Salford Royal NHS Foundation Trust Annual Report and Accounts April 2008 to March 2009 Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 2 Presented to Parliament pursuant to Schedule 7, paragraph 25(4) of the National Health Service Act 2006
Salford Royal NHS Foundation Trust Annual Report and Accounts April 2008 to March 2009
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 3 Contents
Introduction to Salford Royal NHS Page 5 Foundation Trust
Chair’s and Chief Executive’s Page 6 Statement
Directors’ Report Page 8
Quality Report Page 16
Operational Review Page 33
Financial Review Page 42
Board of Directors Page 46
Council of Governors Page 52
Foundation Trust Membership Page 57
Remuneration Report Page 60
Appendix 1 Page 61
Statement of the Chief Executive’s Page 62 Responsibilities as the Accounting Officer of Salford Royal NHS Foundation Trust
Independent Auditor’s Report Page 63
Statement on Internal Control Page 65
Foreword to the Accounts Page 69
Accounts for the Period Page 70 1st April 2008 to 31st March 2009
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 4 An Introduction to Salford Royal NHS Foundation Trust
Salford Royal NHS Foundation Trust was established As a teaching hospital with a significant research on 1st August 2006 as a public benefit corporation programme the Trust is able to attract the highest authorised under the National Health Service Act calibre of staff ensuring that leading edge clinical 2006. It is a large teaching Trust with around 850 practice is maintained. This is reinforced by key beds, employing over 4,800 staff and treating in the partnership arrangements with Salford Primary region of 400,000 patients a year. Care Trust (PCT), the Universities of Manchester and Salford and other teaching hospitals in Greater The Trust provides services across two sites. The Manchester. majority of the Trust’s acute work takes place at the main hospital site on Stott Lane in Salford with some Effective corporate governance is a fundamental specialist services being provided at The Maples cornerstone for the success of Salford Royal Neuro-rehabilitation Centre. NHS Foundation Trust. The autonomy that the Foundation Trust enjoys, its public service purpose The Trust provides a comprehensive range of district and the fact that it is entrusted with public funds, general hospital services to the 220,000 population demand that the Board of Directors, the Council of of Salford, as well as a wider range of specialist Governors and all its employees operate according services to the populations of Greater Manchester to the highest standards of corporate governance. and beyond. The Trust’s core purpose is to provide clinical, The Trust’s district general hospital services academic and service excellence and to strive for include: Accident and Emergency, Obstetrics and these on the basis that what matters most of all is Gynaecology, General Surgery, Ear, Nose and Throat, the patient experience. The Trust’s three quality Trauma and Orthopaedics, Oral Surgery, Urology themes are Safe, Clean and Personal. and a full range of acute and specialist medical services including General Medicine, Cardiology, Endocrinology, Respiratory Medicine, Nephrology, Haematology, Rheumatology, Dermatology and Elderly Care Medicine. Aiming to provide The Trust also provides a range of specialist services to Greater Manchester and beyond including: Safe, Clean, Personal Neurosciences, Renal Medicine, Intestinal Failure, care to Complex Spines, Specialist Cancer, Specialist every patient Dermatology and Specialist Neonatal Care. It also provides specialist Bariatric Surgery to the Greater every time Manchester area. These services are backed up by a comprehensive range of clinical support services including radiology, pathology, pharmacy, high dependency and intensive care units.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 5 Chair’s and Chief Executive’s Statement
Our ambition is to be the safest hospital in the NHS
It is with great pleasure that we present our Annual of the hospital will soon change quite dramatically, Report for 2008/2009. with the demolition of the hospital’s two tower- blocks in early 2009/10. This report marks the end of another successful year for Salford Royal NHS Foundation Trust. We are There have been some changes to the Trust’s Board delighted to have, again, achieved all national and of Directors during the year. Mrs Margaret Morris local quality, performance and financial targets and retired on 30th June 2008 to take up office as been awarded “Excellent” and “Excellent” ratings the Mayor of Salford. The Council of Governors respectively for our use of resources and quality of subsequently undertook a rigorous recruitment services by the Healthcare Commission (Care Quality process, including national advert, which resulted Commission from 1st April 2009). in the Trust’s Vice-Chair, Mr James J Potter, being appointed as Chair from 1st July 2008. Mr David The Trust is committed to provide safe, clean and Wood commenced in post during June 2008 as personal care, which continues to be the driving Executive Director of Organisational Development force in improving the way it delivers services. and Corporate Affairs and then later in 2008, the Standards of care continue to improve, with a Council of Governors appointed Mrs Diane Brown to sustained focus on reducing mortality rates and the vacant non-executive director post. Diane brings reducing harm. The Trust has made significant expertise in organisational development to the progress in implementing its innovative Quality Board and commenced in post on 1st January 2009. Improvement Strategy, which was launched in 2008. This compliments current initiatives at both strategic During 2008/09, the Council of Governors health authority and national level to fundamentally contributed significantly to the development of the transform the quality of care for patients. Trust’s strategic plans and to the implementation of the Membership Development Strategy. It also This financial year has seen significant progress in agreed a plan to strengthen links with Salford City the Trust’s hospital redevelopment project. Building Council’s Community Committees, Patient Interest work commenced on site and during the year Groups associated with the hospital and the Local the multi-storey car park for staff and phase 1 of Improvement Network (LINk). Governors and the redevelopment to construct a new education Directors have worked together to build effective building and support service accommodation was relationships with these groups and this has completed. Phase 2, to build the new clinical provided yet another opportunity for the Trust to accommodation, has now begun and the landscape learn from patients and other stakeholders, and so improve the services it offers.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 6 Patients have confirmed high levels of satisfaction Our focus for 2009/10 will be to deliver our plans with the Trust’s services both in the national patient for safe, clean, personal care for every patient survey and in a local survey undertaken by the Trust and ensure Salford Royal NHS Foundation Trust to support the development of the Trust’s five year progresses even further as one of the best NHS strategy. The Trust has scrutinised this feedback hospitals in the country. and any areas identified by patients and users as requiring improvement have been built into robust development plans. Staff are considered the Trust’s greatest asset and have continued to provide excellent standards of care. The Trust’s Quality Improvement Strategy James J Potter, Chair has been embraced by all levels and types of staff who have shown outstanding innovation and determination to improve the quality of patient care. This has undoubtedly ensured the success of the first year of the Quality Improvement strategy. The Trust is extremely proud of the David N Dalton, Chief Executive numerous awards that members of staff, teams and departments received during 2008/09, both locally and at a national level. We would like to express our personal thanks to all members of staff, our governors and members for their individual contribution to another successful year. While we have enjoyed such a success, we recognise that the Trust will undoubtedly face many challenges in the forthcoming months and years that are likely to be influenced by external factors such as the continued growth of competition for clinical services from the independent sector and the current national financial climate. Given its track record of success and the commitment and strength of its workforce, the Trust is well placed to respond to these challenges. The Board of Directors has an established Assurance Framework which includes management and assurance committees to deliver clear Trust objectives and to identify and manage risks on behalf of the Board of Directors. This comprehensive framework will continue to operate to ensure that key risks are identified and plans developed to reduce the impact on the Trust.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 7 Directors’ Report
Composition of the Board of Directors Salford Royal is headed by a Board of Directors who The Board of Directors ensures that adequate systems are collectively responsible for the exercise of the and processes are maintained to measure and monitor powers and the performance of the NHS Foundation the Trust’s effectiveness, efficiency and economy as Trust. well as the quality of its healthcare delivery. The Board regularly reviews the performance of the Trust in these Chair areas against regulatory requirements and approved Mrs Margaret Morris (until 30.6.08) plans and objectives. Mr James J Potter Chair (from 01.07.08) Vice-Chair (until 30.6.08) Reflecting on 2008/2009 Chief Executive The Trust set out its plans for 2008/09 under eight Mr David N Dalton strategic themes and significant progress has been made against each of these. Key achievements Executive Directors during the year are identified below. Mr Tony Whitfield Executive Director of Finance/Deputy Chief Executive Dr Stephen Waldek Quality Improvement Executive Medical Director Launched and delivered phase one of the Quality Mrs Elaine Inglesby Improvement Programme Executive Nurse Director Mr Simon Neville The Trust has the ambition to be the safest hospital Executive Director of Strategy and Development in the NHS and plans to achieve unprecedented levels of improvement in patient mortality and Mr David Wood incidence of harm. Executive Director of Organisational Development and Corporate Affairs (from 23.06.08) The Trust’s three-year Quality Strategy (2008/11) was launched in April 2008 by the Secretary of State for Non- Executive Director Health, the Rt Hon Alan Johnson MP. The aims of Mr John Willis strategy are to: Vice-Chair /Non-Executive Director l Reduce the Hospital Standardised Mortality Professor Katharine Perera Rate (HSMR) resulting in a saving of 1000 lives; Non-Executive Director / Senior Independent Director l Reduce the number of unintentional harmful Professor David Thompson events (e.g. medication errors, surgical Non-Executive Director infections, and pressure sores) by 10,000; Mr Howard Forster l Minimise the number of hospital acquired Non-Executive Director infections; Mr Michael Halsall l Minimise the number of hospital readmissions; Non-Executive Director l Maximise patient and staff satisfaction; Mrs Diane Brown l Minimise length of stay. Non-Executive Director (from 01.01.09) A report on the Trust’s quality improvement plans is included within the Operational Review.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 8 The Trust has initiated a programme of Salford Royal has been recognised for its excellent improvement projects to deliver these aims. These standards in supporting, promoting and protecting are organised under the three quality improvement breastfeeding. The maternity services at the themes of safe, clean and personal. hospital are one of only 3 units in the North West to be awarded the UNICEF Baby Friendly Initiative The Board of Directors monitors progress against Award. these on a monthly basis. Significant progress has been made during the year. In particular, the Salford Royal and Salford PCT also shared joint Trust has achieved unprecedented reductions in success during 2008/09 as the only health economy healthcare acquired infections, exceeding both in the country where both the Trust and PCT were national and local ‘stretch’ targets for reducing rated by the Healthcare Commission as ‘excellent’ MRSA and Clostridium Difficile infections. for both the quality of services and their use of resources. In addition, the Dr Foster Hospital Guide 2008, which compares performance in NHS hospitals, During 2008/09, the Trust has continued to make highlighted the Trust as having the third best significant progress in delivering national targets, hospital mortality rate. as demonstrated in the following tables. Forecast performance ratings are subject to assessment by Please see our first ‘Quality Account’ on pages 16-32. the new Care Quality Commission which will publish the Annual Health Check ratings in Autumn 2009. “Delivered the Healthcare Commission Standards for quality of services and achieved “excellent” rating” Existing Commitment indicators In 2008/09 the Trust was once again rated ‘excellent’ Data quality on Ethnic Group Achieved by the Healthcare Commission for the quality Time to reperfusion for heart attack Achieved* of services it delivers. This is the third year in Delayed Transfers of Care Achieved succession that the Trust has achieved the highest rating possible. Total Time in A&E Achieved This performance reflects significant progress made Inpatients waiting > 26 weeks Achieved during the previous year in areas such as patient Outpatients waiting > 13 weeks Achieved safety, cleanliness and reducing waiting times. Waiting time for Rapid Access Achieved Salford Royal NHS Foundation Trust was rated in Chest Pain Clinic the top 20% of Trusts in the Healthcare Commission Cancelled Operations Achieved patient survey. The Trust is one of just a handful of NHS *Anticipated organisations to receive the highest patient safety accreditation rating from the NHS Litigation Authority.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 9 National Priority Indicators Satisfying the Needs of Commissioners and Infant Health Under Achieved Users Experience of Patients Achieved Participation of heart disease audits Achieved “Developed relationships with GPs and Practice-based Engagement in clinical audits Achieved commissioners” Stroke Care Achieved A programme of regular meetings with GPs and Maternity Hospital Episodes Achieved Practice-based Commissioners has been established to improve communication and joint working. MRSA Incidence Achieved Areas that have been addressed include improving Clostridium Difficile Incidence Achieved the use of the Accident & Emergency service, 18 week referral to treatment times Achieved development of the Trust’s Assessment and All Cancers: Two Week Wait Achieved* Treatment Services and plans to improve the integration of services for patients with diabetes. All Cancer: Two month urgent Achieved* referral All Cancer: One month diagnosis Achieved* to treatment “Engaged FT public membership to be involved in plans NHS staff satisfaction Achieved* for the future” *Anticipated Foundation Trust members and the Council of Governors have played a key role in informing the There has been a continued increase in the development of the Trust’s new five-year strategy number of patients treated. The pressures of (Service Development Strategy, 2009/10 to 2013/14). meeting increased demand and meeting the target In Autumn 2008, Salford Royal surveyed over 4000 milestones associate with the 18 week target from public members to identify: GP referral to the start of treatment have been challenging. The Trust has met these targets, shown l General perceptions of the Trust; on the table below: l Satisfaction with services provided;
2008/2009 2008/2009 l Views on service development. Plan Out turn Staff members also played a key role developing Elective Day cases 24,013 26,090 the strategy through a series of structured clinical (planned admissions) engagement workshops. Elective In-patients 11,232 11,210 The Council of Governors led on membership (planned admissions) engagement and helped identify the development Non-Elective 33,955 35,018 themes that the Trust will be pursuing over the next (urgent admissions) five years. Out-patient 268,614 304,389 A review of the Council of Governors has also been (total attendances) undertaken in year and the new membership of Accident and Emergency 73,224 74,787 twenty-one reflects the profile of the Trust users and attendances links to the community committees for Salford.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 10 The Trust is committed to using comments and “Reviewed Dermatology Services” feedback from patients to inform both future service plans and service delivery. Following a review of dermatology services, the Trust has made progress in enhancing dermatology The Patient Experience Tracker, which is an services and developing new models of care. electronic device to capture patient feedback, has been implemented in wards and departments In particular, the Trust is developing a range of throughout the hospital. This allows patients to Dermatology Clinical Assessment and Treatment rate their satisfaction with areas such as cleanliness, Services (CATS) which offer quick access to advice privacy and dignity. and treatment and provide care closer to home: l Agreed action plans for improvements are shown on Salford Royal received ‘preferred bidder’ display screens, enabling patients to keep track on status for the Bury CATS in December 2008. how the area is developing. The service will operate from the Primary Care Centre in Radcliffe and will become operational in April 2009; Strategic Service Change and Development l Manchester Skin Care, the result of an innovative partnership between Salford Royal “Developed stroke services” and Manchester Community Health, was awarded ‘preferred bidder’ status to deliver In 2008, Salford Royal was selected as the site for dermatology CATS for the Manchester area a new stroke centre for patients across Greater in March 2009. This service will also become Manchester. The first phase of the implementation operational in 2009. has taken place with the Trafford pathfinder pilot. In addition, the Trust has been exploring ways in Salford is the only hospital in Greater Manchester which it can improve hospital-based dermatology offering a thrombolysis service 24/7. The national services. The Trust has also confirmed plans sentinel audit in 2008 put Salford into the top decile to expand the Mohs (micrographic surgery) of stroke services across the country. dermatology service. Once the service and financial model is agreed with Local and Specialist Multidisciplinary Teams have Commissioners, partner Trusts’ roll-out will take been established within Dermatology Services, place across Greater Manchester. which will be subject to peer review in 2009/10.
“Redesigned Urgent Care Services” Changes in the clinical management of Emergency Assessment Units has supported improved pathways for urgent care. In-reach from specialist inpatient teams will further improve pathways and efficiencies. The use of the virtual ward, outpatient clinics, and rapid response community services has improved services and reduced hospital stays, supporting patients to stay at home where possible. Developments in intermediate care services will allow further service redesign.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 11 Partnership and Joint Ventures “Redesigned Assessment and Treatment Services” “Developing cancer services” The Trust has made significant progress in The Trust’s partnership with the Christie NHS redesigning the way it delivers outpatient services, Foundation Trust has resulted in the formal to deliver quicker access to advice, tests and approval of ambitious plans to build a £17 million treatment and to reduce, where possible, the radiotherapy centre on the Salford Royal site. number of separate appointments required: The centre will be equipped to deliver stereotactic l New urology clinics are available 3 days a radiosurgery, which will complement existing week, which provide a one-stop model of conventional neurosurgery offered by the Greater care for a range of procedures. These are Manchester Neuroscience Centre. Patients from supported by a telephone assessment clinic, Greater Manchester currently travel to Sheffield and which enables patients to have the required further afield for such treatment. This will be one of investigations arranged prior to their initial only a handful of such centres in the UK. consultant consultation; l General surgery outpatient services have been “Reviewed and developed Urology services” improved, with the implementation of an evening rapid access clinic which has access to Service redesign has led to the development of diagnostics and pre-operative assessment; triage and one stop clinics in Urology. The Trust has undertaken to develop lithotripsy l Work is ongoing within ENT to identify services for Salford patients, and for patients from opportunities to expand the range of one-stop our wider catchment area as the service develops. clinics, early diagnostics and the introduction of evening and / or weekend clinics.
The Trust won the Patient Safety category at the “Agreed future service plans for women and children’s prestigious Health Services Journal Awards 2008 services” for its leading initiative to ensure all suspicions of The Foundation Trust has opened a new purpose-built cancer identified via investigation are acted upon at £1.6 million paediatric observation and assessment the earliest possible opportunity. unit for children who are brought in as emergencies. Salford PCT and the Foundation Trust received Providing dedicated support to the A&E, the unit a national award for their joint approach in has 12 beds and is staffed by a team of nurses, tackling Chronic Obstructive Pulmonary Disease paediatricians and emergency physicians. The opening (COPD), which is one of the Salford’s most serious hours of the unit are due to be extended, in 2009, to diseases. The IMPRESS award recognised the work provide 24 hours a day, 7 days a week services. undertaken to create a specialist COPD clinic, which The Trust is working with partners to agree service rotates throughout Salford, enabling patients with models for Women’s and Children’s services as outlined severe or complex needs to be seen nearer their in the ‘Making it Better’ implementation plans. home. The Trust has been awarded a contract to provide bariatric surgical procedures to aid weight reduction “Reviewed requirements for vascular services on Salford in those adults diagnosed as ‘severely obese’. The Royal’s site” service is planned to expand over the next 3 years. Salford Royal NHS Foundation Trust is working with partners to secure greater access to vascular outpatient services onsite and improved on-call arrangements.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 12 Deliver Salford Health Investment for “Delivered a 3% cost improvement” Tomorrow (SHIFT) Programme The Trust achieved the planned cost improvement programme of £6.7 million, which was 3% of “Managed new hospital construction projects and ensured relevant budgets. service resilience” As part of the £200 million state-of-the-art new hospital development, the Trust’s new education Education, Research and Development facility, Mayo Building, became operational in February 2009. “Produced new R&D strategy” The new building provides state-of-the-art facilities Salford Royal and Salford PCT, with other key in which members of the health profession will partners, have established the Manchester Academic receive basic education, postgraduate education and Health Science Centre (MAHSC), which has achieved continuing professional development. The building official national status and should bring huge provides a full range of simulators to train clinical benefits to local patients. skills including, a simulated operating theatre. In addition to the education facilities, the new building provides office accommodation, the mortuary, Strong Corporate Governance and aseptic, linen and decontamination services. Organisational Development “Delivered the capital programme” “Developed new organisational arrangements ensuring Patients are now benefiting from new equipment that the Trust is best placed to deliver its plans and and improved facilities following the opening of the improve its performance’” Trust’s £5.5 million new theatre complex. The Trust has been rated as one of the top NHS Salford Royal now has three new theatres, one set employers in two national surveys: up as a dedicated trauma theatre and two set up as l Salford Royal achieved ratings of ‘best 20% a ‘theatre barn’ for elective orthopaedic surgery. of Acute Trusts’ or ‘above average’ in 30 out of the 36 key findings in the Healthcare Commission’s National NHS Staff Survey; Productivity and Control of Costs l The Trust was rated as one of the Top 20 Healthcare organisations to work for in the “Achieved “excellent” rating for the use of our resources country, in a list compiled by Ipsos MORI on from the Healthcare Commission and “Green” rating from behalf of the HSJ and Nursing Times. ‘Monitor’” Salford Royal won the North West’s Local Employment Partnership award for the ‘Getting For the second year in succession the Trust was rated Back to Work’ category. “excellent” by the Healthcare Commission for the use of resources, this rating reflects how well the The Trust has reduced its carbon footprint by 16% Trust manages its finances. (or 863 tonnes) over four years and continues to develop new energy saving schemes. The Trust has a Finance risk rating of ‘4’ and a Governance risk rating of ‘green’ from Monitor. Salford Royal is one of only a few Trusts in the Both are extremely good ratings indicating low country to have implemented electronic prescribing levels of risk. and medicine administration recording (EPMAR).
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 13 Compliance with National Core Standards Looking Forward to 2009/10 The Healthcare Commission was, until 31st March The environment in which the Trust operates is 2009, the health watchdog in England and one of likely to become increasingly challenging over the its roles was the production of the ‘Annual Health next 12 months and in subsequent years. The NHS Check’ which provided a rating for Trusts based has enjoyed unprecedented growth in funding over on performance against a set of national Core the last eight years which will not be sustained in Standards. This role has now been taken over by the future. Indeed, the national economic position the Care Quality Commission who requires trusts is likely to result in significant cost pressures in to make a declaration about compliance with the healthcare. Standards for 2008/09 by 1st May 2009. For 2009/10 the tariff uplift is limited to 1.7% and There are 24 core standards within the following 7 includes a requirement for 3% efficiency saving. domains: The Trust therefore needs to plan on the basis of real term reductions in available resources. Delivery l Safety of developments during the year will be dependent l Accessible and Responsive Care upon business cases that can demonstrate a return l Clinical and Cost Effectiveness on investment. l Care Environment and Amenities At the same time, it is clear that the Trust will be l Governance expected to continue to achieve existing national l Public Health targets, whilst improving quality (measured by l Patient Focus safety, clinical outcomes and patient experience) and responding to the expectations of patients, At Salford Royal, compliance with all of the Core members and commissioners. Standards is assured via the Board of Directors’ Given its track record of success and the commitment Executive Governance Committees. Each of the 24 and strength of its workforce, the Trust is well Core Standards are designated the responsibility placed to respond to these challenges. of an Executive Director and Senior Operational Lead Manager, who review compliance against all Planned developments for 2009/10 include: aspects of each Standard at a Scrutiny Review and l Expansion of obesity services and bariatric then report on compliance to the relevant Executive surgery; Governance Committee. Compliance is also l Development of Lithotripsy services; reviewed across the course of the year by the Audit l Expansion of clinical assessment and one stop Committee. The Executive Governance Committees services on site; and the Audit Committee then report on compliance with the Core Standards to the Board of Directors l Development of Dermatology Clinical who, following review, subsequently make the assessment and treatment services in Declaration to the Care Quality Commission. Manchester and Bury; l Extended opening hours for the PANDA unit. The Trust therefore has a robust system of executive led scrutiny and review of evidence of compliance. Significant developments are planned within In addition, it has supplemented this with internal Research and Development including: audit reviews of the system of assurance and of l Development of a financially viable strategy; the evidence of compliance with key standards. l For 2008/09 the Board of Directors will submit Development of e-health capability and stand a declaration of full compliance with all Core alone governance arrangements; Standards. l Establishment of an integrated ambulatory clinical trails facility.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 14 NHS Foundation Trust Code of Governance The Trust applies the main and supporting principles l Agreed recruitment process for Non-Executive of the NHS Foundation Trust Code of Governance, Director vacancies; as published by Monitor the NHS Foundation Trust l High quality reports to the Board of Directors Regulator. and Council of Governors; The Board has established governance policies in the l Board evaluation and development plan; light of the principles of the Code of Governance, l Council of Governors’ presentation of these include: performance and achievement at Annual l Corporate Governance Framework Manual Members Meeting; - incorporating the Standing Orders of the l Code of Conduct for Governors; Board of Directors, Standing Orders of the Council of Governors, Scheme of Reservation l Going Concern Report; and Delegation of Powers, and Standing l Robust Audit Committee arrangements; Financial Instructions; l Governor-led appointment process for l Role of Senior Independent Director; External Auditor; l Private meeting between the Chair and the l Whistle-blowing Policy and Counter Fraud Non-Executive Directors; Policy and Plan. l Governance Strategy and Plan; l Non-Executive Director Performance Appraisal The Board of Directors conducts an annual review of Process; the Code of Governance to monitor compliance and identify areas for further development. In March l improved induction programme for Non- 2008 the Board confirmed that the Trust complied Executive Directors; with all of the provisions of the Code, with the l Attendance records for Directors and exception of the following: Governors; l The Council of Governors to establish a policy l Comprehensive Induction Programme for for engagement with Board of Directors for Governors; dealing with matters of concern that can not l Register of Interests - Directors and Governors; be resolved via established methods. l Role of Lead and Deputy-Lead Governor; It has been agreed that although the Trust has l Trust Performance Report to all meetings of robust and comprehensive arrangements in place the Council of Governors; to support the Council of Governors, a policy for engagement is to be developed and considered by l Effective Council of Governors’ sub-committee the Council of Governors during 2009. structure;
l Council of Governors’ Agenda-setting process l Executive Directors to be reappointed at l Membership Development Strategy, intervals of not less than five years. Implementation Plan and Key Performance The Board of Directors has considered this Indicators provision and is of the view that to establish l Nominations, Remuneration and Terms of short-term contracts for Executive Directors Service Committee of the Board of Directors; would be a high risk option for the Trust. Existing l Nominations, Remuneration and Terms of contractual, performance review and management Office Committee of the Council of Governors; arrangements continue and are subject to regular and rigorous review.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 15 Salford Royal NHS Foundation Trust Quality Report 2008-09
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 16 In April 2008, Salford Royal launched one of the most ambitious plans in the NHS. Our Quality Improvement Strategy aims to save 1000 lives and around 10,000 harmful incidents to patients over the next three years. Quality Improvement Strategy
What are we trying to accomplish? Understanding what will drive change MortalityBoardMortality on board Mortality Mortality 1. How good is our care (HSMR)? 2. Is our care getting better? 1. How good is our care (HSMR)? 2. Is our care getting better? 1. How good is our care (HSMR)? 1. How2. goodIs our is care our caregetting (HSMR)? better? 2. Is our care getting better? 1. How good is our care? Hospital Standardised Mortality 6.94 In-Hospital Deaths (As a % Of Admissions) 7 1. How good is our care? UCL = 126.12 In-Hospital Deaths (As a % Of Admissions) Hospital Standardised Mortality 6.94 1. How good is our care? 1. How good is our care? Hospital Standardised Mortality In-Hospital Deaths (As a % Of Admissions) 7 6.94 Hospital Standardised Mortality 6.94 In-Hospital Deaths (As a % Of Admissions) UCL = 126.12 7 7 Average relative risk 120 UCL = 117.93 UCL = 126.12 UCL = 126.12 6 Average relative risk 120 UCL = 117.93 (mean) for period April 120 6 5.26 Average relative risk Average relative risk 120 UCL = 117.93 UCL = 117.93 6 UCL = 107.34 6 (mean) for period April 5 5.26 5.26 2007 –(mean) January for 2009period = April 80.58 UCL = 107.34 (mean) for period April 5.26 100 UCL = 107.34 MeanUCL = 97.92= 107.34 5 5 20072007 – JanuaryJanuary 2009 2009 = =80.58 80.58 5 2007 – January 20094.50 = 80.58 100 100 Mean = 97.92 Mean = 97.92 100 4 Mean = 97.92 Mean = 86.91 4.502.4.50 Is our care getting 4 4.50 4 Mean = 86.91 2. Is our care getting 4 Mean = 80.58 80 Mean = 86.91 better?2. Is our care getting Mean = 86.91 3 2. Is our care getting Mean = 80.58 80 better? Mean = 80.58 2.57 3 % of deaths HSMR LCL80 = 69.72 Mean = 80.58 better? 80 3 better? 3 2.57 % of deaths HSMR LCL = 69.72 LCL = 66.48 2 2.57
2.57 % of deaths HSMR •Current average death LCL = 69.72 LCL = 66.48 % of deaths HSMR LCL = 69.72 2 1.68 •Current average death 60 LCL = 66.48 LCL = 66.48 1.68 60 2 2 •Current average death1.26 rate =•Current 1.25% of average admissions death 1.68 1.26 rate = 1.25% of admissions 1.68 1 60 60 1 QI Launch 1.26 rate =NHSLA (level1.25% 2) NHSLA (level 3)of admissionsQI Launch 1.26 rate = 1.25% of admissions LCL = 43.23 QI Launch NHSLA (level 2) NHSLA (level 3) QI Launch LCL = 43.23 1 1 •February and March data points 40 •February and March data points 40 QI Launch 0 QI Launch NHSLA (level 2) NHSLA (level 3) 0 QI Launch NHSLA (level 2) NHSLA (level 3) QI Launch LCL = 43.23 LCL = 43.23 4 6 4 5 02 02 04 0 02 0 05 0 occur occurbelow below the mean the mean 20 002 006 /2009 •February and March data points •February/2006 /2006 and March/2008 data 20points09 / /2005 /2007 /2007 /2008 /2008 2004 2005 /2002 2002 2003 /2004 2004 /2004 2006 2007 7/20 7 0 7 3 40 440/20 7 7/2003 1/20 7/2002 7 4 0 1 4 4/2006 /10/200 0 01/2007 04/2008 0 10/2007 01/01/0201/009 01/03/2009 01/01/20001/20 01/0 01/10/20001/201/20001/304/20001/30 01/10/20001/30 01/04/200001/41/0701/2000011/404/2001/1/001/20001/1/010504/ /0201/00011/50/20001/30041//10200/0201/307001/5/ 0101//20100/1/020604001/3/012001/0071/04/20/001/061/1007/20/20001/01/640110/200001/1/7001/20001/1/50407/20/02001/51/00771/2001/005101//020001/50011//20001/060401//2007001//6200701/0/20108001//2061000/1/80011//200091/04/20001/707/2001/07100/ 1/0011/01/20/02001/0201/048 /200001/1/2007/20001/01/10810/20/20001/0801/01201/20/2000901/304/20001/307/2001/01/31001/20/20001/01/320104/20001/0240704/20/20001/021/10407/20/02001/02011/10/200/2001/300401/4/200100/1/2030701//200401/0/3201000/1/20500701/3/01200/1/2001001/404/20/02001/0501/01407/20/001/1/60410/20/2000001/1/64001/20001/01/5041 /20001/051/0701/200/201/0051001/7/040/201/01001/7/200701/0/620001/071001//200700/1/270011/10/200/2001/080041/601/200/201/00801/704/20001/01/70707/20/20001/087 01/01/20001/804/2001/0807/20001/807/2001/0801/ (normal9 (normal variation) variation) 2 3 4 4 5 7 8 3 4 7 8 8 02 07 Month Month 08 0 occurMonth belowMonth 06the mean07 occur below the mean 2002 2003 2004 2005 2006 2007 20/0202 /2003 /2003 /2003 /2005 /2005 2008 2009 /2008 /2008 7 7/2008 1/ 1 4 1 0 0/2007 1 4 01/2002 07/20/100/205 02 /01/2004 04/2006 10/2002 /1001/20093 01 01/03/2009 01/03/200 Can we save lives? 01/01/20001/204/20001/207/20001/210/20001/201/20001/304/20001/307/2001/0310/20001/301/20001/404/20001/407/20001/410/20001/401/2001/0504/20001/507/2001/0510/20001/501/2001/0604/20001/607/20001/61001//20001/6010/1/2000401/7/04200/1/2007001/7/0 01/0101/10/200/2001/00101/701/200/2001/00401/804/20/020001/31/00780 001/1/1010//200001/1/380101//2020001/904/20001/07/20001/4100/1/200001/40101//200401/0/52004001//20207001//20001201/1001//200001/50101//20001/060401//200700/1/2060071/03/10200/0201/6010013/20001/60011/04/200/2001/070041/407/20/02001/001/07410/20/0201/0007101/40/20001/071/0104/20/20001/01/04507/20/02001/01/080751 /2001/01081/01/ /20001/1/0016 / 01/07/20001/610/20001/6010/1/2000101/704/200/2001/200401/7/07200/2001/021/07071/20001/021/0 01/01/010/ 001/1/0407/20/20001/1/30707//202001/008 01/01/20001/404/ 01/07(normal/20001/10/20001/401/ 01/04/20001/507/2001/0510/20 001/5variation)01/2001/0604/20001/607/2001/10/ 01/01/ 01/04/20001/07/2001/0710/2001/01/20001/04/2001/0 07/20001/807/2001/0801/2009 (normal variation) Month Month Month Month 3. How3. Howdo we do compare? we compare? 3. How do 3.we How compare? do we compare? 3. How do we compare? Period Deaths Predicted HSMR Lives •UK best3.•UK How =best Whittington do = Whittingtonwe compare? Hospital Hospital 3. How do we compare? saved 3. How do we compare? •UK best = Whittington Hospital•NW best = Warrington and Halton •NW •UKbest best= W arrington= Whittington and Halton Hospital 1999 1097 1206.4 90.9 109 88.9: Salford Royal 88.9: Salford Royal 2000 1107 1185.4 93.4 78 •NW best = Warrington and Halton•NW•No statistical best = Wdifferencearrington and Halton Relative •No statistical difference 88.9: Salford Royal 88.9: Salford Royal between Salford Royal and NW best 2001 1163 1253.5 92.8 90 Relative Risk •No statistical differencebetween Salford Royal and NW best 2002 1302 1346 96.7 44 Risk •No statistical difference Relative Relative 40 55.5: UK best 130:between UK & NW worst Salford Royal160 and NW best 2003 1317 1360.2 96.8 43 Risk between Salford Royal and NW best Risk40 55.5: UK best 130: UK & NW worst 160 2004 1215 1228.5 98.9 13 40 55.5: UK best 130: UK & NW worst 83.3: NW160 best 2005 1181 1259.1 93.8 78 40 55.5: UK best 130: UK & NW worst 160 2006 1139 1316.4 86.5 177 83.3: NW best 83.3: NW best 2007 1157 1369.3 84.5 212 83.3: NW best 2008 1143 1436.1 79.6 293 A programme of projects Project framework
Safe Clean Personal
1. Acutely unwell adult 1. Reduction of infection: 1. Staff engagement & 2. Reliable care: Clostridium diffi cile awareness – focus groups Acute myocardial infarction Central lines Heart failure 2. Patient engagement and Hip and knee replacement Surgical site infection awareness Community acquired Urinary catheter infection 3. End of life care pneumonia MRSA - ICU 3. Stroke 4. Customer care 4. Falls 2. Environment 5. High risk medications Toilets & bathrooms 6. Hip & knee (pre-operative) 7. Pressure ulcers
The following pages provide our ‘Quality Account’ which represents our first year of achievement.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 17
Untitled-3 1 04/06/2009 10:32 Salford Royal is one of the safest hospitals in the country
In April 2008 Salford Royal launched one of All our projects have, at their heart, the deep the most ambitious plans in the NHS for quality involvement of our staff in deciding the changes in improvement and patient safety. practice and improvement they wish to implement. This report is a testimony to their support, Our ambition is to be the safest hospital in the NHS enthusiasm and commitment to this strategy and and this ‘Quality Account’ reports on our first year putting patient safety at the forefront of everything of achievement. that we do. We believe it is important to be open and Salford Royal is one of the safest hospitals in the transparent with the public we serve. Last April country and all who work here commit themselves we acknowledged the harm we can inadvertently to do even better for our patients and their families. cause patients through, for example infections We want to be the best and to provide safe, clean and medications errors. We published our quality and personal care for every patient, every time. improvement strategy which describes a programme of projects identified within the strategy which I hope you find our first ‘Quality Account’ aim to save 1000 lives and avoid 10,000 harmful interesting and informative. I also hope that it gives incidents to patients over the next three years. you confidence that Salford Royal and its staff are putting patient safety and quality improvement at Salford Royal already has an excellent safety record the top of our priorities. - but there is more that we wish to do. We asked patients what they wanted from their hospital and they told us they wanted services which are safe, clean and personal to their needs. We have therefore adopted these three words to be our organising principle. Each of our projects is therefore grouped and reported under one of these three themes. David N Dalton May 2009 Chief Executive Salford Royal NHS Foundation Trust
Our new Strategy will deliver safe, clean and personal care
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 18 Key Achievements
One of only three Trusts in the NHS to be rated ‘excellent’ for quality of services for three consecutive years 98% of patients would recommend the hospital to family and friends (highest NHS score) Clostridium difficile infection reduced by 68% Mortality rate reduced from 84.5 to 79.6 equating to 293 lives saved Stroke care best practice measures improved from 81% to 91% Cardiac arrests reduced by 32% Other significant achievements in 2008/09 included: Salford Royal was rated in the top 20% of Trusts by patients in the Healthcare Commission annual in-patient survey. 98% of our patients stated they would recommend the hospital to a relative or friend; Salford Royal was rated in the top 20% of Acute Trusts in the 2008 staff survey and in particular received the highest score for: l Recommend the Trust as a place to work; l Enabled to provide high quality of care to patients. Named as one of the top 20 NHS employers sponsored by the Health Service Journal and Nursing Times. Staff stated that the Trust is ‘innovative and forward-thinking’ with a board and senior managers who have ‘vision and leadership skills’. National Winner of the Patient Safety category at the annual Health Services Journal Awards for the early identification of cancer through a red flag identification system.
Our New Approach to Quality Improvement l In April 2008, Salford Royal launched its Quality Improvement Strategy which contains a number of key initiatives to ensure patients receive safe, clean and personal care every time. The programme aims to save 1,000 lives and avoid 10,000 harmful incidents to patients over three years. l In October 2008, the Trust scored top marks in the Healthcare Commission’s Annual Health Check, rated as ‘excellent’ for the quality of its services for the third consecutive year. l The Trust Board takes its responsibility for patient safety and quality improvement seriously. The Board has revised its agenda to devote one third of its time to its Quality Improvement strategy. Each Board meeting always starts with listening to a ‘patient story’ to hear of a recent experience so that Board Directors can reaffirm their commitment to patient safety. l The Executive Team began conducting ‘Safety WalkRounds’ to all wards and departments in January 2009. These enable Directors to demonstrate their support for Quality Improvement activity. Staff engage in a structured conversation regarding the potential for harm, reporting of harm and how the Trust can improve safety for both patients and staff. The conversations are documented and reviewed for trends.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 19 What Do We Want to Improve? Our aim, over 3 years, is to save 1,000 lives by reducing than expected died. For Salford Royal, every one our mortality rate (HSMR) to one of the lowest in point below 100 we achieve equates to 14 lives saved. the NHS and to prevent 10,000 harmful events that In 2008, the Trust continued to demonstrate patients would otherwise have experienced. improvement in HSMR with the annual score recorded at 79.6 which equates to 293 extra lives saved. How Will We Know We Have Improved? GTT Explained We use a number of quality improvement tools to We use the Institute for Healthcare Improvement’s measue our progress. They are: (IHI) Global Trigger Tool to provide us with an HSMR Explained understanding of incidence of harmful events. This tool requires us to randomly select clinical records HSMR is a measurement system which compares per month and review them for harmful events. It is a hospital’s actual number of deaths with their on the data produced by this tool that we are basing predicted number of deaths. The prediction our reduction in harmful events. calculation takes account of factors such as the age and sex of patients, their diagnosis, whether the Driver Diagram Explained admission was planned or an emergency. We use a driver diagram (Figure 1) to determine the If the Trust has an HSMR of 100, this means that the components of the strategy and its organisational number of patients who died is exactly as predicted. impact. The driver diagram helps us to illustrate the A HSMR above 100 means more patients died than areas of the organisation in which we need to work would be expected; one below 100 means that fewer in order to achieve our aims.
Figure 1: Salford Royal NHS Foundation Trust Driver Diagram n Outstanding leadership support n Patient involvement at every level Quality Drivers n Evidence based optimal care Leadership and Culture n Fair and just culture n Flatten hierarchy and optimise teamwork behaviour n Build IT infrastructure for electronic record n Strengthen communications internally and externally
Improved patient n Mortality (HSMR) n Re-admissions satisfaction Measurement n Adverse events - global trigger tool and outcomes n Infection - SSI, UTI, VAP, CLI, MRSA, C.diff n Acutely unwell - arrests outside ICU Safe, Clean and Personal n Patient and staff satisfaction
Reduce mortality n Care of the acutely unwell adult (top 10% in NHS) n Infection - SSI, UTI, VAP, CLI, MRSA, C.diff n Stroke and adverse events n Reliable care for high volume conditions (50% reduction) Quality Initiatives n Falls n High risk medications n Environment n Pressure ulcers and urinary catheter infections n Care of the dying
n Patients participate in all improvement teams n Benchmark improvement capability Workforce Capability n Build infrastructure and capability for improvement n Build a culture of continuous quality improvement n Celebrate successes and spread quickly
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 20 How We Have Prioritised Our Quality Improvement Initiatives The strategy is being delivered through a Figure 2: Safe, Clean and Personal Programme programme of projects. The programme (Figure 2) is designed to contribute to our overall aim to provide ‘safe, clean and personal’ care to every patient which has focussed our work to date. Safe We have ‘phased’ the projects over the three years. 1. Acutely unwell adult Our Year 1 projects are highlighted in Figure 2. 2. Reliable care: Acute myocardial infarction The key to success is Executive support, staff Heart failure engagement and teamwork. Clinical experts Hip and knee replacement work with improvement experts to select, test and Community acquired pneumonia implement changes on the front line of care. 3. Stroke Ward teams have permission to redesign care which 4. Falls is delivered through small steps of change. We 5. High risk medications believe that ownership of change at ward level 6. Pressure ulcers results in improved quality care for patients. Clean How Are We Supporting Staff? 1. Reduction of infection: We have invested in a new Quality Improvement Clostridium difficile Directorate which blends the skills of project Central lines management, improvement advisors and clinical fellows to support staff in introducing change and Surgical site infection improvement within wards and departments. This Urinary catheter infection QI Directorate is the largest of its type in the NHS. Ventilator acquired pneumonia All new staff introduced to our QI strategy at 2. Environment: induction. All existing staff are offered a one day l Toilets and bathrooms in-depth programme on the tools of improvement method and measurement. Additional courses are being designed on reliability science and advanced measurement. A Clinical Quality Academy for senior Personal clinical staff and a Leadership of System Change for 1. Patient Experience Tracker (PET) Quality programme will shortly be available. 2. Nursing Assessment and Accreditation System More and more staff are putting their learning (NASS) into practice- they are using charts on the wards to 3. Staff engagement and awareness measure whether a change in practice results in an 4. Patient engagement and awareness improvement they were expecting. 5. End of life care 6. Customer Care
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 21 Safe PROJECT ONE Improving care for the acutely unwell What: Reduce Cardiac Arrests in Wards How much: Minimum 30% Stretch 50% By When: March 2009 Outcome: 32% reduction in cardiac arrest = 67 fewer cardiac arrests Progress: On Track
Current Status
UCL Cardiac arrests can be significantly 3.0 reduced if clinical observations are regularly recorded, accurately 2.5 interpreted and appropriate action UCL taken when necessary. 2.0 Mean
1.5
Mean 1.0 Arrest Rate Per 1000 Admissions Per Rate Arrest LCL 0.5
LCL
0.0 04/07 05/07 06/07 07/07 08/07 09/07 10/07 11/07 12/07 01/08 02/08 03/08 04/08 05/08 06/08 07/08 08/08 09/08 10/08 11/08 12/08 01/09 02/09 03/09 Month Improvements Achieved l New charts introduced enabling reliable clinical observations. l Use of structured decision making tools. l Ward round checklists developed and introduced. l Improved team working and communication. Further Improvements Identified l Manual blood pressure monitoring equipment to be installed at every patient bed area. l Review use of a Rapid Response Team to support early treatment.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 22 Safe PROJECT TWO Delivering reliable care for patients
Salford Royal is participating in a region wide programme known as ‘Advancing Quality’. The aim is to record and report the level of compliance to a set of evidence based measures that clinical staff have agreed that all patients should receive. Four conditions have been selected and this system of assurance of reliable care to patients is new to the NHS. What: To improve the quality of care received by patients with: l Acute myocardial infarction l Heart failure l Community acquired pneumonia l Hip and knee replacement How much: 100% accurate reporting 90% reliable in 2 of the 4 conditions By When: Within one year Outcome: Early data suggests improving compliance to essential care Progress: On Track
Current Status Acute MI Target Achieved Heart failure Behind Schedule Community acquired pneumonia On Track Based on three months Hip and knee Behind Schedule data only
Improvements Achieved l This first year has focussed on the process of collecting information from patient records. l The electronic patient record is being used. l Early diagnosis and communication alerts of relevant patients to appropriate health care professional. l Computerised best practice prompt sheet developed to guide clinical care. Further Improvements Identified l Identification of area for improvement. l Methods of assuring compliance by trainee doctors. l Participation in learning collaboratives to share best practice.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 23 Safe PROJECT THREE Reducing death following a stroke What: Improve care delivered to stroke patients How much: Achieve minimum 90% and stretch 95% in the standards in Stroke care By When: October 2008 Outcome: 91% achieved Progress: Minimum Standard Achieved Close to Stretch Target
Current Status 100 UCL
Mean The NHS measures the quality of care 90 UCL for stroke patients by the use of ten LCL 80 key standards. The score in October Change in system indicating Mean 2008 rated the Trust’s care at 91% 70 improved compliance to processes which is an 18% improvement. 60 LCL 50
% Compliance 40 Further Improvements Identified
30 l Development of Greater Manchester comprehensive (hyper acute) Stroke 20 Unit at Salford Royal. 10 l Increased capacity of Stroke Unit. 0 June 07 July 07 Aug 07 Sept 07 Oct 07 Nov 07 Dec 07 Jan 08 Feb 08 Mar 08 Apr 08 May 08 June 08 July 08 Aug 08 Sept 08 Time (Months) Improvements Achieved Standard Score 1 % of patients treated on a stroke unit 94% 2 % of patients treated on a stroke unit for more than 50% of their admission 94% 3 % of patients receiving a brain scan within 24 hours of onset 88% 4 % of patients weighed during admission 93% 5 % of patients receiving a swallow screen within 24 hours of admission 93% 6 % of patients receiving a physiotherapy assessment within 72 hours of admission 100% 7 % of patients receiving occupational therapy within 4 working days 98% 8 % of patients receiving a mood assessment prior to discharge 75% 9 % of patients receiving a home visit 80% 10 % of patients discharged on anti-thrombotic treatment 100%
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 24 Safe PROJECT FOUR reducing inpatient falls What: To reduce falls on the pilot wards How much: Minimum 20% Stretch goal 40% By When: August 2009 Outcome: Early data suggests this collaborative is making improvements in the reduction of falls Progress: On Track (project commenced in January 2009)
Current Status 45 Last year 1300 patients experienced 40 a fall in Salford Royal usually at UCL the bedside or when attempting to 35 walk unaided. This is consistent with 30 national rates. National pilots have achieved an average reduction of 25 18%. Salford Royal has set a stretch 20 target of 40%.
15 This important project is in progress. Falls Per 1000 Bed Days Per Falls Mean Early indications suggest a reduction 10 in the number of falls within the
5 pilot wards.
0
May 08 June 08 July 08 Aug 08 Sept 08 Oct -08 Nov 08 Dec 08 Jan 09 Feb 09 Mar 09 Apr 09 May 09 June 09 July 09 Aug 09 Time (Months) Identified Areas of Improvement l Compliance with falls risk assessment tool. l Improving monitoring of patients identified as being at high risk of falling. l Accessibility of toilets / commodes. l De-cluttering the ward environment with particular focus on the patient’s bedside. l Provision of appropriate footwear for patients. l Improving care delivered after a fall to prevent further recurrence. l Attention to medication. Further Improvements Identified l Continuation with pilot project.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 25 Clean PROJECT ONE Reducing the incidence of hospital acquired Clostridium difficile (C.diff) What: To reduce the incidence of hospital acquired Clostridium difficile How much: Minimum 50% Stretch 70% By When: March 2009 Outcome: 68% reduction Progress: Minimum Target Achieved Close to Stretch Target
Current Status
UCL 45 This project has exceeded national 40 recommendations in driving down the numbers of patients who acquire 35 C.diff infection. Mean 30 The Trust has reduced its hospital acquired C.diff rates by 68%. 25 UCL 8th data-point below the mean Summit event and handoff 20 Scale up meeting
15 Mean NUmber of Cases Per Month Per NUmber of Cases LCL 10 Start of collaborative 5 Antibiotics restricted Scale up commences
LCL 0 04/ 05/ 06/ 07/ 08/ 09/10/ 11/ 12/ 01/ 02/ 03/ 04/ 05/ 06/ 07/ 08/ 09/ 10/ 11/ 12/ 01/ 02/ 03/ 04/ 05/ 06/ 07/ 08/ 09/ 10/ 11/ 12/ 01/ 02/ 03/ 06 06 06 06 06 06 06 06 06 07 07 07 07 07 07 07 07 07 07 07 07 08 08 08 08 08 08 08 08 08 08 08 08 09 09 09 Month (2006-2009) Improvements Achieved l Increased compliance with hand washing protocols. l Restriction of antibiotics. l Scale up of improvement initiatives from pilot wards to the rest of the hospital. l Publication of Clostridium difficile change package (compendium of successful changes for use by all wards). Further Improvements Identified l Compliance with implementation of Change Package to be monitored via the Nursing Assessment and Accreditation System (NAAS).
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 26 Clean PROJECT TWO Increasing patient and staff satisfaction with toilets and bathrooms What: To achieve a ‘good’ or ‘excellent’ rating for patient and visitor toilets and bathrooms How much: 95% By When: May 2009 Outcome: 93% Progress: Close to Target
Current Status 100% 90% Very satisfied Satisfied 80% Not satisfied 70% 60% 62.3% 50% 40%
30% 30.5% 20%
10% 7.2% 0% Are you satisfied with the toilet / bathroom facilities on this ward / department? Improvements Achieved l Refurbished bathrooms on selected wards. l Improved toilet facilities at one of the main entrances to the hospital. l Improved and standardised cleaning protocols for domestic staff. Further Improvements Identified l Further refurbishments will be progressed through a new project. l Ward environments will continue to be monitored via the Nursing Assessment and Accreditation System and the Patient Experience Tracker.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 27 Personal PROJECT ONE Understanding the views of patients
Patient Experience Tracker (PET) Designed as a performance management tool, the Patient Experience Tracker (PET) collects, assesses and tracks patient experience in real time across multiple areas of the Trust and tracks whether real improvements are being delivered. It helps to understand any underlying causes that affects the patient experience and measures the effectiveness of any remedial action undertaken by teams. The Matron Team across the Trust reviews the results and works with wards/departments to make improvements to the environment and practice.
The results for the year 2008/09 are as follows:
100% Very 100% 90% Quite 90% Yes, definitely Not at all Not sure 80% 80% No 70% 70% 60% 60% 50% 50% 94.6% 40% 74.8% 84.8% 86.0% 40% 30% 30% 20% 23.0% 20% 7.6% 12.4% 10% 7.6% 10% 3.1% 2.1% 2.3% 0% 1.6% 0% In your opinion Have you been Were staff courteous Would you be happy for a friend or relative to how clean is the kept informed of and sensitive to your be treated in this ward / department? ward? your progress on needs on this ward / this ward? department?
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 28 Personal PROJECT TWO Understanding the views of patients
In-patient Survey Comparison 2007/08 and 2008/09
The 2008/09 in-patient survey shows significant 100% Top 20% of Trusts progress in the scores that patients rate the care Middle 60% of Trusts 90% Bottom 20% of Trusts and treatment provided within Salford Royal. As can be seen we have increased the number 80% 31% of criteria which are regarded as within the top 70% 56% 20% of Trusts surveyed and have now eliminated all scores within the bottom 20%. 60% 50% 40% 67% 98% of our patients 30% 44% when surveyed stated they 20% 10% would recommend 2% the hospital to a 0% 2007 2008 relative or friend Nursing Assessment and Accreditation The results so far show: GREEN 1-2 failing standards 17 Reassess in System (NAAS) 2 in total wards 8 months Measuring the quality of nursing care delivered by AMBER 3-4 failing standards 14 Reassess in individuals and teams is not easy. This performance 1 in total wards 4 months assessment framework based on the Trust’s Safe, RED 5 failing standards 3 Reassess in Clean, Personal approach to service delivery 0 or more in total wards 2 months incorporates Essence of Care standards and key clinical indicators, whilst providing evidence for the The NAAS was introduced into the Trust in Care Quality Commission’s Core standards. September 2008. To date, 34 areas of the Trust have been assessed (complete assessment of the whole The NAAS is designed to support nurses in practice Trust will take place by the end of June 2009). to understand how they deliver care, identify what works well and where further improvements are The key improvements required that have been needed. identified as a result of the assessments are: Each ward will have an assessment completed and l Developing a ‘link nurse’ system focusing on will be accredited with a level 0 to 2. continence issues; Following two consecutive assessments at Level 2 l Improve attendance on ‘Safeguarding’ training; the ward will be awarded a Level 3 (Safe, Clean and l Improve awareness and training in relation to Personal, every time status). care for people with mental health conditions; Reassessment takes place depending upon previous l Improve the quality of the nursing documentation; results. l Standardise nursing care plans across the Trust.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 29 Achievements Against National Requirements The Healthcare Commission’s Annual Health Check Any concerns raised via Salford’s LINk, Members and for 2008/09 reported that Salford Royal continued to Governors will be fully reviewed by the Trust and provide an excellent quality of service to patients. any necessary action will be taken to ensure patient care is continually improved. The Healthcare Commission’s Hygiene Team, awarded Salford Royal full compliance with the Healthcare Act and Hygiene Code leading to unconditional registration with the Care Quality Commission for 2009/10. How We Keep Everyone Informed? Salford Royal significantly invested in the role of the Matron increasing the numbers across the High attendance and participation organisation from 14 to 21. This provides senior by our Council of Governor clinical nursing presence 24 hours a day, 7 days per representatives to the safe, clean week to ensure the quality of care and the patient and personal sub-groups experience is regularly monitored and managed (until December 2008) promptly. Foundation Trust members invited to take part in Quality Feedback From Members, Governors and the Improvement learning sessions. Public Foundation Trust members The Board values the involvement of its Governors in regularly updated through reviewing and supporting its Quality Improvement Strategy. The Council of Governors during 2008/09 quarterly publication of organised their sub committee work into the 3 ‘My Hospital’ themes of Safe, Clean and Personal. Quality Improvement Team raise The Salford LINk became fully operational in September 2008 and has not to date raised any area awareness of programme to the of concern with the Trust public through hospital open days The Overview and Scrutiny Committee have and events. received a presentation from the Trust around the work of the Acutely Unwell Adult and the associated Quality Improvement Collaborative Project initiated to improve care and reduce harm. Examples of feedback from the public, including the Foundation Trust Membership and Governors include: l Widespread appreciation of Trust facilities staff, including porters and car parking attendants upon whom many patients rely during visits to the hospital; l High satisfaction with the Trust’s continual improvements relating to the prevention of hospital acquired infections.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 30 Quality Overview
Performance of Trust Against Selected Metrics
2007- 2008- Safety Measures Reported 2008 2009 Improved 1. Number of patients with MRSA infection 29 16 2. Number of patients with C.difficile 237 117 3. Hospital falls / injuries (falls / 1000 inpatient admissions) 3.70%*2 4.28%*1 4. Falls risk assessments completed within 24 hours of admisison 89.11% 94.2% 5. Waterlow tests completed within 24 hours of admission to the ward N/A 94.6% 6. MUST assessments being completed within 24 hours of admission to the ward 83.8% 90.7% Clinical Outcome Measures Reported 1. Hospital Standardised Mortality Rate 84.5 79.6 2. Stroke Sentinel audit 81 91 3. Stroke mortality rates (Acute Cerebral Vascular Disease)*3 20.2% 19% 4. Cardiac arrests outside critical care units/1000 admissions 1.8 1.1 Patient Experience Measures Reported 1. % of patients that would recommend hospital to relative / friend*4 95% 98% 2. Overall, how would you rate the care you received 81% 84% 3. % of patients who felt that they were treated with dignity and respect 82% 92% 4. % of patients who had not shared sleeping area with opposite sex 71% 75%
Notes on Recommended Metrics *1 Awareness comparison to encourage staff to The data on reported falls and cardiac arrests are report patient falls. used to inform the work of the quality improvement collaboratives that are underway at the Trust. *2 Figure includes all reported falls - patient and staff. The stroke sentinel audit measures and stroke mortality rate are used to inform the ongoing work *3 2008/09 Stroke Mortality Rate for England 21.6%. in stroke services to improve quality of care. *4 Picker Institute in patient satisfaction survery. The patient experience measures are taken from the annual Care Quality Commission and the Picker Institute in patient satisfaction surveys.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 31 National Targets and Regulatory Requirements
2007- 2008- Achieved National Targets and Regulatory Requirements 2008 2009 National Standard The Trust has fully met the HCC core standards, and national targets Fully met Fully met self- declaration Clostridium difficile year on year reduction 237 117 MRSA - maintaining the annual number of MRSA bloodstream 29 16 infections at less than half the 2003/04 level 18-week maximum wait from point of referral to treatment 92% 90.1% (admitted patients) 18-week maximum wait from point of referral to treatment 95% 95.2% (non-admitted patients) Maximum waiting time of four hours in A&E from arrival to 98.10% 98.22%*1 admission, transfer or discharge Maximum waiting time of 31 days from diagnosis to treatment for 100% 99.33% all cancers Maximum waiting time of 62 days from urgent referral to treatment 99% 99.62%*1 for all cancers People suffering heart attack to receive thrombolysis within 60 N/A Patient minutes of call (where this is the preferred local treatment for heart numbers 67%*2 attack) below dominium of 20 Maximum waiting time of two weeks from urgent GP referral to first 99.89% 100%*1 outpatient appointment for all urgent suspect cancer referrals
Notes on Recommended Metrics *1 April 2008 - December 2008 (full year not The Trust is compliant with the Healthcare available). Commission core standards and national targets. *2 Clinical notes and data still to be confirmed and subsequent scoring.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 32 Operational Review
Valuing Our Staff Workforce by Directorate
Our reputation for delivering excellent quality Medical Group services depends on the skill and dedication of our Neuro, Ortho, W&C staff. At the end of 2008/09 the Trust employed Theatres / Anaesthesia / Surgery c. 4,800 whose contribution remains vital to our success. Diagnostics Facilities The Trust has appointed an additional 250 (full time equivalent) staff in year in response to service Finance, Supplies & IT developments (additional Intensive Care facilities, Human Resources Stroke and bariatric developments) and increased Trust Management number of Matrons across the Trust. Research
The Trust has exceeded the 3 year Local Employment 0 200 400 600 800 1000 1200 Partnerships target in year by employing FTE disadvantaged and unemployed local people and agreed a further target to extend this in the future. Workforce by Grade The Trust is acknowledged as an employer of choice and has been rated by the Health Service Journal Miscellaneous and Nursing Times as being one of the top 20 Band 1 healthcare sector employers in the UK. Band 2 Band 3
Band 4 Success Band 5 through the Band 6 Band 7 hard work of Band 8a staff Band 8b Band 8c Workforce by Staff Group Band 8d Consultant Nursing and Midwifery Registered Foundation House Officer Administrative and Clerical House Officer Additional Clinical Services Associate Specialist
Estates and Ancillary Senior House Officer Medical and Dental Specialty Registrar Add Prof Scientific and Technic 0 200 400 600 800 1000 1200 Healthcare Scientists FTE Allied Health Professionals
Students
0 200 400 600 800 1000 1200 1400 1600 FTE
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 33 Workforce by Ethnic Group Workforce by Age Band
Asian 8% Black 1% Chinese 1% Mixed 1% Other 1% 30 Not Stated 2% 25 % 20
15
10
5 White 86% 0 16 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65+ Age
Workforce by Gender Engaging with Staff Male 23% We use a wide range of ways to engage with our staff and constantly review and develop these to ensure staff are satisfied with the level of their involvement. Our staff have access to a well developed intranet, a quarterly staff magazine “The Gen”, and an effective monthly team briefing system. Team brief is a face to face meeting between the Chief Executive and Trust managers as well as a written cascade ensuring staff are aware of current performance and how they contribute to Female 77% Trust objectives. Staff have the opportunity to provide feedback to Part Time 34% senior management via the annual staff satisfaction survey, a clear reporting system for concerns and a Chief Executive question and answer forum. The Trust was visited by Clare Chapman, NHS Director General of Workforce, in March 2009 who complimented the Trust on its positive outcome in the National NHS Staff Survey and commented on the Trust having achieved the highest score in the country in one particular area: ‘Percentage of staff feeling satisfied with the quality of work and Full Time 66% patient care they are able to deliver.’ The Trust comprehensively reviews the outcomes of the national NHS staff survey and ensures any areas highlighted as requiring attention are built into the Trust’s plans.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 34 Partnership Working Equality and Diversity The Trust continues to work with the Joint The Trust is committed to providing equal treatment Partnership Forum and Joint Local Negotiating of patients and staff whatever their gender, marital Committee and has over the course of the year status, sexual orientation, social class, race, ethnic developed and improved local arrangements for origin, colour, nationality, national origin, religion, communicating and consulting with staff. age or disability. The Trust recognises that its staff, patients and suppliers are becoming increasingly diverse. Its goal is to ensure that through effective leadership and the individual behaviours and actions Sickness Absence of every employee it demonstrates that it truly values diversity and inclusion. The Trust recognises The Trust has policies to support staff to stay in work its public duty with regard to Equality and this or to expedite an early return to work following is demonstrated by the publication of its Single sickness. The support of the Occupational Health Equality Scheme which incorporates its Disability Department, physiotherapy and counselling services Equality Scheme, Race Equality Scheme and its are important components of maintaining regular Gender Equality Policy. The Trust has now made attendance. The Trust also works closely with Equality and Diversity training mandatory. local Disability Employment Advisers regarding reasonable adjustments to working practices where Ending discrimination in health services is not just disability is an issue. Ultimately, where staff are about making buildings accessible or providing unable to maintain a satisfactory level of attendance information in alternative formats. It is about they may be subject to notification and dismissal identifying actual or potential barriers at all procedures. The Trust is one of the pilot sites levels within the organisation and working in for the two-year Department of Health wellness partnership with community groups and partnership programme provided through Vielife. organisations to work to reduce these and develop services and policies that can meet the diverse needs The overall levels of sickness absence have decreased of our service users and employees. To achieve since 2007/08 to 4.01%. The Trust is aiming for this, the Trust is committed to delivering a range of further reductions to the target level of 3.6%. projects and work-streams including: l Equality impact assessments; Trust Sickness Absence (March 2008 - March 2009) l Consultation and Involvement with patient 6.00 user groups;
5.00 4.72 l Working with Salford Disability Forum; 4.42 4.46 % 4.22 4.07 4.13 3.98 3.94 3.90 4.01 4.01 4.00 3.85 l Working with Jobcentre plus; 3.46 3.02 l Working with partner organisations e.g. 3.00 Salford PCT.
2.00 The Trust’s Diversity and Equality Committee will monitor and review all equality related issues within 1.00 the Trust.
0.00 March 08 April 08 May 08 June 08 July 08 Aug 08 Sept 08 Oct 08 Nov 08 Dec 08 Jan 09 Feb 09 March 09 April 09 Months
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 35 Health and Safety Vocational Development The Trust has a Health and Safety Committee is The Trust is committed to meeting the development made up of representatives from all clinical and needs of all its staff and last year our Chief Executive non clinical groups, trade unions and staff. The signed the ‘Skills Pledge’ providing commitment and Committee also includes advisors with expertise support to developing the skills of all non-clinical in health and safety, fire and security. It meets staff to a minimum standard of National Vocational regularly to receive reports from all areas and Qualification (NVQ2). Learning and Development provides an opportunity for managers and staff to is an established NVQ Centre providing a variety raise concerns and issues. The committee also sets of vocational awards and is also committed to action plans for improvement in specific areas and supporting local people applying to the Trust tracks progress. for healthcare posts through the Skills for Life programme that includes literacy, numeracy and The Trust’s Health and Safety Department provides essential Information Technology (IT) and provides an advisory service on safety, hygiene, health and staff with access to further development through safety training and related matters. the NVQ route. Occupational Health Professional and Workforce Development The Trust provides a comprehensive on site Occupational Health Service. The professional development of clinical staff is supported both through in-house development and During 2008/09 several new standards have been through access to a broad range of programmes at trialled relating to quality of service delivered within local universities. This year, the Trust also received a the department and these will be introduced from cash allocation from the Strategic Health Authority April 2009 and audited quarterly. The improvements (SHA) to support the professional development of to service delivery are based on a number of key clinical staff not accessible through local universities. performance indicators including: In addition, Learning and Development staff, l The management of pre-employment support the ongoing development of new and questionnaires within 48 hours; existing roles to meet emerging service demand. l Issue of medical reports report within 48 hours of appointment. Leadership and Management Development A range of interactive leadership and management Learning and Development programmes are offered as twelve month and shorter Learning and Development has a fundamental development opportunities. These include well role in achieving real service improvement and established leadership programmes, coaching, team supporting the Trust’s three quality themes of building/working, and a management programme Safe, Clean and Personal through the personal/ for managers who are new to post, focusing on professional development and performance of key management skills. Current plans include the its workforce. In early 2009, the Learning and development of a service manager development Development, Undergraduate and Post Graduate programme, a website providing useful information Medical Departments moved to new purpose built for new managers including a menu of options for educational facilities in Mayo Building. The state-of- leadership and management development and access the-art lecture theatres, seminar rooms and clinical to a broader range of psychometric tests for the skills facilities are up and running and we are able to development of leaders and managers. offer a truly professional educational environment for our students and staff across the Trust.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 36 Learning Technology This year has seen the development of a range who are responsible for junior medical staff of e-learning programmes including a blended education. We already include this training as mandatory training and learning package for clinical mandatory for consultants and are now including staff called the Essential Annual Training (EAT) staff and associate specialist grades in a programme Workbook. This has provided a more flexible option of certified study days. for staff and is aimed at ensuring patient safety.
The top priority for 2009 is the development of the Specialty Tutor Role Over twenty individual departments in the hospital Care of the Acutely Unwell Adult Programme and have a tutor identified responsible for the delivery Safeguarding Children Awareness for non-clinical staff. of specialty training. The Trust is working hard to set time within job plans for this substantial duty. Appraisal and Knowledge Skills Framework Learning Needs Assessment (LNA) (KSF) A detailed questionnaire is completed by each junior doctor as they commence at the Trust that allows The Trust has introduced a revised Knowledge us to review and record clinical competence and Skills Framework (Salford KSF), new appraisal arrange for necessary additional training. This has documentation and individual personal development improved the Trust’s induction of junior doctors. plans for Trust Agenda for Change staff groups which will help staff to reach their potential and Foundation Progress Review provide quality care to every patient every time. 2009 will be the second year that all prospective The aim is to increase staff engagement in appraisal and current foundation trainees are included in a and personal development planning and increase competency-based assessment that covers key aspects effectiveness by bringing measurable benefits to of current practice. Last year’s results demonstrated patients through improved pathways of care. impressive learning during the foundation years. Medical Simulation Supporting Students in Practice With the completion of the 21st century education facilities within the Mayo Building, we are able to The Learning and Development Department through increase access to simulation-based training for medical practice educator facilitators ensures that the Trust staff using the innovative ‘Simman’ and ‘Simbaby’. meets the requirements of the SHA ‘Learning and Development Agreement’ in relation to support for students and provision of facilities to deliver Undergraduate Medical Education education. During the past year, over 40 clinical Following a successful pilot last year, the placements have supported on average 180-200 Undergraduate Medical Education Department is pre-registration healthcare students at any one time. now running a series of practical workshops for year 5 students on common acute medical problems. Postgraduate Medicine The exciting aspect of this innovation in Salford is The North Western Deanery endorsed a number of that it has been led by Specialty Trainee Doctors our latest developments during its inspection visit to who have taken a teaching idea from original us in December 2008. These were: concept through to planning and implementation. Clinical scenarios were designed for chest pain, sepsis, Continuing Clinical Teacher Development upper gastrointestinal bleeding and the management The Postgraduate Medical Education and Training of the breathless patient. The goal was to develop Board (PMETB) has set a deadline of January 2009 students’ ability to progress from recognising an for the completion of formal training for all staff acute medical problem to managing it effectively.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 37 Simulation As with Post-graduate Education, the move to the The Trust continues to undertake activities to become new Mayo building at Salford has enable us to take ever more responsive to patients and to the public. advantage of the purpose-built simulation facilities. One of the key ways in which it hopes to achieve this This method of teaching has been designed to is through encouraging people to join the Foundation help students tackle common emergency medical Trust as members and become active stakeholders. problems in a simulated patient environment. The Trust has an active Council of Governors, with an elected component to represent members. Simulation training has the advantage of allowing students to experience real time clinical problems in Members of Council of Governors or Trust Directors a safe environment with direct supervision, as well can be contacted through the Trust’s Executive as the facility for students to review the teaching Offices at the following address: session on the TV screen. Students are able to Trust Headquarters interpret physical signs practise clinical skills, make Mayo Building management decisions as well as improve skills in Salford Royal NHS Foundation Trust, communication, teamwork and data interpretation. It Stott Lane is widely believed that this kind of simulation training Salford has a major role in the future of medical education Greater Manchester for everyone from medical students to consultants. M6 8HD Telephone: 0161 206 5249
Listening to Patients and Visitors The Trust receives feedback from patients and The Trust continues to participate in the Annual visitors via the Patient Advice and Liaison Service In-Patient Survey as it provides valuable feedback (PALS). This valuable feedback is used quickly on patients’ experience and helps to shape the resolve individual concerns and to improve services development of targets for areas for improvement. for all users. Patients have once again rated the quality of care The Trust also receives feedback from patients and received at Salford Royal as among the best in the visitors by complaints. The Trust views complaints country. as an opportunity to receive important and valuable The annual inpatient survey published by the feedback from our patients that may inform Healthcare Commission puts Salford Royal in the top improvements to practice or service. There is a 20% of Trusts for a number of important areas. formal complaints policy with clear accountability for the management of complaints. The Trust These include: employs a Complaints Management Team that takes l The overall care received by patients; responsibility for enforcing the policy and ensuring l Patients being treated with dignity and respect; that all complaints are dealt with in a transparent l Patients having enough help from staff to eat and timely manner and that any action that arise as their meals; a result of complaints are embedded into the Trust’s l Staff explaining the risks and benefits of an practices in future. operation or procedure, how patients may feel The number of complaints received in 2008/2009 has afterwards and how the operation has gone; remained the same as the previous year at 281. All l Patients receiving clear information about complaints are acknowledged within 2 days of their their medicines, how to take them and any receipt and during 2008/09 91.8% of complainants side effects; receiving a full written response within 25 days. l Patients feeling involved in decisions about their discharge from hospital.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 38 Hospital Environment The Trust scored a ‘Good’ for Environment and an Both buildings are distinctive in their architectural ‘Excellent’ for Food rating in the 2007/2008 Patient design and offer a new face to Salford Royal Environment Action Team (PEAT) assessment. This Hospital. demonstrates an improving trend as a result of the This is the first phase of the redevelopment of the greater focus that has been given to the Hospital’s site and coincides with the opening of a new pain environment. centre, IM&T expansion and other environmental The Trust has strengthened the PEAT group which improvements for patients. is well represented by ward based staff and The Trust has delivered a programme of decants patient representatives, the introduction of a site and decommissioned a number of buildings to manager of the week, who has the responsibility for allow these new facilities to be constructed whilst monitoring the standard of public areas. continuing to provide services to patients. The Trust’s 5 year redevelopment programme has The second phase of the PFI development has progressed during the year with the opening of resulted in the release of the North of the site to a new multi-storey car park (MSCP) and the Mayo our partners, Consort, and work has commenced building which is a purpose built education facility. to demolish Webb and Worthington House two The Mayo building is now fully operational and landmark buildings in Salford. Following this, is seen as an excellent learning environment for construction will commence mid 2009 on the new medical students, Trust staff and academics alike. clinical Hope building. The facility also houses a new Mortuary, Linen Planning is currently underway to create a new Services, Decontamination and a state-of-the-art Heart Care Unit and Dermatology facility. We are Aseptic Suite that will be fully compliant with also working with our colleagues from The Christie current legislation. on the development of a Cancer Centre on the The MSCP has greatly eased pressure on staff Salford Royal site to be named Christies @ Salford. parking which has resulted in a number of off-site This service will provide radio therapy treatment car parks being closed. closer to people’s homes.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 39 Standards of Cleanliness Information Governance The Trust monitors the standards of cleanliness The Trust has robust information governance achieved on a weekly basis across all areas, achieving policies and practices in place that are continually the standards expected within the National reviewed, refreshed and monitored. As part of the Standards of Cleanliness. national Information Governance Framework for 2008/2009, the Trust has implemented a number of Domestic Services have introduced a rapid response additional information security initiatives: cleaning team, the Specialist Action Squad (SAS). The team is allocated a ward and other clinical l NHS approved encryption software on all Trust areas on a weekly rota to deep clean all appropriate laptops; medical equipment and difficult to clean areas l Trust-wide network secure password and equipment. The Team covers areas on a programme; programmed basis and will also provide a rapid l Centralised data storage; response in the event of terminal cleans being l required elsewhere. The team has proved very Desktop and laptop locking devices; successful and will continue their work throughout l Additional physical security and theft deterrants; the Trust. l All removable media such as DVD’s/CD’s, memory sticks, PDA’s, external hard drives etc are in the process of being encrypted. The Trust reported one serious untoward incident Social and Community Issues involving personal data to the Information Commissioner’s Office in 2008/09. The theft of a The Trust is committed to the ‘Go Green’ strategy. desktop computer was reported in October 2008. Following on from a Carbon Trust site survey, the The incident involved the loss of information Trust successfully bid for funding for digital controls relating to some 3,500 people of which 684 cases for the main boilers, steam traps, inverters on the were categorised as sensitive personal identifiable main electrical motors and automatic doors. information. The Police, the Information The Trust was chosen to be one of 10 Trusts in Commissioner and the Trust’s regulator, Monitor, the UK to pilot the NHS Carbon Management were informed and a full investigation took Programme which culminated in March last year place. A number of immediate security actions with the production of a Carbon Management were implemented, including changed door Implementation Plan. This followed with a access controls and desktop computer security. successful bid for further energy saving schemes The computer was password protected and a full which have been implemented throughout the year. analysis of the nature and sensitivity of data was undertaken. The Trust recognises the seriousness of this data loss and has signed a formal undertaking agreed with the Information Commissioners Office to ensure appropriate security measures are in place.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 40 Principal Risks and Uncertainties The Trust continues to face risks to achieving its strategic developments and as outlined in the Chair’s and Chief Executive’s Statement, a robust Assurance Framework is maintained which enables the identification, analysis and management of risk. The table opposite sets out a number of risks that the Board of Directors considers to be of particular significance, but these do not represent all those identified as impacting on the Trust. There may be other risks or uncertainties not yet identified by the Trust that could impact on future performance.
Education, Research and Development Partnerships and Joint Ventures Risk: Risk: Due to changes in research and development There is a risk that on-site vascular services will funding arrangements, there is a risk not adequately meet the requirements of local that funding will not meet research and specialist services. development costs. Impact and Likelihood: Impact and Likelihood: Both impact and likelihood are high. Both impact and likelihood are high. Mitigation: Mitigation: The Trust is developing the service needs A deficit budget is agreed and plans are in specification and liaising with acute Trusts to place to achieve a surplus budget through an improve access to vascular support services. agreed Cost Improvement Programme.
Productivity and Cost Control Quality Improvement Risk: Risk: There is a risk that the Trust will not be able If staff fail to follow agreed hygiene protocols, to maintain financial stability during potential then the Hygiene Code may be at risk. equal value claims. Impact and Likelihood: Impact and Likelihood: Impact is high likelihood is medium. Impact is high likelihood is medium. Mitigation: Mitigation: Established policies, procedures and audits of Key national test case resolved in NHS favour. compliance are in place and standards and Appeal possible. performance target are expected to be met.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 41 Financial Review
Introduction Performance Compared to Annual Plan The purpose of this section of the Annual Report is Targets to provide a narrative on the financial performance of the Trust, whilst highlighting some points that Annual Plan Actual Performanmce are of interest within the Annual Accounts and the Target to 31st March 2009 Trusts performance against its financial targets. Heading Achieve- Risk Achieve- Risk The Annual Accounts have been prepared under a ment Rating ment Rating direction issued by Monitor and are appended to EBITDA margin 5.5% 3 5.4% 3 this Report in Appendix 1. EBITDA 132.1% 5 109.0% 5 percentage achieved Return on assets 4.2% 3 5.6% 4 Summary of Performance I&E surplus 1.2% 2 1.2% 3 margin The following are the main headlines of financial performance for the Trust in 2008/09. Liquidity ratio 48.3 5 49.6 5 days days l The overall income and expenditure position Overall weighted N/A 4 N/A 4 shows a deficit of £5.9 million compared to average the Trust target deficit of £5.4 million, with an underlying surplus of £3.6 million before exceptional items. The Healthcare Commission uses Monitor’s Risk l The risk rating based on the position as at the Rating scoring to assess the use of resources score end of March is 4, giving a forecast excellent within there Annual Health check assessments. A score for “Use of Resources” in the Healthcare risk rating of 4 or 5 will ensure that FTs receive Commission assessment. an excellent rating for use of resources. This is an excellent result for the Trust and is testament to the work of all staff within the Trust.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 42 Income and Expenditure Position Trust Income The following table summarises the actual The Trust receives the majority of its income for the performance as at the 31st March 2009 compared to delivery of patient care (£206.8 million - 69.4%) the Annual Plan forecast levels. from commissioners (predominantly PCT’s). Of this the Trusts Lead Commissioner is Salford PCT from Annual Actual whom £102.7 million was received in 2008/09. Plan Results Variance £000’s £000’s £000’s In addition the Trust received £40.5 million for the delivery of non-patient care services, with the Income 271,300 297,814 26,514 majority coming from the NHS North West (Deanery) Expenditure (256,460) (281,636) (25,176) to support Education and Training (£23.1 million - EBITDA 14,840 16,178 1,338 57%). In the year the Trust has seen income of £4.2 Profit / loss on 0 (64) (64) million to support Research and Development. asset disposals Exceptional (7,060) (9,494) (2,434) income / costs and impairments Trust Expenditure Depreciation (8,010) (8,030) (20) The largest item of expenditure within the Trust relates to payments of Salaries to staff [including Total interest 780 1,502 722 receivable / payable Directors] (£173.7 million or 58% of operating expenses). Of the non pay related expenditure Unwinding of 0 (56) (56) Drugs accounts for £44.1 million (14.7% of discounts operating expenses), with Clinical Supplies the next PDC dividends (5,910) (5,910) (0) biggest item of spend at £24.7 million (8.3% of Net deficit (as per (5,360) (5,874) (514) operating expenses). annual accounts Normalising adjustments Impairments 7,060 9,494 2,434 Cost Efficiency / accelerated The Trust received an inflation uplift of 2.3% within depreciation the National Tariff for 2008/09, which was net of a Underlying 1,700 3,620 1,924 savings target of 3%. Within the Annual Plan the trading surplus Trust set a savings target of £6.7 million (3% of the relevant budgets). The savings identified to deliver this target included the following: Whilst the Annual Accounts show a Net Deficit of £5.9 million this is due to the charging of a number of exceptional non cash items, valued at £9.5 million. £M Within the Monitor calculations for risk rating Procurement of Goods and Services 1.2 purposes these exceptional items are excluded, giving Delivery of existing activity at Lower Cost 4.3 an underlying normalized surplus of £3.6 million. Delivery of new activity at Marginal rates 1.2 The exceptional items are an impairment of fixed Total Savings 6.7 assets and accelerated depreciation predominantly associated with a revaluation of the Trust’s land and building assets undertaken by the Valuation Office as at 31st March 2009, due to the changing economic climate and the re-development of the hospital site.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 43 Capital Expenditure Investments The Prudential Borrowing Limit The Foundation Trust continues to invest in As an NHS foundation trust, greater freedoms the development of the asset infrastructure of have been earned to borrow money to finance buildings and equipment. The following table capital investment. The limits on the amount the shows the amounts and schemes that have had Trust can borrow and the conditions that it must capital expenditure during the year, which totals meet to demonstrate that the levels of borrowing £13.8 million, which is a significant investment in are affordable are set out in the Trust’s Prudential the enhancement of facilities for patients and staff Borrowing Limit (PBL), issued by Monitor, the who attend the Salford Royal site. In addition Independent Regulator of Foundation Trusts. £2.8 million was invested in small items of medical The Trust did not access external sources of equipment that have been charged to operating borrowing during 2008/09 to fund its capital expenses. investment programme. The following table sets out the Trust’s performance against the single Variance relevant ratio during the period and shows that the Against Trust exceeded the minimum value required. Approved Approved Expenditure Budgets to Spend to 31st 31st March 2008/09 March 2009 2009 2008/09 £000’s £000’s £000’s Results SHIFT - Pain Centre 3,565 3,176 (389) Minimum dividend cover (min >1x) 3.8 SHIFT - other schemes 2,146 2,278 132 Minimum interest cover (min >3x) N/A Theatres, wards 3,367 3,001 (366) Minimum Debt service cover (min >2x) N/A and ICU schemes Maximum Debt Service to Revenue N/A Maintenance 2,264 1,933 (331) (max 3%) schemes Maximum Debt Capital Ratio (Max 25%) N/A Medical equipment 4,956 2,172 (2,784) Working capital facility (not to exceed £20m Energy efficiency 611 604 (7) £20 million) Electrical schemes - 853 438 (415) including lifts and fire panels The working capital facility is a maximum sum of NW eHealth - 223 223 £20 million which expires in October 2010, the Trust Development has not drawn down any part of this facility. Project Total 17,762 13,825 (3,937)
The under spending on Medical Equipment relates to the purchase of scanners associated with the development of the Stroke Service on behalf of Greater Manchester Primary Care Trusts. The purchase of the equipment is (at the time of writing) out to tender and the purchase will be made during the early part of 2009/10. The Trust will hold the cash associated with this purchase ready for payment at the appropriate time.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 44 Liquidity and Short Term Investments Going Concern The Trusts cash balance remains strong at circa. Following review by the Trust’s Audit Committee, £32 million at the year end, with interest receivable the directors have a reasonable expectation that of £1.5 million pounds helping to deliver better the Trust has adequate resources to continue in services for patients within the hospital. The cash operational existence for the foreseeable future. balance has been accumulated from previous years For this reason, they continue to adopt the going surpluses as well as from Internally Generated concern basis in preparing the accounts. resources (depreciation etc), this cash is being accumulated as the Trust will be making further investments in capital infrastructure in future years to support the hospital re-development programme. A Forward Look Given the turbulence in the financial markets and Whilst the 2008/09 year has been another successful the banking sector during the latter stages of 2008, year for the Trust the coming years will represent a the Board of Directors took the decision to leave the challenge to the wider economy and for the Trust. Trusts accumulated cash balance within the National This is largely as a result of two main factors: Loans Fund. Whilst short term investment where l Unitary Payment associated with the Hospital made during the year with a range of High Street Re-development; banks the Trust has received back all investments made in the banking sector during 2008/09. l The Current Economic Climate.
Accounting Policies Unitary Payment The Trust has produced the Annual Accounts for The Trusts PFI partner Consort have completed work 2008/09 following the requirements of UK (GAAP). on the Multi Storey Car Park and the Mayo Building, The policies are approved by the Audit Committee and whilst Multi Storey Car Park is a Trust asset on for use in preparing the accounts and are amended our balance sheet, the project agreement states annually to reflect the changing circumstances and that a Unitary Payment of circa. £6 million will be accounting regulation and guidance. required to be paid by the Trust during 2009/10 onwards. This represents a significant new cost to Accounting policies for pensions and other the Trust. retirement benefits are set out in note 1.19 on page 10 of the accounts. Details of senior employees’ remuneration can be The Current Economic Climate found in note 5.4 on pages 18 and 19 of the accounts. Indications are that the level of Public Borrowing The Trust will be preparing the 2009/10 Annual in the coming financial years will mean that Accounts on the basis of International Financial developments of services within the public services Reporting Standards (IFRS), and whilst a great will have to be financed from efficiency savings deal of preparatory work has taken place the generated within the public services. The NHS IFRS standards have not been used to prepare the will be required to contribute to the savings 2008/09 Annual Accounts. requirements as service developments continue in line with Government plans. This will mean that deliver of efficiency savings will be at a higher level than previously seen but will be required to enable the continued investments in patient services.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 45 Board of Directors
The Board of Directors operates according to the Post Balance Sheet Events highest corporate governance standards. It is a The Directors of the Trust do not believe that there unitary Board with collective responsibility for all are any material post balance sheet events. aspects of the performance of the Trust, including financial performance, clinical and service quality, management and governance. The Board is legally accountable for the services provided by the Trust Disclosure to Auditors and key responsibilities include: For each individual director, so far as he or she is l Setting the strategic direction (having taken aware, there is no relevant audit information of into account the Council of Governors’ views); which the auditors are unaware, and each director l Ensuring that its services provide safe, clean, has taken all of the steps that they ought to have personal care for patients; taken as a director in order to make themselves l Ensuring robust governance arrangements are aware of any relevant audit information and in place supported by an effective assurance to establish that the auditors are aware of that framework that support sound systems of information. internal control; l Ensuring rigorous performance management which ensures that the Trust continues to achieve all local and national targets; l Ensuring that the Trust, at all times, is compliant with its Terms of Authorisation.
Declaration of Interests of the Board of Directors The Board of Directors undertakes an annual review of its Register of Declared Interests. At each meeting of the Board of Directors a standing agenda item also requires all Executive and Non-Executive Directors to make known any interest in relation to the agenda, and any changes to their declared interests. The Register of Declared Interests for the Board of Directors is held by the Trust Secretary and is available for public inspection. Members of the public can gain access by contacting: Trust Headquarters Mayo Building Salford Royal NHS Foundation Trust, Stott Lane, Salford Greater Manchester M6 8HD Telephone: 0161 206 5249 Email: [email protected]
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 46 Non-Executive Directors
Mrs Margaret Morris Mr James J. Potter Professor Katharine Perera Professor David Thompson Chair (until 30.06.08) Chair (from 01.07.08) Non-Executive Director and Senior Non-Executive Director Appointed in March 2002, Margaret held a Vice-Chair (until 30.06.08) Independent Director Re-appointed in July 2007, David has number of other senior positions including Originally appointed as a Non-Executive At her appointment to the Board in 1999, previously held the post of Non-Executive Chair of Salford and Trafford Health Authority Director in 1999, Jim was appointed as Katharine was nominated by the University Director, at Salford and Trafford Health and Chair of Salford CHC. Margaret is Chair on 1 July 2008. He is the Managing of Manchester. She was reappointed in Authority and Deputy Chairman of Salford a Salford City Councillor and has been Director of a manufacturing company, her own right in 2005. Katharine held and Trafford Health Authority. He has the Deputy Chair of City of Salford Social based in the north-west, and has a the positions of Pro-Vice-Chancellor and significant clinical and academic experience. Services. strong track record of success in private Senior Pro-Vice-Chancellor of the University David is a member of the Senate of the Margaret is a qualified nurse and worked in sector management. Jim maintains of Manchester. She has retired from the University of Manchester and was Clinical the NHS for many years. strong contacts with private businesses, University but continues her relationship Academic Group leader. Chambers of Commerce, CBI, IOD, and the by holding the post of Advisor on Women local authority. in Leadership and by providing training on aspects of leadership and management.
Mr Howard Forster Mr Michael Halsall Mr John Willis Mrs Diane Brown Non-Executive Director Non-Executive Director Non-Executive Director / Vice-Chair Non-Executive Director Howard was appointed in April 2007 and is Mike was appointed in April 2007. He John is a qualified accountant and was Chief As a human resources professional Diane has a Partner in a Global Built Asset Consultancy started out as a physicist but then qualified Executive of Salford City Council from 1993 worked with Senior Global Leaders such as firm. He has over 17 years experience in the as a lawyer. Mike has worked in industry until his retirement in 2006. John led the AstraZeneca and Marks & Spencer. Diane health sector, including Executive Director and was a partner in a private practice in team that secured funding for the Lowry, has a developed commercial understanding roles in the NHS. Howard maintains an Salford. Mike is currently Head of Legal for and oversaw much of the regeneration of business and people related issues. She extensive network within the health sector a Metropolitan Borough Council working in of Salford. In 2006, he was appointed a maintains her personal development through and with the business community in the child and adult protection, prosecutions and Commander of the British Empire for services the CIPD and in HR/Business activities North West and is also a Regional Council anti-social behaviour, and employment. to local government in Salford. John has as a Principal Consultant and Training & Member for the CBI North West. Mike’s current speciality is corporate considerable experience of managing large, Development Associate. governance looking at partnerships and complex public sector organisations with * The Board of Directors considers all non- new ways of working within the public substantial revenue and capital budgets. executive directors to be independent. sector. The Board of Directors elected John to be the Trust’s Vice-Chair in July 2008.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 47 Executive Directors
Mr David Dalton Mr Tony Whitfield Dr Stephen Waldek Chief Executive Executive Director of Finance and Deputy Executive Medical Director Appointed to Salford in July 2001, David has been Chief Executive Appointed as a Consultant Renal Physician in 1980 he a Chief Executive for 15 years. Holding an MSc in With 25 years NHS experience, of which 15 years changed specialities in 2006 to take up the position Health Management, David maintains his continuing have been as a director, Tony is a Fellow of the as Consultant in Adult Inherited Metabolic Diseases. professional development. David has a strong Institute of Chartered Management Accountants. As well as developing the new service in metabolic profile, both locally within Greater Manchester, and His experience and role extends beyond his role as medicine he continues to play an active role in the also nationally. David has led the development of Executive Director of Finance. Tony is interested acute medicine rota so as to keep in touch with services in the hospital and is committed to the in the links between quality patient outcome and colleagues on the ‘shop floor’. programme of improving patient safety and quality. efficient practice.
Mrs Elaine Inglesby Mr Simon Neville Mr David Wood Executive Nurse Director Executive Director of Stategy and Executive Director of Organisational Elaine has held Executive Nurse positions since 1996 Development Development and Corporate Affairs in specialist and large acute Trusts. She has a strong Simon is a career NHS Manager with extensive David has worked in Personnel and Human Resources track record in professional nursing and operational experience in general management, service since 1982. He was previously Executive Director management. development and capital planning, where notably of Human Resources and Corporate Services at the Elaine has participated in a number of national he led a £120m PFI scheme from conception to Countess of Chester Hospital NHS Foundation Trust initiatives, including the National Policy Group for close. Simon is educated to degree level and is an and took up his position at Salford Royal in June 2008. Comprehensive Critical Care and the National Quality accredited OGC Gateway reviewer having reviewed David is the national Chairman of the Foundation Taskforce. a number of major PFI schemes on behalf of the Trust Network’s HR Directors’ Group, through which he Department of Health. is a member of the Department of Health’s Equal Pay Elaine is educated to degree level and maintains her Project Board. professional development.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 48 Executive Directors
Appointment Date Name Responsibilities From To Board Attendance David N. Dalton Chief Executive 2001 Present 11/11 Tony Whitfield Director of Finance / Deputy Chief Executive 2003 Present 10/11 Stephen Waldek Executive Medical Director 2006 Present 10/11 Elaine Inglesby Executive Nurse Director 2004 Present 10/11 Simon Neville Executive Director of Strategy and Development 2002 Present 11/11 David Wood Executive Director of Organisational 2008 Present 8/9 Development and Corporate Affairs (June)
Non-Executive Directors
Appointment Date Name Responsibilities From To Board Attendance Margaret Morris Chair 30.06.08 1/3 James J. Potter Chair 01.07.08 30.06.12 11/11 Non-Executive Director / Vice-Chair Reappointed 30.06.08 on 01.11.07 John Willis Vice Chair / Non-Executive Director 01.01.08 31.12.11 9/11* Katharine Perera Senior Independent Director 01.03.07 Present 10/11 Non-Executive Director Reappointed 30.06.09 on 01.08.06 David Thompson Non-Executive Director Reappointed 31.07.11 10/11 on 01.08.07 Howard Forster Non-Executive Director 01.04.07 31.03.11 7/11* Michael Halsall Non-Executive Director 01.04.07 31.03.11 11/11 Diane Brown Non-Executive Director 01.01.09 31.12.11 3/3
* The meeting dates for the October 2008 and January 2009 Board meetings were changed from those published due to necessary commitments of the Chair and Chief Executive, causing unavoidable absence for some Non-Executive Directors.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 49 Committees of the
Board of Directors Nominations, Remuneration and Terms of Service (NRTS) Committee The Board of Directors has established the following The Board of Directors reviewed and approved committees to support the Board and provide changes to the Constitution and Terms of Reference assurance that the key risks are effectively controlled: of this Committee in September 2008. l Risk Management Executive Governance Its responsibilities include consideration of matters Committee; pertinent to the nomination, remuneration and l Clinical Effectiveness Executive Governance associated terms of service for Executive Directors Committee; (including the Chief Executive), matters associated l Patient and Staff Executive Governance with the nomination of Non-Executive Directors and Committee; remuneration of senior managers/clinical leaders. l Finance and Performance Executive The committee comprises the Trust’s Chair and all Governance Committee; Non-Executive Directors. One meeting was held during l Strategy Advisory Group; 2008/09 and attendance was recorded as 100%. l Hospital Redevelopment Project Board; The Chief Executive attends the Committee in l Charitable Funds Committee. relation to discussions about Board composition, succession planning, remuneration and performance In addition: of Executive Directors. The Chief Executive is not present during discussions relating to his/her own Audit Committee performance, remuneration and terms of service. The Director of Organisational Development Provides an independent and objective review of and Corporate Affairs attends meetings to act the Trust’s system of integrated governance, risk as Committee Secretary, and to offer advice and management and internal control, across the whole guidance, but he/she withdraws from the meeting of the organisation’s activities (both clinical and when discussions about his/her own performance, non-clinical), that supports the achievement of the remuneration and terms of service are held. Trust’s objectives. The committee met its responsibilities set out in its A review of the effectiveness of the Audit terms of reference by: Committee during 2008/09 was conducted and reported to the Board of Directors. All aspects of l Monitoring and evaluating the performance the terms of reference were fulfilled. of the Chief Executive and Executive Directors; The Trust’s Non-Executive Directors (with the exception l Determining appropriate remuneration, of the Chair) are members of the Audit Committee. relative to individual and Trust performance; Attendance during 2008/09 was as follows: l Evaluating the balance of skills, knowledge Mr James J Potter (Chair until June 08) 3/3 and experience on the Board and producing Mr John Willis (Chair from Sept 08) 6/6 descriptions of roles for the appointment of two Non-Executive Directors; Professor David Thompson 4/6 Professor Katharine Perera 6/6 l Considering and approving a revision to the local remuneration and performance-related Mr Michael Halsall 6/6 pay/bonus arrangements for the most senior Mr Howard Forster 4/6 managers (sub-Executive Director level) within Mrs Diane Brown 1/1 the Trust.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 50 A work plan was agreed for 2009/10 to: Professor Katharine Perera continued to support the Council of Governors as the Senior Independent l Review Executive pay and performance Director (SID) during 2008/09. All newly appointed arrangements and implement the Governors were informed of the role of the recommendations of such review during SID during the Council of Governors’ Induction 2009/10; Programme, attended by Professor Katharine Perera. l Seek evidence that robust controls have been This also provided the opportunity to further put in place, by the Executive Board, relating highlight the role of the SID for re-appointed to the arrangements for senior manager governors. remuneration, approved by the Committee in The below table summarises Director attendance at 2008. Council of Governors’ meetings:
Name Title Attendance The Board of Directors’ Relationship with the Mr James Potter Chair 4/4 Council of Governors Mr John Willis Vice Chair 4/4 Professor Non-Executive Director/ 3/4 The Board works closely with the Trust’s Council Katharine Perera Senior Independent of Governors. The Trust’s Chair is also the Chair Director of the Council of Governors and is supported at Professor Non-Executive Director 2/4 every meeting of the Council of Governors by the David Thompson Chief Executive or Deputy Chief Executive. The Mr Michael Halsall Non-Executive Director 2/4 Senior Independent Director and the other Non- Mr Howard Forster Non-Executive Director 1/4 Executive Directors attend each meeting of the Mrs Diane Brown Non-Executive Director 1/1 Council of Governors and contribute to discussion and workshop sessions as requested. Executive Mr David Dalton Chief Executive 2/4 Directors attend the Council’s meetings to provide Mr Tony Whitfield Deputy Chief Executive 4/4 information and lead discussion. and Executive Director of Finance An Executive Director and a Non-Executive Director Mrs Elaine Inglesby Executive Nurse 4/4 is assigned to each of the Council of Governors’ Director Sub-groups and works as an integral member of Mr Stephen Waldek Executive Medical 4/4 these groups. Director Directors support Governors with their work with Mr David Wood Executive Director 4/4 of Organisational City Council Community Committees and Patient Development and Interest Groups. Corporate Affairs The Chair works closely with the elected Lead Mr Simon Neville Executive Director 3/4 and Deputy Lead Governors to review all relevant of Stategy and matters. The Chair, Chief Executive, Trust Secretary, Development Lead Governor/Deputy Lead Governor meet prior to each meeting of the Council of Governors to set the Agenda and review key issues.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 51 Council of Governors
Council of Governors As required, Salford Royal NHS Foundation has a There were a number of changes to the membership Council of Governors, responsible for representing of the Council of Governors in 2008/2009. the interests and views of Foundation Trust In the period 1st April 2008 to 5th January members and partner organisations. 2009 the Council of Governors consisted of 35 The Council of Governors are responsible for: members. Further to a review of the policy for the composition of the Council of Governors, governors l Appointment (and removal) of the Chair and recommended a reduction in membership from 35 non executive directors and determining their to 21 members of the Council of Governors. remuneration and allowance; The amended composition of the Council of l Approval of the appointment of the Chief Governors was approved at the Annual Members’ Executive; Meeting in October 2008. A subsequent election l Appointment or removal of the Trust’s process was coducted and 21 governors commenced External Auditor; their term of office on 6th January 2009. All elections were carried out in accordance with rules l Providing their view to the Board of Directors stated in the Trust’s Constitution. on the Trust’s forward plans; Governors felt a reduced composition would l To review the Trust’s Membership facilitate a more cohesive Council of Governors, Development Strategy; encourage commitment and further develop the l To respond to the Board of Directors when working relationship with the Board of Directors. consulted and to undertake functions as The reduced Council of Governors continues to requested by the Board of Directors; reflect the geographical profile of the local area and the patient profile of the Trust. l To make recommendations for the revision of the Trust’s Constitution. A comprehensive two-day Governor Induction Programme took place in February 2009 for all The Council of Governors support the Trust in an newly appointed and re-appointed Governors. advisory capacity, communicating the views and comments of the wider membership community to the Board of Directors. In addition, the Council Register of Interests of Governors advise on the longer-term strategic All Governors are required to comply with the Trust’s direction of the Trust. Code of Conduct and declare any interests that may result in a potential conflict of interest in their role as governor of the Trust. The Register of Interests is maintained and available to the public via the Trust’s Secretary at the following address: Trust Headquarters Mayo Building Salford Royal NHS Foundation Trust, Stott Lane, Salford Greater Manchester M6 8HD Telephone: 0161 206 5249 Email: [email protected]
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 52 Public Governors - Elected continued Mr Michael Price Swinton 3 years Elected Members (2009) Mrs Rosemary Knights Worsley and 3 years To become a member of the Council of Governors Boothstown (2009) you must be over 16 years of age and a member of Mr Gordon Parker Worsley and 2 years the Trust’s public or staff constituencies. Further Boothstown (2008) eligibility criteria for Governors are stated in the Mr Bernard McDermott Out of Salford 3 years Trust’s Constitution which can be found on the Trust (2009) website www.srft.nhs.uk or by contacting the Trust Mr Peter Rose Out of Salford 2 years Secretary on 0161 206 5249. (2008) Mr Michael Harnor Out of Salford 2 years (2008) Dr Michelle Byrne Out of Salford 3 years Council of Governors (2009) Mrs Sandra Breen Out of Salford 2 years 1st April 2008 to 5th January 2009: (2008) Staff Governors - Elected Term of Office (End of Mr Maurice Harrington Medicine and 3 years the Annual Elderly Care (2009) Consituency / Members Mr Robert Heywood Critical Care and 3 years Name Organisation Meeting) Diagnostics (2009) Ms Lorraine Reynolds Neurosciences, 2 years Public Governors - Elected Orthopaedics and (2008) Mrs Valerie Ivison Claremont, Weaste 2 years Ears, Nose and and Seedley (2008) Throat Mrs Jackie Flynn Claremont, Weaste 3 years Rev Dr Ian Carter Corporate and 2 years and Seedley (2009) General Services (2008) Ms Elizabeth Judge East Salford 3 years Dr Carl Gwinnutt Surgery, Women’s 2 years (2009) and Children’s (2008) Mr Mike Thorpe East Salford 2 years Services (2008) Partner Organisation Governors - Appointed Mrs Diana Tyldesley Eccles 3 years Mr Tom McDonald Salford Primary 3 years (2009) Care Trust (2009) Mr Peter Dempsey Eccles Remainder Councillor Stephen Coen Salford City 3 years of term Council (2009) (2008) Dr Spencer Nicholson General Medical 3 years Mr Brian Myles Irlam and 3 years Practitioner (2009) Cadishead (2009) Dr Jeremy Tankel General Medical 3 years Mrs Barbara Tynan Irlam and 2 years Practitioner (2009) Cadishead (2008) Prof. Martin Humphries University of 3 years Ms Jean Whittaker Little Hulton and 3 years Manchester (2009) Walkden (2009) Mrs Ida Seddon Little Hulton and 2 years Mr Michael Garrity University of 3 years Walkden (2008) Salford (2009) Mrs Joyce Fitzpatrick Ordsall and 2 years Mr Mark Holden PFI Partner Remainder Langworthy (2008) of term (2009) Mrs Shirley McGinn Ordsall and 3 years Christopher Lysaght Youth Governor 3 years Langworthy (2009) (2009) Mrs Christine Mullen Swinton 2 years Vacancy Voluntary Sector 3 years (2008) (2009)
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 53 The Council of Governor election process began in October 2008 following the Annual Members Meeting. Results of the election were announced on 5th January 2009.
Council of Governors 6th January 2009 to 31st March 2009:
Term of Term of Office (End of Office (End of the Annual the Annual Consituency / Election Members Consituency / Election Members Name Organisation Satus Meeting) Name Organisation Satus Meeting) Public Governors - Elected Staff Governors - Elected Mrs Valerie Ivison Claremont, Uncon- 2 years Mrs Stephanie Gibson Medicine Uncon- 2 years Weaste and tested (2010) tested (2010) Seedley Ms Elizabeth Judge East Salford Uncon- 2 years Mr Robert Heywood Clincial Uncon- 3 years tested (2010) Support tested (2011) Ms Diana Tyldesley Eccles Uncon- 2 years Services tested (2010) Mr Iain Anderson Surgery Con- 3 years Mr Brian Myles Irlam and Uncon- 3 years tested (2011) Cadishead tested (2011) Mr Craig Wood Corporate Uncon- 2 years Ms Jean Whittaker Little Hulton Con- 3 years and General tested (2010) and Walkden tested (2011) Services Mr John Lyons Ordsall and Con- 3 years Partner Organisation Governors - Appointed Lambert Langworthy tested (2011) Dr Brian Hope Salford App- 3 years Mr Roy Harding Swinton Uncon- 3 years Primary Care ointed (2011) tested (2011) Trust Mrs Rosemary Steven Worsley and Con- 2 years (formerly Knights) Boothstown tested (2010) Vacancy Salford City App- 3 years Council ointed (2011) Mr Peter Rose Out of Con- 2 years Salford tested (2010) Dr Jeremy Tankel General App- 3 years Medical ointed (2011) Mr Michael Harnor Out of Con- 3 years Practitioner Salford tested (2011) Professor University of App- 3 years Dr Michelle Byrne Out of Con- 3 years Matt Lambon-Ralph Manchester ointed (2011) Salford tested (2011) Dr Leela Joseph Out of Con- 2 years Mrs Lillian Neville University of App- 3 years Salford tested (2010) Salford ointed (2011)
Mrs Rosemary Steven was appointed as Lead Governor and Mrs Valerie Ivison as Deputy Lead Governor by the Council of Governors in March 2009.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 54 Name Title Attendance Mrs Christine Mullen Public Governor - 1/3 Council of Governors Meetings Swinton Mr Michael Price1 Public Governor - 0/0 Meetings of the Council of Governor are held on Swinton a quarterly basis. Since the start of the year the Mrs Rosemary Knights Public Governor 2/3 Council of Governors have met on 4 occasions: - Worsley and l Thursday 12th June 2008 Boothstown Mr Gordon Parker Public Governor 3/3 l Thursday 11th September 2008 - Worsley and l Thursday 11th December 2008 Boothstown Mr Bernard McDermott Public Governor - 3/3 l Wednesday 4th March 2009 Out of Salford
The following table summarises Governor Mr Peter Rose Public Governor - 2/3 Out of Salford attendance at Council of Governor meetings Mr Michael Harnor Public Governor - 2/3 between 1st April 2008 to 5th January 2009: Out of Salford Dr Michelle Byrne Public Governor - 3/3 Name Title Attendance Out of Salford Mrs Valerie Ivison Public Governor - 3/3 Mrs Sandra Breen Public Governor - 2/3 Claremont, Weaste Out of Salford and Seedley Mr Maurice Harrington Staff Governor - 1/3 Mrs Jackie Flynn Public Governor - 2/3 Medicine and Claremont, Weaste Elderly Care and Seedley Mr Robert Heywood Staff Governor - 2/3 Ms Elizabeth Judge Public Governor - 3/3 Critical Care and East Salford Diagnostics / Clinical Mr Mike Thorpe Public Governor - 2/3 Support Services East Salford Ms Lorraine Reynolds Staff Governor 3/3 Mrs Diane Tyldesley Public Governor - 2/3 - Neurosciences, Eccles Orthopaedics and Mr Peter Dempsey Public Governor - 2/3 Ears, Nose & Throat Eccles Rev Dr Ian Carter Staff Governor 2/3 Mr Brain Myles Public Governor - 2/3 - Corporate and Irlam and Cadishead General Services Mrs Barbara Tynan Public Governor - 2/3 Dr Carl Gwinnutt Staff Governor - 2/3 Irlam and Cadishead Surgery, Women’s Ms Jean Whittaker Public Governor - 3/3 and Children’s Little Hulton and Services Walkden Mr Tom McDonald Appointed Governor 0/3 Mrs Ida Seddon Public Governor - 3/3 - Salford Primary Little Hulton and Care Trust Walkden Councillor Appointed Governor 0/3 Mrs Joyce Fitzpatrick Public Governor 0/3 Maureen Lea - Salford City Council - Ordsall and Dr Spencer Nicholson2 Appointed Governor 0/1 Langworthy - General Medical Mrs Shirley McGinn Public Governor 1/3 Practitioner - Ordsall and Dr Jeremy Tankel Appointed Governor 2/3 Langworthy - General Medical Practitioner
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 55 Name Title Attendance Name Title Attendance Professor Appointed Governor 0/1 Mr Peter Rose Public Governor - 1/1 Martin Humphries3 - University of Out of Salford Manchester Mr Michael Harnor Public Governor - 1/1 Mr Michael Garrity4 Appointed Governor 1/1 Out of Salford - University of Dr Michelle Byrne Public Governor - 0/1 Salford Out of Salford Mrs Lillian Neville Appointed Governor 2/2 Dr Leela Joseph Public Governor - 0/1 - University of Out of Salford Salford Mrs Stephanie Gibson Staff Governor - 1/1 Mr Mark Holden Appointed Governor 2/3 Medicine - PFI Partner Mr Christopher Lysaght Appointed Governor 3/3 Mr Robert Heywood Staff Governor - 1/1 - Youth Governor Clinical Support Services Not Appointed Appointed Governor N/A - Voluntary Sector Mr Iain Anderson Staff Governor - 1/1 Surgery
1 Resigned 18th May 2008 Mr Craig Wood Staff Governor 1/1 - Corporate and 2 Resigned 24th July 2008 General Services 3 Resigned 1st September 2008 Dr Brian Hope Appointed Governor 1/1 - Salford Primary 4 Resigned 1st September 2008 Care Trust Vacancy Appointed Governor N/A - Salford City Council The following table summarises Governor Dr Jeremy Tankel Appointed Governor 1/1 attendance at Council of Governor meetings - General Medical between 6th January 2009 to 31st March 2009: Practitioner Professor Appointed Governor 0/1 Name Title Attendance Matt Lambon-Ralph - University of Manchester Mrs Valerie Ivison Public Governor - 1/1 Claremont, Weaste Mrs Lillian Neville Appointed Governor 1/1 and Seedley - University of Salford Ms Elizabeth Judge Public Governor - 0/1 East Salford Mrs Diana Tyldesley Public Governor - 1/1 The Council of Governors have established a number Eccles of sub-groups in order to fulfil their roles and Mr Brian Myles Public Governor - 1/1 responsibilities. These are: Irlam and Cadishead l Communications and Marketing Sub-group Mrs Jean Whittaker Public Governor - 1/1 Little Hulton and l Strategic Direction Sub-group Walkden l Safe Sub-group Mr John Lyons Lambert Public Governor 0/1 Combined to form - Ordsall and l Clean Sub-group Quality Sub-group Langworthy l in March 2009 Mr Roy Harding Public Governor - 1/1 Personal Sub-group Swinton l Nominations, Remuneration and Terms of Mrs Rosemary Steven Public Governor 1/1 Office Committee - Worsley and Boothstown
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 56 Foundation Trust Membership
Salford Royal NHS Foundation Trust believes that involving public and patients in decisions about Staff Members services is an essential step to meeting the needs Staff who are permanently employed by the Trust of the communities we serve. We actively seek or have a fixed term contract of at least twelve to recruit an involved and active membership months, or who have been continuously employed community to contribute to the planning, design by the Trust for a period of at least twelve months and improvements of services. are automatically registered as members unless they choose to ‘opt out’.
Eligibility Requirements Membership Overview Salford Royal NHS Foundation Trust membership community includes two constituencies - Public and The below table highlights the Trust’s current Staff. membership figures as of 31st March 2009 and our three and five year recruitment targets:
August August Public Members As at: 2009 Target 2011 Target All members of the public who are over 16 years of 1st April (Planned 3 (Planned 5 Consituency 2009 Year Target) Year Target) age and living in one of the following constituencies can become a member: Public - 4,251 6,000 9,000 Salford Residents l Claremont, Weaste and Seedley Public - 2,790 1,500 2,000 l East Salford Out of Salford l Eccles Staff 4,565 4,000 4,000 l Irlam and Cadishead Total 11,606 11,500 15,000 l Little Hulton and Walkden l Ordsall and Langworthy l Swinton The overall three year target of 11,500 members l Worsley and Boothstown has been exceeded. The Council of Governors has however, identified a requirement to increase the l Outside of Salford number of Salford Public Residents in order to Public constituencies reflect the eight Local maintain a representative membership. Targeted Authority Community Committee areas, based on recruitment with these constituencies will take place groupings of Salford’s electoral wards. Additionally, from 1st April 2009 to achieve and exceed our three approximately one-third of the Trust’s patients live year target for this group. outside of Salford using the Trust’s specialist and/or tertiary services, therefore a separate membership constituency for Out of Salford also applies.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 57 The following tables analyse the current and forecasted membership against relevant indicators.
2009 / 2010 Public Consituency Number of Eligible Public Consituency 2008 / 2009 (Estimated) Age (Years) Members Membership* At year start (April 1st) 5,904 7,041 0-16 0 42,883 New Members 1,187 2,750 17-21 69 19,241 Members leaving 50 0 22+ 6,972 156,761 At year end (March 31st) 7,041 9,791 * Members of the Foundation Trust must be aged Eligible membership relates to Salford demographic 16 or over. Eligible membership relates to Salford data provided by CACI - March 2009. demographic data provided by CACI - March 2009.
2008 / 2009 Number of Eligible Staff Consituency 2007 / 2008 (Estimated) Ethnicity Members Membership At year start (April 1st) 4,415 4,565 White 6,357 210,481 New Members 611 0 Mixed 57 2,220 Members leaving 461 0 Asian or Asian Black 235 3,014 At year end (March 31st) 4,565 4,565 Black or Black British 135 1,197 Other 257 1,993 Eligible membership relates to Salford demographic data provided by CACI - March 2009. Eligible membership relates to Salford demographic data provided by CACI - March 2009. Public Constituency - Salford Local Authority Area 2008 / 2009 Claremont, Weaste and Seedley 614 Number of Eligible Socio-economic Groupings Members Membership East Salford 564 ABC1 3,085 103,613 Eccles 732 C2 861 42,648 Irlam and Cadishead 321 D 1,606 54,059 Little Hulton and Walkden 550 E 1,489 18,565 Ordsall and Langworthy 391 Swinton 582 Eligible membership relates to Salford demographic data provided by CACI - March 2009. Worsley and Boothstown 497
Eligible membership relates to Salford demographic Number of Eligible data provided by CACI - March 2009. Gender Members Membership Male 3,312 109,907 Female 3,729 108,978
Eligible membership relates to Salford demographic data provided by CACI - March 2009.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 58 The Trust’s aim is to build a representative In addition, our Governors have worked to ensure membership during the first five years of being a representative membership by promoting a Foundation Trust. We have initiated plans to membership at meetings and events of stakeholder better understand the demographics of the areas organisations and internal events and forums the hospital serves and target those areas which open to both members and the public. A direct are currently under-represented within the Trust’s mail recruitment campaign to former patients also membership. The Trust continues to make every ensured the recruitment of over 700 new members. effort to involve people who are easy to overlook within our membership constituencies. A number of initiatives have been implemented to encourage the retention of members these include; The Communications and Marketing Sub-group of quarterly membership newsletter “My Hospital”, the Council of Governors worked in partnership membership seminars and “Health Matters” events with one of the Trust’s Non-Executive Directors and the Trust’s Annual Open Day. and Membership Engagement Manager to refresh the Trust’s Membership Development Strategy. Further information on becoming a member and This reflected the progress of the organisation as opportunities to engage with the Trust can be a Foundation Trust in relation to understanding found on the Trust’s website www.srft.nhs.uk. its membership community and incorporating the Additionally, members can contact their respective wider patient and public involvement activity taking governor directly via the form in the Members and place across the Trust. Governors section of the website.
The Membership Development Strategy provides Members who wish to communicate with the a comprehensive framework for growth of and Council of Governors or Board of Directors can do so engagement with the Foundation Trust membership through the Trust Secretary at the following address: community. The Strategy emphasises the Trust’s Trust Headquarters aims to involve and engage members and the wider Mayo Building patients and public in the design, planning, delivery Salford Royal NHS Foundation Trust, and improvement of our services and will shape Stott Lane the Trust’s recruitment and engagement activities Salford throughout the next twelve months Greater Manchester The Council of Governors have also worked M6 8HD in partnership with the Trust’s Directors and Telephone: 0161 206 5249 Membership Engagement Manager to identify Email: [email protected] and establish relationships with local groups and communities, including patient interest groups, in order to recruit active and engaged members. These partnerships will facilitate future recruitment activities and engagement with members and the wider public.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 59 Remuneration Report
The Nominations, Remuneration and Terms of The contracts of employment for all senior managers Service Committee meets at least once a year to are substantive (permanent), continuation of review the terms and conditions of employment which is subject to performance conditions. All of the executive team, assess performance and senior managers have contracted notice periods recommend salary changes. of six months. The Trust is aware of the provision within Monitor’s NHS Foundation Trust Code of The Trust applied a 2.75% uplift to the basic salaries Governance that relates to contracts of employment of Executive Directors and sub-Director senior for Executive Directors and has explained to managers in 2008/09, in recognition of the first of Monitor that the Board of Directors has considered the three year pay deal, agreed nationally for staff this provision and is of the view that to establish on Agenda for Change terms and conditions of short-term contracts for Executive Directors service. The remuneration of the Chair and Non- would be a high risk option for the Trust. Existing Executive Directors was approved by the Council of contractual, performance review and management Governors, following consideration of a survey of arrangements continue and are subject to regular Foundation Trusts undertaken nationally in 2008. and rigorous review.
The structure of remuneration for sub-Director There were no termination payments, compensation senior managers was reviewed in year and changed, payments or significant awards made to senior with effect from 1st October 2008, to bring this in managers in 2008/09. line with the performance conditions applicable to Executive Directors. Further information about the remuneration of senior managers is provided within the Annual Performance-related payments, recurrent and non- Accounts for 2008/09. recurrent, were awarded to Executive Directors in accordance with the scheme agreed in 2003 by the Nominations, Remuneration and Terms of Service Committee (further information about this committee is provided under Committees of the Board of Directors). The Trust has commissioned Ernst and Young to review and make proposals for Executive Director remuneration, including performance-related benefits, in 2009/10.
All elements of remuneration, including ‘annual cost of living increase’, are subject to performance conditions.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 60 Appendix 1
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 61 Statement of the Chief Executive’s Responsibilities as the Accounting Officer
The National Health Service Act 2006 (‘2006 Act’) l State whether applicable accounting states that the Chief Executive is the Accounting standards as set out in the NHS Foundation Officer of the NHS Foundation Trust. The relevant Trust Financial Reporting Manual have responsibilities of accounting officer, including their been followed, and disclose and explain responsibility for the propriety and regularity of any material departures in the financial public finances for which they are answerable, and statements; and for the keeping of proper accounts, are set out in l Prepare the financial statements on a going the accounting officers’ Memorandum issued by the concern basis. Independent Regulator of NHS Foundation Trusts (“Monitor”). The accounting officer is responsible for keeping Under the 2006 Act, Monitor has directed Salford proper accounting records which disclose with Royal NHS Foundation Trust to prepare for each reasonable accuracy at any time the financial financial year a statement of accounts in the form position of the NHS Foundation Trust and to enable and on the basis set out in the Accounts Direction. him/her to ensure that the accounts comply with The accounts are prepared on an accruals basis and requirements outlined in the above mentioned must give a true and fair view of the state of affairs Act. The Accounting officer is also responsible for of Salford Royal NHS Foundation Trust and of its safeguarding the assets of the NHS Foundation income and expenditure, total recognised gains and Trust and hence for taking reasonable steps for losses and cash flows for the financial year. the prevention and detection of fraud and other irregularities. In preparing the accounts, the Accounting Officer is required to comply with the requirements of the To the best of my knowledge and belief, I have NHS Foundation Trust Financial Reporting Manual properly discharged the responsibilities set out in and in particular to: Monitor’s NHS Foundation Trust Accounting Officer Memorandum. l Observe the Accounts Direction issued by Monitor, including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis; l Make judgements and estimates on a reasonable basis; David N Dalton, Chief Executive Date: 3 June 2009
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 62 Independent Auditor’s Report to the Council My responsibility is to audit the financial statements of Governors of in accordance with statute, the Audit Code for NHS Foundation Trusts and International Standards on Auditing (UK and Ireland). Salford Royal NHS I report to you my opinion as to whether the financial statements give a true and fair view in accordance Foundation Trust with the accounting policies directed by Monitor as being relevant to NHS Foundation Trusts. I report whether the financial statements have been properly prepared in accordance with the accounting I have audited the financial statements of Salford policies directed by Monitor as being relevant to NHS Royal NHS Foundation Trust for the year ended Foundation Trusts. I also report to you whether, in 31st March 2009 under the National Health Service my opinion, the information which comprises the Act 2006. The financial statements comprise the Director’s Report, included in the Annual Report, is Income and Expenditure Account, the Balance Sheet, consistent with the financial statements. the Cash Flow Statement, the Statement of Total Recognised Gains and Losses, the Remuneration I review whether the Accounting Officer’s statement Report and the related notes. These financial on internal control reflects compliance with the statements have been prepared under the requirements of Monitor contained in the NHS accounting policies set out within them. Foundation Trust Financial Reporting Manual 2008/09. I report if it does not meet the requirements This report is made solely to the Council of specified by Monitor or if the statement is misleading Governors of Salford Royal NHS Foundation Trust or inconsistent with other information I am aware of as a body in accordance with paragraph 24(5) of from my audit of the financial statements. I am not Schedule 7 of the National Health Service Act 2006. required to consider, nor have I considered, whether My work was undertaken so that I might state to the the Accounting Officer’s statement on internal Council of Governors those matters I am required control covers all risks and controls. Neither am I to state to it in an auditor’s report and for no other required to form an opinion on the effectiveness of purpose. In those circumstances, to the fullest the Trust’s corporate governance procedures or its risk extent permitted by law, I do not accept or assume and control procedures. responsibility to anyone other than the Foundation Trust as a body, for my audit work, for the audit I read the other information contained in the report or for the opinions I form. Annual Report and consider whether it is consistent with the audited financial statements. The other information comprises the Background information, Respective Responsibilities of the the Chair’s and Chief Executive’s Statement, Operating and Financial Review, the sections on Accounting Officer and Auditor the Board of Directors, the Council of Governors, The Accounting Officer’s responsibilities for preparing membership and public interest disclosures. I the financial statements in accordance with consider the implications for my report if I become directions made by the Independent Regulator of aware of any apparent misstatements or material NHS Foundation Trusts (Monitor) are set out in the inconsistencies with the financial statements. My Statement of Accounting Officer’s Responsibilities. responsibilities do not extend to other information.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 63 Basis of Audit Opinion Opinion I conducted my audit in accordance with the National In my opinion: Health Service Act 2006 and the Audit Code for l The financial statements give a true and fair NHS Foundation Trusts issued by Monitor, which view of the state of affairs of Salford Royal NHS requires compliance with International Standards Foundation Trust as at 31st March 2009 and of on Auditing (UK and Ireland) issued by the Auditing its income and expenditure for the year then Practices Board. An audit includes examination, on ended in accordance with the accounting policies a test basis, of evidence relevant to the amounts adopted by the Trust; and disclosures in the financial statements. It also includes an assessment of the significant estimates l The Remuneration Report has been properly and judgements made by the directors in the prepared in accordance with the accounting preparation of the financial statements, and of policies directed by Monitor as being relevant to whether the accounting policies are appropriate to NHS Foundation Trusts; and the Trust’s circumstances, consistently applied and l Information which comprises the Director’s Report, adequately disclosed. included in the Annual Report, is consistent with I planned and performed my audit so as to obtain all the financial statements. the information and explanations which I considered necessary in order to provide me with sufficient evidence to give reasonable assurance that: l The financial statements are free from material Certificate misstatement, whether caused by fraud or other I certify that I have completed the audit of the irregularity or error; and accounts in accordance with the requirements of the l The financial statements have been properly National Health Service Act 2006 and the Audit Code prepared. for NHS Foundation Trusts issued by Monitor.
In forming my opinion I also evaluated the overall Jackie Bellard ACA adequacy of the presentation of information in the Officer of the Audit Commission financial statements. Audit Commission Aspinall House Aspinall Close Middlebrook Bolton BL6 6QQ 8th June 2009
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 64 Statement on Internal Control
Scope of Responsibility The Purpose of the System of Internal The Board is accountable for internal control. As Control Accounting Officer, and Chief Executive of this Board, I have responsibility for maintaining a The system of internal control is designed to sound system of internal control that supports the manage risk to a reasonable level rather than to achievement of the NHS Trust’s policies, aims and eliminate all risk of failure to achieve policies, objectives, whilst safeguarding the public funds aims and objectives; it can therefore only provide and departmental assets for which I am personally reasonable and not absolute assurance of responsible, in accordance with the responsibilities effectiveness. The system of internal control is assigned to me. I am also responsible for ensuring based on an ongoing process designed to identify that the NHS Trust is administered prudently and prioritise the risks to the achievement of the and economically and that resources are applied policies, aims and objectives, evaluate the likelihood efficiently and effectively. I also acknowledge of those risks being realised and the impact should my responsibilities as set out in the NHS Trust they be realised, and to manage them efficiently, Accounting Officer Memorandum. effectively and economically. I carry out my accountability role: The system of internal control has been in place in the Salford Royal NHS Foundation Trust for the l With commissioning bodies through service year ended 31st March 2009 and up to the date of agreements; approval of the annual report and accounts. l With local partners and wider communities through holding public meetings, publishing business plans, an annual report and accounts, and through compliance with the Code of Practice on Openness in the NHS; l With members through the Council of Governors; l With patients through management of standards of care; l With Monitor through ensuring compliance with the Terms of Authorisation; l To the Secretary of State for performance and statutory financial duties.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 65 Capacity to Handle Risk The Risk and Control Framework As Chief Executive and supported by Board Members Risk management requires participation, I have responsibility for the introduction and commitment and collaboration from all staff. The implementation of the risk management processes process starts with the systematic identification of within the Trust. The Audit Committee scrutinises risks throughout the organisation and these are these risk management processes and the Trust’s documented on ‘risk registers’. These risks are systems of internal control. then analysed in order to determine their relative importance using a risk scoring matrix. In order to ensure that risk management becomes integrated into all practices and procedures Low scoring risks are managed by the area in carried out by staff, the Trust provides training and which they are found while higher scoring risk are procedures which: managed at progressively higher levels within the organisation. l Increase the awareness of staff to report all Adverse incidents and near misses; Achieving control of the highest scoring risk is given priority over low scoring risks. Risk control l Facilitate proactive self assessment of risks measures are identified and taken to reduce throughout the Trust; the risk’s potential for harm. Some risk control l Develop systems and processes which have the measures do not require extra funding and these capability to reduce risk; are implemented as soon as practically possible. l Improve procedures for reporting and However, where risk control requires extra funding feedback mechanism; then a risk funding process determines how best to use the organisation’s financial resources to control l Continue to ensure compliance with policies that risk. Risk funding can direct funds to further and professional standards; risk control measures or it may decide to transfer l Provide consistency in the management of the risk to others such as NHS insurance schemes risks; or sharing the risk in the contracts drawn up with others. The whole process is a continual iterative l Ensure compliance with professional process. registration requirements; Information governance risks are managed as part l Ensure compliance with professional codes of of this process and assessed using the Information practice; Governance Toolkit. During the year there has l Promote continuing personal and professional also been a detailed review of storage and transfer development that meets the needs of of information. A detailed action plan based on individuals and the business needs of the guidance provided by Connecting for Health is Trust; currently being implemented. The risk register is up to date with the currently identified information l Enable staff appraisal to focus on risks. improvements in performance related to adverse incidents/near misses, concerns and complaints received.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 66 Review of Effectiveness In order to provide evidence in support of the As Accountable Officer, I have responsibility for Statement on Internal Control the Trust has a Board reviewing the effectiveness of the system of internal Assurance Framework which is based on six key control. My review is informed in a number of elements: ways. The head of internal audit provides me with an opinion on the overall arrangements for gaining l Clearly defined principal objectives agreed assurance through the Assurance Framework and on with stakeholders together with clear lines of the controls reviewed as part of the internal audit responsibility and accountability; work. Executive managers within the organisation l Clearly defined principal risks to the who have responsibility for the development and achievement of these objectives together with maintenance of the systems of internal control an assessment of their potential impact and provide me with assurance. The Assurance likelihood; Framework itself provides me with evidence that l Key controls by which these risks can be the effectiveness of controls that manage the risks managed, this includes involvement of to the organisation achieving its principal objectives stakeholders in agreeing controls where risks have been reviewed. My review is also informed impact on them; by the work of the internal auditors and the executive managers within the NHS trust who have l Management and independent assurances responsibility for the development and maintenance that the risks are being managed effectively; of the internal control framework, and comments l Board reports identifying that risks are being made by the external auditors in their management reasonably managed and objectives being letter and other reports. The head of internal met, together with gaps in assurances and audit provides me with an opinion on the overall gaps in risk control; arrangements for gaining assurance through the Assurance Framework and on the controls reviewed l Board action plans which ensure the as part of the internal audit work. through delivery of objectives, control of risk and reviews by the standing committees and the Audit improvements in assurances. Committee. The Assurance Framework/Risk Register is reviewed by the Trust Board three times a year The Trust has a robust systematic process for the and it provides me and the Board with evidence of assessment of compliance with core standards for the effectiveness of controls in place to manage risks better health. The Trust is fully compliant with the to achieving the organisation’s principal objectives. core standards for better health. My review is also informed by: External Audit, audit As an employer with staff entitled to membership by the National Health Service Litigation Authority of the NHS Pension Scheme control measures and periodic audits of compliance with its standards are in place to ensure all employer obligations by the Healthcare Commission and other external contained with the Scheme regulations are complied inspections, accreditation and reviews. with. This includes ensuring that deductions from I have been advised on the implications of the salary, employer’s contributions and payments in results of my review of the effectiveness of the to the scheme are in accordance with the Scheme system of internal control by the Board, the Audit rules, and that member Pension Scheme records Committee, Risk Management Committee and the are accurately updated in accordance with the other standing committees of the Trust Board. A timescales detailed in the Regulations plan to address weaknesses and ensure continuous Control measures are in place to ensure that all the improvement of the system is in place. organisations obligations under equality, diversity and human rights legislation are complied with.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 67 Processes are well established and ensure regular l Following the discovery on the 23rd April review of systems and action plans on the 2009 of an administrative error within the effectiveness of the systems of internal control Pain Management process, we discovered 37 through: patients who at the end of March had waited more than 13 weeks. Since the discovery, l Trust Board review of Board Assurance urgent arrangements have now been made Framework, risk register and action plans; for these patients to be seen. By the end l Audit committee scrutiny of controls in place; of April, we would expect the only patients l Review of serious incidents and learning by still remaining will be those who chose not the standing committees, including those for to attend the special clinics. Alternative Risk Management and Clinical Effectiveness; rapid appointments will be offered to these patients. l Review of progress in meeting the Standards of the Healthcare Commission’s Standards for Better Health by the board’s assurance Action to improve the control of all of the above committees; risks has been progressing throughout 2008/09 and the effectiveness of these improvements has been l Internal Audits of effectiveness of systems of reviewed by the Trust Board. internal control.
No significant control issues were identified during the year April 2008 to March 2009 however, the following control issues, not amounting to significant control issues, were identified:
l The Board has acknowledged financial risk David N Dalton, Chief Executive and agreed deficit budget for Research and Date: 3 June 2009 Development for this year and action plans will be pursued which reduce costs and increase R&D income during the coming year; l Provision of adequate vascular surgery provision at the Trust with new service agreements being developed to improve this; l Potential financial consequences of equal value claims; l Hygiene code visit was positive with the exception of Duty 4 - sub-duty 4c and as a result the Trust has improved ‘its cleaning arrangements to ensure that all parts of the premises where healthcare is provided are kept clean and fit for purpose, with adequate monitoring to provide a consistently good standard’;
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 68 Foreword to the Accounts
Salford Royal NHS Foundation Trust
These accounts for the year ended 31st March 2009 have been prepared by the Salford Royal NHS Foundation Trust under schedule 7, sections 24 and 25 of the National Health Service Act 2006.
David N Dalton, Chief Executive Date: 3 June 2009
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 69 Income and Expenditure Account for the Year Ended 31st March 2009
Year to Year to 31st March 31st March 2009 2008 Note £000 £000 Income from activities 2 257,276 229,050 Other operating costs 3 40,538 41,274 Operating expenses 4 (299,160) (278,990) OPERATING SURPLUS / (DEFICIT) (1,346) (8,666) Loss on disposal of fixed assets 7 (64) 0 (DEFICIT) BEFORE INTEREST (1,410) (8,666) Interest receivable 1,502 1,876 Interest payable 0 0 Other net gain / losses on financial instruments 0 0 Other finance costs - unwinding of discount 14 (56) (31) SURPLUS BEFORE TAXATION 36 (6,821) Taxation 0 0 SURPLUS AFTER TAXATION 36 (6,821) Public Dividend Capital dividends payable (5,910) (5,474) RETAINED (DEFICIT) FOR THE PERIOD (5,874) (12,295)
The notes on pages 73 to 101 form part of these accounts. All income and expenditure is dreived from continuing operations.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 70 Balance Sheet as at 31st March 2009
Year to Year to 31st March 31st March 2009 2008 Note £000 £000 FIXED ASSETS Intangible assets 8 1,644 1,886 Tangible assets 9 142,090 164,820 TOTAL FIXED ASSETS 143,734 166,706 CURRENT ASSETS Stocks and work in progress 10 2,959 2,367 Debtors 11 17,892 23,001 Investments 12 0 25,000 Cash at bank and in hand 18 31,973 5,006 TOTAL CURRENT ASSETS 52,824 55,374 CREDITORS: Amounts falling due within one year 13 (33,598) (31,740) NET CURRENT ASSETS 19,226 23,634 TOTAL ASSETS LESS CURRENT LIABILITIES 162,960 190,340 CREDITORS: Amounts falling due after more than one year 0 0 PROVISIONS FOR LIABILITIES AND CHARGES 14 (5,530) (6,182) TOTAL ASSETS EMPLOYED 157,430 184,158
FINANCED BY: TAXPAYERS’ EQUITY Public dividend capital 23 114,272 111,312 Revaluation reserve 16 43,358 66,646 Donated asset reserve 16 6,700 7,533 Available for sale investment reserve 0 0 Income and expenditure reserve 16 (6,900) (1,333) TOTAL TAXPAYERS’ EQUITY 157,430 184,158
The financial statements on pages 70 to 101 were approved by the Audit Committee under delegated authority on behalf of the Board of Directors on 3rd June 2009 and signed by:
David N Dalton, Chief Executive Date: 3 June 2009
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 71 Statement of Total Recognised Gains and Losses for the Year Ended 31st March 2009
Year to Year to 31st March 31st March 2009 2008 Note £000 £000 Surplus for the financial year before dividend payments 36 (6,821) Fixed assets impairment losses 16 (23,895) (560) Unrealised surplus/deficit on fixed asset and current asset revaluations 16 372 11,418 Increases in the donated asset reserve due to receipt of donated assets 23 114 Increases in the donated asset reserve due to depreciation, impairment and disposal (314) (312) receipt of donated assets TOTAL RECOGNISED GAINS AND LOSSES (23,778) 3,839
Cash Flow Statement for the Year Ended 31st March 2009
Year to Year to 31st March 31st March 2009 2008 Note £000 £000 OPERATING ACTIVITIES Net cash inflow from operating activities 17 21,715 9,024 RETURNS ON INVESTMENTS AND SERVICING OF FINANCE Interest received 1,493 1,876 NET CASH INFLOW FROM RETURNS ON INVESTMENTS AND SERVICING OF FINANCE 1,493 1,876 TAXATION PAID / RECEIVED 0 0 CAPITAL EXPENDITURE Payments to acquire tangible fixed assets (18,263) (27,057) Payments to acquire intangible assets (28) (155) NET CASH OUTFLOW FROM CAPITAL EXPENDITURE (18,291) (27,212) DIVIDENDS PAID (5,910) (5,474) NET CASH (OUTFLOW) BEFORE MANAGEMENT OF LIQUID RESOURCES AND FINANCING (993) (21,786) MANAGEMENT OF LIQUID RESOURCES Purchase of current asset investments (331,500) (485,523) Sale of current asset investments 356,500 489,523 NET CASH INFLOW FROM MANAGEMENT OF LIQUID RESOURCE 25,000 4,000 NET CASH OUTFOW BEFORE FINANCING 24,007 (17,786) FINANCING Public dividend capital received 2,960 23,663 Public dividend capital repaid 0 (1,956) NET CASH INFLOW FROM FINANCING 2,960 21,707 INCREASE IN CASH 26,967 3,921
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 72 Notes to the Accounts
1 Accounting Policies and Other Information
Monitor has directed that the financial statements The Trust changed the form of its contracts with NHS of NHS Foundation Trust’s shall meet the accounting commissioners to follow the Department of Health’s requirements of the NHS Foundation Trust Financial Payment by Results methodology in 2005/06. Reporting Manual which shall be agreed with HM Treasury. Consequently, the following financial statements have been prepared in accordance 1.4 Expenditure with the 2008/09 NHS Foundation Trust Financial Expenditure is accounted for by applying the Reporting Manual issued by Monitor. The accruals convention. accounting policies contained in that manual follow During the year, the Trust has estimated an accrual UK generally accepted accounting practice for for Clinical Negligence Scheme for Trusts (CNST) companies (UK GAAP) and HM Treasury’s Financial liabilities arising up to and including 31st March Reporting Manual to the extent that they are 2009 that have not been invoiced by the NHSLA and meaningful and appropriate to NHS Foundation therefore are owed to the NHSLA. During 2008/09, Trusts. The accounting policies have been applied the Department of Health issued a loan to the consistently in dealing with items considered NHSLA to fund these liabilities on behalf of all NHS material in relation to the accounts. bodies but the NHSLA will recoup the costs from each member organisation in two instalments in 1.1 Accounting Convention 2009/10 and 2010/11. These accounts have been prepared under the historical cost convention modified to account for the 1.5 Tangible Fixed Assets revaluation of tangible fixed assets at their value to Capitalisation the business by reference to their current costs. NHS Foundation Trusts, in compliance with HM Treasury’s Tangible assets are capitalised if they are capable of Financial Reporting Manual, are not required to being used for a period which exceeds one year and comply with the FRS 3 requirements to report they: “earnings per share” or historical profits and losses. l Individually have a cost of at least £5,000; or l Form a group of assets which collectively have 1.2 Acquisitions and Discontinued Operations a cost of at least £5,000, where the assets are The Trust has not made any acquisitions or functionally interdependent, they had broadly discontinued any operations during the financial simultaneous purchase dates, are anticipated to year and it is not anticipated that it will do so in the have simultaneous disposal dates and are under next financial year. single managerial control; or l Form part of the initial setting-up cost of a new 1.3 Income Recognition building, service or refurbishment of a ward or unit, Income is accounted for by applying the accruals irrespective of their individual or collective cost. convention. The main source of income for the Trust is under contracts from commissioners in respect of healthcare services. Income is recognised in the period in which services are provided. Where income is received for a specific activity which is to be delivered in the following financial year, that income is deferred.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 73 Valuation Depreciation, amortisation and impairments Tangible fixed assets are stated at the lower of Tangible fixed assets are depreciated at rates replacement cost and recoverable amount. On calculated to write them down to estimated residual initial recognition they are measured at cost (for value on a straight-line basis over their estimated leased assets, fair value) including any costs, such as useful lives. No depreciation is provided on freehold installation, directly attributable to bringing them land, and assets surplus to requirements. into working condition. The carrying values of Assets in the course of construction and residual tangible fixed assets are reviewed for impairment interests in off-balance sheet PFI contract assets are in periods if events or changes in circumstances not depreciated until the asset is brought into use or indicate the carrying value may not be recoverable. reverts to the trust, respectively. The costs arising from financing the construction of the fixed asset are not capitalised but are charged to Buildings, installations and fittings are depreciated the income and expenditure account in the year to on their current value over the estimated which they relate. remaining life of the asset as assessed by the Trust’s professional valuers. Leaseholds are depreciated All land and buildings are revalued using professional over the primary lease term. valuations in accordance with FRS 15 every five years. A three yearly interim valuation is also carried Unless there is a clear operational reason why the out. Due to the current economic climate and the following criteria should not be applied equipment negative pressure on prices, a valuation of land and is depreciated on current cost evenly over the building assets took place as at 31st March 2009. estimated life of the asset within the following lives: The 2008/09 valuation took place with a prospective Years valuation date of 31 March 2009 by Mr. R Yardley, MRICS, working for the Valuation Office Agency. Plant and machinery, information 5-15 This valuation was prepared in accordance with technology, furniture and fittings the terms of the Royal Institution of Chartered Transport 3-7 Surveyors’ Valuation Standards, insofar as these terms are consistent with the agreed requirements Fixed asset impairments resulting from losses of of the National Health Service, the Department of economic benefits are charged to the income and Health and HM Treasury. expenditure account. All other impairments are The valuations are carried out primarily on the basis taken to the revaluation reserve and reported in the of depreciated replacement cost for specialised statement of total recognised gains and losses to operational property and existing use value for non- the extent that there is a balance on the revaluation specialised operational property. The value of land for reserve in respect of the particular asset. existing use purposes is assessed at existing use value. For non-operational properties including surplus land, the valuations are carried out at open market value. Assets in the course of construction are valued at cost and are valued by professional valuers as part of the five or three-yearly valuation or when they are brought into use. Operational equipment other than IT equipment, which is considered to have nil inflation, is valued at net current replacement cost through annual uplift by the change in the value of the Department of Health deflator. Equipment surplus to requirements is valued at net recoverable cost.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 74 1.6 Intangible Fixed Assets 1.9 Current Asset Investments Intangible assets are capitalised when they are Current asset investments are short term deposits capable of being used in the Trust’s activities for that are readily convertible into known amounts more than one year; they can be valued; and they of cash at their carrying value with the interest have a cost of at least £5,000. accrued to the Income and Expenditure Account. They are treated as liquid resources in the cash flow Intangible fixed assets held for operational use are statement. valued at historical cost and are amortised over the estimated life of the asset on a straight line basis. The carrying value of intangible assets is reviewed 1.10 Government Grants for impairment at the end of the first full year Government grants are grants from government following acquisition and in other periods if events bodies other than income from Primary Care Trusts or changes in circumstances indicate the carrying or NHS Trusts for the provision of services. Grants value may not be recoverable. from the Department of Health, are accounted for Purchased computer software licences are capitalised as government grants as are grants from the Big as intangible fixed assets where expenditure of Lottery Fund and the North West Development at least £5,000 is incurred and amortised over the Agency for example. Where the government shorter of the term of the licence and their useful grant is used to fund revenue expenditure it is economic lives. taken to the Income and Expenditure account to match that expenditure. Where the grant is used to fund capital expenditure, the grant is held as 1.7 Donated Fixed Assets deferred income and released to the income and Donated fixed assets are capitalised at their current expenditure account over the life of the asset on value on receipt and this value is credited to the a basis consistent with the amortisation charge for donated asset reserve. Donated fixed assets are that asset. valued and depreciated as described above for During the year, the Trust accrued capital grant purchased assets. Gains and losses on revaluations income from the North West Development Agency are also taken to the donated asset reserve and, which has been used to fund the North West each year, an amount equal to the depreciation e-Health project - a collaboration between the Trust, charge on the asset is released from the donated Salford PCT and the University of Manchester. This asset reserve to the income and expenditure income has been recorded as deferred income in the account. Similarly, any impairment on donated balance sheet. assets charged to the income and expenditure account is matched by a transfer from the donated asset reserve. On sale of donated assets, the net book value of the donated asset is transferred from the donated asset reserve to the income and expenditure reserve.
1.8 Current Assets Current assets are valued in line with UK financial reporting standards.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 75 1.11 Private Finance Initiative (PFI) Transactions The NHS follows HM Treasury’s Technical Note 1 overdrafts are disclosed within creditors. Interest (Revised) “How to Account for PFI transactions” earned on bank accounts and interest charged on which provides definitive guidance for the overdrafts is recorded as, respectively, “interest application of application note F to FRS 5. receivable” and “interest payable” in the Income and Expenditure Account in the periods to which Where the balance of the risks and rewards of they relate. Bank charges are recorded as operating ownership of the PFI property are borne by the expenditure in the periods to which they relate in PFI operator, the PFI payments are recorded as an the Income and Expenditure Account. operating expense. Where the Trust has contributed land and buildings, a prepayment for their fair value is recognised and amortised over the life of the PFI 1.14 Research and Development contract by charge to the income and expenditure Expenditure on research is not capitalised. account. Where, at the end of the PFI contract, a Expenditure on development is capitalised if it property reverts to the trust, the difference between meets the following criteria: the expected fair value of the residual on reversion and any agreed payment on reversion is built up l There is a clearly defined project; over the life of the contract by capitalising part of l The related expenditure is separately identifiable; the unitary charge each year, as a tangible fixed asset. l The outcome of the project has been assessed with reasonable certainty as to its technical Where the balance of risks and rewards of feasibility and its resulting in a product or services ownership of the PFI property are borne by the that will eventually be brought into use; and trust, it is recognised as a fixed asset along with the liability to pay for it which is accounted for as a l Adequate resources exist, or are reasonably finance lease. Contract payments are apportioned expected to be available, to enable the project to between an imputed finance lease charge and a be completed and to provide any consequential service charge. increases in working capital. From 1st April 2009, the Trust will adopt Expenditure so deferred is limited to the value of International Financial Reporting Standards as future benefits expected and is amortised through the basis of preparing the annual accounts which the income and expenditure account on a systematic will lead to the PFI schemes being reported as on basis over the period expected to benefit from the balance sheet transactions. project. It is revalued on the basis of current cost. Expenditure which does not meet the criteria for capitalisation is treated as an operating cost in the 1.12 Stocks year in which it is incurred. Where possible, the Stocks are valued at the lower of cost and net Trust discloses the total amount of research and realisable value other than pharmacy stock which is development expenditure charged in the Income valued at average cost. and Expenditure account separately. However, where research and development activity cannot 1.13 Cash, Bank and Overdrafts be separated from patient care activity it cannot be identified and is therefore not separately disclosed. Cash, bank and overdraft balances are recorded at the current values of these balances in the Trust’s Fixed assets acquired for use in research and cash book. These balances exclude monies held in development are amortised over the life of the the Trust’s bank account belonging to patients (see associated project. “third party assets” below). Account balances are only set off where a formal agreement has been made with the bank to do so. In all other cases
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 76 1.15 Provisions 1.17 Clinical Negligence Costs The Trust provides for legal or constructive The NHS Litigation Authority (NHSLA) operates a risk obligations that are of uncertain timing or amount pooling scheme under which the Trust pays an annual at the balance sheet date on the basis of the best contribution to the NHSLA, which, in return, settles estimate of the expenditure required to settle the all clinical negligence claims. Although the NHSLA is obligation. Where the effect of the time value of administratively responsible for all clinical negligence money is significant, the estimated risk-adjusted cases, the legal liability remains with the Trust. The cash flows are discounted using HM Treasury’s total value of clinical negligence provisions carried discount rate of 2.2% in real terms. by the NHSLA on behalf of the Trust is disclosed at note 14. Paragraph 1.4 to these accounting policies refers to an accrual included in this year’s financial 1.16 Contingencies statements to show the full value of the Trust’s Contingent assets (that is, assets arising from past 2008/09 contribution to the NHSLA and not the value events whose existence will only be confirmed by invoiced by the NHSLA as at 31st March 2009. one or more future events not wholly within the entity’s control) are not recognised as assets, but are disclosed in note 21 where an inflow of economic 1.18 Non-clinical Risk Pooling benefits is probable. The Trust participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Contingent liabilities are provided for where a transfer Both are risk pooling schemes under which the trust of economic benefits is possible. Otherwise, they are pays an annual contribution to the NHS Litigation not recognised, but are disclosed in note 21 unless Authority and in return receives assistance with the the probability of a transfer of economic benefits is costs of claims arising. The annual membership remote. Contingent liabilities are defined as: contributions, and any ‘excesses’ payable in respect l Possible obligations arising from past events of particular claims are charged to operating whose existence will be confirmed only by the expenses when the liability arises. occurrence of one or more uncertain future For buildings and contents, the Trust also has “top- events not wholly within the entity’s control; or up” insurance provided through a commercial l Present obligations arising from past events but insurer that insures from the NHSLA limit of cover of for which it is not probable that a transfer of £1m to total reinstatement value (as assessed by the economic benefits will arise or for which the Valuation Office). The annual premium is charged amount of the obligation cannot be measured to operating expenses when the liability arises. with sufficient reliability. Other commercial insurance held by the Trust includes (building) contract works, motor vehicle, personal accident and group travel (for specified groups of clinical staff required to work off-site e.g. for specialist retrieval of patients) and overseas travel. The annual premiums and any excesses payable are charged to operating expenses when the liability arises.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 77 1.19 Pension Costs 1.20 Value Added Tax Past and present employees are covered by the Most of the activities of the Trust are outside the provisions of the NHS Pensions Scheme. The scheme scope of VAT and, in general, output tax does not is an unfunded, defined benefit scheme that covers apply and input tax on purchases is not recoverable. NHS employers, general practices and other bodies, Irrecoverable VAT is charged to the relevant allowed under the direction of Secretary of State, expenditure category or included in the capitalised in England and Wales. As a consequence it is not purchase cost of fixed assets. Where output tax is possible for the Trust to identify its share of the charged or input VAT is recoverable, the amounts underlying scheme liabilities. Therefore, the scheme are stated net of VAT. is accounted for as a defined contribution scheme under FRS 17. 1.21 Corporation Tax The scheme is subject to a full actuarial investigation Under s519A ICTA 1988 Salford Royal NHS every 4 years. The last investigation had an Foundation Trust is regarded as a Health Service effective date of 31st March 2004 and covered the body and is, therefore, exempt from taxation on its period from 1st April 1999 to that date. This was income and capital gains. Section 148 of the 2004 published in December 2007 and is available on Finance Act provided the Treasury with powers to the NHS Pensions website http://www.nhspa.gov. disapply this exemption. Accordingly the Trust is uk/nhspa_site/foi/foi1/Scheme_Valaution_Report/ potentially within the scope of Corporation Tax in NHSPS_Valuation_Report.pdf respect of activities which are not related to, or The main purpose is to assess the level of liability ancillary to, the provision of healthcare and where in respect of benefits due under the scheme and the profits exceed £50,000 pa. Activities such as to recommend the contribution rates to be paid by staff and patient car parking and sales of food are employees and employers. considered to be ancillary to the core healthcare objectives of the Trust (and not entrepreneurial) and The 2004 review showed an accumulated notional therefore not subject to corporation tax. Any tax deficit of £3.3bn. The conclusion of the valuation liability will be accounted for within the relevant tax was that the scheme continues to operate on a year. sound financial basis. Every four years, employer contribution rates are reviewed following the scheme valuation. At the 1.22 Foreign Exchange last valuation, it was recommended that employers Transactions that are denominated in a foreign pension cost contributions continue at 14% of currency are translated into sterling at the exchange pensionable pay. These are charged to operating rate ruling on the dates of the transactions. expenses as and when they become due. From 1st Resulting exchange gains and losses are taken to the April 2008, employees pay contributions on a tiered income and expenditure account. scale from 5% up to 8.5% of their pensionable pay. Additional pension liabilities arising from early 1.23 Third Part Assets retirements are not funded by the scheme except Assets belonging to third parties (such as money where the retirement is due to ill-health. The full held on behalf of patients) are not recognised amount of the liability for the additional costs is in the accounts since the Trust has no beneficial charged to the income and expenditure account at interest in them. However, they are disclosed in a the time the Trust commits itself to the retirement, separate note to the accounts in accordance with regardless of the method of payment. the requirements of the HM Treasury Financial Reporting Manual.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 78 1.24 Leases 1.27 Financial Instruments and Financial Liabilities Where substantially all risks and rewards of Recognition ownership of a leased asset are borne by the Trust, Financial assets and financial liabilities which arise the asset is recorded as a tangible fixed asset and a from contracts for the purchase or sale of non- debt is recorded to the lessor of the minimum lease financial items (such as goods or services), which are payments discounted by the interest rate implicit in entered into in accordance with the Trust’s normal the lease. The interest element of the finance lease purchase, sale or usage requirements, are recognised payment is charged to the income and expenditure when, and to the extent which, performance occurs account over the period of the lease at a constant i.e. when receipt or delivery of the goods or services rate in relation to the balance outstanding. Other is made. leases are regarded as operating leases and the rentals are charged to the income and expenditure The Trust does not have any finance leases. account on a straight-line basis over the term of the All other financial assets and financial liabilities are lease. recognised when the Trust becomes a party to the contractual provisions of the instrument. 1.25 Public Dividend Capital De-recognition Public dividend capital (PDC) is a type of public sector equity finance. All financial assets are de-recognised when the rights to receive cashflows from the assets have A charge, reflecting the forecast cost of capital expired or the Trust has transferred substantially all utilised by the Trust, is paid over as public dividend of the risks and rewards of ownership. capital dividend. The charge is calculated at the real rate set by HM Treasury (currently 3.5%) on the Financial liabilities are de-recognised when the average relevant net assets of the Trust. Relevant obligation is discharged, cancelled or expires. net assets are calculated as the value of all assets less the value of all liabilities, except for donated assets Classification and Measurement and cash held with the Office of the Paymaster Financial assets are categorised as ‘Fair Value General. Average relevant net assets are calculated through Income and Expenditure’, Loans and as a simple mean of opening and closing relevant receivables or Available for Sale financial assets. net assets. The actual rate achieved is shown in note 24. Financial liabilities are classified as ‘Fair value through Income and Expenditure’ or as ‘Other 1.26 Losses and Special Payments Financial liabilities’. Losses and special payments are charged to Financial Assets and Financial Liabilities at ‘Fair the income and expenditure account as part of Value Through Income and Expenditure’ operating expenses. Financial assets and financial liabilities at ‘fair value through income and expenditure’ are financial assets or financial liabilities held for trading. The Trust does not hold any of this particular class.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 79 Loans and Receivables Determination of Fair Value Loans and receivables are non-derivative financial For financial assets and financial liabilities carried assets with fixed or determinable payments which at fair value, the carrying amounts are determined are not quoted in an active market. They are from any of quoted market prices, independent included in current assets. appraisals or discounted cash flow analysis. The Trust’s loans and receivables comprise: current investments, cash at bank and in hand, NHS debtors, Impairment of Financial Assets accrued income, other debtors and provisions for At the balance sheet date, the Trust assesses impairment of debtors. whether any financial assets, other than those held Loans and receivables are recognised initially at fair at ‘fair value through income and expenditure’ value, net of transactions costs, and are measured are impaired. Financial assets are impaired and subsequently at amortised cost, using the effective impairment losses are recognised if, and only if, interest method. The effective interest rate is the there is objective evidence of impairment as a result rate that discounts exactly estimated future cash of one or more events which occurred after the receipts through the expected life of the financial initial recognition of the asset and which has an asset or, when appropriate, a shorter period, to the impact on the estimated future cash flows of the net carrying amount of the financial asset. asset. Interest on loans and receivables is calculated using For financial assets carried at amortised cost, the the effective interest method and credited to the amount of the impairment loss is measured as the income and expenditure account. difference between the asset’s carrying amount and the present value of the revised future cash flows discounted at the asset’s original effective interest Available-for-sale Financial Assets rate. The loss is recognised in the income and The Trust does hold any of this class of assets. expenditure account and the carrying amount of the asset is reduced directly. Other Financial Liabilities All other financial liabilities are recognised initially at fair value, net of transaction costs incurred, and measured subsequently at amortised cost using the effective interest method. The effective interest rate is the rate that discounts exactly estimated future cash payments through the expected life of the financial liability or, when appropriate, a shorter period, to the net carrying amount of the financial liability. They are included in current liabilities except for amounts payable more than 12 months after the balance sheet date, which are classified as long-term liabilities. Interest on financial liabilities carried at amortised cost is calculated using the effective interest method and charged to the income and expenditure account.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 80 2 Income From Activities
2a Income from Activities - By Point of Delivery 2c Income from Activities - Mandatory & Non-Mandatory Year to Year to Year to Year to 31st March 31st March 31st March 31st March 2009 2008 2009 2008 £000 £000 £000 £000 Elective income 45,049 40,981 Income from activities - 255,434 227,884 Non-elective income 63,147 59,703 mandatory services Outpatient income 43,823 39,730 Income from activities - 1,842 1,166 A&E income 5,327 5,562 non-mandatory services Other type of activity income 97,217 80,931 TOTAL 257,276 229,050 PBR (clawback) / relief 0 428 Private patients income 870 550 Other non-protected clinical income 1,843 1,165 2d Private Patient Income TOTAL 257,276 229,050 The NHS Act Act 2006 requires that the proportion Other type of activity income includes services such of private patient income to the total patient as: renal dialysis, high dependency and critical care, related income of Foundation Trusts should not intestinal failure service, neuro-rehabilitation, direct exceed its proportion whilst the body was an NHS access by GPS to imaging and diagnostic services Trust in 2002/03 (the base year). and specialist drugs excluded from the NHS national tariff. Base Year to Year to Year 31st March 31st March 2002/2003 2009 2008 2b Income from Activities - By Source £000 £000 £000 Private patient income 574 870 550 Year to Year to Total patient related 129,876 257,276 229,050 31st March 31st March income 2009 2008 Proportion (as a 0.44% 0.34% 0.24% £000 £000 percentage) not to Primary Care Trusts 206,769 190,301 exceed the base year Department of Health 10,739 11,465 cap NHS other 37,010 25,471 Non NHS: Private patients 870 550 Overseas patients (non-reciprocal) 46 97 Injury cost recovery scheme 1,699 1,029 Other 143 137 TOTAL 257,276 229,050
NHS Injury costs recovery scheme income is subject to a provision for impairment of debt of 15.8% to reflect expected rates of collection, based on the Foundation Trust’s previous rates of collection.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 81 3 Other Operating Income 4 Operating Expenses
Year to Year to 31st March 31st March 4.1 Operating Expenses Comprise: 2009 2008 Year to Year to £000 £000 31st March 31st March Research and development 4,205 2,943 2009 2008 Education and training 23,077 21,788 £000 £000 Charitable and other contributions 0 0 Services from NHS Foundation Trusts 1,298 119 to expenditure Services from NHS Trusts 1,398 3,605 Transfers from donated asset reserve 314 312 Services from other NHS bodies 6,431 6,704 Non-patient care services to other 5,537 6,744 Purchase of healthcare from 1,626 1,121 bodies non-NHS bodies Other income 7,405 9,487 Executive directors costs 1,100 1,110 TOTAL 40,538 41,274 Non-executive directors costs 125 118 Staff costs 172,482 156,435 Other income includes a number of items. The Drugs cost 44,112 31,524 material items include: income from sales to staff, Supplies and services - clinical 24,674 24,185 patients, other organisations and the public for Supplies and services - general 3,933 3,697 provision of services such as the restaurant (£1,184k) Establishment 3,560 3,169 and car parking (£962k), charges made to other Transport 316 256 organisations occupying Trust accommodation Premises 13,866 11,495 e.g. rent, energy, utilities, maintenance services Increase in provision for 55 91 (£1,376k), income to establish the Stroke Local impairment of debtors Research Network (£789k). Depreciation and amortisation 10,824 8,313 Fixed asset impairments 6,700 19,225 Audit fees - statutory audit 47 56 Audit fees - other services 10 0 Clinical negligence - annual premium 2,713 2,351 Capital grants to local authority 0 1,956 Other 3,890 3,460 TOTAL 299,160 278,990
Other expenditure includes costs such as professional consultancy services (£868k), legal fees (£203k), internal audit services (£202k), interpretation services (£166k) and insurance costs (£138k).
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 82 4.2 Operating Expenses (Continued) 4.3 Operating Leases Fixed Asset Impairments 4.3.1 Operating Expenses Include: During the year, the Trust instructed the Valuation Year to Year to Office to undertake a number of building asset 31st March 31st March revaluations when significant expenditure had 2009 2008 been incurred in building new assets or upgrading £000 £000 exisiting property. In addition, in view of the Hire of plant and machinery 0 0 current economic climate and the falling values of Other operating lease rentals 1,346 973 property, the Trust also instructed the Valuation TOTAL 1,346 973 Office to undertake an interim valuation of other land and building assets. The result of these valuations was to reduce the overall value of Trust 4.3.2 Annual commitments under non-cancellable land and building assets by £30,595k. £6,700k operating leases are: of this reduction was charged to the Income and Expenditure Account in 2008/09. The balance of the Land and Other revaluation was charged to balance sheet reserves. Buildings Leases As at 31st March 2009 £000 £000 Depreciation and Amortisation Operating leases which expire: Within 1 year 0 83 This figure includes £2,797k for accelerated depreciation related to assets that will be Between 1 and 5 years 115 563 transferred to the Trust’s PFI partner Consort to After 5 years 549 95 an agreed timetable for demolition as part of the TOTAL 664 741 hospital redevelopment. Land and Other Buildings Leases As at 31st March 2008 £000 £000 Operating leases which expire: Within 1 year 0 199 Between 1 and 5 years 0 393 After 5 years 326 101 TOTAL 326 693
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 83 5 Staff Costs and Numbers
5.1 Staff Costs 5.2 Average Number of Persons Employed Year to Year to Year to Year to 31st March 31st March 31st March 31st March 2009 2008 2009 2008 £000 £000 Number Number Salaries and wages 140,985 128,869 Medical and dental 511 503 Social Security costs 9,880 9,319 Administration and estates 924 858 Employer contributions to NHSPA 14,935 13,775 Healthcare assistants and other 835 801 Agency / contract staff 7,782 5,582 support staff Nursing, midwifery and health 1,441 1,397 TOTAL 173,582 157,545 visiting staff Nursing, midwifery and health 7 12 The salaries and wages costs exclude those for Non visiting learners Executive Directors’ remuneration. Scientific, therapeutic and 438 423 In 2008/9, the Trust paid £14,935k in contributions to technical staff employees pension costs. In 2007/08, this total was Bank and agency staff 179 165 £13,775k. TOTAL 4,335 4,159
The numbers shown above are Full Time Equivalent values.
5.3 Retirements Due to Ill-Health During the period there were 7 (2007/08 - 4) early retirements from the Trust which were agreed on the grounds of ill-health. The estimated additional pensions liability of these ill-health retirements will be £328k (2007/08 - £424k).
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 84 5.4 Salary and Pension Entitlements of Senior Managers
A) Remuneration for the year to 31st March 2009
Salary Bands Other Remuneration Benefits in Kind of £5000 Bands of £5000 Rounded to the Nearest £100 Name and Title £000 £000 £ S. Waldek Medical Director 175-180 25-30 100 D.N. Dalton Chief Executive 215-220 0 10,100 T.A. Whitfield Director of Finance and Deputy Chief Executive 145-150 0 6,000 E. Inglesby Executive Nurse 125-130 0 5,600 S.H.G. Neville Director of Strategy and Development 125-130 0 6,000 D.P. Wood Director of Organisational Development and Corporate Affairs 80-85 0 4,300 M.A. Morris Chair to 30th June 2008 10-15 0 100 J.J. Potter Non-Executive Member and Chair from 1st July 2008 35-40 0 900 K. Perera Non-Executive Member 10-15 0 900 D.G. Thompson Non-Executive Member 10-15 0 0 H. Forster Non-Executive Member 10-15 0 0 M. Halsall Non-Executive Member 10-15 0 0 J. Willis Non-Executive Member 10-15 0 400 D. Brown Non-Executive Member 0-5 0 0
D P Wood - was appointed as a Director from 23rd June 2008 D Brown - was appointed as a Non Executive Member from 1st January 2009 M A Morris - resigned as Chair and Non Executive Member on 30th June 2008 J J Potter - was appointed as Chair from 1st July 2008
Benefits in kind were for lease car allowance, business mileage and telephone allowances.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 85 5.4 Salary and Pension Entitlements of Senior Managers (continued)
Remuneration for the year to 31st March 2008
Salary Bands Other Remuneration Benefits in Kind of £5000 Bands of £5000 Rounded to the Nearest £100 Name and Title £000 £000 £ S. Waldek Medical Director 170-175 25-30 0 D.N. Dalton Chief Executive 195-200 0 9,600 T.A. Whitfield Director of Finance and Deputy Chief Executive 135-140 0 5,000 E. Inglesby Executive Nurse 120-125 0 0 S.H.G. Neville Director of Strategy and Development 115-120 0 8,200 R.K. Jain Director of Organisational Development and Corporate Affairs 115-120 0 6,700 M.A. Morris Chair 40-45 0 0 J.J. Potter Non-Executive Member 10-15 0 0 K. Perera Non-Executive Member 10-15 0 0 D.G. Thompson Non-Executive Member 10-15 0 0 H. Forster Non-Executive Member 10-15 0 0 M. Halsall Non-Executive Member 10-15 0 0 J. Willis Non-Executive Member 0-5 0 0
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 86 5.4 Salary and Pension Entitlements of Senior Managers (continued)
B) Pension Benefits for the year to 31st March 2009
Real Real Increase Total Accrued Lump Sum at Cash Cash Real Employers Increase in in Pension Pension at Age 60 Related Equivalent Equivalent Increase Contribution Pension at Lump Sum Age 60 at to Accrued Transfer Transfer in Cash to Age 60 at Age 60 31st March Pension as at Value at Value at Equivalent Stakeholder 2009 31st March 2009 31st March 31st March Transfer Pension 2009 2008 Value (Bands of (Bands of (Bands of (Bands of £2500) £2500) £5000) £5000) To Nearest Name and Title £000 £000 £000 £000 £000 £000 £000 £100 S. Waldek 2-2.5 5-7.5 70-75 220-225 N/A N/A N/A N/A Medical Director D.N. Dalton 5-7.5 20-22.5 70-75 215-220 1,170 913 234 0 Chief Executive T.A. Whitfield 10-12.5 15-17.5 50-55 155-160 1,054 717 319 0 Director of Finance and Deputy Chief Executive E. Inglesby 2.5-5 12.5-15 45-50 135-140 854 597 243 0 Executive Nurse S.H.G. Neville 2.5-5 10-12.5 35-40 110-115 654 452 191 0 Director of Strategy and Development D.P. Wood 2.5-5 10-12.5 35-40 115-120 670 467 191 0 Director of Organisational Development and Corporate Affairs
As Non-Executive members do not receive pensionable remuneration, there are no entries in respect of pensions for Non-Executive members. A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any contingent spouse’s pension payable from the scheme. A CETV is a payment made by a pension scheme, or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which the disclosure applies. The CETV figures and other pension details, include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries. Real Increase in CETV - This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another pension scheme or arrangement) and uses common market valuation factors for the start and end of the period.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 87 B) Pension Benefits for the year to 31st March 2008
Real Real Increase Total Accrued Lump Sum at Cash Cash Real Employers Increase in in Pension Pension at Age 60 Related Equivalent Equivalent Increase Contribution Pension at Lump Sum Age 60 at to Accrued Transfer Transfer in Cash to Age 60 at Age 60 31st March Pension as at Value at Value at Equivalent Stakeholder 2008 31st March 2008 31st March 31st March Transfer Pension 2008 2007 Value (Bands of (Bands of (Bands of (Bands of £2500) £2500) £5000) £5000) To Nearest Name and Title £000 £000 £000 £000 £000 £000 £000 £100 Stephen Waldek 5-7.5 15-17.5 70-75 205-210 N/A N/A N/A N/A Medical Director D.N. Dalton 7.5-10 22.5-25 60-65 190-195 913 759 135 0 Chief Executive T.A. Whitfield 2.5-5 17.5-20 45-50 135-140 717 587 115 0 Director of Finance E. Inglesby 2.5-5 12.5-15 40-45 120-125 597 503 81 0 Executive Nurse S.H.G. Neville 2.5-5 10-12.5 30-35 95-100 452 379 63 0 Director of Strategy and Development R.K. Jain 2-2.5 5-7.5 15-20 55-60 254 210 39 0 Director of Organisational Development and Corporate Affairs
David N Dalton, Chief Executive Date: 3 June 2009
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 88 6 Better Payment Practice Code 7 Disposal of Fixed Assets
The Trust disposed of a number of fixed assets 6.1 Better Payment Practice Code - Measure of Compliance during the year. The total net book value of the assets that were disposed amounted to £64k. The For the Year to 31st March 2009 Number £000 total loss on disposal was also £64k which has been Total non-NHS trade invoices paid 73,275 117,248 reported in the Income and Expenditure Account. in the period Total non-NHS trade invoices paid 68,428 109,125 within target Percentage of non-NHS trade 93% 93% invoices paid within target
Total non-NHS trade invoices paid 3,762 40,661 in the period Total non-NHS trade invoices paid 3,660 38,152 within target Percentage of non-NHS trade 97% 94% invoices paid within target
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.
For the Year to 31st March 2008 Number £000 Total non-NHS trade invoices paid 66,367 114,895 in the period Total non-NHS trade invoices paid 60,612 109,704 within target Percentage of non-NHS trade 91% 95% invoices paid within target
Total non-NHS trade invoices paid 3,084 36,371 in the period Total non-NHS trade invoices paid 3,017 34,144 within target Percentage of non-NHS trade 98% 94% invoices paid within target
6.2 The Late Payment of Commercial Debts (Interest) Act 1998 During the period there were no claims for interest, made against the Trust, under the above Legislation.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 89 8 Intangible Fixed Assets
Software Licenses and Development Licenses Trademarks Expenditure Total £000 £000 £000 £000 Gross cost at 1st April 2008 3,456 4 0 3,460 Impairments 0 0 0 0 Reclassifications 0 0 0 0 Other revaluation 0 0 0 0 Additions purchased 0 0 223 223 Additions donated 0 0 0 0 Disposals (11) 0 0 (11) Gross cost at 31st March 2009 3,445 4 223 3,672 Amortisation at 1st April 2008 1,574 0 0 1,574 Provided during the year 465 0 0 465 Impairments 0 0 0 0 Reversal of impairments 0 0 0 0 Reclassification 0 0 0 0 Other revaluation 0 0 0 0 Disposals (11) 0 0 (11) Amortisation at 31st March 2009 2,028 0 0 2,028 Net book value Purchased at 1st April 2008 1,859 4 0 1,863 Donated at 1st April 2008 23 0 0 23 Total at 1st April 2008 1,882 4 0 1,886 Purchased at 31st March 2009 1,400 4 223 1,627 Donated at 31st March 2009 17 0 0 17 Total at 31st March 2009 1,417 4 223 1,644
Development expenditure relates to the North West e-Health Project which is funded by a grant from the North West Development Agency, which will amount to £5m over a four-year period. The North West e-Health Project is a collaboration between the Trust, Salford PCT and the University of Manchester which aims to deliver a series of “e-laboratories” across the NHS in the North West that will use Project developed analytical tools to enable clinical research and to support optimal delivery of patient care. As this project is a collaboration, the Trust reports its ‘fair share’ of the North West e-Health asset in the annual accounts which, in 2008/09 is a one-third share.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 90 9 Tangible Fixed Assets
9.1 Tangible Fixed Assets at the Balance Sheet Date Comprise the Following Elements: Buildings Assets Inform- Furniture Excluding Under Plant and Transport ation and Land Dwellings Dwellings Construction Machinery Equipment Technology Fittings Total £000 £000 £000 £000 £000 £000 £000 £000 £000 Cost or valuation at 1st April 2008 32,381 104,947 490 11,827 32,612 86 3,719 415 186,477 Additions purchased 0 9,245 0 5,538 2,844 3 227 36 17,893 Additions donated 0 0 0 0 23 0 0 0 23 Impairments (14,381) (9,473) 0 0 (41) 0 0 0 (23,895) Reclassifications 0 15,406 0 (16,039) 210 0 321 102 0 Other in period revaluation 0 16 0 0 850 2 0 11 879 Disposals 0 (2,699) (490) 0 (4,113) (21) (126) 0 (7,449) Cost or valuation at 18,000 117,442 0 1,326 32,385 70 4,141 564 173,928 31st March 2009 Depreciation at 1st April 2008 0 0 0 0 19,377 25 2,175 80 21,657 Provided during the year 0 6,064 490 0 3,119 13 617 55 10,359 Impairments 0 6,700 0 0 0 0 0 0 6,700 Reversal of impairments 0 0 0 0 0 0 0 0 0 Reclassifications 0 0 0 0 0 0 0 0 0 Other in period revaluation 0 0 0 0 505 0 0 2 507 Disposals 0 (2,689) (490) 0 (4,059) (21) (126) 0 (7,385) Depreciation at 31st March 2009 0 10,075 0 0 18,942 17 2,666 137 31,838
Net book value Purchased at 1st April 2008 32,381 97,774 490 11,827 12,932 61 1,538 307 157,310 Donated at 1st April 2008 0 7,173 0 0 303 0 6 28 7,510 Total at 1st April 2008 32,381 104,947 490 11,827 13,235 61 1,544 335 164,820 Purchased at 31st March 2009 18,000 100,950 0 1,326 13,205 53 1,471 402 135,407 Donated at 31st March 2009 0 6,417 0 0 238 0 4 25 6,683 Total at 31st March 2009 18,000 107,367 0 1,326 13,443 53 1,475 427 142,090
As at 31st March 2009 the Trust had no land, buildings or dwellings valued at open market values.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 91 9.2 Net Book Value of Land, Buildings and Dwellings 31st March 31st March 2009 2008 £000 £000 Freehold 125,367 137,818
9.3 Protected and Unprotected Tangible Fixed Assets Arrests Under Land Buildings Construction Equipment Total £000 £000 £000 £000 £000 Protected tangible assets - as at 31st March 2008 32,381 95,389 0 0 127,770 Unprotected tangible assets - as at 31st March 2008 0 10,048 11,827 15,175 37,050 32,381 105,437 11,827 15,175 164,820 Protected tangible assets - as at 31st March 2009 18,000 86,072 0 0 104,072 Unprotected tangible assets - as at 31st March 2009 0 21,295 1,326 15,397 38,018 18,000 107,367 1,326 15,397 142,090
10 Stocks and Works in Progress
31st March 31st March 2009 2008 £000 £000 Raw materials and consumables 2,959 2,367
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 92 11 Debtors 13 Creditors
31st March 31st March 31st March 31st March 2009 2008 2009 2008 £000 £000 £000 £000 Amounts falling due within one Amounts falling due within one year: year: NHS debtors 12,079 13,197 Payments received on account 192 498 Provision for impaired debtors (789) (1,179) NHS creditors 3,993 5,978 Prepayments and accrued income 959 4,854 Tax and social security costs 3,424 3,244 Other debtors 4,269 5,091 Capital 1,350 1,503 Sub Total 16,518 21,963 Other creditors 16,994 16,034 Accruals and deferred income 7,645 4,483 Amounts falling due after more than one year: TOTAL 33,598 31,740 Other debtors 1,632 1,038 Other creditors include: Provision for impaired debtors (258) 0 £1,281k of employers pensions contributions as at 31st Sub Total 1,374 1,038 March 2009 (2007/08 - £1,176k). TOTAL 17,892 23,001
12 Investments
12.1 Current Asset Investments National Short Term Loans Money Fund Market Total £000 £000 £000 Balance as at 1st April 0 25,000 25,000 2008 Additions 103,500 228,000 331,500 Disposals (103,500) (253,000) (356,500) Balance as at 31st 0 0 0 March 2009
The Board of Directors has agreed that in view of the current economic climate and recent losses experienced by the public sector from investing in financial institutions that have been in difficulty, Trust operating cash would be retained in government bank accounts. This arrangement began in October 2008 and continued to be Trust practice to 31st March 2009 and beyond.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 93 14 Provisions for Liabilities and Charges 15 Prudential Borrowing Limit
Legal The Trust is required to comply and remain within a Claims Other Total prudential borrowing limit. This is made up of two £000 £000 £000 elements: At 1st April 2008 251 5,931 6,182 a. the maximum cumulative amount of long- Arising during the period 1 741 742 term borrowing. This is set by reference to the Utilised during the period 0 (101) (101) five ratio tests set out in Monitor’s Prudential Reversed unused 0 (1,349) (1,349) Borrowing Code. The financial risk rating Unwinding of discount 0 56 56 set under Monitor’s Compliance Framework determines one of the ratios (Maximum Debt / At 31st March 2009 252 5,278 5,530 Capital Ratio) and therefore can impact on the Expected timing of level of allowed long term borrowing. cashflows: Within one year 76 126 202 b. the amount of any working capital facility Between one and five years 176 3,357 3,533 approved by Monitor. After five years 0 1,795 1,795 Further information on the NHS Foundation At 31st March 2009 252 5,278 5,530 Trust’s Prudential Borrowing Code and Compliance Analysis: Framework can be found on the website of Monitor, Employers / Public Liability 252 the Independent Regulator of Foundation Trusts. Injury Benefit 2,551 The Trust has a prudential borrowing limit of Non clinical claims 2,727 £55,300k. The Trust has not yet borrowed against this limit. Provisions are liabilities that are of uncertain timing The Trust has £20,000k of approved working capital or amounts which the Trust expects to be settled by facility. The Trust has not drawn down any of this a transfer of economic benefits. Provisions for legal facility during the year. claims are based on information suplied by the NHS Litigation Authority. The Trust has made a provision for other claims based on information provided by Actual professional advisers. Ratios Limits 2008/09 2008/09 The Trust has estimated the impact of the full value of claims made relating to past events but only Prudential Borrowing Code Financial Ratios included a provision for that part that it considers to Maximum Debt / Capital Ratio n/a <25% be most likely to be settled. The Trust has included a contingent liability where the transfer of economic Minimum Dividend Cover 3.0 > 1x benefit is possible (see note 21). Minimum Interest Cover n/a > 3x Minimum Debt Service Cover n/a > 2x £16,747k (2007/08 - £18,668k) is included in the Maximum Debt Service to Revenue n/a < 3% provisions of the NHS Litigation Authority at For the Year to 31st March 2008 31st March 2009 in respect of clinical negligence liabilities of the Trust. Maximum Debt / Capital Ratio n/a <25% Minimum Dividend Cover 3.8 > 1x Minimum Interest Cover n/a > 3x Minimum Debt Service Cover n/a > 2x Maximum Debt Service to Revenue n/a < 3%
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 94 16 Movements on Reserves
Movements on reserves in the period comprised the following:
Income and Revaluation Donated Expenditure Reserve Asset Reserve Reserve Total £000 £000 £000 £000
At 1st April 2008 66,646 7,533 (1,333) 72,846 Transfer from the income and expenditure account 0 0 (5,874) (5,874) Fixed asset impairments (a) (23,345) (550) 0 (23,895) Surplus on revaluations of fixed assets (b) 364 8 0 372 Transfer of realised profits/(losses) to the Income and (57) 0 0 (57) Expenditure Reserve Receipt of donated assets 0 23 0 23 Transfers to the Income and Expenditure Account for 0 (314) 0 (314) depreciation, impairment, and disposal of donated assets Other transfers between reserves (250) 0 307 57
At 31st March 2009 43,358 6,700 (6,900) 43,158
During 2008/09 an interim valuation of Trust land and building assets was undertaken by the Valuation Office as outlined in note 4.2 on page 83. The total downward valuation of assets amounted to £30,595k with £23,895k charged to reserves. a. Downward valuations of fixed assets where the asset has an exisiting revalaution reserve balance are charged against the revaluation reserve until the reserve is used. Any remaining balance of the downward valuation is then charged to operating expenditure. b. The result of all upward revaluations are shown here. This note also shows the impact of applying indexation to the net book value of non-land and building fixed assets. The impact of downward valuations of land and building assets with no revaluation reserve balance are charged as operating expenses amounting to £6,700k - see note 4.1 on page 82.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 95 17 Notes to the Cash Flow Statement
17.1 Reconciliation of operating surplus to net cash flow from operating activities: Year to Year to 31st March 31st March 2009 2008 £000 £000 Total operating surplus (1,346) (8,666) Depreciation and amortisation 10,824 8,313 charge Fixed asset impairments 6,700 19,225 Transfer from donated asset reserve (314) (312) Increase in stocks (592) (252) Decrease in debtors 5,109 (12,222) Increase in creditors 2,011 1,848 Decrease in provisions (677) 1,090 Net cash inflow from operating 21,715 9,024 activities
17.2 Reconciliation of net cash flow to movement in net funds Year to Year to 31st March 31st March 2009 2008 £000 £000 Increase in cash in the year 26,967 3,921 Cash inflow from decrease in (25,000) (4,000) liquid resources Change in net debt resulting from 1,967 (79) cashflows Net funds at 1 April 2008 30,006 30,085 Net funds at 31 March 2009 31,973 30,006
18 Analysis of Changes in Net Debt
At Cash Non-Cash At 1st April Changes Changes 31st March 2008 in Year in Year 2009 £000 £000 £000 £000 OPG cash at bank 4,488 27,207 0 31,695 Commercial cash at bank and in hand 518 (240) 0 278 Current asset investments 25,000 (25,000) 0 0 TOTAL 30,006 1,967 0 31,973
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 96 19 Capital Commitments 22 Movement in Taxpayers Equity
Commitments under capital expenditure contracts at £000 31 March 2009 were £2,312k (2007/08 - £4,405k). Taxpayers equity as at 1st April 2008 184,158 Surplus after taxation for the period 36 Public dividend capital dividends (5,910) 20 Post Balance Sheet Events Fixed asset impairments charged to the (23,895) Statement of Recognised Gains and Losses There are no post balance sheet events having a Surplus on revaluations of fixed assets and 372 material effect on the accounts. current asset investments Public dividend capital received 2,960 Public dividend capital repaid 0 21 Contingencies Reductions in donated assets reserve (291) Taxpayers equity as at 31st March 2009 157,430 At At 31st March 31st March 2009 2008 £000 £000 23 Movement in Public Dividend Capital Contingent liabilities (gross value) 1,536 1,309 Amounts recoverable against 0 0 £000 contingent liabilities Public Dividend Capital as at 1st April 2008 111,312 Net value of contigent liabilities 1,536 1,309 Public Dividend Capital received in the 2,960 period Analysis: Employers and Public Liability Claims 90 97 Public Dividend Capital as at 31st March 2009 114,272 Non clinical claims 1,446 1,212 TOTAL 1,536 1,309
See also Provisions - Note 14. 24 Public Dividend Capital The Trust is required to pay a dividend to the Department of Health at a rate of 3.5% of average relevant net assets. The rate is calculated as the percentage that dividends paid on public dividend capital, (for the period 1st April 2008 to 31st March 2009) totalling £5,910k bears to the average relevant net assets of £145,048k that is 4.1%.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 97 25 Related Party Transactions
Salford Royal NHS Foundation Trust is a public interest body authorised by Monitor - the Independent Regulator for NHS Foundation Trusts. The Department of Health is regarded as a related party. During the year Salford Royal NHS Foundation Trust has had a significant number of material transactions with the Department, and with other entities for which the Department is regarded as the parent Department including Primary Care Trusts, the NHS Litigation Authority and NHS Professionals. Certain members of the Board of Directors, key members of staff (or parties related to them) and members of the Council of Governors have connections with organisations which also have transactions with the Trust. These organisations are listed below:
Debtor Creditor Organsisation Income Expenditure Balance Balance £000 £000 £000 £000 Advanced Life Support Group 0 2 0 0 City of Salford 140 1,394 0 5 E C Harris 0 565 0 0 G E Health 0 358 0 162 Genzyme UK Limited 33 2,854 0 0 Johnson & Johnson 0 1,109 0 14 Medicines and Healthcare products Regulatory Agency 0 5 0 0 Medtronic 0 915 0 5 Motor Neurone Disease Association 54 0 16 0 Resusitation Council 0 3 0 0 Shire Pharmaceuticals 0 243 0 0 UNISON 4 105 0 0 University of Manchester 729 2,317 49 304 University of Salford 94 83 0 3 TOTAL 1,054 9,952 65 492
The Trust has a related charity (Salford Royal NHS Foundation Trust - Charitable Funds) to which it made an administrative charge of £35k during the year. The Trust also makes purchases and pays for research staff on behalf of the charity, these amounted to £410k during the year. The charity owed the Trust £61k as at 31st March 2009 for goods and services provided but not yet paid.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 98 26 Private Finance Transactions
26.1 PFI Schemes Deemed to be Off-balance Sheet
Year to Year to Year to Year to 31st March 31st March 31st March 31st March A. The Maples 2009 2008 B. Hospital Redevelopment 2009 2008 £000 £000 £000 £000 Amounts included within 332 326 Amounts included within 0 0 operating expenses in respect of operating expenses in respect of PFI transactions deemed to be off- PFI transactions deemed to be off- balance sheet - gross balance sheet - gross Amortisation of PFI deferred asset 0 0 Amortisation of PFI deferred asset 0 0 Net charge to operating expenses 332 326 Net charge to operating expenses 0 0 The Trust is committed to make The Trust is committed to make the following payments during the the following payments during the next year. next year. 16th to 20th years (inclusive) 332 333 31st to 35th years (inclusive) 6,230 0 Estimated capital value of the PFI 960 960 Estimated capital value of the PFI 136,619 scheme scheme Contract Start date : March 2000 Contract Start date : September 2007 Contract End date : March 2025 Contract End date : June 2042
The scheme is for the provision of clinical The scheme is for the re-provision of clinical and accommodation for patients with acute neuro non-clinical accommodation. rehabilitation requirements. There are no The Trust is not required to make any payments for guarantees, obligations or other rights associated this scheme in 2008/09. with the scheme. There are no deferred assets or residual interests associated with the PFI transaction. Discussions are ongoing with Salford PCT for the 26.2 PFI schemes deemed to be on-balance sheet potential transfer of The Maples PFI scheme from The Trust has no PFI schemes deemed to be on- the Trust to the PCT in 2009/10. balance sheet.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 99 27 Financial Instruments FRS 13, Derivatives and Other Financial Instruments, 27.1 Financial Assets requires disclosure of the role that financial instruments have had during the period in creating or Loans and Held to Denominated in £ Sterling Total Receivables Maturity changing the risks an entity faces in undertaking its activities. Because of the continuing service provider £000 £000 £000 relationship that the NHS Foundation Trust has with At 31st March 2009 local Primary Care Trusts and the way those Primary NHS debtors 12,079 12,079 0 Care Trusts are financed, the NHS Foundation Trust Provision for impaired (1,047) (1,047) 0 is not exposed to the degree of financial risk faced debt by business entities. Also financial instruments play Other debtors 5,901 5,901 0 a much more limited role in creating or changing Current asset 0 0 0 investments risk than would be typical of the listed companies to Cash at bank and in 31,973 31,973 0 which FRS 13 mainly applies. The NHS Foundation hand Trust has a cap on its borrowing limit and has an Gross financial assets 48,906 48,906 0 investment policy to mimimise risk relating to the investment of surplus operating cash. At 31st March 2008 NHS debtors 13,197 13,197 0 As allowed by FRS 13, debtors and creditors that are Provision for impaired (1,179) (1,179) 0 due to mature or become payable within 12 months debt from the balance sheet date have been omitted Accrued income 4,854 4,854 0 from all disclosures other than the currency profile. Other debtors 6,129 6,129 0 Provisions are shown gross. Any amount expected in Current asset 25,000 0 25,000 reimbursement against a provision (and included in investments debtors) is separately disclosed. Cash at bank and in 5,006 5,006 0 hand The Treasury has concluded that PDC is not a Gross financial assets 53,007 28,007 25,000 financial instrument.
Liquidity Risk 27.2 Financial Liabilities The NHS Trust’s net operating costs are incurred Other Financial under annual service agreements with local Primary Denominated in £ Sterling Liabilities Care Trusts, which are financed from resources £000 voted annually by Parliament. Salford Royal NHS Foundation Trust is not, therefore, exposed to At 31st March 2009 significant liquidity risks. NHS creditors 3,993 Other creditors 16,994 Accruals 4,191 Interest-Rate Risk Capital creditors 1,350 All of the Trust’s financial assets carry floating or fixed Provisions 5,530 rates of interest. All current asset investments are Gross financial liabilities 32,058 subject to a fixed rate of interest for the period of At 31st March 2008 investment. Salford Royal NHS Foundation Trust is not, NHS creditors 5,978 therefore, exposed to significant interest-rate risk. Other creditors 16,034 Accruals 4,483 Foreign Currency Risk Capital creditors 1,503 The Trust has no foreign currency income or Provisions 6,182 expenditure. Gross financial liabilities 34,180
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 100 27.3 Fair Values Set out below is a comparison, by category, of book values and fair values of the Trust’s financial assets, defined by Treasury guidance, as at 31st March 2009.
As at 31st March 2009 As at 31st March 2008 Book Value Fair Value Book Value Fair Value Financial Assets £000 £000 £000 £000 Cash 31,973 31,973 5,006 5,006 Investments 0 0 25,000 25,000 Debtors over 1 year 1,374 1,374 1,038 1,038 TOTAL 33,347 33,347 31,044 31,044 Financial Liabilities The Trust has no financial liabilities that are to be disclosed under this note. 28 Third Party Assets The Trust held £19k cash at bank and in hand at 31st March 2009 which relates to monies held by the Trust on behalf of patients. This has been excluded from the cash at bank and in hand figure reported in the accounts.
29 Intra-Government and Other Balances Debtors: Amounts Debtors: Amounts Creditors: Amounts Creditors: Amounts Falling Due Within Falling Due After More Falling Due Within Falling Due After More One Year Than One Year One Year Than One Year £000 £000 £000 £000 English NHS Foundation Trusts 1,811 0 670 0 English NHS Trusts 244 0 184 0 Department of Health 125 0 130 0 English Strategic Health Authorities 4,724 0 2 0 English Primary Care Trusts 5,136 0 2,078 0 RAB Special Authorities 39 0 611 0 NHS CGA bodies 0 0 0 0 NHS WGA bodies 0 0 318 0 Total NHS bodies 12,079 0 3,993 0 Other WGA bodies 1,604 0 4,707 0 At 31st March 2009 13,683 0 8,700 0 30 Losses and Special Payments There were 114 cases of losses and special payments totalling £191k paid during the year to 31st March 2009. Losses and Special Payments are actual cash payments made within the year and are not calculated on an accruals basis. 31 Auditors Liability There is no specified limitation in the Trust’s contract with its external auditors, the Audit Commission, that provides for limitation of the auditor’s liability.
Salford Royal NHS Foundation Trust - Annual Report and Accounts April 2008 to March 2009 101 Salford Royal NHS Foundation Trust Tel: 0161 789 7373 Stott Lane Fax: 0161 206 4809 Salford, M6 8HD Email: [email protected] www.srft.nhs.uk
Unique Identifier : Issue Number : One. Review Date : 2010
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