and patients will use our Quality Account to understand:•
•
•
•
What our organisation is doing well
Where improvements in the quality of service we provide is required
What our priorities for improvement are for the coming year
How we have involved service users, staff and others with an interest in our
organisation in determining these priorities for improvements.
We are keen to ensure that our Quality Account reflects the views and needs of the local
population and the people who use our services. During the course of 2010 we will
commence a process of involvement and engagement in the development of our Quality
Account.
Our Performance
On 1 April 2009, it became a legal requirement for all NHS organisations that provide
healthcare directly to patients to register with the Care Quality Commission
(CQC). The Care Quality Commission is the new independent regulator of all health and
adult social care in England. They also protect the interests of people detained under the
Mental Health Act, and ensure that essential common standards of quality are met
everywhere that care is provided. They have a wide range of enforcement powers to take
action if services are deemed to be unacceptable.
8
Periodic Review (Annual Health Check in 2008/9)
The Periodic Review, formally referred to as the Annual Health Check, is a process
operated by the Care Quality Commission to consider a range of quality standards
and targets and assesses an organisation’s performance and whether levels of
service are being maintained. The process results in all Trusts being awarded two
public ratings: one for the ‘quality of services’ and the other for the ‘quality of
financial management’.
The results of the Annual Health Check for 2008/09 were received in October 2009
and the Trust was rated ‘good’ for the quality of financial management but ‘fair’ for
the quality of services provided.
*the data for 2009/10 is published in October 2010 which is after this report has gone to print. We were disappointed that we did not maintain our rating of good for quality of services. We
failed to meet one target in relation to ‘Access to crisis resolution home treatment’ and
marginally underachieved in four others which resulted in our rating of ‘Fair’. Plans have
been put in place to ensure that we meet these targets in future.
Commissioning for Quality and Innovation (CQUIN) Framework
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. In 2009/10 .
A proportion of North Staffordshire Combined Healthcare’s income in 2009/10 was
conditional on achieving quality improvement and innovation goals agreed between our
Trust and any person or body we entered into a contract, agreement, or arrangement with
for the provision of NHS services, through the CQUIN framework. In 2009/10, the Trust and
Commissioners set CQUIN targets to the value of 0.5% of the Trust’s income against the
following priorities:
ƒ
ƒ
ƒ
The development of Yorkshire Care Pathways
Productivity Improvement Plans
Physical Healthcare Screening
To support the delivery of our service improvement plans, our main Commissioners have
worked with us to establish a Clinical Quality Review Group, made up of Commissioners and
Senior Trust Clinicians.
During the course of the year, the Trust achieved ??80% of this target and associated
income
Performance Management and Monitoring
9
The Trust has developed a comprehensive framework called the Performance and Quality
Management Framework (PQMF) to measure performance across a range of areas; to
report outcomes and to target areas for improvement. The PQMF contains a number of Key
Performance Indicators (KPIs) which are summarised in the table below and include
indicative performance outcomes for 2008/9 and 2009/10.
It needs to be stressed that 2009/10 data may change based on Q4 outcomes
Anne – I have constructed the following based on 2009/10 objectives and KPIs and have
excluded any from 2008/9 which we no longer use in 2009/10. Let me know if you are keen
to ensure that there is absolute consistency with the 2008/9 Annual Report in which case I
will add them?
Key Performance Indicator (KPI)
2008/9
2009/10
Customer Focus
Objective 1: Ensure we have service user and carer engagement at all levels in the
organisation
Satisfaction levels as measured by the National Service User Survey
KPI 1.1Number of senior management appointments for which a
service user was involved
?
No data
No data
Objective 2: Ensure all service users have a care plan and a named care coordinator
KPI 2.1(i) Number of service users on the Care Programme Approach
(CPA) with an electronic care plan in place
KPI 2.1(ii) Clients in learning disability services with a care plan
Objective 3: Establish quality indicators and outcomes for each division
KPI 3.1 Clinical outcome measurement process in place
No data
?
KPI 3.2 Admissions to Crisis Resolution Home Treatment (CRHT)
Services via gatekeeping
KPI 3.3 Care Programme Approach (CPA) – Follow up within 7 days
of discharge
KPI 3.4 Delayed transfers of care
?
KPI 3.5 Drug users sustained in drug treatment programmes
?
KPI 3.6 Clients in a learning disability campus bed with a discharge
plan in place
KPI 3.7 Year on year reduction in cases of MRSA
KPI 3.8 Screening of patients for MRSA
n/a
? 10
KPI 3.9 Year on year reduction in cases of Clostridium Difficile
Key Performance Indicator (KPI)
2008/9
2009/10
Workforce
Objective 4: Ensure all staff are up to date with Statutory and Mandatory Training
KPI 4.1 Staff up to date with the range of mandatory training
programmes
?
Objective 5: Implement Service Line Reporting and continue to develop the Trust’s
approach to team based working.
KPI 5.1 Progression towards Service Line Management / Reporting in
line with key milestones in the plan
?
KPI 5.2 Staff satisfaction as assessed by the National Staff Survey
?
Objective 6: Develop a Trust workforce plan
KPI 6.1 Progress towards the development of a robust five-year
Workforce Plan
KPI 6.2 Implementation of variance reports against the five year
Workforce Plan
?
Key Performance Indicator (KPI)
2008/9
2009/10
Governance
Objective 7: Achieve excellent in our Care Quality Commission assessment by Meeting
National Priorities
KPI 7.1 Meeting core quality standards as defined by Standards for
Better Health and assessed by the Care Quality Commission
KPI 7.2 Registered by the Care Quality Commission under the Health
& Social Care Act 2008
n/a
KPI 7.3 Quality of Financial Management (ALE):
Financial Reporting
? Financial management
? Financial standing
? Internal control
? Value for money
? 11
KPI 7.16 Best practice in mental health services for people with a
learning disability
KPI 7.18 Assessment of Child and Adolescent Mental Health services
KPI 7.28 Mental health minimum data set (MHMDS) patterns of care
assessing whether clients have a care coordinator in place
KPI 7.30 Access to mental health services for people with a learning
disability
n/a
?
Objective 8: Implement the benefits realised from the Productivity Improvement
Programme (PIP) and Yorkshire Care pathway
Objective 10: Ensure the Trust secures CQUIN monies
KPI 8.2 Reference costs and progress towards reducing reference
costs
?
KPI 10.1 Implement the benefits realised from the Productivity
Improvement Programme (PIP) and Yorkshire Care pathway
n/a
?
KPI 10.2 Service users who have had a physical health check
n/a
?
Objective 9: Develop information systems that support the full implementation of
service line reporting
KPI 9.1 Progress towards the implementation of a new Business
Intelligence solution to help to support the effective sharing of
information in line with the plan
n/a
KPI 9.2 Accuracy of primary and secondary diagnosis coding
?
?
KPI 9.3 Data quality for recording of ethnicity status
KPI 9.4 Mental health minimum data set (MHMDS) completeness
?
Key Performance Indicator (KPI)
2008/9
2009/10
Business Development
Objective 11: Establish an effective local system to measure stakeholder satisfaction
KPI 11.1 Progress in developing a revised customer focus strategy
KPI 11.1 Stakeholder satisfaction with the services provided
n/a
No data
No data
Objective 12: Develop and approve a five year Trust business plan and financial model
KPI 12.1 Developing a five-year Integrated Business Plan (IBP) and
12
Long Term Financial Model (LTFM) to support an application for
Foundation Trust Status
Objective 13: Progress the five year estates strategy to support IBP
KPI 13.1 Developing an effective strategy to manage the Trust’s
estate
Objective 14: Monitor new business within the divisions
KPI 14.1 Market assessment complete and used to inform the
Integrated Business Plan
Key Performance Indicator (KPI)
2008/9
2009/10
Finance
Objective 15: Successfully deliver the 2009/10 financial plan
KPI 15.1 Annual Financial Plan in place
KPI 15.2 In year breakeven, financial performance in line with plan
? KPI 15.3 Cumulative breakeven
? KPI 15.4 Break even against the External Financing Limit (EFL)
? KPI 15.5 Performance in line with the Better Payment Practice Code
? KPI 15.6 Achieve the 3.5% cost absorption duty
? Objective 16: Implement service line reports and prepare the Trust for the
implementation of cost and volume contracts
KPI 16.1 Progress in devolving income and expenditure budgets to
service lines
KPI 16.2 Progress in introducing patient level costing
?
n/a
?
Objective 17: Deliver a five year cost reduction strategy
KPI 17.1 Board approved 5-year cost reduction strategy in place
KPI 17.2 Achievement of targets and milestones set in the 5-year cost
reduction strategy
?
n/a
?
Key:
All milestones met or rated as achieved by the Care Quality Commission
Milestones almost met
13
Milestones partly met or underachieved rating by the Care Quality Commission
Milestones not met or failed rating by the Care Quality Commission
Indicators that contribute to the Care Quality Commission’s Rating for the Quality
of Services
Indicators that contribute to the Audit Commission’s Rating for the Quality of
Financial Management
The indicators highlighted in yellow are all of the indicators which contribute to the
Care Quality Commission’s rating for the ‘quality of services’ and those highlighted in
blue contribute to the rating for the quality of ‘financial management’.
Patient Environment Action Team Assessment (PEAT)
The annual PEAT audit is undertaken by a team made up of Modern Matrons, the Support
Services Manager, who manage the area to be audited, Estates Operational Manager, Head
of Support Services, Infection Control nurse and representatives from North Staffs Users
and LINks (Local Involvement Network) representatives who represent the general public.
The inspection team assess each site on three elements: the environment, food, privacy
and dignity. In 2009/10 we received 21 ‘excellent’ ratings out of a total of 24 and good for
three others.
Site Name
Environment
Score
Food
Score
Privacy &
Dignity
Score
Bucknall Hospital Excellent
Excellent
Excellent Fox Hollow & Meadow View Excellent
Excellent
Excellent Dragon Square Community Unit Excellent
Excellent
Excellent Learning Disabilities Unit Hilton Road Good
Excellent
Excellent The Bungalows, 1 ‐ 6 Chebsey Close Good
Excellent
Good Darwin ‐ FKA Clydesdale Centre Excellent
Excellent
Excellent Harplands Hospital Excellent
Excellent
Excellent Mandalay & Ashlea Learning Disability Homes
Excellent
Excellent
Excellent Healthcare Associated Infections.
Infection control and prevention remains a high priority for us and we have strengthened our
systems and procedures further in 2009/10. Senior management have worked with the
14
infection control team to ensure that this topic remains a priority for all staff particularly
amongst clinicians, nurses, therapists and support services.
We are compliant with all six criteria defined by the national indicator and have registered
with the Care Quality Commission (CQC) in relation to healthcare associated infection
Commission legal requirement in April 2009.
We have had no Meticillan-resistant Staphylococcus Aureus (MRSA) bloodstream infections
since 2007 largely as a result of the introduction of the MRSA screening programme for all
admissions to hospital inpatient wards and units.
We did however have six cases of Clostridium difficile (CD) reported which were contained
and did not result in any ward closures.
Reported infections are monitored through electronic surveillance, a system which allows
changes in trends or emerging threats to be identified through laboratory reports. This data
showed that the Trust has sustained a consistent year on year improvement in healthcare
associated infections.
15
Section 4 Our Workforce
We employ over 1,900 staff. The table below shows the broad groups in which they work
and shows that over 75% of our staff provide professional healthcare directly to our service
users.
We communicate with our staff using a variety of methods including a weekly News Round,
via the website and global e-mail and through cascades from line managers at directorate
and team meetings. We will look to strengthen communication further with a new Intranet
site for staff due to come on line in June 2010.
We have a well established joint negotiating consultative committee (JNCC) which meets
bi-monthly where issues are discussed and agreed with trade unions. The Trust’s
Recognition Agreement ensures that the Trust provides a regular forum for communication,
consultation and negotiation on issues affecting the Trust and its workforce.
The Trust is committed to equality of opportunity in employment and this is reflected within
the Trust’s policy supporting guidance for Equality of Opportunity in Employment.
As part of our commitment to ‘Positive about Disability’ (Two Ticks Symbol), all applicants
with a disability who meet the minimum requirements of the job as set out in the person
specification will be guaranteed an interview. Where appropriate, reasonable adjustments
will be made to recruitment processes and or position applied for to ensure that no applicant
is unfairly disadvantaged because of their disability.
Staff Group
Headcount
% of Group
Nursing
575
30
Prof Scientific and Technical
154
8
Other Clinical Services
582
29
Administrative and Clerical *
342
17
57
3
166
8
Medical
77
4
Students
14
1
1967
**100%
Allied Health Professionals
Estates and Ancillary
Staff Group Summary Total
*Includes IT service staff who also provide a service to the two Primary Care Trust’s
** Figures rounded to nearest decimal point
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Workforce Strategy
Throughout 2009/10 the Trust reviewed, updated and remodelled its five year workforce
strategy to support the development and retention of a first class workforce, in order to
improve the mental health and wellbeing of the local community and to meet our strategic
goals. The workforce strategy is underpinned by a leadership and Organisational
Development (OD) plan, Education and Workforce plan.
It is anticipated that there will be a reduction in the number of staff required over the next few
years as more services are transferred to other providers to manage. In April 2009 the
Paediatric Occupational Therapy Service was transferred out and in September 2009, a
staged transfer of Older People’s Physical Health services was also completed. In
accordance with national policy, the first phase of the transfer of learning disability campus
services is due to be implemented in April 2010 and will continue throughout the course of
2010/11.
Under a section 75 agreement, 40 staff from Social Services in Staffordshire County Council
were transferred to us under TUPE regulations, as part of a pooling of resources to improve
the local provision of health and social care services.
Staff Survey 2009
Our staff survey took place in November 2009. The report of the survey results published by
the Care Quality Commission (CQC) is based on a random sample of staff. The response
rate for the sample was 47% against an average response rate for Mental Health and
Learning Disabilities (MHLD) Trusts of 54%.
The questionnaire responses are summarised by the Care Quality Commission (CQC) and
presented in the form of key findings. This year the number of key findings has risen from 36
to 40, as new questions were added in relation to health and wellbeing issues. Overall, we
have improved in 7 of the key findings and have done less well in 3 others.
Key Findings
2008
2009
Average or above
16
21
Below average
20
19
We also opted to conduct a census survey for the first time involving all staff with a response
rate of 49%. We have produced an action plan to make improvements in these areas and
work is ongoing in each of the divisions to respond to these specific issues.
Improving Sickness Absence
Steady progress has been made in reducing sickness absence over the last three years
from 5.51% in 2007/08 to a current figure in 2009/10 of 4.85%. This compares favourably
with other mental health and learning disability trusts nationally.
17
Regular sickness returns are distributed to business managers and are reported at divisional
meetings. HR managers support business managers in working to reduce sickness
absence. Regular meetings are held between the occupational health service and HR
managers relating to individual cases to expedite a timely and supported return to work.
In partnership with the local health economy , we have retendered the occupational health
service contract which will have a stronger emphasis on health and wellbeing
Leadership Development
We recognised the need to ensure we invested in resources to promote strong clinical
leadership and during the year we appointed Clinical Directors and Clinical Leads for
services that are empowered to bring about service transformation that will meet the needs
of the future. It is also important that our clinical staff are supported by strong and effective
managers who will back good ideas and remove blockages in the system where this may
prohibit service redesign and innovative practice. We must actively support and encourage
our clinical staff to innovate, collaborate and work across the local economy in order to
provide timely and appropriate care for patients where there is a need.
PICTURE 1
Development CentreWe revised and finalised our leadership plan in October 2009 to ensure
an integrated approach to leadership and management development and to enable the Trust
to identify and support leadership talent at all levels.
This led us to tender for an external partner to work with us on further developing our
competency framework and to design a Development Centre for our Senior Leaders and
Managers. The Trust Board recommended that all managers at 8a and above should take
part in a Development Centre to match existing skills against the competencies required and
to inform of future leadership development requirements. This process started in January
2010.
We also engaged with a regional programme called ‘Catalyst Future Leaders’ which is
supported by Improvement & Efficiency West Midlands. This programme is a crossorganisational course for the public sector to promote leadership, partnership skills and
networks required for the future. Two candidates were successfully nominated and are now
on the programme.
People Management Programme
Work on the Leadership strategy during 2008/09 identified a gap in learning and
development opportunities for our first line managers. In order to address this gap the
People Management Programme was developed and the first cohort of managers undertook
the programme in December 2009.
Managers have reported having undergone the Management Programme they have
changed the way in how they deal with issues. For example:o
o
Not shying away from difficult situations
Being tighter on management processes
18
o
o
Adopting a more proactive in dealing with absenteeism
Being more focused on solution based approaches and doing things as a team rather
than alone.
Corporate Induction Programme
We also updated our approach to the induction of new employees during the year. Based on
feedback from other new starters, corporate induction has been redesigned to make it a
more interactive and engaging day. The new format has run monthly since April 2009 and
has received excellent feedback.
The Corporate Induction Programme operates alongside the local workplace induction,
which together provides vital knowledge about the Trust, an employee’s place within it and
the procedures that they need to know and should follow.
Education – e-learning Mandatory Training
Throughout 2009/10 we started to introduce e-learning for our staff in order to provide a
broader range of learning opportunities. It is our intention to use the courses which are
currently available on the National Learning Management System and can be accessed
directly by staff through Electronic Staff Records (ESR).
Internal training providers have reviewed and approved the content of the Statutory and
Mandatory training courses and a pilot project using the Fire training package is nearing
completion. Learning points will be incorporated in the future rollout which aims to provide an
e-learning option for all staff.
Chairman’s Awards
The Chairman’s awards exist to highlight and celebrate outstanding contributions made by
staff to patient care and the running of services within the Trust. It is also a chance to share
successes with each other, with the public, patients, carers and the wider healthcare
community of north Staffordshire. All categories are open to all staff employed by the Trust.
The categories for 2009 were:
Improving Experience Award – Huntingdon’s Disease Team
This award recognised outstanding partnership working between service users, carers and
staff that improved the experiences of those receiving and providing care.
Service Transformation Award
The award was presented to the team that delivers the Pregnant Drug Users Service who
demonstrated a fundamental change in the way that their service was delivered which had a
positive impact on those receiving the service.
Customer Care Award
19
This award was for individuals and teams, nominated by service users and carers who
believe that staff had demonstrated a real commitment to patient care, and who had shown a
meaningful contribution to a positive experience for those who use the services and reflected
positive values and behaviours.
The winners were:
•
•
•
•
•
•
•
•
No. 4 Chebsey Close Team
Diane Morris & Julie Richardson, Residential & Resettlement Team,
Denise Pearson, Head of Service
Bennett Centre Community Mental Health Team
Assessment & Treatment Unit & The Telford Unit
Ronald Edwards, Art Therapist, Knivedon Partnership
Complex Needs Ward, Bucknall Hospital
“Stay at Home Scheme” Team
20
Section 5
GOVERNANCE
Compliance with the Core Standards for Better Health
Since 1 April 2005 all Trusts have been required to self assess against the core quality
standards defined by Standards for Better Health and submit an annual declaration of
compliance to the Healthcare Commission (HCC), and since 2008/9 to the Care Quality
Commission (CQC). The Care Quality Commission is the new independent regulator of all
health and adult social care. The last declarations were submitted to the Care Quality
Commission in December 2009 for the period from 1 April to 31 October 2009, and a less
formal year end process for the full year. The Trust declared full compliance in 2009/10
for the fifth consecutive year. The core standards defined by Standards for Better Health
remained in place until 31 March 2010 after which this national process will be fully replaced
by the new Registration process.
Registration under the Health & Social Care Act 2008
On 1 April 2010, it became a legal requirement for all NHS organisations that provide
healthcare directly to patients to be registered with the Care Quality Commission
(CQC).
The new standards place the patient at the centre of the registration system and focus on
clinical outcomes and people’s experience of quality and safety rather than an administrative
/ management process of compiling evidence about policies and process.
During 2009 we carried out a comprehensive self assessment to measure our compliance
with the new regulations which are structured as ‘Essential Standards of Quality and Safety’.
The outcome of our self assessment indicated good levels of compliance with the essential
standards and we therefore applied to the CQC for registration to provide services.
We are pleased to report that following a review of our application, the CQC registered the
Trust to provide specified regulated activities. Those activities are:•
Personal care
•
Accommodation for persons who require nursing or personal care
•
Accommodation for persons who require treatment for substance misuse
•
Treatment of disease, disorder or injury
•
Assessment or medical treatment for persons detained under the 1983 Mental Health
Act
The Trust has established robust processes to ensure ongoing compliance with the essential
standards of quality and safety.
21
Managing Risk is Everyone’s Business
We believe risk management to be everyone’s business whether they are an employee or a
contractor and consider this a top priority for the Trust. We are committed to providing
healthcare and services which are safe and of the highest quality and have a Risk
Management Strategy which was reviewed at the Trust Board in March 2010.
Following assessment by the NHS Litigation Authority (NHSLA) we successfully achieved
level 1 against their risk management standards. The Trust has committed to undertaking a
further assessment in January 2011.
Preparing for an Emergency
The Trust has a major incident plan which is fully compliant with national guidance on
‘Handling Major Incidents: an Operational Doctrine’, and accompanying guidance on major
incident preparedness and planning. The Trust regularly holds tabletop exercises to assess
effectiveness of parts of the major incident plan.
In 2009/10 the Trust responded to the flu pandemic by implementing elements of the major
incident plan. Although the pandemic was not as severe as the Department of Health
expected our supporting plans have been reviewed and adjusted to ensure that we are as
prepared as possible in the event of any future pandemic incidents.
Protecting the Environment
We take climate change and environmental issues very seriously. Through our central
purchasing function, we are part of a consortium where 15% of our energy comes from
renewable resources. We have also started a service for separating out reusable material
into appropriate waste containers for recycling.
We spent approximately £50k on energy efficiency works including loft and wall insulation
around various Trust properties and are continually looking are ways in which we can save
energy now and in the future.
Serious Untoward Incidences (SUIs)
A total of 37 incidents were reported to the Strategic Health Authority with 10 being
subsequently downgraded from SUI status. A full Root Cause Analysis is undertaken for
each incident using the National Patients Safety Agency’s guidelines and our staff have
received comprehensive training to assist with this.
With effect from 1st April 2010 the Trust will report SUIs directly to PCT Commissioners not
the SHA.
Freedom of Information (FOI)
In 2009/10 we responded to 71 Freedom of Information Act requests. The table below shows
the types of organisations requesting information and number of requests under each
category.
22
FOI Request
Number
Government
6
Media
6
NHS
1
Private Business
32
Public
26
Total
71
Information Security
We have reviewed all incidents of data loss or confidentiality breach since April 2009. Whilst
there has been a slight increase in the number of incidents reported compared to the
previous year, (2008/09 - 12 & 2009/10 - 14), this has been attributed to improved
information collection, monitoring and reporting of incidents.
When an incident is recorded an assessment is made using guidance issued by the
Department of Health as to whether or not it is a serious untoward incident. There were no
incidents reported during the year which were classed as category 3 serious untoward
incidents.
There were three incidents in the year from 1 April 2009 to 31 March 2010. None of these
are serious untoward incidents. An assessment of whether or not the incident is a serious
untoward incident has been made using the guidance issued by the Department of Health.
The table below summarises the personal data related incidents in the 2009-10 financial
year and includes incidents up to the date of publication of this annual report.
Summary of Personal Data Related Incidents in 2009-10
Category
Nature of Incident
Total
1
Loss of inadequately protected electronic equipment,
devices, or paper documents from secured NHS premises.
1
11
Loss of inadequately protected equipment, devices or paper
documents from outside secured NHS premises.
0
111
Insecure disposal of inadequately protected electronic
equipment, devices or paper documents.
0
1V
Unauthorised disclosure.
0
1V
Other.
2
23
Local Counter Fraud Squad
In 1999 the Secretary of State Directions were issued to Trusts setting out the requirements
for countering fraud in the NHS. The Local Counter Fraud Specialist provision at this Trust
is provided by RSM Tenon and their officers’ report to the Trust’s Audit Committee on all
aspects of counter fraud and investigation. A work plan was agreed by the Audit Committee
and reports on progress were provided during the year. Their annual report details all
activities undertaken of both a proactive and reactive nature in the year 1 April 2000 to 31
March 2010.
24
Section 6
Customer Focus
Patient & Public Involvement (PPI) - Patient Experience
We continue to focus on making the necessary changes to support and drive forward
improved outcomes and experiences for people who come into contact with our services and
responding to their feedback with the importance that it deserves.
We will be introducing further supportive service user and carer feedback tools to seek near
or real time feedback so that the Trust may respond in a timely and pro-active manner to
what service users and carers are telling us.
It is very important that service users, carers and the public have confidence in their local
health services at all times. We have undertaken a comprehensive review of lessons to be
learnt from the Mid-Staffordshire Hospital Care Quality Commission Investigation and the
subsequent Independent ‘Francis’ Inquiry. Any responsive actions that we need to address
will be taken forward and monitored at regular intervals.
Patient Advice & Liaison Service (PALS) Comments, Compliments, Concerns
Throughout the year our PALS and Complaints staff have been working more collaboratively
and now offer a single point of contact for patients and the public who have enquiries,
requests for help or information, concerns and complaints.
A 16-page booklet, ‘Listening, Responding and
Improving’, was published by the PALS and Complaints
team following the introduction of new complaints
regulations, which came into effect at the beginning of
April 2009.
During the course of the year, the PALS Office has
responded to over 400 requests, comments and
enquiries, including over 150 issues which have been
addressed through the PALS service.
Issues that people bring to PALS are wide-ranging and
include
concerns
about
access
to
services,
appointments, choice, support needs, communication
problems, and requests for quality improvements in their
healthcare.
The PALS Manager also supports trust teams in the development of patient and carer
information. During the year, PALS helped teams to produce 18 new publications, including
the
popular
‘We’re here to help’ guide to local mental health
services,
of
which 12,000 copies were distributed throughout
North
Staffordshire.
25
New Complaints Procedures
On 1st April 2009, New Complaints Regulations (The Local Authority Social Services and
National Health Service Complaints (England) Regulations 2009) came into force. The
Regulations and new principles of good complaint handling which are :1. Getting it right
2. Being customer focused
3. Being open and accountable
4. Acting fairly and proportionately
5. Putting things right
6. Seeking continuous improvement
We received 84 complaints throughout 2009/10 which is an increase of 38% from the 61
complaints received during 2008/09. Under the new Regulations, any concerns which are
not resolved within 24 hours are now handled under the Regulations, with the agreement of
the complainant, and this has contributed to some of the increase in complaints received in
comparison to last year.
Under these new regulations the Trust is required to acknowledge all complaints no later
than 3 working days after the day on which the complaint is received. We acknowledged 79
of the 84 complaints (94%) within this timescale.
There are no longer any set timescales for responding to complaints in the new Regulations.
Each case is dealt with on its own merits and each complainant is offered the opportunity to
discuss and agree an appropriate timescale for investigation and response.
Learning from Complaints
The type of complaints received range from issues such as, concerns regarding care and
treatment, attitude of staff and access to services. During the year learning actions have
been identified from specific complaints and changes to improve services or processes
made as a result. For example:ƒ
The Child Health system has been developed to include an early warning mechanism for
appointments.
ƒ
A review and work has been undertaken with teams to ensure cross-working and
involvement from all professionals across services and with other agencies.
ƒ
Work has been undertaken to further improve communication and provide greater
understanding regarding discharge plans with patients and carers.
Compliments
Our staff regularly receive cards and letters from service users either personally or via the
ward thanking them for the care they have received. In addition, some service users contact
our PALS office to pass on their thanks to teams and individual members of staff. During
2009/10 twenty such compliments were recorded by the PALS office.
From a comments and suggestions card received in February 2010
26
“Regarding my stay on Ward 2, I cannot fault the ward or staff or the treatment I have
received.
From a thank you card
“To Jim and all the Bennett Centre team – a huge Thank You! I found the Bennett Centre a
therapeutic haven . . . thanks to everyone for your enduring Support!”
The National Mental Health Acute In-patient Service Users Survey
We undertook a service user survey as part of the national programme led by the Care
Quality Commission (CQC). The results of the survey will be used to help the organisation
identify areas where we have performed well and to identify the areas where there is room
for improvement.
Questionnaires were posted to a random sample of 850 adults who had used our acute
services at the Harplands Hospital between July and September 2009. Service users were
asked about various aspects of their experiences including:
•
•
•
•
•
•
Health & Social Care Workers
Medications, Talking Therapies
Care Coordinators, Care Plans
Care Reviews
Day-to-day Living
Crisis Care.
The results from the 2009 survey provided an overview of the patient experience and
showed that we are in the top 20% of NHS Trusts in England for staff:
•
•
•
•
•
introducing them to the ward area
making them feel welcomed
providing them with information around meals
providing them with information around visiting times
providing other general information.
We were also rated as being in the top 20% for nursing staffing treating patients with respect
and dignity and for the cleanliness of ward areas, toilets and bathrooms.
Other results matched about the same as other NHS Trusts in England (60% on average)
and focus around the patient’s experience of:
• their psychiatrist listening to and spending time with them to discuss their condition
and treatment,
• being informed and involved in their care and treatment, medication and side effects,
• access to talking therapies and activities, meeting their physical healthcare needs,
their rights
• effective discharge arrangements.
27
Adult Mental Health Consultation
In February 2010 we undertook a three month public consultation on dementia services in
conjunction with both Primary Care Trust’s. The aim of the consultation was to raise issues
about how we could improve adult mental health services and provide services in the
community in order to reduce the need for people to go in to hospital.
We asked about three areas which our commissioners wanted to improve.
•
we wanted to move Lymewood Ward from Bradwell Hospital to Harplands Hospital.
which would provide more specialist doctors 24 hours a day.
•
we wanted to change where neuropsychiatry services( for people with brain injuries)
were delivered by moving them from ward based services to community settings with
more mental health nurses in the community.
•
we wanted to change where rehabilitation is carried out. We know it is more
successful in a community setting. People should only stay in hospital when they
require it.
Approximately 200 people attended nine public meetings and 232 individual surveys were
returned. Together this produced 1,200 lines of information which will be used to inform the
Commissioners.
The consultation was completed on 12 April 2010. The results are currently being analysed
and feedback will be delivered in May 2010.
The Care Programme Approach (CPA)
The Care Programme Approach is the system that links people who are affected by mental
illness and their families with specialist mental health and social care services to help
maximise the potential for individual recovery.
This nationally recognised framework supports people accessing our services and provides
them with a care plan setting out the interventions and actions that will enable people
engaged with their treatment plan and to gain access to services that they need.
Combined Healthcare is closely monitored on its performance in relation to this process and
we are required to ensure that service users are regularly asked about what is contained
within their care plan and how effective it is in terms of meeting their assessed need. This
information is routinely shared with local Commissioners, the Care Quality Commission
(CQC) and the NHS Information Centre.
During 2009/10 we have made some significant changes to our internal operating
procedures to ensure the capture of data to strengthen support to service users. Our
approach has been to develop a recovery focus and this is reflected in a revision of
supported documentation including the development of wellness recovery action plans which
have been a key issue raised by service users during the annual survey of their views of our
service.
28
Spirituality
In August 2009 we undertook a comprehensive review of Spirituality; ‘Seeing the Person in
the Patient’. The review was undertaken in recognition of the importance that spirituality and
faith play in an individual’s recovery and well being.
Recognising a person’s spiritual dimension is one of the most vital aspects of care and
recovery in mental health. People who use services increasingly wish to have services view
them as a whole person in the context of their whole lives and spirituality and faith is a vital
element in that.
A spirituality project group has been formed including the chaplain, service users, carers and
staff to devise the review/audit. Two questionnaires were introduce; one seeking the views
and feedback from service users about their views and experiences of their spiritual and faith
needs being responded to whilst accessing services and the other for staff to share their
views and experiences. The audit results are due to be published in the summer once the
feedback has been reviewed.
Consult & Communicate Conference
The first Carers and Users of Mental Health Services in North Staffordshire took place at the
Medical Institute, Stoke-on-Trent in January 2009 organised by the User and Carer Group
and supported by the Trust. 156 Delegates attended from a variety of backgrounds. Users
and carers of services were well represented as were Clinicians, Managers and
Commissioners of Services. Representatives of the Non-Statutory and Voluntary Services
were also present.
Personal presentations from two service users and two carers followed. These were all
eloquent and moving accounts of the strengths and weaknesses of our services. Delegates
were encouraged to browse stands advertising other local resources available. They were
also encouraged to post notes of comment or concern about local services.
A second conference is planned for the 10th of June 2010.
Membership
This is fourth year in which we have seen significant growth in our overall public
membership. We have 50.7% of the membership below the age of 50 years old. 27.8%
below the age of 35 years old. 10.43% of our membership has a background other than
white-British. The total FT membership, including staff, currently stands at 8420.
29
30
Section 7
BUSINESS DEVELOPMENTS
During 2009/10, the financial and business context for the NHS changed as the impact of the
economic downturn on public sector organisations became clear.
The ‘QIPPPp agenda’ which stands for Quality, Innovation, Productivity, Partnership,
Prevention and people , was developed at a national level with an expectation that this
would be rolled out through regions to local health economies. QIPPP is identified as the
means through which organisations will improve quality and outcomes whilst managing
increasing demand on services without further growth in investment. Locally we included an
extra ‘p’ to include Partnership and people.
Advice received from Monitor, the Government’s watchdog for Foundation Trusts and
aspirant Trust’s like Combined Healthcare emphasised that we should plan our future
business development on the basis of substantially reduced potential for growth in funding in
the coming years.
We applied this advice when we developed our five year Integrated Business Plan and Long
Term Financial Model and this means that our future business plans are not based on doing
existing work at higher volumes and when there is an opportunity from taking on new
services, they are not reliant on income growth. We will however, take opportunities to
develop new business as they arise.
The Trust Board is committed to exploring every opportunity to help grow and secure the
long term future of the organisation.
Information Technology Developments
A key challenge for us is to make better use of the information which is available to us now,
as well as planning for information that is not currently available but may be in the future.
During 2009/10 the Trust has made significant progress by making more information
available on-line and is using web technologies to improve information sharing. Building on this progress, we undertook a project to:• understand what our information needs are •
assess the electronic tools available to allow different types of information users to
access information in a way that best suits them, • look at how all the information could be made available from one place using one
version of the truth. The project highlighted the need for more advanced software than is currently available in
the Trust. We have therefore developed a comprehensive development specification and
tendered for the provision of improved data warehousing and a Business Intelligence (BI)
solution. 31
New Website Development
The Trust is committed to improving how it communicates with users, carers, members of
the general public and staff. In January 2009 the Trust commissioned BT Engage to build a
new Internet and staff website.
The public facing website (internet) will provide much more comprehensive information
about the organisation than currently exists and will have a powerful search engine so
information can be found easily. There will also be a dedicated Members area. The website
will continue to be improved with members and user / carer involvement following the launch
of both sites in June 2010.
New Computer System for Pharmacy
A new pharmacy dispensing computer system was installed and went live in January 2010
called ‘Ascribe’. The new system will help reduce the risk of error by enabling us to see
what was dispensed previously and includes a record of allergies. The system interfaces
with University Hospital North Staffordshire PAS and Finance systems to update and
maintain patient medication records, ease the process of dispensing and provide greater
financial and audit control.
In future, Ascribe will enable further development of medicines management on the wards
and can support electronic prescribing.
Directory of Services (DoS)
We have developed a Directory of Services (DoS) which accurately reflects the clinical
services that we provide. The Directory of Services diagram brings key elements of
information together in one place relating to each of the services and teams within the Trust.
The finished product with all the clinical services mapped will be displayed throughout Trust
premises. It will also appear on the new website when it becomes operational in June 2010.
This visual aid will enable the public and staff to easily identify the inter-relationships in the
services that we provide.
Service Developments
Opening of the Boat House
The Children and Young Peoples Division held the official opening of a new building in
January 2010, known as “The Boat House”. This new venture brings together a number of
different services under one roof: CAMHS Disability (D), CAMHS Autistic Spectrum Disorder
(ASD), Paediatric Psychology and First Steps Psychological services, thus providing the
Children and Young People’s Team with a more suitable space to see and work with
children and families.
Preparations for the day involved a community art project, staged at Aynsley Special School
where a competition was held to design the invitation leaflet for the open day. From this a
joint venture between two Community Artists from Staffordshire University and Aynsley
32
School resulted in the creation of a large interactive mural for the open day. The day was
highly successful with over 400 visitors to the building,
Personality Disorder Service
The Personality Disorder Service successfully bid to become one of three organisations in
the West Midlands training to deliver the Knowledge and Understanding Framework (KUF)
for Personality Disorder in the region.
Education and awareness training are major elements of the national strategy for improving
services for people with Personality Disorders. A consortium of organisations sponsored by
the Department of Health developed an innovative awareness training model based around
e-learning and experiential workshops. The model is now being rolled out nationally and
because of our local success in securing funding, North Staffordshire will be in the vanguard
for both receiving and delivering the training.
North Staffordshire Primary Care New Psychological Services, Improving Access to
Psychological Therapies (IAPT)
North Staffordshire Primary Care Psychological Service (a partnership between South Staffs
& Shropshire Foundation Trust, North Staffordshire Combined Healthcare Trust and Mental
Health Matters) commenced a new IAPT service. The service started taking referrals in
March 2009 in phase-one for the Leek, Werrington and Newcastle North areas. From
September 2009 in phase-two the service was rolled-out to the remaining Newcastle and
Moorland areas.
The service is commissioned to treat anxiety disorders and depression. IAPT offers
Cognitive Behavioural Therapy (CBT) in a convenient treatment format including a
programme of structured telephone sessions with a practitioner, supported by a choice of
CBT workbooks, interactive CBT self-help programmes via the internet and regular face to
face appointments.
Performance indicators demonstrated that 56% of service users discharged from treatment
are moving towards recovery and that 87% of service users had reported that they were
satisfied or very satisfied with the treatment they received in the IAPT service.
It’s a Goal! Comes to Stoke City Football Club
It’s A Goal! was created by social entrepreneur Malcolm McClean and Community
Psychiatric Nurse Pete Sayers in response to extremely disturbing statistics around levels of
depression and suicide in young men.
It’s a Goal! is an eleven week self-development programme that takes place in a local
football stadium and uses football stories, metaphors and analogies to help those who
attend, to improve their mental health and self esteem through goal setting. The programme
has enjoyed huge success so far and has transformed the lives of many of the people who
have completed it.
33
It’s A Goal! Stoke is supported by Lou Macari, former manager of Stoke City; who spoke at
the launch held in September 2009. He will also offer ongoing support to the programme.
Challenging Behaviour Foundation Charter (CBFC)
In November 2009, Fiona Myers, Chief Executive in November 2009 signed the Challenging
Behaviour Foundation Charter which restates the Rights & Values of individuals who are
described as challenging.
We recognise that challenging behaviour is often perceived as a problem or an illness to be
treated, cured or stopped. The problem is seen as being part of the person rather than
focusing on what needs to change around them, such as their environment or how people
support them. This earlier approach is now recognised as being unhelpful and potentially
damaging for these individuals. We fully endorse the Challenging Behaviour Foundation
Charter (CBFC) and are committed to look beyond our clients’ behaviour and provide
appropriate person-centered, holistic support to enable them to achieve their full potential.
Dementia Strategy
In April 2009 Learning Disabilities and Neuropsychiatry Division began work on their
response to the National Dementia Strategy produced in 2009.
Working with service users and carers a draft document was produced which outlined a
seamless pathway of care for those living with dementia and outlined a clear strategy to
provide support for those who care for people with dementia. In May 2009 the Division also
began a review of their memory clinics and the accessibility of these clinics as part of the
National Dementia Strategy.
In addition a new initiative called Primary Care Liaison Nurse (PCLN) was designed to
signpost clients towards the most appropriate services. This approach ensures that people
get into hospital quickly when they need to and also ensures that they are not admitted to
hospital when it is unnecessary.
Expert Witness Pilot
In February 2010, we signed a contract with the Legal Services Commission to pilot a project
aimed at improving access to Expert Witnesses. The project is a joint venture between the
Department of Health (DoH), the Legal Services Commission, and Cardiff University. The
purpose of the project was to look at implementing some of the key recommendations made
by the consultation paper Bearing Good Witness: Proposal for reforming the delivery of
medical expert evidence in family law cases, written by the Chief Medical Officer in 2006. At
the time, the report highlighted the spiralling costs, shrinking availability and (some) poor
quality of reports in the court arena resulting in an increasingly limited service for vulnerable
children.
The Chief Medical Officer saw a real solution to this problem from within the NHS. As a
result, the DoH asked Trusts to tender to the Legal Services Commission as pilots. North
Staffordshire Combined Healthcare is one of 7 projects nationally awarded a contract. We
have agreed to supply the local Family County Court 7 multidisciplinary assessment reports
(to be commissioned before the end of September 2010).
34
This is an excellent opportunity for us to contribute to improved outcomes for children
involved in court proceedings. It also allows clinicians who are new to this field the
opportunity to learn from experienced colleagues thereby developing a sustainable increase
in the supply of quality assured expert witnesses, and for clinicians with many years of
experience to share good practice and up to date knowledge to ensure a high standard of
evidence based practice.
The project will be evaluated by Cardiff University during 2010 for the Legal Services
Commission who will report back findings in 2011. We will also evaluate the cost
effectiveness and viability of the service internally.
35
Section 8
Our Trust Board
Board of Directors
The Trust’s establishment order and Standing Orders set out the composition of the Trust
Board (Board of Directors). There are eleven positions on the Trust Board; five are
Executive Directors, including the Chief Executive, and five part-time Non Executive
Directors under a part-time Non-Executive Chairman.
The role of the Trust Board is to:
•
•
•
•
•
Set the overall strategic direction of the Trust
Monitor the Trust’s performance against objectives
Provide effective financial stewardship through value for money, financial control and
financial planning
Ensure the Trust provides high quality, effective and patient-focused services through
effective clinical governance
Ensure high standards of corporate governance and personal conduct The Board is accountable to the Secretary of State for Health for the performance of the
Trust. Meetings
Board Members throughout 2009/10 (pictures to be inserted)
Sir Philip Hunter
Chairman
Fiona Myers
Chief Executive
Chair of the Remuneration
Committee
NON EXECUTIVE DIRECTORS
Marilyn Andrews
Member of Quality and Governance
Committee
Member of Charitable Funds
Management & Scrutiny Committee
Ian Ashbolt
Chair of Charitable Funds
Management & Scrutiny Committee
Member of the Remuneration
Committee
Member of Finance & Activity
Committee
Member of Audit Committee
Tony Gadsby
Member of Quality & Governance Committee
Member of Finance & Activity Committee
Jennifer Perks
Member of Remuneration
Committee
Member of Quality & Governance
Committee
Fred Worth
Chair Finance & Activity Committee
Chair of Audit Committee
Member of Remuneration Committee
36
EXECUTIVE TEAM
Dr Mike Jorsh
David Pearson
Medical Director
Director of Nursing
Adrian Hackney
Chief Operating Officer
Caroline Donovan
Interim Director of Human Resources and
Organisational Development
There were a significant number of changes to the membership of the Trust Board during the
year to 31 March 2010.
•
•
•
•
•
During the later part of 2008/09 a recruitment exercise was undertaken for a Chief
Operating Officer. This is a new Executive Director position, which replaces the
Director of Operations role left vacant by the appointment of Fiona Myers as Chief
Executive. Adrian Hackney was appointed to this post and took up office at the
beginning of April 2009.
Dr Mike Jorsh took up post as Medical Director following the retirement of Dr Roger
Bloor in his role as Medical Director in October 2009.
Joe Boulton, Non Executive Director retired from post in October 2009.
Tony Gadsby, Non Executive Director took up post in November 2009.
David Edwards, Director of Finance left the Trust to take up a post with the West
Midlands Strategic Health Authority in February 2010.
Mary Leadbeater
subsequently took up post as interim Finance Director from April 2010.
Additional information about the appointment of Directors and the composition of the Trust
Board is provided in the Remuneration Report provided in chapter (…) of this document.
37
REGISTER OF DIRECTORS’ DECLARED PRIVATE INTERESTS
As at 31 March 2010
NAME OF DIRECTOR
INTEREST DECLARED
Sir P Hunter
No interests declared
Chairman
Professor M Andrews
No interests declared
Non Executive Director
I Ashbolt
Audley & District Labour Party
Non Executive Director
Branch Treasurer
Newcastle-under-Lyme Rural Parishes Transport
Scheme Ltd
Director
Dr M Jorsh
Category 2 Medico-Legal Work (ad hoc basis)
Medical Director
F Myers
No interests declared
Chief Executive
D Pearson
Moorlands Housing Management Board
Executive Director – Nursing
Director
Parish Council
Councillor
A Hackney
No interests declared
Chief Operating Officer
J Perks
Eccleshall Day Care Centre Action
Non Executive Director
Chairman
F Worth
The Royal Mencap Society Ltd
Non Executive Director
Director and Trustee
Pentland Consultants Ltd
Director and Shareholder
Acqsys Supply Chain Solutions Ltd
Director and Shareholder
38
Futurebuilders – England Fund Management Ltd
Director
Adventure Capital Fund Ltd
Director
T Gadsby
No interests declared
Non Executive Director
39
Section 9
Remuneration Report
This report provides information about the remuneration of the Trust’s directors and those
who influence the decisions of the Trust as a whole. Guidance issued to NHS organisations
is that this includes:
‘Those persons in senior positions having authority or responsibility
for directing or controlling the major activities of the NHS body. This
means those who influence the decisions of the entity as a whole
rather than the decisions of individual directorates or departments.’
The guidance states that the Chief Executive is required to confirm whether this covers more
than the executive and non-executive directors. The Chief Executive has confirmed that for
North Staffordshire Combined Healthcare NHS Trust this report will include the Executive
Directors and the Director of Human Resources & Organisational Development (collectively
referred to as very senior managers) and the Non Executive Directors, including the
Chairman. The Remuneration and Terms of Service Committee has responsibility to
determine the remuneration of a wider group of staff. However, as their duties do not meet
the definition provided above, details about their remuneration are not included in this report.
Duties and membership of the Remuneration and Terms of Service Committee
The Trust Board has established a committee of the Board which is known as the
Remuneration and Terms of Service Committee. The current terms of reference of the
Remuneration and Terms of Service Committee were revised and approved by the Trust
Board in January 2009. The purpose of the Committee is to determine appropriate
remuneration and terms of service for the Chief Executive, Executive Directors and other
senior management employed on Trust terms and conditions, including:
ƒ
ƒ
ƒ
ƒ
ƒ
all aspects of salary (including any performance related elements / bonuses);
additional non pay benefits, including pensions and cars;
contracts of employment;
arrangements for termination of employment and other contractual terms; and
severance packages (severance packages must be calculated using standard
guidelines any proposal to make payments outside of the current guidelines must be
subject to the approval of the Treasury).
The Committee also advises the Board on its arrangements for succession planning for both
Executive and Non Executive Directors and recommends to the Trust Board the form and
content of the report on directors’ remuneration.
The current membership of the Remuneration Committee is:
40
ƒ
ƒ
ƒ
ƒ
Sir Philip Hunter, Chairman;
Ian Ashbolt, Non Executive Director;
Jennifer Perks, Non Executive Director; and
Fred Worth, Non Executive Director.
Sir Philip Hunter became a member of the Committee upon his appointment as Chairman of
the Trust (effective from 1 March 2009). Dr Eddie Slade was a member of this Committee in
his capacity of Chairman of the Trust Board until his retirement from the Trust on 28
February 2009.
The Chief Executive, the Trust Secretary and the Director of Human Resources and
Organisational Development attend meetings of the committee. Others may be invited to
attend meetings at the request of the committee. Those in attendance are required to
withdraw from meetings for the consideration of business in which they are personally
interested.
Policy On The Remuneration Of Very Senior Managers.
The terms and conditions of the Chief Executive, Executive Directors and other senior
managers are determined by the Remuneration and Terms of Service Committee. For these
purposes the Trust Board has defined senior management as the Director of HR, the Trust
Secretary and posts directly accountable to the Chief Executive, executive directors and
other directors provided that the post is on Band 8b or higher under Agenda for Change.
The appointment and tenure of Non Executive Directors, including the Chairman, are
governed by the National Health Service Trusts (Membership and Procedure) Regulations
1990. More information is available at www.appointments.org.uk
The Remuneration and Terms of Service Committee reviewed its policy on the remuneration
of very senior managers in January 2010. The committee has determined that its policy is to
benchmark salary levels against those of similar sized NHS Trusts and to uplift salary levels
in line with guidance from the Department of Health on very senior managers. Very senior
managers will be recruited onto permanent contracts with notice periods of three or six
months.
The performance of very senior managers will be reviewed at regular intervals with the Chief
Executive, except that the performance of the Chief Executive will be reviewed by the
Chairman. The reviews will consider progress against agreed objectives. There is no
element of performance related pay for very senior managers.
41
The committee will accept the national pay awards for staff under the remit of the
Remuneration and Terms of Service Committee that are employed on Agenda for Change
terms and conditions. The committee also accepted the 2009 guidance from the
Department of Health on the pay for Senior Executives. Salary and Pensions Tables
Salary and pension entitlements of senior managers
(A) Remuneration
Name and Title
2009-10
Salary
Other
Remuneration
(bands of
£5000)
£000's
(bands of
£5000)
£000's
F. Myers - Chief Executive
Officer
120 to 125
0
A. Hackney - Chief
Operating Officer (from 1
April 2009)
90 to 95
C. Donovan - Interim
Director of Human
Resources
2008-09
Benefits
in Kind
(Rounded
to the
nearest
£100)
Salary
Other
Remuneration
(bands of
£5000)
£000's
(bands of
£5000)
£000's
1
115 to 120
0
0
1
0
0
65 to 70
0
0
0
0
D. Pearson - Director of
Nursing
85 to 90
0
0
95 to 100
0
M. Jorsh - Medical
Director (from 1 October
2009)
35 to 40
35 to 40
0
0
0
D. Edwards - Director of
Finance (up to 17
February 2010)
85 to 90
0
2
100 to 105
0
Sir P. Hunter - Chairman
15 to 20
0
0
0 to 5
0
F.E. Worth - Non
Executive Director
5 to 10
0
0
5 to 10
0
42
M.P.Andrews - Non
Executive Director
5 to 10
0
0
5 to 10
0
I. Ashbolt - Non Executive
Director
5 to 10
0
0
5 to 10
0
J. Perks - Non Executive
Director
5 to 10
0
0
5 to 10
0
A. Gadsby - Non
Executive Director (from 1
November 2009)
0 to 5
0
0
0
0
J. Boulton - Non Executive
Director (up to 31
October 2009)
0 to 5
0
0
5 to 10
0
65 to 70
65 to 70
0
100 to 105
100 to 105
D. Folkes - Director of
Personnel (up to 30 May
2008)
0
0
0
10 to 15
0
F. Sharp - Interim
Director of Human
Resources (up to 19
January 2009)
0
0
0
80 to 85
0
E. Slade - Chairman (up
to 28 February 2009)
0
0
0
15 to 20
0
R.N. Bloor - Medical
Director (up to 19
December 2009)
43
Salary and pension entitlements of senior managers
(B) Pension
Benefits
Total
accrued
pension at
age 60 as at
31 March
2010
Real
Increase in
pension at
age 60
Lump sum
at age 60
(bands of
£5000)
£000's
(bands of
£2500)
£000's
(bands of
£5000)
£000's
Real
increase
in Lump
sum at
age 60
(bands
of
£2500)
£000's
F. Myers - Chief
Executive Officer
30 to 35
0 to 2.5
95 to 100
5 to 7.5
A. Hackney - Chief
Operating Officer
(from 1 April 2009)
30 to 35
D. Pearson Director of Nursing
40 to 45
M. Jorsh - Medical
Director (from 1
October 2009)
40 to 45
D. Edwards Director of Finance
(up to 17 February
2010)
20 to 25
0 to 2.5
65 to 70
2.5 to 5
R.N. Bloor - Medical
Director (up to 19
December 2009)
65 to 70
12 to 14.5
205 to 210
25 to
27.5
Name and Title
95 to 100
(0 to 2.5)
125 to 130
Cash
Equivalen
t Transfer
Value at
31 March
2010
Cash
Equivalent
Transfer
Value at 31
March 2009
Real
Increase
in cash
Equivalent
Transfer
Value
£000's
£000's
£000's
663
584
71
878
6
467
419
41
0
1479
617
(2.5 to 5)
130 to 135
897
901
44
The Secretary of State has directed that the Chief Executive should be the Accountable Officer to
the trust. The relevant responsibilities of Accountable Officers are set out in the Accountable
Officers Memorandum issued by the Department of Health. These include ensuring that:
•
•
•
•
•
There are effective management systems in place to safeguard public funds and
assets and assist in the implementation of corporate governance;
Value for money is achieved from the resources available to the trust;
The expenditure and income of the trust has been applied to the purposes intended
by the Parliament and conform to the authorities which govern them;
Effective and sound financial management systems are in place; and
Annual statutory accounts are prepared in a format directed by the Secretary of State
with the approval of the Treasury to give a true and fair view of the state if affairs as
at the end of the financial year and the income and expenditure, recognised gains
and losses and cash flows for the year.
To the best of my knowledge and belief, I have properly discharged the responsibilities
set out in my letter of appointment as an accountable officer.
Insert signature
Fiona Myers
Chief Executive
Date….June 2010
45
STATEMENT OF DIRECTORS' RESPONSIBILITIES IN RESPECT OF THE ACCOUNTS
The 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 reasonable 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
nb: sign and date in any colour ink except black
..............................Date.............................................................Chief Executive
..............................Date............................................................Finance Director
46
SUMMARY FINANCIAL
STATEMENTS 2009/10
47
Introduction to the Financial Statements
We are pleased to report that, as in previous years the Trust achieved the primary financial
objectives for the year ended 31st March 2010 as illustrated in this report. The key financial
challenges that the Trust met during the year were the delivery of the Cost Improvement
Schemes (CIPs) and the implementation of the fundamental change in the basis of
accounting from GAAP (Generally Accepted Accounting Principles) to preparing the
accounts following International Accounting Financial Reporting Standards.
The Trust is required to ensure that its income is sufficient to meet its expenditure, taking
one year with another. In 2009/10 the Trust achieved an operational surplus of £449,000,
after allowing for asset impairments and the IFRS IFRIC 12 (International Financial
Reporting Interpretations Committee) financial impact in respect of the Trust’s PFI scheme.
This is covered in detail in the summary financial statements below.
Taking account of the surpluses reported in the previous two years, the Trust has now
accumulated a surplus of £939,000. and the table below summarises the Trust’s
performance over the last five years:
Turnover
Retained
Operational
Surplus for
the Year
2005/06
£000's
2006/07
£000's
2007/08
£000's
2008/09
£000's
2009/10
£000's
91,076
90,092
87,021
90,910
90,599
505
80
214
256
449
The reported financial performance of the Trust shows that the organisation has managed to
achieve surpluses consistently during an era of relatively static overall income. The Trust
has, however, experienced a number of individual strategic shifts in income streams that
have resulted in significant changes to it’s portfolio of services.
These included the changes from the traditional income profile where a very high proportion
of clinical income was received from local PCTs, towards a more mixed portfolio of income
streams. Significant income contracts have moved from PCT commissioners to the Local
Authority, increasing specialist service income has been received from the NHS regional
consortia, and there has also been a rise in non clinical income.
During 2009/10 the Trust saw the first full year of operation of local partnership agreements
with both Local Authorities for social care services for adults with mental health needs, the
first full year of operation of the Improving Access to Psychological Therapies (IAPT) service
that was secured at the end of 2008-09 and the first full year of a range of psychological
services for children that we also secured in 2008-09.
By contrast, 2009/10 also saw the transfer of provision of frail elderly services from the Trust
to the provider services arms of the two local PCTs. This has cemented the Trusts focus as
a specialist provider of Mental Health and Learning Disability Services.
Management of Trust services took place in a climate of rising operating costs, notably
inflation pay awards and associated increased pay costs due to staff progression within
salary scales. In order to meet clinical service specifications in this constrained financial
environment, all divisions implemented a series of CIPs. Whilst some were specific initiatives
related to the 2009/10 financial year, the discipline of continually driving more financial
48
efficiencies across all services was managed within a longer 3-5 year planning cycle as part
of the development of the Trust Integrated Business Plan.
External Financing Limit and Capital Resource Limits
For 2009/10 the Trust was given an External Financing Limit (effectively a cash limit) to work
within. In 2009/10 the Trust under utilised this limit by £2.3M.
The Trust is also given a Capital Resource Limit. In 2009/10 the Trust had a reduced capital
programme as future service plans and its Estate strategy continued to be developed.
Accordingly it under used the Capital Resource Limit by £966,000
Better Payment Practice Code Measure of Compliance
The NHS Executive requires that the Trust pays non-NHS trade creditors in accordance with
the CBI prompt payment code and Government accounting rules. The target is to pay
creditors within 30 days of receipt of goods or a valid invoice (whichever is the later) unless
other payment terms have been agreed with the supplier. Trusts are also required to monitor
payments to other NHS organisations against a similar target of payment with 30 days.
Details of compliance with the code can be found in the summary financial statements
below.
The Trust is also required to disclose any charges made by suppliers under the Late
Payment of Commercial Debts (Interest) ACT 1998. The Trust did not incur any such
charges in 2009/10.
Capital Cost Absorption Rate
The Trust is required to finance the cost of capital at a rate of 3.5% of average relevant net
balance sheet assets. The rate is calculated as the percentage that dividends paid on public
dividend capital (totalling £1,073m) bears to the average relevant net assets (£30.7m). The
Trust met this target exactly in 2009/10.
Commentary
With effect from 1 April 2009 the NHS changed its accounting methodology by adopting
IFRS. Accordingly during the year the Trust restated its 2008/09 accounts into an IFRS
format in order to ensure that the opening balances for 2009/10 were correctly stated. These
restated accounts were then audited during 2009/10 to confirm that the standards had been
applied appropriately. In addition the 2009/10 Accounts have been prepared in accordance
with IFRS.
The primary impact of this change in accounting methodology is that the Harplands Hospital
(which was funded under the PFI (Private Finance Initiative) scheme is now accounted for
on the Trust’s Statement of Financial Position (the balance sheet). There have been
changes to both the value of the annual unitary charge (payment for the use of the asset)
and to the asset and liability valuations.
During 2009/10, and in line with HM Treasury instructions, the Trust also changed the basis
of valuing its own land and building assets to a ‘depreciated replacement cost on a modern
equivalent asset’ basis. The Trust carried out this revaluation with effect from 30 September
2009 with the resulting impact of a £3m increase in land values and a £5.2m decrease in
building values. Furthermore, in order that the Trust ensures that land and building values
are carried at fair value at the date of the Statement of Financial Position, a further reduction
49
of 2.7% in building values was applied with effect from 31 March 2010, following professional
valuer advice. This resulted in a further reduction of building values of £994,000. In
instances where downward valuations occur, the Trust is allowed to offset them in the first
instance by any related balance it holds in it’s revaluation reserve (a specific reserve into
which the impact of rises in value of assets is placed, be it from formal valuations or annual
indexation processes) Any resultant balance of the downward valuation is then recognised
as an impairment on the Statement of Comprehensive Income (previously the “Income and
Expenditure Account”) In aggregate the asset valuation changes described above resulted in
an impairment of £3.8m.
Planning and Forecasts
As noted above, the Trust has completed a medium term planning process and as a result
the Trust has produced a 5 year Integrated Business Plan (IBP) and Long Term Financial
Model (LTFM) which was approved by the Trust Board and submitted to the Strategic Health
Authority in March 2010. This serves as both the Trusts key direction of travel and business
plan and will facilitate an application to become a Foundation Trust.
The IBP and LTFM have been constructed to take account of anticipated future pressures
facing the NHS nationally and locally and as such have assumed that no additionally
sourced funds will be available to support service developments or growth. The primary
focus of the plans is therefore the delivery of efficiencies from existing services and the
redesign of those services where necessary to improve quality and patient satisfaction and
ensure they are fit for purpose going into the future. The Trust has therefore identified a
challenging 5 year CIP programme and the delivery of this programme and the continuation
of the sound financial stewardship highlighted above will ensure that the Trust is able to
deliver the modest level of financial surpluses contained within its long term plan and
contribute within the Local Health Economy accordingly.
Internal Auditors RSM Tenon
In April 2008, following a competitive tender process, the Trust Board appointed RSM
Bentley Jennison as the Trust’s Internal Auditor for a period of three years. During 2009
RSM Bentley Jennison and Tenon joined forces. RSM Tenon now provide services to an
even larger public sector client base increasing the opportunities for sharing best practice
and facilitating benchmarking among clients. More information about the role of internal
auditors is found under the section entitled Audit Committee (to include Local Counter Fraud
Specialist (LCFS).
50
STATEMENT OF COMPREHENSIVE INCOME FOR THE YEAR ENDED 31 March 2010
2009/10
£000
2008/09
£000
Revenue from patient care activities
78,050
79,903
Other operating revenue
12,549
11,007
-91,775
-88,336
Operating surplus
-1,176
2,574
Investment revenue
20
293
183
-4
Finance costs
-1,787
-1,614
Deficit for the financial year
-2,760
1,249
Public dividend capital dividends payable
-1,073
-1,296
Retained deficit for the year
-3,833
-47
Operating expenses
Gains on disposal of Non Current Assets held for sale
Reconciliation to Operational Surplus
The following items are included in the retained defict above but are considered exceptional and do not count towards the measurement of the Trusts Operational Position
Asset Impairments
Increased Financial Impact in respect of PFI schemes
Revised operational surplus
3,765
517
449
Other comprehensive income
Impairments and reversals
Gains on revaluations
Receipt of donated/government granted assets
Net loss on other reserves - LGPS - defined benefit pension scheme
Net gains/(losses) on available for sale financial assets
-7,425
-2,943
5,875
0
0
0
-5,479
0
183
0
-6
-7
-10,685
-2,997
Reclassification adjustments:
- Transfers from donated and government grant reserves
Total comprehensive income for the year
51
STATEMENT OF FINANCIAL POSITION AS AT 31 March
2010
31 March 2010
£000
31 March
2009
£000
1 April
2008
£000
Non-current assets
46,774
53,390
58,159
61
42
38
46,835
53,432
58,197
146
141
142
Trade and other receivables
5,185
4,538
4,189
Cash and cash equivalents
3,253
2,304
1,697
312
434
0
8,896
7,417
6,028
55,731
60,849
64,225
-4,570
-3,916
-4,606
-253
-328
-402
0
0
0
-1,755
-2,367
-1,288
2,318
806
-268
49,153
54,238
57,929
-14,738
-14,991
-15,319
-884
-327
-256
Property, plant and equipment
Intangible assets
Total non-current assets
Current assets
Inventories
Non-current assets held for sale
Total current assets
Total assets
Current liabilities
Trade and other payables
Borrowings
Other financial liabilities
Provisions
Net current assets
Total assets less current liabilities
Non-current liabilities
Borrowings
Provisions
52
Other liabilities
-5,479
0
0
Total assets employed
28,052
38,920
42,354
Public dividend capital
7,998
7,998
8,435
Retained earnings
5,106
8,807
8,570
20,328
22,007
25,234
Donated asset reserve
70
77
83
Government grant reserve
29
31
32
Other reserves
-5,479
0
0
Total Taxpayers' Equity
28,052
38,920
42,354
Financed by taxpayers' equity:
Revaluation reserve
53
STATEMENT OF CASH FLOWS FOR THE YEAR ENDED 31 March 2010
2009/10
£000
2008
£00
Cash flows from operating activities
-1,176
2
Depreciation and amortisation
1,918
1
Impairments and reversals
3,765
Operating deficit
Transfer from donated asset reserve
-5
Transfer from government grant reserve
-1
Interest paid
-1,565
-1
Dividends paid
-1,073
-1
Increase in inventories
Increase in trade and other receivables
Increase in trade and other payables
Increase decrease in provisions
Net cash inflow from operating activities
-5
-648
-
740
-
-277
1
1,673
1
Cash flows from investing activities
Interest received
Payments for property, plant and equipment
20
-686
Proceeds from disposal of plant, property and equipment
304
Payments for intangible assets
-34
Outflow from investing activities
Net cash inflow before financing
-396
1,277
-
1
Cash flows from financing activities
Public dividend capital repaid
0
-
Capital element of finance leases and PFI
-328
-
Net cash inflow/(outflow) from financing
-328
-
54
Net increase in cash and cash equivalents
949
55
NOTES TO THE SUMMARY FINANCIAL STATEMENTS
Management Costs
2009/10
£000
2008/09
£000
4,683
4,341
Income
90,599
90,910
Management costs as a % of income
5.17%
4.78%
Management costs
Management costs are defined as those on the Department of Health Management Costs
website at:
www.dh.gov.uk/PolicyAndGuidance/OrganisationPolicy/FinanceAndPlanning/NHSManagementCost
s/fs/en
Better Payment Practice Code - Measure of compliance
2009/10
Number
2009/10
£000
Total Non-NHS trade invoices paid in the year
14,288
17,414
Total Non NHS trade invoices paid within target
12,793
16,470
Percentage of Non-NHS trade invoices paid within target
90%
95%
Total NHS trade invoices paid in the year
598
6,902
Total NHS trade invoices paid within target
556
6,737
Percentage of NHS trade invoices paid within target
93%
98%
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.
The Trust has not yet signed up to the Prompt Payment Code initiative developed by the
Department for Business, Enterprise & Regulatory Reform (BERR) and the Institute of Credit
Management (ICM).
56
Independent Auditor’s Opinion and Report
57
Statement on Internal Control 2009/10
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.
The performance of the Trust is monitored by the West Midlands Strategic Health
Authority. The Trust’s performance is assessed by the submission of data and by
meetings between the Strategic Health Authority and Trust staff.
The Trust has a range of formal and informal mechanisms in place to facilitate effective
working with key partners. These include participation in partnership boards which bring
together health, social care, independent and voluntary sector organisations in the City of
Stoke on Trent and the County of Staffordshire.
The Trust has Health and Social Care Act (Section 75) 2006 partnership agreements with
Stoke on Trent City Council (since April 2008) and Staffordshire County Council (since May
2009) for the provision of adult community mental health services. There are systems in
place to ensure effective working with these partner organisations, including formal meetings
between senior officers from the partner organisations to oversee the partnership
agreements.
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 North Staffordshire Combined
Healthcare NHS Trust for the year ended 31 March 2010 and up to the date of approval
of the annual report and accounts.
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The Statement on Internal Control (SIC) has been made following the guidelines published
by the Department of Health on the 1 February 2010 which set out how and where NHS
organisations are required to make disclosures or qualifications within their SIC.
There are two new mandatory disclosures which must be made in the 2009/10 SIC. These
relate to Climate Change Adaptation and World Class Commissioning (WCC) assurance.
WCC is not applicable to this organisation and therefore no statement is being made in this
regard.
3.
Capacity to handle risk
The Trust Board and its committees take an active role in risk management and ensure that
there are effective risk management processes to support the achievement of the Trust’s
policies, aims and objectives. The Trust has had a risk management strategy in place for
many years. The Risk Management Strategy and Policy are reviewed and refreshed on an
annual basis and are reviewed by the appropriate committees and endorsed by the Board.
Together they create a framework for the consideration of risk at all levels within the
organisation and mandate the maintenance of a register of all risks. The risk register is a
dynamic tool which is updated as circumstances change and is subdivided into two parts;
principal risks and operational risks. The Risk Register sets out how these different types of
risks are identified measured and monitored.
The aims of the Risk Management Strategy and Policy are to:
ƒ maintain the highest possible standards of service delivery where the numbers of
serious errors are few relative to the volume and complexity of activity undertaken;
ƒ support the achievement of the Trust’s principal objectives in an efficient and effective
manner, delivering value for money; and
ƒ make sure that risk management arrangements are continually strengthened and
combined with robust control and reporting arrangements to create an effective
system of integrated governance.
The Risk Management Strategy and Policy set out the Trust’s approach to the management
of risk. They define the way in which risks are identified, measured and managed and the
management of situations where control failure leads to the realisation of risk. They clearly
define the roles and responsibilities of key managers and committees and set out the
specific responsibilities of the Directors for the effective management of risk. The Risk
Management Strategy and Policy set out the organisation’s plans for improving its capacity
to measure and manage risk and for ensuring that the Trust continues to be a safe and
reliable organisation in the conduct of the services it delivers.
On the 26 March 2009 a paper was presented to the Trust Board requesting a three-month
extension of the current risk management strategy pending the redrafting of the Integrated
Business Plan. On the 30 July 2009 a paper was presented to the Trust Board seeking
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approval of the risk management strategy and it was approved for one year. The current
strategy is therefore still in place until July 2010.
Work has progressed during 2009/10 and there have been later iterations of the Integrated
Business Plan. Work has also progressed with regard to the development of enabling
strategies. One of the enabling strategies is the Governance Strategy. The Governance
Strategy is supported by the Performance and Quality Management Framework (PQMF); the
Risk Management Strategy; the Assurance Framework and the Membership Strategy. As a
result of the enabling strategies there has since been a further iteration of the Risk
Management Strategy. Therefore, while the Trust’s Risk Management Strategy is in date
until July 2010, it has been refreshed and will be represented for approval in the coming
months.
The Trust Board set out four objectives for the development of risk management in the year
to 31 March 2010. These were:
1. To further develop integrated governance arrangements.
The Trust ensures that the responsibilities of the Trust Board and its sub committees
are clearly defined. The Trust’s Standing Orders and the terms of reference for all
committees of the Trust Board have been reviewed during the year.
An audit of Clinical Governance Information Flows was undertaken as part of the
approved internal audit periodic plan for 2009/10. The objective of the audit was to
evaluate the adequacy of risk management and control within the system and the
extent to which controls have been applied. During the year the reporting structures
within the Trust have been refreshed; key changes have included new membership
for committees and the streamline of their terms of reference. The Quality and
Governance Committee is the main committee to which assurances in respect of
clinical matters are provided. There are a number of Groups that report to the
Committee; these are currently under review and work is being completed in respect
of their merits. The review gave the Trust Board substantial assurance that the
controls upon which the organisation relies to manage this area, as currently laid
down and operated, are effective.
An audit of the Trust’s revised committee structures was also undertaken as part of
the approved internal audit periodic plan for 2009/10. Extensive work has taken
place during the year to ensure that the terms of reference are appropriate and
include comprehensive roles and responsibilities of the Committees, the frequency of
meetings is appropriate, and that business cycles are aligned to the roles and
responsibilities of both the Board and the Committees. The review, based on the
Trust’s own planned work in relation to governance arrangements, gave the Trust
Board substantial assurance that the controls upon which the organisation relies to
manage this risk area, as currently laid down and operated, are effective.
An audit of the Assurances on the Achievement of the Trust’s Principal Objectives
was undertaken as part of the approved internal audit periodic plan for 2009/10. The
review sought to validate that individual sources of assurance were actually in
existence and that they were appropriate for the objectives against which they had
been listed. It was noted that some of the assurances were not felt to be key to the
principal objectives to which they were mapped. From discussions that took place at
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the Audit Committee in March 2010 it was established that the current register of
assurances and register of controls are used for a number of purposes. It was
acknowledged that work has taken place to reduce the number of assurances and
risks within its Assurance Framework, whilst acknowledging that the register of
assurances serves a number of purposes. As the Trust is considering and
strengthening the contents of the Assurance Framework, no recommendations were
made in this area. Based on the work carried out to date, the audit concluded that
the assurances recorded within the Assurance register of the Assurance framework
are in existence and up to date, and that there are a number of key assurances in
relation to each of the objectives included in the review.
2. To further raise awareness.
The Trust has reviewed the effectiveness of risk management training and continued
to ensure that there is appropriate advice and training available for the Trust Board
and key managers.
A comprehensive Risk Management training session with input from the Trust’s
Internal Auditors, was provided to Board members during the year. In addition a
training programme has been further developed for presentation to key leads. This
programme commenced in 2008/9 and continued during 2009/10 targeting those with
a key responsibility for risk management.
3. To improve performance in risk management year on year.
During 2008/09 significant progress was made in the development of the Trust’s
understanding of strategic risk and the development of mitigations to respond to
those risks.
An integral part to the development of the Divisional Level Business Plans and the
Trust’s Integrated Business Plan (IBP) has been the development of a clear listing
and analysis of all strategic risks including the gross, residual and projected risk
scores. Each residual risk has been reviewed and actions taken during the course of
the year to mitigate those risks identified.
The Trust was subject to assessment against the NHS Litigation Authority Risk
Management Standards in February 2009. The Trust successfully achieved level
one accreditation, which demonstrates that the Trust has documented effective risk
management systems and processes. An action plan for further improvements in
this area has been developed and the Trust is progressing towards being assessed
against level two accreditation later in 2010.
4. To utilise effective information technology.
The Trust has continued to develop ‘delivering…health’ as a tool for the electronic
recording of the risk register. Following a review early in 2008/9 a decision was made
to continue with the operation of the current system and focus on improving
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awareness, data quality and responsiveness to the risk register. The effectiveness of
the electronic tool was reviewed during 2009/10 and will be reviewed again in
2010/11.
4.
The risk and control framework
There is a clear and well defined approach to the identification of risks. The identification
process takes many forms and involves both a pro-active approach and one which reviews
issues retrospectively.
The organisation’s risk analysis system uses descriptive scales to determine the magnitude
of the potential consequences of an identified risk and the likelihood that those
consequences would occur. Consideration of the controls in place for the risk and the
effectiveness of those controls also form part of the assessment. Using this method enables
the production of a list of prioritised risks with an indication of the action that is required.
A risk review group regularly reviews the operational risk register and advises the Finance
and Activity Committee of risk with a focus on those which threaten the delivery of the
Trust’s objectives in the areas of finance, business development and workforce. The Quality
and Governance Committee ensures operational and clinical risks are identified, measured
and adequate controls are in place.
Reports of the risk review group are presented to the Quality and Governance Committee,
which is the committee responsible for reviewing controls to manage the risk, ensuring that
an appropriate risk treatment plan is in place and that the risk is assigned to a manager with
the appropriate resources to control the risk. The Quality and Governance Committee seeks
to ensure that all controls are based on an active consideration of the options for controlling
risk to an acceptable level and that the control measures continue to be effective and
represent best value for money. Reports on the risk register are included in the reports of
the Finance and Activity Committee and Quality and Governance Committee, which are
presented to the Trust Board.
The processes for managing principal risks are an important element in the Assurance
Framework, which is the system used by the Board to ensure that all principal risks are
controlled, that the effectiveness of those key controls has been assured, and that there is
sufficient evidence to support this statement on internal control. The Finance and Activity
Committee has overall responsibility for ensuring the effective management of principal risks
in the Trust.
The Board defines the principal objectives on an annual basis in accordance with the
strategic planning cycle. The annual review of principal objectives is followed by a formal
review of principal risks. The Trust Board is responsible for Risk Management in the Trust
and receives regular briefing reports from the Executive Directors in relation to principal risks
and the associated risk treatment plans.
Each principal risk has an Executive Director lead responsible for formally reviewing that risk
on a quarterly basis and by exception on a monthly basis. Any weakness in control
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measures, or inconsistent application of controls identified as a result of assurance activity is
considered. Collectively, the Executive Team, on behalf of the Trust Board, has overall
responsibility for managing principal risks and monitoring risk treatment plans to ensure that
principal risks included in the Trust Risk Register are effectively managed. The Executive
Directors take collective responsibility for monitoring and reviewing the processes for the
effective management of principal risks, and ensure that the Trust Board is kept fully
informed of all principal risks. The quarterly principal risk report is signed off by the
Executive Directors before it is presented to the Trust Board.
The Quality and Governance Committee has a responsibility to oversee the effective
management of the principal risks which threaten the delivery of the Trust’s principal
objectives in the areas of customer focus and governance. The Quality and Governance
Committee also has a responsibility to advise the Board and the Finance and Activity
Committee of any operational risks that they consider pose a threat to the delivery of the
principal objectives. The Board reviews these risks and determines whether to add them to
the principal risk register.
The Executive Director Lead determines the controls that are required to manage the
principal risks. Once these are approved by the Trust Board they form the register of
controls.
The Trust Board determines the assurances it needs to have confidence that the controls it
has determined are in place and operating effectively. These form the register of
assurances. The Trust Board delegates responsibility for receiving assurance on the
effectiveness of the controls to its committees. Each committee is instructed on the
assurances it is expected to receive and the date by which it is expected to receive them.
The Assurance Framework register is updated with the reports of the committees on the
receipt of assurances.
The Audit Committee has responsibility for reviewing the establishment and maintenance of
an effective system of integrated governance, risk management and internal control across
the whole of the Trust’s activities. It does this by receiving regular reports on the assurances
that are due to be received, the positive assurances that have been received, the negative
assurances that have been received and any failure to provide assurance in accordance with
the agreed timetable. The Audit Committee also receives any assurances which have been
delegated to it by the Board and reports from internal audit, external audit and others on the
systems of internal control.
The Audit Committee prepares a report to the Board after each of its meetings on:
ƒ the effectiveness of the system of integrated governance, risk management and
internal control,
ƒ areas where controls need to be strengthened to ensure that principal risks are
being managed effectively,
ƒ areas where new assurances are required,
ƒ the appropriateness of disclosure statements such as the Statement on Internal
Control and declarations of compliance with the Standards for Better Health.
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The Board uses the reports of the Audit Committee to obtain assurance about the
effectiveness of the system of integrated governance, risk management and internal control,
and to obtain assurance that disclosure statements are appropriate.
Operating in this way the Assurance Framework allows the Trust Board to review the
internal controls in place to manage the principal risks and to examine the assurance
mechanisms which relate to the effectiveness of the system of internal control. With
this information the Board is able to address gaps in control and assurance.
Managing and controlling risks related to information is a key element on the risk and control
framework. The Information Governance Toolkit from the Department of Health, is the
method by which the Trust assesses its compliance with current legislation, Government
directives and other national guidance and is a key part of the organisation’s Assurance
Framework. The Trust scored 80% compliance with the toolkit in the year ended 31 March
2010, the national average was xxxx insert when available
All NHS organisations are expected to secure person identifiable data related to both
patients and staff and to safeguard data holding systems and data flows. There have been
no significant control issues related to data loss or confidentiality breach during the year
ended 31 March 2010 and up to the date of approval of the annual report and accounts.
The Assurance Framework has identified that the organisation has a sound system of
internal control with no significant control issues. This year the West Midlands Strategic
Health Authority requested that annual checklists be completed by internal auditors. The
auditors concluded that the Trust has established an Assurance Framework which is
designed and operating to meet the requirements of the 2009/10 Statement of Internal
Control and provides substantial assurance that there is an effective system of internal
control to manage the principal risks identified by the organisation.
During the course of 2009/10, a matrix was introduced for assessing the strengths of
assurances in the Trust’s Assurance Framework. The matrix has been applied to the
register of assurances and highlights those assurances that require attention and further
action, but also draws out those assurances which are prominent in relation to specific
business objectives. It is intended that the matrix will be expanded to allow it to be applied
and further enhance the register of controls. The Assurance Framework has allowed the
Board to identify some weakness in the design or inconsistent application of controls which
put the achievement of particular objectives at risk.
Following an internal audit carried out during 2009/10, on the assurances on the
achievement of the Trust’s principal objectives, it was acknowledged by the Audit Committee
that a revised document would be useful for the purpose of reporting to the Trust Board in a
more simplified format to ensure that attention is drawn to the gaps in controls and
assurances which are directly related to the business objectives. Following the introduction
of the matrix tool, work will be progressed during 2010/11 to revise the layout of the
Assurance Framework.
The Board has requested improvements to other controls arrangements where some
weaknesses were identified following internal audit:
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ƒ An introduction of spot checks in relation to the Trust’s Care Homes was put in place
and the internal auditors follow up review at year end showed that sufficient action
had been taken to address some control weaknesses;
ƒ Action was taken by the Trust to ensure service user and carer engagement in
relation to Research and Development Governance arrangements. A subsequent
internal audit review showed that sufficient action had been taken and the opinion was
therefore positive;
ƒ Action was taken by the Trust to ensure service user and carer engagement in
relation to Charitable Funds. Further fieldwork by internal auditors and action taken in
year by the management team concluded in a positive opinion being given.
The organisation seeks to involve public stakeholders in managing risks which impact on
them. The Trust also invites a range of organisations including local Overview and Scrutiny
Committees to review the performance of the Trust, particularly in regard to the declaration
of compliance with Standards for Better Health, Registration, and to comment on that
performance.
During 2009/10 the Trust has put in place a robust process for assessing compliance against
the core standards contained within Standards for Better Health. The Audit Committee has
reviewed the process of control and the full outcome of the assessment. The initial
assessment is that the Trust is fully compliant with the core standards for better health.
In addition the Trust applied for registration as a service provider under the Care Quality
Commission and were formally notified under section 28 (1)(a) of the Health and Social care
Act 2008 that the Trust has been registered without conditions.
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,
employer’s contributions and payments in to the Scheme are in accordance with the Scheme
rules, and that member Pension Scheme records are accurately updated in accordance with
the timescales detailed in the Regulations.
Control measures are in place to ensure that all the organisation's obligations under equality,
diversity and human rights legislation are complied with.
In the 2009/10 SIC guidance, it requires Trusts to make a new mandatory disclosure in
relation to Climate Change Adaptation. 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 the UKCIP 2009 weather projects, to
ensure that this organisation’s obligations under the Climate Change Act and Adaptation
reporting requirements are complied with.
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.
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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 core standards self assessment declaration and the annual
performance assessment of Trusts conducted by the Care Quality Commission. My review
is also informed by the work of the Strategic Health Authority, the NHS Litigation Authority,
external assessments by organisations such as ROSPA and the British Safety Council, and
the work of external audit, including the Auditors Local Evaluation (ALE), and clinical audit.
The Board and its Committee consider and take action on the effectiveness of the system of
internal control. Each level of management, including the Board and its sub committees
regularly reviews the risks and controls for which it is responsible and takes action on the
recommendation of assurance providers. These reviews are monitored and reported to the
next level of management.
Principal objectives have been identified and the totality of assurance activity relating to the
Trust’s principal risks has been reviewed within the assurance framework. Key controls are
identified. The Board has mapped its assurance needs and identified sources for providing
them. Independent assurance, from a wide variety of sources, is provided on the process of
risk identification, measurement and management.
The organisation has in place arrangements to monitor, as part of its risk identification and
management processes, compliance with other key standards covering areas of potentially
significant risk such as the core standards contained within Standards for Better Health and
the NHS Litigation Authority Risk Management Standards.
I have been advised on the implications of the result of my review of the effectiveness of the
system of internal control by the Trust Board, the Quality and Governance Committee, the
Finance and Activity Committee and the Audit Committee. I have also considered the work
of Internal Audit throughout the year and the Head of Internal Audit Opinion on the overall
arrangements for gaining assurance through the Assurance Framework and on the controls
reviewed as part of the internal audit work. A plan to address any weaknesses and ensure
continuous improvement of the system is in place.
As Accountable Officer I can confirm that North Staffordshire Combined Healthcare NHS
Trust has a generally sound system of internal control that supports the achievement of its
policies, aims and objectives.
________________________
Ms Fiona Myers
Chief Executive
……June 2010
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