Blackpool, Fylde and Wyre Hospitals
B
ANNUAL REPORT ANNUAL REPORT AND SUMMARY OF ACCOUNTS 2006/07 contents
02 Review of the Year by the Chairman 04 Review of the Year by the Chief Executive 06 Trust Vision 12 Trust Profile 18 Trust Performance 24 Divisional Achievements 62 Strategy for the Future Delivery of Health Care on the Fylde Coast 64 Foundation Trust Application 67 The Trust Board 77 Trust Compliance
Contained within the fold-out finance section: Audit Report; Remuneration Report; Financial Review; Summary Financial Statements; Auditors Report. REVIEW OF THE YEAR BY THE CHAIRMAN
My review of the year must begin by thanking and congratulating everyone working in the Trust for the extremely mature and thoughtful way they have tackled the forecast deficit of £24m. When this was first revealed in April 2006 it seemed absolutely impossible to achieve. It was the choice of our clinicians and staff to do it in one year, rather than two which is the norm. Our financial constraints actually became a positive force for change and were fully embraced by everyone. Divisions began to examine what they did, how they did it and how things could be done differently. This resulted not only in achievement of our aim but enormous improvement in patient care as set out in the Chief Executive’s report. I sincerely thank everyone for their incredible hard work.
02 Another In the Healthcare Commission ratings tremendous we received “fair” for financial benefit to patients, management and “good” for quality not only on the of services. This was a pleasing result Fylde Coast but but we are ambitious and aim to also in South achieve an “excellent” rating in both Cumbria and categories in time. Lancashire, was the We aim to be among the top 10 opening of the Lancashire Cardiac hospitals in the UK - and in some Centre in April 2006. This is going areas we are - but we seek to achieve from strength to strength and we this in all areas. Achieving Foundation intend that the unit will be a national Trust status will assist us to reach our centre of excellence in cardiac goal. services. I have no hesitation in commending We also opened a state-of-the-art Day this Annual Report to you and to say Surgery Unit. This is now in full swing to our community that we should be and we are carrying out many more the hospital of choice for you. procedures as day cases, which patients clearly prefer. The unit has played a critical part in enabling us to Beverly Lester improve length of stay and reduce our Chairman costs. Again thanks are due to everyone involved.
03 REVIEW OF THE YEAR BY THE CHIEF EXECUTIVE
Looking back to where we were at the beginning of the year and where we are now, it is quite staggering to see all that has been achieved. I would firstly like to thank every member of staff for their magnificent efforts over the past 12 months in what has been the most challenging year in the Trust’s history.
In April 2006 we faced the prospect of and protection of surgical in-patient a £24m gap between income and beds has reduced the length of time expenditure. This represented around patients stay in hospital, significantly 12% of our total turnover. We drew reduced cancelled operations and up a radical series of cost reduction saved valuable resources. By running programmes, which were challenging our services more efficiently, it means and difficult to implement. These we now need fewer beds so we have involved tough decisions and caused been able to successfully reduce the great anxiety to staff. One of the most overall number of beds across the impressive outcomes of the year’s Trust by more than 200. This has also work has been the way that staff have meant that we have needed fewer responded to the challenge to look at staff and we have successfully ways to make savings through clinical redeployed more than 400 staff into services being more efficient and vacant posts. responsive. For example, the reduction
04 Not only has the Trusts nationally selected to deliver agenda been about the 18 weeks maximum waiting time cost reduction, we by December 2007 – a year earlier have also made a than planned. series of Looking to the future, we have an improvements to exciting but challenging time ahead as patient services. The we prepare for Foundation Trust new Lancashire Cardiac Centre and status, which gives every staff member Day Surgery Unit offer our patients the chance to become a member of modern, well-equipped environments the Trust and influence its and enable us to provide more development. effective care. In addition, a number of our clinical teams, supported by The on-going implementation of The effective management, have Blackpool Way is vital in order to demonstrated our ability to deliver improve the levels of job satisfaction improvements to patient care – and effective management across our shorter waiting times and significantly Trust. Our future success depends fewer cancellations whilst improving entirely on your continuing our efficiency. commitment, dedication and talent in giving our patients the best possible There have been many similar care. achievements in a wide range of areas, which are highlighted in the Thank you for your efforts in 2006/07 pages of this Annual Report, that and your continued commitment to show it is possible to deliver both high the Trust as we aim to achieve even quality and cost effective services for greater success in 2007/08. our patients. We have also reduced waiting times in Julian Hartley all areas and we are one of only 12 Chief Executive
05 TRUST VISION
In April 2006 we launched our Trust’s Vision and Values. The four pillars of our Vision are supported by detailed strategic and operational plans. The development of the Trust’s Vision has been a participative process led by the Chief Executive involving more than 400 staff at all levels in the organisation. Support for the Vision was also received from our partner organisations at our fortnightly Joint Strategy Development Meetings.
06 OUR VISION
To offer ‘best in NHS’ care for our patients
To be the first choice for the residents of the Fylde Coast and beyond
To offer outstanding value for money for the taxpayer
To be a great place to work
OUR VALUES
We put patients at the heart of what we do
We respect each other and prize teamwork
We put our customers’ needs first
We praise more than blame
We have a ‘can do’ attitude
We embrace change for the better
We communicate, communicate, communicate
07 TRUST VISION
08 Trust Vision - Progress Towards Realisation
GOALS ACHIEVEMENTS PLANS
Offer the ‘best in This goal is measured by The Trust plans to achieve 18 NHS’ care for our achieving top 10% weeks target by December patients. performance across the NHS 2007 with support of for all Key Performance Blackpool PCT and North Indicators (KPIs). The Trust is Lancashire PCT. We plan to already in the top 10% for reduce maximum A&E waits to waiting list size, A&E 4 hour three hours from four by target, and MRSA target December 2007 also. We aim achievement. We have been to achieve an ‘excellent’ rating selected as one of 18 national for quality of service in the sites to achieve 18 weeks wait next Annual Health Check. by December 2007. Achieved Lengths of stay and day case ‘good’ for quality in the 05/06 rates are planned to reach top Annual Health Check and 3 10% performance by Star rating in 03/04 and 04/05. September 2007. Lengths of stay have been reduced from among longest in NHS to CHKS Peer average. We are one of the cleanest hospitals in the NHS with top 10% PEAT ratings.
09 GOALS ACHIEVEMENTS PLANS
Be the first choice Opening of new £52m The Trust needs to improve its for the residents of Lancashire Cardiac Centre and responsiveness to referrers, the Fylde Coast Day Surgery Unit in spring particularly discharge and beyond. 2006 has enabled us to provide communication. A plan to state of the art facilities and tackle this is currently being environment for patients. New implemented. The Trust has minimally invasive surgical set a target of 10% increase in techniques for heart patients market share from key ward place us at the forefront of areas. The Trust is innovation across a Regional implementing a marketing footprint. Our performance and communications strategy against KPIs, particularly for to increase its profile and access, put us in a strong reach with referring practices position locally and regionally. and Practice Based Commissioners (PBC). Patient satisfaction needs to increase further and the Board has approved a plan to take us to top 10% performance by April 2008.
10 GOALS ACHIEVEMENTS PLANS
Offer outstanding The Trust’s Reference Cost Delivery of the 2007/2008 cost value for money Index has improved from 110 improvement programme will for the taxpayer. in 04/05 to 88 in 05/06. The enable the Trust to generate a Trust has reduced its recurrent surplus at the end of 07/08 cost base by £17m to date. with further, larger surpluses Lengths of stay have reduced in 08/09 and 09/10. We are significantly and, consequently, developing ‘service line bed numbers have been reporting’ with help from reduced by 227. Clinical Ernst & Young to develop a productivity has increased with more commercial approach a reduction in the total cost and support clinical divisions per spell from £2,609 in 04/5 to to operate as ‘business units’. £2,247 in 06/7.
Be a great place to The Trust offers a full range of The Trust is currently work. flexible working options for implementing a far reaching staff including an on-site Organisational Development nursery and on-site leisure Programme called The club. We have achieved both Blackpool Way. Details of this Improving Working Lives and project are outlined on page Investors in People. However, 60 of the Annual Report. staff feedback indicates we have much work to do to improve staff morale, motivation and engagement.
11 TRUST PROFILE
12 TRUST PROFILE
The Blackpool, Fylde and Wyre The key features of the Trust in Hospitals NHS Trust was established on 2006/07 are as follows: 1st April 2002 following the merger of Blackpool Victoria Hospital NHS Trust • Income in excess of £200m. and Blackpool, Wyre and Fylde Community Health Services NHS Trust. • Employment of approximately 4,000 staff. The Trust comprises Blackpool Victoria Hospital, which is the main District • Treatment of 56,938 in-patients and General Hospital for the Fylde Coast, day case patients. and five other community hospitals, as • Treatment of 252,053 out-patients. well as the National Artificial Eye Service and the Blackpool Child • 91,446 accident and emergency Development Centre. attendances. The Trust serves a population of • 2,959 births. approximately 330,000 residents of • Total bed complement of 834. Blackpool, Fylde and Wyre and approximately 12m holidaymakers • Regional Centre for Cardiac Services. who visit the area every year. • Recognised Cancer Unit.
13 Location Map of Blackpool, Fylde and Wyre
14 The Trust provides a comprehensive The Trust manages all the hospital range of services to the population of sites on the Fylde Coast as follows:- the Fylde Coast which include:- • Victoria Hospital – 612 beds • 24 Hour Accident and Emergency • Bispham Hospital – 40 beds Facilities • Clifton Hospital – 102 beds • Anaesthetics • Rossall Hospital – 40 beds • Cardiac • Wesham Hospital – 40 beds • Child Health • Fleetwood Hospital – out-patient • General Medicine, including Elderly and diagnostic services Care • Acute Medicine Other services include:- • Specialist Medicine • General Surgery and Urology • Blackpool Child Development Centre • Ear, Nose and Throat Surgery • National Artificial Eye Service • Ophthalmology • Poulton Office • Oral Surgery • Orthopaedics • Gynaecology • Intensive, High Dependency and Coronary Care • Maternity Services • Support Services for diagnosis and treatment including Pathology, X-Ray, Physiotherapy, Occupational Therapy and Specialist Nurses
15 A description of services on the Trust’s hospital sites is given below:-
A description of services on the Trust’s underlying emphasis on rehabilitation hospital sites is given below:- with the ultimate aim of maximising the social, physical, psychological, Victoria Hospital is a large acute emotional and spiritual well being of hospital that treats in-patients, day its patients. A purpose designed Renal cases and out-patients from across Unit opened in May 2005 to replace Blackpool, Fylde and Wyre. The the renal services previously provided Accident and Emergency Department at Devonshire Road Hospital. In is one of the busiest in the country addition, a new combined with more than 91,000 attendances rheumatology and dermatology unit during 2006/07. It provides a wide was opened on the site in January range of services from maternity to 2007. care of the elderly, and from cancer services to heart surgery and is one of Fleetwood Hospital is a community four tertiary centres in the North West unit that serves residents from Wyre that provides specialist Cardiac and surrounding areas. There is an Services to patients from Lancashire Out-Patient Department which houses and South Cumbria, a catchment seven consulting suites, one of which population of 1.6m. A purpose built has been adapted for audiology use Day Surgery Unit opened in April 2006 and diagnostic radiology services on and a new £52m Cardiac Centre the site. opened in April 2006. Rossall and Wesham Hospital Clifton Hospital is a community unit Rehabilitation Units are purpose-built that provides sub-acute and fast- units that provide rehabilitation, stream in-patient care for older recovery and continuing care services people, rehabilitation and respite care to older people from across the Fylde for the disabled and an active out- Coast. Rossall also provides day patient service. The hospital has an hospital facilities, which includes the
16 provision of a Falls Service for the but operates nationwide. Fylde Coast. Approximately 30,000 patients are treated each year and approximately The Nurse Led Ward was transferred to 1,000 new patients are referred each the Bispham Hospital Rehabilitation year. There are more than 70 clinics in Unit in May 2006, increasing the England and the service provides on- number of nurse-led beds available going aftercare and maintenance for from 20 to 40. The Unit provides nurse approximately 40,000 patients led rehabilitation, recovery and throughout the country. continuing care services to older people from across the Fylde Coast. Poulton Office is based at Furness Drive, Poulton, and includes Trust staff Blenheim House is a Child from various administrative Development and Family Support departments, for example Centre for children across Blackpool, Management Accounts, Payroll, Wyre and Fylde who have physical or Recruitment and Information learning needs. The Centre forms part Management and Technology. of the Trust’s Child Health Department. It aims to provide assessment, on- Following a public consultation, going intervention and family support “Improving Patient Care”, which took for pre-school children in a friendly place from June to September 2006, a and informal environment. There are number of changes to the Trust’s seven consultant clinics each month infrastructure have taken place. These and a genetics clinic and paediatric include vacating the Lytham and South neurology clinic every three months. In Shore Hospital sites to make way for addition, orthoptic clinics take place as Primary Care Centre developments and required. completion of the Trust’s long term strategy of vacating the Devonshire The National Artificial Eye Service is Road Hospital site. managed and controlled by the Trust
17 TRUST PERFORMANCE
18 TRUST PERFORMANCE
One of the key measures of performance for Health Care organisations, and their patients, is the Healthcare Commission Annual Health Check, which is published nationally. The table sets out each of the key areas surveyed and details the Trust’s performance for 2005/2006.
Target Trust Level of Performance Maximum waiting time of one month from diagnosis to treatment 100% for all cancers by December 2005. Achieved
Maximum waiting time of two months from urgent referral to 95% treatment for all cancers by December 2005. Achieved
Two week maximum wait from urgent GP referral to first 100% out-patient appointment for all urgent suspected cancer referrals. Achieved
From April 2002 all patients who have operations cancelled for Underachieved non-clinical reasons to be offered another binding date within 28 days or fund the patient’s treatment at the time and hospital of the patient’s choice.
Ensure that by the end of 2005 every hospital appointment will be 100% booked for the convenience of the patient, making it easier for Achieved the patients and their GPs to choose a hospital and consultant that best meets their needs. By December 2005, patients will be able to choose from at least four different healthcare providers for planned hospital care, paid for by the NHS (Convenience and Choice - provider information in place to support choice).
19 Target Trust Level of Performance
Delayed transfers of care to reduce to a minimal level by 2006. Achieved
Maximum wait of 26 weeks for in-patients. 100% Achieved
Maximum wait of 13 weeks for an out-patient appointment. 100% Achieved
Three month maximum wait for revascularisation (open heart 100% surgery) by March 2005. Achieved
10 percentage point increase per year in the proportion of people 100% suffering from a heart attack who receive thrombolysis within 60 Achieved minutes of calling for professional help.
Four hour maximum wait in A&E from arrival to admission, transfer 99% or discharge. Achieved
Maximum two-week wait standard for Rapid Access Chest Pain 100% Clinics. Achieved
20 The one area where the Trust failed to achieve the required level of performance was the re-admission of patients to hospital who had had their operation cancelled. In response to this, more robust management arrangements have been introduced for patients who have had their operations cancelled at short notice. This has resulted in cancelled operations due to ward bed shortages reducing from 126 during the period April 2005 to January 2006, to three for the same period in 2006/07. In addition, measures are in place to ensure that patients who require re-admission to hospital are given a date within 28 days of the cancellation.
During the year the Trust delivered key patient access targets three months ahead of schedule and continued to maintain access targets in other areas as set out below:
Waiting Times Target Mar-07
Out-Patients No patient waiting over 10 Achieved & Maintained weeks for first out-patient appointment (Local Target)
Elective In-Patients & Day No patient waiting over 20 Achieved & Maintained Cases weeks (Local Target)
Revascularisation Surgery No patient waiting over 3 Maintained within Cardiac Services months
Cataract Surgery within No patient waiting over 3 Maintained Ophthalmology months
21 Waiting Times Target Mar-07
Diagnostics Maximum waiting time of Achieved 13 weeks for diagnostics (excluding Nuclear Medicine).
Cancer 1) Maintain a 2-week 100% maximum wait from urgent GP referral to first out-patient appointment for 100% of urgent suspected cancer referrals. 2) A maximum waiting 97% time of two months (62 days) from urgent referral to treatment for 95% of patients diagnosed with cancer from December 2005.
3) A maximum waiting 100% time of one month (31 days) from diagnosis to treatment for 98% of patients diagnosed with cancer from December 2005.
22 Trust’ s Financial Performance
At the start of the financial year 10% cost reduction in clinical 2006/07 the Trust faced the prospect departments and 12.5% in corporate of a £24m gap between income and areas. These plans were wide ranging expenditure. At over 12% of our across the whole organisation and turnover this represented a significant included bed reductions of 250, potential debt that threatened the reductions in headcount of around viability of both individual services 400 and rationalisation of services and the Trust as a whole. from Lytham, Devonshire Road and South Shore Hospitals. In many areas, We had originally planned to manage as highlighted in the clinical Divisional this over a two year period, however, reviews, cost reduction has been the NHS financial rules at the time achieved by making clinical services would have resulted in a ‘doubling up’ more efficient and responsive. of any deficit and potentially increased the problem year on year. As a result of these processes the Trust After lengthy internal debate it was delivered £19.1m of cost agreed that the Trust would plan to improvements and recovered an deliver the savings required in one additional £4m of income from better year. recording of clinical activity. The Trust has now started 2007/08 in recurrent To achieve this the Trust developed a financial balance. number of cost improvement initiatives with an overall target of
23 Divisional Achievements Women’ s and Children’ s Division
24 Women’ S and Children’ s Division
Children’ s Assessment Unit
We were delighted to open a new Children’s Assessment Area on the Children’s Ward at Blackpool Victoria Hospital in January 2007. The area has been created for children who need urgent assessment and comprises a three-bedded observation bay, three treatment cubicles and an open play area. The unit is open from 8.30 am - 9.00 pm, Monday to Friday. Children who The unit is staffed by specialist need medical investigations can be paediatric nurses and doctors who can referred directly to the unit by their carry out any necessary tests, such as GP, via the admitting Senior House x-rays and blood tests and Officer, or from the Accident and observations. As well as providing a Emergency Department. more child-friendly environment for young patients, the assessment area Dr Kate Goldberg, Consultant aims to reduce any unnecessary Paediatrician, said: “Being in hospital admissions to hospital. can be distressing, particularly for children and their parents. We want to make sure that their visit to
25 hospital is as pleasant as possible and that they do not have to stay in any longer than is necessary. “In the A&E Department there is a section for children but it is very small and there is no observation area. Previously children would often have to be admitted to the children’s wards so that they could be observed for a few hours when sometimes this was not necessary. This will make a huge difference to families.” CNST Level 1 “I truly feel the staff on the Special Care The Maternity Services Department Baby Unit were always there for any questions or problems. Without them I was proud to achieve CNST (Clinical would have found my first weeks at Negligence Scheme for Trusts) Level 1 home very difficult – they have all in 2006 and at the end of the financial gone out of their way to help me year the department was well on its when I’ve needed advice.” way to achieving CNST Level 2. This Sarah Tomlinson, Thornton Cleveleys. recognises the importance that the Trust places in reducing risk and improving patient safety.
26 A team working on behalf of the NHS Litigation Authority visited the Improved Care for department to interview staff, review paper documentation and protocols Diabetic Mums-to-be and ensure all risk management systems had been implemented A number of developments have led properly. The Trust received a glowing to improved care for pregnant women report. with diabetes. The Division appointed Alison Leyland as the first Diabetic Dr Mary Johnson, Divisional Director Specialist Midwife whose role is to for Women’s and Children’s Health, ensure women are better supported said: “This is a fantastic achievement throughout pregnancy. Linked to this and recognises all the hard work that appointment was the launch of a new staff from within the Women’s and one-stop clinic which gives diabetic Children’s Division and Clinical women access to a high level of Governance Department have put in. specialist care and reduces the number We are totally committed to of hospital appointments they need. minimising risk, improving patient safety and delivering high quality Pregnant women can now see their care.” Consultant Physician, Consultant Obstetrician, Diabetes Specialist Midwife, Diabetes Specialist Nurse, Dietician and even have a scan in just one appointment. Historically the patient may have needed four separate appointments all in the same week.
27 Neonatal Outreach One Stop Uro- Team Gynaecology Clinic
The Neonatal Outreach Team had Women with bladder problems are cause for celebration when they benefiting from a new one-stop clinic scooped a national award for the which has not only reduced the time work they do with premature babies they wait for appointments but also and their families. The team was reduced the amount of appointments nominated in the Community Team of they need. the Year category of the National Patients can now see an Uro- BLISS Baby Charter Awards and won Gynaecology Consultant, a runner up prize. Gynaecology Nurse Practitioner, a The Neonatal Outreach Team makes Physiotherapist and have any home visits to babies who are born investigative procedures carried out less than 36-weeks into pregnancy and during one appointment. Patients can have on-going nursing needs. They also be listed for theatre directly from offer guidance and support for the clinic if required. Prior to the clinic families if their baby is dependent on being developed the patient may have oxygen, or they need extra help with needed four separate appointments, feeding, such as mums who are tube each with their own waiting list. feeding or breastfeeding smaller babies.
28 Two New Consultants
The Division has appointed two new consultants. Miss June Davies joined the Trust as a Consultant Obstetrician and Gynaecologist. She is the first female consultant to join this specialty. Dr Kate Goldberg joined the paediatric team as Consultant Paediatrician. The department also said farewell to Consultant Obstetrician, Mr Bedford, who retired after 25 years at Victoria Hospital.
“I cannot speak highly enough of every member of the team on Ward D. Thank you all sincerely for the care, attention and continued reassurance during my stay. Nothing was ever too much trouble and everything was done with a smile.” Mary Higgins, Thornton Cleveleys.
29 Divisional Achievements Medical division
30 Medical Division
Opening of New Rheumatology/ Dermatology Unit Dermatology and rheumatology patients are now receiving their care in bright and spacious facilities in a new purpose-built unit at Clifton Hospital. The new £1m unit replaces rheumatology services previously provided at South Shore Hospital and delighted with the new unit. The dermatology services previously standard of accommodation is far provided at Devonshire Road Hospital. better here than what patients have The centre has 12-in-patient beds, an had previously. Devonshire Road is an out-patient suite, a meeting room and old hospital and dermatology was a phototherapy suite providing housed in an open ward. The new specialist light therapy treatment for development has single or double patients with skin conditions, such as rooms with en-suite facilities, which psoriasis and eczema. will mean better privacy for patients and the risk of infection will be Dr John Kellett, Consultant greatly reduced.” Dermatologist, said: “We are
31 Stroke Unit/Early Support Discharge Team
Stroke patients across the Fylde Coast are benefiting from a new dedicated Combined Stroke Unit at Blackpool Victoria Hospital.
Previously, stroke patients were Supported Discharge Team (ESDT), admitted to the Acute Stroke Unit at who work with patients on the ward Victoria Hospital for their first phase and at home following discharge. The of treatment and transferred to multi-disciplinary team includes a Clifton Hospital Gloucester Unit for Stroke Co-Ordinator, Physiotherapist, their second phase of rehabilitation. Speech and Language Therapist and Now stroke patients receive all of Occupational Therapist. their treatment and rehabilitation from the dedicated Combined Stroke Dr James McIlmoyle, Consultant in Unit. Stroke Medicine, said the development of the new unit was The unit is supported by an Early great news for staff and patients.
32 He said: “The biggest benefit is that patients can now start their DVD Haematology rehabilitation early, which is critical in Staff and patients at Victoria Hospital helping them to achieve maximum have produced a DVD to educate recovery.” patients undergoing chemotherapy The new 31-bedded unit has 4 four- about the warning signs of bedded bays and 15 single rooms with neutropenic sepsis. The condition can en suite facilities, a gym and a kitchen be potentially fatal if the symptoms where occupational therapists work are not picked up early. The aim of with patients to regain their the DVD is to educate patients about independence in daily activity for what to look out for so that they can when they leave hospital. seek help early and recover quicker.
“The kindness, caring, patience and “Thank you to the staff on the dedication shown – not only to me but Rehabilitation Unit at Rossall Hospital to all patients on Ward 19 - are a fine for the kindness in making my Dad’s example of excellence and teamwork.” final weeks more bearable.” John Gower, Poulton-le-Fylde. Doreen Robinson, Worsley.
33 and given an appointment to come Reduced Length of back for their test. This is better for Stay the patient and frees up beds. By being more efficient we have been Work has been on-going to ensure able to reduce the overall length of patients do not have to spend any stay, meaning the division now needs unnecessary time in hospital. A fewer medical beds. number of initiatives have been brought in including the introduction Introduction of of seven-day discharging. In the past patients who have been fit to go Short Stay Ward home over the weekend would have A short-stay ward opened at Victoria had to wait until Monday until a Hospital in July 2006 for patients with doctor had declared them medically medical conditions that require a fit for discharge. hospital stay of no longer than 72 Other schemes include Fit for hours. This has enabled the division to Discharge where patients who are focus on actively managing those only waiting for tests to be done (such patients with an anticipated short as a CT scan) can be discharged home length of stay.
34 Gastro Waiting Development of Out- Times Fall of-Hours GI Bleed
Patients are benefiting from shorter Service waiting times for gastroenterology procedures. During the past 12 A new on-call rota has been set up months, waiting times for colonoscopy with the Consultant and gastroscopy have fallen from nine Gastroenterologists to provide a months to six weeks and the waiting service for patients who present to A time for flexible sigmoidoscopy is now & E with severe upper GI bleeding just one week. This is the result of a out-of-hours. The Trust is one of the massive team effort from staff across first in the North West to develop such the department. An additional a service. consultant and associate specialist have been appointed to support the service.
35 Divisional Achievements Surgical division
36 Surgical Division
Opening of Day Surgery Unit
A new £5.7m Day Surgery Unit opened at Victoria Hospital in April 2006. The new multi-million pound facilities have enabled the Division to increase the number and types of procedures carried out as day cases. This means more patients are able to have their surgery and go home the same day without the need for an overnight stay in hospital. The unit also provides a much-improved environment for staff and patients. The Trust was delighted to welcome world famous Manchester United boss Sir Alex Ferguson to officially open the new day case facility in October.
37 Having all the post-surgery patients in Opening of Surgical one place means that we can cater for High Care Unit their needs more effectively and also take the pressure off other wards.” Patients recovering from surgery at Victoria Hospital are benefiting from As the unit only takes post-operative the development of a new and patients, nursing staff do not have the pioneering Surgical High Care Unit. same volume of paperwork as normal Higher staffing levels ensure patients wards that deal with admissions. This are given more intensive nursing care. means that nursing staff can dedicate It is hoped that the presence of the more time to patient care. new unit will free up beds on the High Dependency Unit for patients with the greatest need, such as cancer Transfer of patients. Orthopaedics from Matron of the new Unit, Maggie South Shore Hospital Doughty, said: “We are not intending this unit to be a replacement for Orthopaedic patients are now being Higher Dependency but we recognise treated under one roof thanks to new that the recovery of some patients spacious facilities which opened at would be helped by being more Victoria Hospital in February 2007. closely monitored. It is a really exciting development for all concerned. The unit, which includes a day case
38 In addition, day case patients previously treated on our Day Surgery Unit for minor operations are now being treated in the Orthopaedic Unit meaning dedicated Orthopaedic staff are nearby to supervise the care of their patients more closely. The space freed up in the Day Surgery Unit will also have a beneficial impact on waiting times in other specialties. ward, two new operating theatres Orthopaedic Matron Marjorie Holden and a 20 bedded ward area, replaces said: “Staff are delighted with the facilities on the South Shore Hospital new facilities; they are lovely and site. bright and the response from patients and their visitors has been very Patients who would previously have positive. It is better to have our been treated at South Shore now whole Orthopaedic Team working benefit from the reassurance of together; not only can we give more having all the facilities of an acute specialised care to our patients but it hospital at their disposal. This includes also gives us greater opportunity for an Intensive Care and High training.” Dependency Unit in case they need more specialised care after their operation.
39 Opening of Surgical One-Stop Nurse Led Assessment Unit Cataract Services
A new 24-hour Surgical Assessment Cataract patients are now being seen Unit opened at Victoria Hospital in quicker and have fewer trips to August 2006. A specialist area has hospital, thanks to the introduction of been created on Ward 7 where nurse-led cataract clinics. When patients who are referred by their GP consultants receive referrals from GPs or from A&E are surgically assessed by or opticians they identify which cases a dedicated doctor. If the patient they consider to be straight forward needs to be admitted to hospital the and refer them direct to the nurse-led doctor will admit them to the short- clinic. The nurses examine the patients stay ward on Ward 7 or to a more and do their pre-operative checks appropriate ward depending on their before listing them for surgery – specialist needs. Some patients are meaning they don’t have to wait for a able to be assessed, go home, and further out-patient appointment with come back on a later date for surgery, a doctor. This reduces waiting times which is much better for the patient and cuts down the number of hospital and frees up hospital beds. Between appointments patients need. August 2006 and March 2007 the unit saw 2,050 patients, of which 1,800 were admitted and 250 were discharged.
40 “Thank you to everyone on Ward 6 for Diabetes Eye your attention and help. You are all so Screening wonderful – please stay as you are!” Joyce Brent, Lytham. The Diabetes Eye Screening team is now offering annual screening for diabetic patients. Previously patients “A huge and grateful thank you to were only invited for screening every everyone involved in making my stay two years. Now, thanks to funding on Ward 6 so pleasant. Your readiness from the Primary Care Trust for to help me in any way, your lovely additional staff, patients can attend sense of humour, genuine warmth and once a year. It is vital that diabetic friendly words have meant a great patients are screened regularly so that deal to me.” any complications can be picked up Jeff Chambers, Wesham. early and treatment can be started.
41 Divisional Achievements Cardiac division
42 Cardiac Division
New 52m Lancashire Cardiac Centre
The Lancashire Cardiac Centre opened its doors to its first patients in April 2006. The £52m unit, which is the biggest development Victoria Hospital has seen in its history, provides state- of-the-art cardiac care to heart patients across South Cumbria and The Cardiac Unit also houses an Lancashire. Education Centre featuring a lecture The Trust was delighted to welcome theatre, seminar rooms, a research His Royal Highness the Duke of laboratory and library which can be Gloucester to the hospital in October used by medical and nursing staff 2006 to officially open the new unit. from across the Trust to keep them up-to-date with the latest technology The unit’s high tech facilities include and techniques. 15 critical care beds, three operating theatres and three cardiac catheter The centre is kitted out with the most- laboratories (both with capacity to up-to-date equipment and is staffed expand to five), around 90 in-patient by experienced, dedicated clinicians and day case beds, x-ray facilities and who can offer complete cardiac care an out-patient department. from diagnosis to treatment from the one location.
43 New Equipment for Ultrasound Images of the Heart
Cardiac Anaesthetists at the Lancashire Cardiac Centre can now produce detailed images of the heart during surgery after completing a specialist qualification in Texas, USA. surgery, giving them and the surgeons Consultants Carl Humphries, Andy a detailed view of the structure and Knowles and Chris Rozario are movement of the whole of the heart. amongst only a small number of This enables surgeons to make Cardiac Anaesthetists in the UK to decisions prior to, during and after gain the Certificate of Special surgery. Competence in Perioperative Transoesophageal Echocardiography The operating theatres at the new (TOE). They join Cardiac Anaesthetists £52m Lancashire Cardiac Centre have Mike Hartley and Noel Gavin who been kitted out with high-tech TOE completed the course last year. equipment at a cost of £70,000 each and are now able to offer this state- TOE involves the anaesthetist inserting of-the-art service to patients. an ultrasound probe down the patient’s oesophageas during heart
44 Minimal Access Appointment of Five Valve Surgery Visiting Consultant
The Division continued to develop Cardiologists minimal access surgery this year with the introduction of minimal access Patients waiting for coronary valve surgery. The benefit to patients interventions such as angioplasties or is that the procedure involves less stents are benefiting from shorter surgical trauma, patients recover more waiting times. Five visiting Consultant quickly, and they spend less time in Cardiologists, three from Preston and hospital. The Division is also two from Blackburn, now spend one developing a new technique for day a week carrying out procedures in minimal access vein harvesting for Lancashire Cardiac Centre’s catheter bypass surgery. laboratories. This has helped us to maximise capacity in the catheter laboratories and reduce waiting times “I would like to express heartfelt thanks for patients across Lancashire and for the excellent, prompt emergency South Cumbria. treatment my cousin received on the Coronary Care Unit. There is no doubt that the early emergency treatment he received saved his life.” Brian Kay, Blackpool.
45 Waiting Times Plans to Introduce Fall for Primary Angioplasty
Echocardiography At the end of March 2007 the Division was preparing for the introduction of Staff in the echocardiography a new technique for treating heart department have been working attack patients. From June, patients extremely hard to tackle waiting times who are admitted as emergencies for echocardiography. At the after suffering a heart attack will be beginning of April 2006 patients were given an angioplasty. The technique waiting up to 20 weeks. Now, thanks involves a small cylindrical tube called to changes in the way the department a stent being inserted in the artery works, together with funding from and has a 25 per cent higher success Blackpool PCT for an additional rate than current treatment. The locum, waiting times have fallen to service will operate from 9am–5pm just two weeks. initially but will be rolled out to a 24- hour service later in the year.
46 “The staff on the Cardiac Day Care Ward went out of their way to make New Coronary Care me feel comfortable and reassured in Unit a spotlessly clean environment and in all aspects of a procedure which not At the end of March 2007 the Division having gone through before I was very was preparing for the transfer of the grateful for. Whilst I obviously hope I Coronary Care Unit from the main will never have to return to any Victoria site to the Lancashire Cardiac hospital – if I have to, and have any Centre, bringing together all cardiac choice in the matter, I will have far services under one roof. fewer fears being re-admitted to your facility.” Paul Hayden, Morecambe.
47 Divisional Achievements Clinical Support division
48 One-Stop Dispensing
The Pharmacy Department has piloted a one-stop dispensing service on seven wards at Victoria Hospital. The pilot has been extremely successful and has helped to reduce delays in patients being discharged from hospital and reduced the volume of medication that is wasted. Louise Sadler, Senior Pharmacy Technician, said: “When patients were admitted to a ward, the staff would use the ward stock for medication and anything that wasn’t available on the ward, Pharmacy would give a 14 day supply for that patient. When it was time for the patient to be discharged, Pharmacy would dispense another supply of medication for the patient to take home. This was duplicating work in Pharmacy and was creating waste.”
49 “Now we have dedicated Pharmacy Technicians on the wards. They visit Aseptic Unit the patients when they are admitted Work is well underway on a £500,000 to look at what medication they have refurbishment of the Aseptic Unit. and if the technician thinks it This is in preparation for when the appropriate the patient’s own Trust becomes a Tertiary Haematology medicine is used. Pharmacy then Unit later this year. Haematology dispenses whatever other medication the patient needs to last them patients will be referred to Blackpool throughout their hospital stay and from all over Lancashire and Cumbria when they leave hospital. This means for the initial stages of their that we dispense drugs once and chemotherapy. This means that the there is no delay in the patients being workload within the Aseptic Unit is discharged while they are waiting for likely to triple. The Trust has invested their medication to be dispensed. This £500,000 to allow a full refurbishment benefits the ward staff, the Pharmacy of the existing facilities. The facilities staff but most importantly the will include a new air-handling unit patient.” and dedicated ultra clean rooms and isolator cabinets for the preparation The Division will be rolling the system of sterile medicines. The suite has four out to other wards later this year. isolate rooms (two for chemotherapy and two for a Central Intravenous “What wonderful care I have received Additive Service (CIVAS)) and total from all the staff in the Pathology Lab. parental nutrition. The doctors, nurses and clerical staff are very efficient workers, delivering their care with kindness and understanding. I certainly appreciate the standard of care which has enabled my general health to improve.” Sheila Sharratt, Thornton Cleveleys.
50 A&E Performance
Patients needing treatment at Blackpool’s Accident and Emergency Department are benefiting from shorter waiting times. Staff have worked tirelessly to ensure patients are seen, treated and either admitted or discharged as quickly as possible. The department has consistently exceeded the Government target of 98% and is amongst the top performing Trusts in the country. Nigel Kidner, A & E Consultant, said: “This is a fantastic achievement and is down to the hard work and commitment of staff, not only in A & E but throughout the whole hospital. It has been a huge team effort and staff should be proud of the progress they have made in cutting waiting “To the staff on the Accident and times and improving the experience of Emergency Department… Never have patients attending our A & E I felt so humbled. Thanks to your Department.” skill, dedication and amazing caring abilities, I am alive to write this card. Blackpool has one of the busiest A & E I owe you all an immense dept.” departments in the country with more Doreen Robinson, Worsley. than 91,000 attendances last year.
51 thrombosis and strokes. Patients who International use the drug need to be monitored Recognition for ADAS regularly to ensure that the medication is keeping their blood at a Service suitable consistency. Fifteen clinics are held each week around the Fylde Fylde patients who require regular coast conducting over 70,000 blood blood tests are needing fewer tests a year. appointments and their treatment is more stable, thanks to the work of Urgent Care Centre the Anti-Coagulant Dosing Advisory Service. The department has been Plans are underway to develop an recognised in an international report, Urgent Care Centre at Victoria which compared the performance of Hospital, bringing together the its service with that of 81 others existing A&E and GP out-of-hours worldwide. The Blackpool service service under one roof. This is a joint received special recognition for its venture across the whole of the health success in stabilising the treatment of economy, which will improve access patients who use warfarin. for patients needing unplanned Around 4,500 patients on the Fylde treatment and will reduce Coast use warfarin (a blood thinning inappropriate admissions to hospital. drug) which reduces the risk of
52 Reduction in Radiography Led Waiting Times for Reporting
MRI Scans Radiographer reporting was introduced to the Trust over six years The Radiology Directorate has ago and has continued to develop developed a tele-radiology service in during the year. More than 30,000 conjunction with Eurad Consult, a radiographs are reported in this way Belgian group of Radiologists, for the allowing for a timely and quality reporting of MRI scans. This assured review of plain films. An audit partnership has enabled around 900 of radiographer reporting has shown patients awaiting a routine MRI combined report variances to be investigation to have their scan, which significantly better (2%) than the otherwise would not have been target gold standard for Radiologists possible. It allows for MRI sessions to (3%). be held flexibly to suit the needs of patients and radiographers. Daily multi-disciplinary meetings are held in A&E to discuss any missed At the end of March 2007 the fractures/pathology that require maximum waiting time for a routine further treatment and management. MRI scan was 15 weeks with the More than 500 patients per year see majority of patients being seen in less their treatment improve following this than 10 weeks. process.
53 Social and Community Services
54 Social and Community Services
The Trust takes its responsibilities of working with the local community seriously. Initiatives relating to the progression of this agenda include:
• The Trust has over 480 volunteers • The Trust is a member of the from a variety of organisations who Blackpool Compact Agreement provide invaluable and much together with the local voluntary appreciated services to patients. sector, Blackpool Primary Care Trust, The Trust has employed a Voluntary Police, Fire Service, Social Services Services Manager to further and Blackpool Council. The aim of enhance and develop our the Compact is to clarify the relationship with this important relationship between Public sector of the community. All our Organisations and the Community volunteers are supported by a full Voluntary Sector by recognising the induction programme and training sector’s desire for greater security, opportunities. the organisation’s desire for genuine accountability and the user’s desire for the delivery of good quality services.
55 • Working relationships with the local • The Trust has developed a Patients Forum is extremely positive. partnership with the Grange Park Forum members are involved in Residents Association. Youngsters many of the Trust’s Committees and from the area have taken part in a have provided input to monitoring photography taster course, bulb the quality of the Trust’s services in planting and litter clean-up several areas. campaigns within the hospital grounds.
• Members of the Executive Team • In preparation for our application regularly attend meetings of the for Foundation Trust status, the Lancashire and Blackpool Overview Trust has actively engaged with and Scrutiny Committees to explain members of the public within our to their members the rational for catchment areas to develop a robust service reconfigurations, membership. developments, etc.
56 57 ORGANISATIONAL DEVELOPMENT AND STAFF ENGAGEMENT
58 Organisational Development and Staff Engagement
The Trust Board is firmly of the view The Blackpool Way will involve: that if the organisation is to flourish in the long term, then this will be • Developing a fully engaged achieved by fully harnessing the workforce where individuals and potential of our staff. The changing teams have greater influence and environment in which the NHS is autonomy in driving the Trust operating means that the traditional towards best in class performance. top-down approach to management • Charging managers with achieving and operational performance can only the Trust’s objectives through an achieve limited results. All of our staff inspired and motivated workforce. need to feel they have a role to play Management success will be in the development of high quality measured in future not only by cost-effective services to patients. This results but by how those results are in turn will ensure the on-going obtained. success of the Trust. It is recognised that to achieve our goal of being • Introducing a policy deployment amongst the top 10% of Trusts we approach where management need to put in place an organisational ensures that local priorities match development programme that will the overall imperatives and change the way in which we operate. performance measures of the This has led to the introduction of organisation. ‘The Blackpool Way’.
59 This will be achieved by: • Recognition and acknowledgement of good work. • A much more structured programme • Creation of action teams and focus of communication with staff. groups to deliver continuous • Changing the way in which improvement. managers manage, so that • Development of standards of managers listen, share and consult behaviour expected by the more and display a positive Blackpool Person and Blackpool demeanour. Manager.
An action plan has been developed to deliver the above changes.
60 Working In Partnership During the last 12 months the Trust has continued to work with healthcare partners, as set out below, to deliver its strategy and contribute to whole Health Community goals:
Blackpool Primary Care Trust Lancashire Social Services North Lancashire Primary Care Trust Blackpool and Lancashire Overview and Scrutiny Committees Specialist Commissioners Lancashire Care Trust North West Strategic Health Authority Patient Forums Blackpool Social Services Volunteers
61 Strategy for the Future Delivery of Health Care on the Fylde Coast
In June 2006, a three-month public • Further enhance community and consultation was held entitled home-based services for people with “Improving Patient Care”. This set out long term conditions such as the proposed joint vision for future asthma, diabetes and coronary heart health services across the Fylde Coast disease. as follows: • Provide more out-patient and • Expand the provision of high quality diagnostic services such as x-rays, community and primary health care ultrasounds and MRI scans, in the with some new purpose-built health community. premises. • Transfer some services out of the Community Hospitals and provide them in different ways, in response to the changing health needs of the population. • Concentrate specialist acute hospital services on the Victoria Hospital site and further develop the hospital as a centre of excellence.
62 Artist Impressions Of The New Primary Care Centre at Lytham
The proposals were widely accepted by the public, particularly the closure of three of the hospital sites; namely Devonshire Road, South Shore and Lytham. The Trust is now working closely with the local health economy to implement the proposals.
63 Foundation Trust Application
Our application for Foundation Trust status was submitted to the Department of Health in February 2007 following a three-month consultation exercise.
The Trust’s aim is to continue to The Trust’s progress during the past provide and develop excellent services year has been significant, particularly and provide high quality care and in the areas of finance, performance treatment. During the next few years, and Board development. However, the Trust will face increasing there is still more to learn, with competition from within and outside identified areas for improvement. the NHS and, as a Foundation Trust, The key reasons for becoming a we will be able to build on our Foundation Trust, and the way the strengths whilst having the flexibility Trust intends to use the freedoms it to meet the challenges. The offers, are set out opposite:- achievement of Foundation Trust Status is, therefore, critical in order for the Trust to continue to develop as the healthcare provider of first choice on the Fylde Coast.
64 Rationale for Foundation Trust Status
Rationale for Foundation Trust Status Benefit Realisation as a Foundation Trust
Community Ownership Our members will provide a critical resource in terms of feedback, regular Establish real and lasting engagement participation in Members’ events, special with our community to inform the interest groups. Responses to development of strategy and services. consultation (579) indicate a promising level of engagement. Our Governors will cement our local accountability and root our planning in a local context.
A Model Corporate Citizen We will use our freedoms to forge strategic partnerships with local Our place as a major local employer in an organisations, particularly education, area of deprivation and badly needed business and regeneration, to increase regeneration provides us with the skill levels in young people and provide opportunity as a Foundation Trust to clinical and non-clinical career provide employment, skills training and opportunities in our Trust. We will use to forge strategic partnerships with our Members and Governors to facilitate other local organisations. these partnerships.
65 Rationale for Foundation Trust Status Benefit Realisation as a Foundation Trust
A Great Place to Work We will use our freedoms to consider additional rewards and incentives for We want to develop deep employee staff, linked to improved performance. engagement as part of ‘The Blackpool Staff Members and volunteer Members Way’ and encourage our staff Members will have the opportunity to act as to influence the future direction of the Governors of the Trust, helping to shape Trust. its future and increase the profile of staff input.
Providing a Better Service We will use the financial freedoms to generate surpluses to consider re- We aim to improve both the range and investment in service and associated quality of health care treatment services capital developments such as:- we provide. The current capital investment regime is slow to translate • New Vascular Laboratory service plans into improved facilities for • Centralised Theatre Suite patients. Foundation Trust status will • New Children’s Centre enable us to act quickly and responsively • New Main Entrance to our patients’ needs. • Staff Development Centre • New Mortuary
Such developments will be important if we are to operate successfully as a patient and customer focused organisation in a dynamic market for healthcare.
66 THE TRUST BOARD
Management Changes
The term of office for two of the Non- Executive Directors, Mr Jim Armfield and Mr Michael Carr, expired in May 2006. The Appointments Commission appointed Mr Peter Hosker and Mr Bill Robinson as their replacement with effect from 1st July 2006. Mr Andrew Foster replaced Mr John Lyons as Director of Human Resources and Organisational Development on 1st May 2006. Mr Foster subsequently resigned from the Trust in January 2007 and will be replaced by Mr Nick Grimshaw in May 2007. Mr Grimshaw was formerly the Director of HR at Tameside and Glossop Acute Services NHS Trust. Dr Paul Kelsey, Consultant Haematologist at the Trust, replaced Dr Peter Hayes, Consultant Physician, as the Trust’s Medical Director on 1st June 2006.
67 Chief Chairman Executive
Director Non- Deputy Director Director Medical of Nursing Finance Executive Chief of HR & of Director and Director Directors Executive OD Facilities Quality
Clinical Financial Planning Personnel Facilities Medical Governance Services Division
Cancer Risk Staff IM&T Estates Services Clinical Management Development Support Booked Services Management Occupational Hotel Chaplaincy Admissions Division Accounts Health Services
Out Patient Surgical Tissue Procurement Payroll Services Division Viability
Medical Complaints Nurse Bank Cardiac Records Division Volunteers Women’s and Children’s PPI Division
68 Trust Board
The following are voting members of the Trust Board:
Beverly Lester (Chairman) appointed in April 2002
Qualification: • Trustee of the Ladies Sick Poor • Qualified Solicitor – LL.B Association • Governor of Carters Primary School Experience and Interests: • Member of the SHA Regional • Former Non-Executive Director of Training Board Blackpool Victoria Hospital • Member of Blackpool Council’s • Former Chairman of Blackpool, Children’s Trust Board Wyre and Fylde Community Health • Member of the Court – University of Services NHS Trust Central Lancashire • Partner at Cooper, Law & Lester • Former Deputy District Judge Solicitors • Trustee of Thornton Horse Club • Part time Deputy District Chairman and Tribunal Chairman for the Tribunals Judiciary (Department for Constitutional Affairs)
69 Paul Olive Chris Breene (Non-Executive Director) (Non-Executive Director) appointed in May 2002 appointed in May 2002
Qualification: Experience and Interests: • Chartered Accountant – • Former Non-Executive Director of Fellow Institute of Chartered the Blackpool, Wyre and Fylde Accountants Community Health Services NHS Trust Experience and Interests: • Former Manager for Marks and Spencer • Former Finance Director of Stanley Leisure plc • Vice Chairman of the Employment Committee for Blackpool, Wyre • Former Non-Executive and Fylde Blind Society Director of Crown Leisure plc • Former Member of the Blackpool • Former Governor of Blackpool Partnership Against Crime Sixth Form College Community Group • Trustee of Age Concern • Former Governor of Blackpool Sixth Form College
70 Michael Peter Hosker Brown (Non-Executive Director) (Non-Executive appointed in Director) July 2006 appointed in March 2004 Qualification: Qualification: • Qualified Solicitor – LL.B (Hons) • Qualified Solicitor – LL.B Experience and Interests: Experience and Interests: • Former Senior Partner at Napthens • Former Chief Executive of Wyre Solicitors Borough Council • Part time Deputy District Chairman • Former Board Member - LAWTEC and Tribunal Chairman for the • Former Board Member - Tribunals Judiciary (Department for Lancashire Learning & Skills Constitutional Affairs) Council • Chairman of the AvenCentral • Former Vice Chairman of Business Regeneration Partnership in Link Lancashire Preston • Former Member of Blackpool and • Select Vestryman of the Churches the Fylde College Governing Body of St John the Evangelist and St • Former Governor of Baines School George the Martyr in Preston. • Chairman of Wyre Housing • Director of The Select Vestry of Association Preston Charity Ltd • Managing Director of Eccleston • Former Trustee of the British Red Services Ltd Cross in Lancashire • Director of Canatxx Gas Storage • Vice Patron of Deafway Ltd • Governor and Trustee and former Chairman of the Kirkham Educational Foundation and Kirkham Grammar School
71 Bill Julian Hartley Robinson (Chief Executive) appointed in (Non-Executive December 2005 Director) appointed in July 2006 Qualifications: Qualification: • Master of Business Administration (MBA) • Chartered Public Finance Accountant – C.P.F.A. • Certificate in Healthcare Marketing Experience and Interests: • Certificate in Managing Health Services • Former Director of Finance at South Ribble Borough Council • Post Graduate Certificate in Education • A Vice President of Lancashire County Cricket Club • BA (Hons) – English Language and Literature • Chairman of the Lancashire Youth Cricket Coaching Experience and Interests: Committee • Former Chief Executive of Tameside • Honorary Treasurer of the and Glossop Primary Care Trust Lancashire Cricket Board • Former Director of Planning and • Trustee of Lancashire County Operations at North Tees and Youth Cricket Trust Hartlepool NHS Trust • Director/Trustee and Honorary • Joined NHS as National Trainee of Company Secretary to the British the NHS General Management Commercial Vehicle Museum Training Scheme Trust • Non Executive Director of Skills for Health • Trustee of National Association of Assistants in Surgical Practice
72 00 Aidan Tim Welch Kehoe (Director of Finance) (Deputy Chief appointed in Executive) August 2005 appointed in April 2004
Qualifications: Qualifications: • Qualified Chartered Accountant • CIPFA CPD Certified – Institute of Chartered • Member CIPFA Accountants (ACA) • BSc (Hons) – Biochemistry • Diploma in Health Service Management (Dip HSM) Experience and Interests: • B.sc (Hons) – Managerial and Administrative Studies • Former Director of Finance at City and Hackney Teaching PCT • Former Deputy Director of Experience and Interests: Finance at City and Hackney • Former Director of Operations Teaching PCT at Blackpool, Fylde and Wyre • Joined NHS as Financial Hospitals NHS Trust Management Trainee • Former Divisional Manager at University Hospital Birmingham NHS Trust • Joined NHS as National Trainee of the NHS General Management Training Scheme
73 00 Mandie Dr Paul Sunderland Kelsey (Director of (Medical Director) Nursing and appointed in June Quality) 2006 appointed in January 2001 Qualifications: • M.B.,B.S. (Hons) – Pathology Qualifications: • MRCP (UK) • Registered General Nurse • MRCPath • MSc Health Professional Practice (Nursing) • Post Graduate Certificate in Experience and Interests: Education (ENB Approved • Consultant Haematologist at Registered Nurse Tutor) Blackpool, Fylde and Wyre Hospitals • BSc Health Care Studies NHS Trust • Diploma in Management • Former Senior Registrar in Haematology – North West Rotational Training Scheme Experience and Interests: • Director of Fylde Pathology Ltd • Former Director of Nursing and Patient Services at Halton General Hospital NHS Trust • Former Nursing Officer for Quality at the NHS Executive, Department of Health
74 00 The following are non-voting members of the Trust Board:
Mike Andrew Gallagher Foster (Director of (Director of Human Facilities) Resources and appointed in July Organisational 1989 Development) appointed in May Qualifications: 2006 • PhD in Environmental Management Qualification: • MSc in Facilities Management • Fellow of the Chartered Institute • Royal Institution of Chartered of Personnel and Development Surveyors (FCIPD) • Chartered Institute of Building
Experience and Interests: Experience and Interests: • Former Workforce Director • Former Director of Facilities at General at the Department of Blackpool Victoria Hospital NHS Health Trust • Director of World Crest Ltd • Director of Estates at Blackpool, • Senior Civil Servant at the Wyre and Fylde Health Authority Department of Health • Deputy Director of Estates at Wigan Health Authority
75 00 Board Development
Following the Trust diagnostic process towards Foundation Trust status early in 2006, the Chairman reviewed would change the way in which the the skills and experience of the Non- Board operated. With this in mind, the Executive Directors to ensure that the induction, training and development composition of the Board was arrangements for Non-Executive appropriate for the challenges ahead. Directors have been updated. It was This review resulted in the also recognised that all Board appointment of two new Non- members would need continuous Executive Directors as existing post- development and, as a result, a series holders reached the end of their term of development days have been held of office. One of the new Non- with a plan to continue these on a Executive Directors has a strong regular basis in the future. These financial background and the other development days have been used to has had a long career in corporate refine our strategic plans and to law. It was also felt that the Trust improve understanding of our internal would benefit from the appointment and external environment. In of an additional Non-Executive particular, key issues around the use Director with experience in marketing of resources and service quality have and communications and the been explored and debated. recruitment process is currently underway. The Trust has also commissioned the services of IMD to provide coaching It was also recognised that the and mentoring services to members of changing financial regime, the Board. competitive environment and move
76 TRUST COMPLIANCE
Department routinely advises on Emergency disability issues and the way in which Preparedness posts can be re-designed to cater for those employees affected by disability. The Trust has in place robust systems in the event of a major incident. The Equality Statement Major Incident Plan is reviewed annually, is regularly tested, and is The Trust has an Equal Opportunities fully compliant with “Handling Major Policy and trains managers in best Incidents: An Operational Doctrine” practice. The Trust has developed a and all other NHS guidance on major Race Equality Scheme and has an incident preparedness and planning. action plan to ensure compliance with legislative changes. Disability Discrimination Act Public Meetings
The Trust has a Policy on the The Trust holds an Annual Public Employment of Disabled Persons and Meeting to discuss the Annual Report has achieved the Two Tick Symbol in and Accounts. The next Annual Public relation to its recruitment practices. Meeting is being held at 6pm on Training and the introduction of E- Thursday September 27th at the De Recruitment have further diminished Vere Hotel, Herons Reach, Blackpool. the chances of discrimination in this area. The Occupational Health Nine Trust Board Meetings have been held in public during 2006/2007.
77 Financial Information
78 During the year 2005/06 the posts of There are no other elements of performance is assessed:- Director of Operations and Director of remuneration such as bonuses or b) By type of • The “Better Payment Practice Code” Planning and Performance were dis- additional pension contributions, with expenditure requires the Trust to pay all valid established and a new post of Deputy the exception of a lease car scheme or variances by a due date, or within 30 Chief Executive was established. This payment for business miles at Whitley days of receipt of the goods or a valid resulted in the redundancy of the Council rates. The Trust’s lease car invoice, whichever is the later. We were former Director of Planning and scheme is available to Executive able to pay 84% of invoices by value Performance. The postholder worked Directors but there are no other within the Government’s prompt his notice period and was made benefits paid to Executive Directors. target. No payments were made during redundant on 31st October 2006. The The remuneration of Non-Executive the year under the Late Payment of postholder received a redundancy Directors is determined by the Commercial Debts (Interest) Act 1998. payment in line with terms and Secretary of State and was £5,673 per conditions of service for NHS staff. In • The Trust restricted the pay inflation of annum from 1st April 2006 with an May 2006 the post of Director of HR its Senior Managers to 2.5%. This increase to £5,800 from 1st November Medicine 16% was dis-established and a new post of figure is in line with the inflation 2006. Director of Human Resources and Finance and Other 16% increase agreed nationally for staff in Organisational Development was The following tables provide details of Facilities 11% 2006/07. Details of Senior Managers created. The Director of HR was made the remuneration and pension benefits Corporate 14% remuneration are given in the previous
redundant and received a termination for senior managers in 2006/07. Clinical Support Service 13% column. payment in line with the guidelines set Women and Children 6% out in the NHS Superannuation • Management costs for the year were £9,083K or 4.2% of the income Scheme and the NHS Terms and Signed ……………….………………… Conditions of Service Handbook. There The Trust spends over 55% of its generated by the Trust. This is in line (Chief Executive) have been no other significant awards resources on staff pay with the largest with the % of income from 2005/06. to senior managers. spend being on nurses. The Trust has a The management and administration Date August 31st 2007 costs are detailed overleaf.
Financial Information higher than average spend on non-pay items and this reflects the high cost of The Trust invested £11,062k in capital the specialist devices and equipment projects during the year, with the main used in our Cardiac Services. Salary and Pension Entitlements of Senior expenditure being incurred on the new Managers The Trust has met its statutory financial Lancashire Cardiac Centre and the Day duties and achieved the following Surgery Unit. Both of these projects results:- were commissioned and formally opened A) Remuneration during 2006/07. • Broke even when comparing income 2006-07 2005-06 and expenditure, and generated a Summarised financial statements are surplus of £1,572k. included on this fold out section of this Salary Other Benefits in Salary Other Benefits in report. The Trust’s financial statements Remuneration Kind Remuneration Kind • Operated within our net cash limit of Name and Title have been prepared in accordance with (bands of (bands of Rounded to (bands of (bands of Rounded to £5,145k. the 2006/07 NHS Trusts Manual for £5000) £5000) the nearest £5000) £5000) the nearest Audit Report Management £000 £000 £100 £000 £000 £100 • Absorbed a 3.4% return on capital Accounts. The accounting policies contained in the Manual follow UK The Trust’s Audit Committee has the assets in our costs. To request and review reports and B Lester - Chairman 20 - 25 20 - 25 Generally Accepted Activity Practice (UK following responsibilities:- positive assurances from directors and J Hartley - Chief Executive 120 - 125 35 - 40 There are a number of other measures GAAP) to the extent that it is managers on the overall arrangements against which the Trust’s financial appropriate for the NHS. for governance, risk management and PR Male - Chief Executive 85-90 Governance, Risk (resigned 30.11.05) internal control. A Kehoe - Deputy Chief 85 - 90 3,000 70 - 75 3,300 Management and To request specific reports from Executive Looking Forward to 2007/08 individual functions within the Internal Control T Welch - Finance Director 95 - 100 60 - 65 The Trust aims to build upon the success of 2006/07 and continue to deliver organisation (eg clinical audit) as TH Evans - Finance 20-25 500 robust financial performance. In conjunction with The Blackpool Way all areas To review the establishment and appropriate to the overall Director (resigned 30.6.05) maintenance of an effective system of arrangements. continue to review their efficiency and develop new ways of working. This PJ Hayes - Medical 5-10 15- 20 35 - 40 105- 110 process will support the Trust’s application to become a Foundation Trust and integrated governance, risk Director (resigned 30 May management and internal control Financial Reporting 06) ensure the on-going future of the Trust’s services. across the whole of the organisation’s P Kelsey - Medical Director 15 - 20 120- 125 In support of developing Divisions as ‘business units’, the Trust will develop in activities (both clinical and non- To review the Annual Report and (appointed 1 June 06) 2007/08 service line reporting. This will support managers to better clinical), that supports the achievement Financial Statements before submission A Sunderland - Director of 90 - 95 6,100 75 - 80 6,100 understand the relationship between the income earned and the cost of of the organisation’s objectives, in to the Board, focusing particularly on:- Nursing and Quality providing services and will support more robust decision-making in the future. particular the adequacy of:- • The wording in the Statement on PJ Dewdney - Director of 75-80 3,900 Planning and Performance • All risk and control related disclosure Internal Control and other disclosures (to 31.1.06) The following Summary Financial Statements are extracted from the 2006/07 relevant to the Terms of Reference of Annual Accounts of the Blackpool, Fylde and Wyre Hospitals NHS Trust. statements (in particular the J Lyons - Director of 35 - 40 80 - 85 Statement on Internal Control and the Committee. Human Resources Information on obtaining a full set of accounts is detailed on the reverse of (resigned 30 June 06) this document. declarations of compliance with the • Changes in, and compliance with, MJ Gallagher - Director of 80 - 85 3,100 80 - 85 3,000 Standards for Better Health), accounting policies and practices. together with any accompanying Facilities Head of Internal Audit statement, • Unadjusted mis-statements in the JC Armfield - Non- 0 - 5 5-10 INCOME AND EXPENDITURE ACCOUNT FOR THE YEAR external audit opinion or other financial statements. Executive (resigned 12 May 06) appropriate independent assurances, ENDED 31 March 2007 • Major judgmental areas. prior to endorsement by the Board. C Breene - Non-Executive 5-10 5-10 • Significant adjustments resulting M Carr - Non-Executive 0 - 5 5-10 2006/07 2005/06 • The underlying assurance processes (resigned 19 May 06) from the audit. NOTE £000 £000 that indicate the degree of the PA Olive - Non-Executive 5-10 5-10 achievement of corporate objectives, To ensure that the systems for financial Income from activities 3 220,816 189,026 M Brown - Non-Executive 5-10 5-10 the effectiveness of the management reporting to the Board, including those Other operating income 4 16,932 16,391 of principal risks and the P Hosker - Non-Executive 0 - 5 of budgetary control, are subject to Operating expenses 5 (229,612) (199,154) appropriateness of the above review as to completeness and (appointed 1 July 06) disclosure statements. accuracy of the information provided WG Robinson - Non- 0 - 5 OPERATING SURPLUS/(DEFICIT) 8,136 6,263 Executive (appointed 1 to the Board. Cost of fundamental reorganisation/restructuring* 0 0 • The policies for ensuring compliance July 06) with relevant regulatory, legal and Profit/(loss) on disposal of fixed assets 8 (11) 0 code of conduct requirements. Other Matters SURPLUS/(DEFICIT) BEFORE INTEREST 8,125 6,263 • The policies and procedures for all The Terms of Reference for the Audit Salary and Pension Entitlements of Senior Interest receivable 466 405 work related to fraud and corruption Committee were reviewed by the Managers Interest payable 9 0 0 as set out in Secretary of State Committee on 5th July 2006 and were Other finance costs - unwinding of discount 16 (53) (52) approved by the Trust Board on 26th Directions and as required by the Other finance costs - change in discount rate on provisions 0 (176) Counter Fraud and Security July 2006. B) Pension Benefits SURPLUS/(DEFICIT) FOR THE FINANCIAL YEAR 8,538 6,440 Management Service. The Trust’s External Auditors are Name and Title Real Total accrued Cash Cash Real Increase Employers Public Dividend Capital dividends payable (6,966) (6,433) PricewaterhouseCoopers based at 101 increase in pension and Equivalent Equivalent in Cash Contribution Internal Audit Barbirolli Square, Manchester, M2 3PW. pension and related lump Transfer Transfer Equivalent to Stakeholder RETAINED SURPLUS/(DEFICIT) FOR THE YEAR 1,572 7 related sum at age 60 Value at 31 Value at 31 Transfer Pension Their assurance (audit) work cost the To ensure that there is an effective lump sum at at 31 March March 2007 March 2006 Value Trust £181,250. age 60 2007 internal audit function established by (bands of (bands of £000 £000 £000 To nearest NOTE TO THE INCOME AND EXPENDITURE ACCOUNT management, that meets mandatory Membership of the Audit Committee:- £2500) £2500) £100 NHS Internal Audit Standards and £000 £000 FOR THE YEAR ENDED 31 March 2007 Mr P Olive – Chairman provides appropriate independent J Hartley - Chief 2.5 - 5 97.5 -100 289 261 15 0 assurance to the Audit Committee, Mrs C Breene Executive 31 March 2007 31 March 2006 Chief Executive and Board. This will be Mr M Brown A Kehoe - Deputy 17.5 - 18 75 - 77.5 237 177 38 0 £000 £000 achieved by:- Chief Executive Mr P Hosker Retained surplus/(deficit) for the year 1,572 7 • Consideration of the provision of the T Welch - Finance 2.5 - 5 57.5 - 60 148 130 10 0 Mr B Robinson Director Financial support included in retained surplus/(deficit) for the 0 0 Internal Audit Service, the cost of the year - NHS Bank audit and any questions of Miss J A Oates – Secretary PJ Hayes - Medical (7.5) - (10) 182.5 - 185 n/a n/a n/a 0 resignation and dismissal. Director (resigned 30 Financial support included in retained surplus/(deficit) for the 0 2,647 Five meetings of the Audit Committee May 06) year - Internally Generated
• Review and approval of the Internal took place during 2006/2007. P Kelsey - Medical 7.5 - 10 190 - 192.5 775 687 41 0 Retained surplus/(deficit) for the year excluding financial support 1,572 (2,640) Audit strategy, operational plan and Director (appointed 1 June 06) more detailed programme of work, REMUNERATION REPORT ensuring that this is consistent with A Sunderland - 2.5 - 5 77.5 - 80 248 226 12 0 Financial support is income provided In 2006/07 the provision of financial The membership of the Trust’s Director of Nursing wholly to assist in managing the NHS support has been replaced by a regime the audit needs of the organisation and Quality as identified in the Assurance Remuneration Committee includes all Trust's financial position. Internally of loans and deposits with the six Non-Executive Directors as follows:- J Lyons - Director of 0 - 2.5 142.5 - 145 n/a n/a n/a 0 generated financial support is financial Department of Health. Details of loans Framework. Human Resources (resigned 30 June 06) support received from within the local received or deposits placed with the • Consideration of the major findings Mr M Brown - Chairman health economy, consisting of the area Department of Health can be found in MJ Gallagher - 2.5 - 5 152.5 - 155 642 602 17 0 of internal audit work (and Mrs C Breene Director of Facilities of responsibility of NHS North West. notes 14.2 and 15.1 to the accounts. management’s response), and ensure Mr P Hosker co-ordination between the Internal BALANCE SHEET AS AT 31 March 2007 and External Auditors to optimise Miss B Lester The pension benefits for Executive Directors who left post in 2005/06 has not been audit resources. Mr P Olive determined. As identified in Table A above these were P R Male, T H Evans and P J 31 March 2007 31 March 2006 • Ensuring that the Internal Audit Mr B Robinson Dewdney. NOTE £000 £000 function is adequately resourced and Miss J A Oates – Secretary As Non-Executive members do not receive pensionable remuneration, there will be no has appropriate standing within the FIXED ASSETS Four meetings of the Remuneration entries in respect of pensions for Non-Executive members. organisation. Intangible assets 10 343 324 Committee took place during 2006/07. A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the • Annual review of the effectiveness of pension scheme benefits accrued by a member at a particular point in time. The Tangible assets 11 189,004 205,102 The Committee establishes pay ranges internal audit. benefits valued are the member's accrued benefits and any contingent spouse's and progression within those pay Investments 14.1 0 0 pension. ranges for executive director posts and 189,347 205,426 for director posts which report to the External Audit CURRENT ASSETS Chief Executive. FINANCIAL REVIEW Stocks and work in progress 12 3,601 3,213 To review the work and findings of the The Committee establishes the ranges Debtors 13 32,804 16,231 External Auditor appointed by the for director posts by reference to the At the start of the financial year Audit Commission and consider the annual pay awards made to other NHS 2006/07 the Trust faced the prospect of Investments 14.2 0 0 implications and management’s Staff Groups and by comparison with a £24m gap between income and Cash at bank and in hand 18.3 181 181 responses to their work. This will be pay information for similar posts in expenditure. At over 12% of our achieved by:- acute Trusts of the same size and turnover, this represented a significant 36,586 19,625 • Consideration of the appointment complexity. The Trust participates in potential debt that threatened the CREDITORS: Amounts falling due within one year 15 (13,939) (19,442) the annual salary survey for senior NHS and performance of the External viability of both individual services and NET CURRENT ASSETS/(LIABILITIES) 22,647 183 Auditor, as far as the Audit posts conducted by NHS Partners and the Trust as a whole. this information is presented to the Non-Clinical Income 9% TOTAL ASSETS LESS CURRENT LIABILITIES 211,994 205,609 Commission’s rules permit. We had originally planned to manage Committee to enable comparison of Other Clinical Income 2% CREDITORS: Amounts falling due after more than 15 0 0 this over a two year period, however, one year • Discussion and agreement with the pay ranges. The Committee recognises Specialist Commissioning 14% External Auditor, before the audit the NHS financial rules at the time the need to ensure that salaries remain North Lancashire PCT 37% PROVISIONS FOR LIABILITIES AND CHARGES 16 (3,897) (1,744) commences, of the nature and scope competitive with NHS comparators to would have resulted in a ‘doubling up’ Blackpool PCT 38% TOTAL ASSETS EMPLOYED 208,097 203,865 of the audit as set out in the Annual aid recruitment and retention. The of any deficit and potentially increased Plan, and ensure co-ordination, as Committee awarded a staged cost of the problem year on year. After FINANCED BY: lengthy internal debate it was agreed appropriate, with other External living pay increase of 2.2% for 2006 / TAXPAYERS' EQUITY that the Trust would plan to deliver Auditors in the local health economy. 2007 for directors, with 1% being paid Allowing for exceptional items the Public dividend capital 22 160,028 165,173 from April 2006 and a further 1.2% the savings required in one year. • Discussion with the External Auditors Trust’s income increased by 2.5% from from November 2006. Revaluation reserve 17 36,150 41,646 of their local evaluation of audit risks To achieve this the Trust developed a 2005/06 and reflects the year on year increases in the level of activity and assessment of the Trust and Progression within the salary ranges is number of cost improvement Donated asset reserve 17 2,875 2,832 initiatives with an overall target of provided. associated impact on the audit fee. determined by an assessment of Government grant reserve 17 0 0 performance against personal 10% cost reduction in clinical • Review all External Audit reports, The resources received are utilised as Other reserves* 17 0 0 objectives. The Chairman assesses the departments and 12.5% in corporate including agreement of the annual demonstrated in the following two performance of the Chief Executive areas. These plans were wide ranging Income and expenditure reserve 17 9,044 (5,786) audit letter before submission to the charts: and recommends salary progression as across the whole organisation and Board and any work carried outside TOTAL TAXPAYERS' EQUITY 208,097 203,865 appropriate. The Chief Executive included bed reductions of 250, the annual audit plan, together with a) By Division assesses the performance of those reductions in headcount of around 400 the appropriateness of management Directors who report to him and and rationalisation of services from The financial statements on these pages Signed ……………….……………………… responses. Lytham, Devonshire Road and South recommends salary progression as were approved by the Board on 21st (Chief Executive) appropriate. There are six points on Shore Hospitals. In many areas, as June 2007 and signed on its behalf by: highlighted in the clinical Divisional Other Assurance the salary ranges for the executive Date August 31st 2007 directors and directors who report to reviews, cost reduction has been Functions achieved by making clinical services the Chief Executive. Progression STATEMENT OF TOTAL RECOGNISED GAINS AND through these six points is wholly more efficient and responsive. To review the findings of other dependent on appraisal and LOSSES FOR THE YEAR ENDED 31 March 2007 significant assurance functions, both As a result of these processes the Trust assessment of performance against internal and external to the delivered £19.1m of cost improvements objectives. organisation, and consider the and recovered an additional £4m of 2006/07 2005/06 income from better recording of £000 £000 implications to the governance of the All executive directors and directors Medicine 16% organisation. who report to the Chief Executive are clinical activity. The Trust has now Finance and Other 16% Surplus/(deficit) for the financial year before dividend payments 8,538 6,440 employed on open-ended contracts of started 2007/08 in recurrent financial To review the work of other Facilities 11% employment (i.e. not fixed-term) and balance. Fixed asset impairment losses 0 0 committees within the organisation, all have notice periods of six months. Corporate 14% whose work can provide relevant The Trust receives the majority of its Unrealised surplus/(deficit) on fixed asset 7,942 3,461 Clinical Support Service 13% revaluations/indexation assurance to the Audit Committee’s Termination payments are made in income for patient services from own scope of work. This will accordance with the provisions set out Blackpool PCT, North Lancashire PCT Women and Children 6% Increases in the donated asset and government grant reserve 221 194 due to receipt of donated and government grant financed (formerly Fylde and Wyre PCTs) and Cardiac 11% particularly include the Clinical in the standard NHS terms and assets Governance Committee and any Risk conditions of service and the NHS the North West Specialist Surgery 17% Management committees that are superannuation scheme as applied to Commissioners (who have Defined benefit scheme actuarial gains/(losses) 0 0 responsibility for paying for Cardiac established. all staff and contractual period of In 2006/07 over 60% of the Trust’s Additions/(reductions) in "other reserves" 0 0 notice. Services). The following chart resources were spent within the clinical highlights where income is recovered areas, with the balance spent on Total recognised gains and losses for the financial year 16,701 10,095 from:- corporate, facilities and estate costs. Prior period adjustment 0 0
Total gains and losses recognised in the financial year 16,701 10,095 CASH FLOW STATEMENT FOR THE YEAR ENDED 31 Related Party As Accountable Officer I have overall The elements of the Assurance • The Trust Board also monitors and accountability for Internal Control. To Framework are monitored and reviews the effectiveness of the March 2007 Transactions support this role, there are clear reviewed on a quarterly basis by the Board Assurance Framework on a systems of accountability within the Risk Management Committee and the quarterly basis. Blackpool, Fylde and Wyre Hospitals organisation with each Executive Audit Committee followed by the Trust 2006/07 2005/06 • The Risk Management Committee NHS Trust is a body corporate Director having specific areas of Board. This provides the evidence to manages and reviews the Board NOTE £000 £000 established by order of the Secretary responsibility. Performance against the support the Statement on Internal Assurance Framework, which is of State for Health. Trust’s objectives is reported to the Control. OPERATING ACTIVITIES agreed in conjunction with Executive Board on a monthly basis. Net cash inflow/(outflow) from operating activities 18.1 13,629 9,319 During the year none of the Board The Audit Committee is a sub Directors. The Risk Management Members or members of the key In accordance with the responsibilities committee of the Trust Board and Committee minutes are presented to management staff or parties related to assigned to me, I am also personally provides independent assurance on the Trust Board. The Risk RETURNS ON INVESTMENTS AND SERVICING OF FINANCE: them have undertaken any material responsible for ensuring that the aspects of governance, risk Management Committee produces Interest received 466 405 transactions with Blackpool, Fylde and organisation is administered prudently management and internal controls. an annual Risk Management report, Wyre Hospitals NHS Trust. Interest paid 0 0 and economically and that resources The Finance Director and the Head of which is presented to the Audit Mr M J Gallagher, Director of Facilities are applied efficiently and effectively. Clinical Governance are also members Committee followed by the Trust Interest element of finance leases 0 0 of the Risk Management Committee Board to provide assurance on for Blackpool Fylde and Wyre Hospitals Partnership working arrangements Net cash inflow/(outflow) from returns on investments and 466 405 and provide Governance and Risk controls. servicing of finance NHS Trust, has a minor shareholding in have been established and I meet with Management assurance to the Audit Patientline Limited. All transactions in all Chief Executives across the North • The Audit Committee reviews the Committee at each of its meetings, the year between the Trust and West Strategic Health Authority (and establishment and maintenance of an CAPITAL EXPENDITURE thus ensuring an integrated risk Patientline Limited were conducted as their predecessor organisations) on a effective system of integrated management approach. (Payments) to acquire tangible fixed assets (12,927) (25,587) arms length transactions under normal six weekly basis. governance, risk management and commercial terms. There are no significant gaps in internal control across the whole of Receipts from sale of tangible fixed assets 10,943 450 I foster a cohesive working control. However, I have to highlight the organisation’s activities (both (Payments) to acquire intangible assets 0 0 The Department of Health is regarded relationship with Blackpool Primary the major financial risks that the Trust clinical and non-clinical) that as a related party. During the year Care Trust and North Lancashire Receipts from sale of intangible assets 0 0 faced in 2006/07. As a consequence of supports the achievement of the Blackpool Fylde and Wyre Hospitals Primary Care Trust (and their an inadequate financial recovery plan organisation’s objectives. It reviews (Payments to acquire)/receipts from sale of fixed asset 0 0 NHS Trust has had a significant number predecessor organisations) by meeting investments for 2005/06 the Trust faced a deficit of the Board Assurance Framework on a of material transactions with the fortnightly at Chief Executive Level. Net cash inflow/(outflow) from capital expenditure (1,984) (25,137) £24m before cost improvement quarterly basis. Department, and with other entities Regular officer level meetings initiatives. The Trust has made major for which the Department is regarded underpin the Trust’s integrated • The relevant clinical and non-clinical progress and demonstrated the ability as the parent Department. These business plan and contract targets. sub committees report directly to the DIVIDENDS PAID (6,966) (6,433) to meet its financial obligation to entities are listed below: Risk Management Committee and Net cash inflow/(outflow) before management of liquid 5,145 (21,846) achieve breakeven in 2006/07. Over the Clinical Governance Committee. resources and financing the last year, this has been achieved by • NHS North West* The Purpose of the implementing the following controls • Internal Audit reviews the Board • Blackpool PCT System of Internal MANAGEMENT OF LIQUID RESOURCES and review processes: Assurance Framework and the • Blackburn with Darwen PCT Control effectiveness of the system of (Purchase) of investments with DH 0 - • A Board level Finance Committee has internal control as covered by the • Cumbria PCT* been established to continuously (Purchase) of other current asset investments 0 0 The system of internal control is audit work to assist in the review of • East Lancashire PCT* designed to manage risk to a oversee and make recommendations Sale of investments with DH 0 - effectiveness. reasonable level rather than to on financial strategy and review • Central Lancashire PCT* Sale of other current asset investments 0 0 eliminate all risk of failure to achieve financial performance; • NHS Litigation Authority (NHSLA) • North Lancashire PCT* assessment on 2nd March 2006 Net cash inflow/(outflow) from management of liquid resources 0 0 policies, aims and objectives; it can • A revised Financial Recovery Plan was therefore only provide reasonable and resulted in the achievement of Net cash inflow/(outflow) before financing 5,145 (21,846) • Lancashire Care NHS Trust approved by the Trust Board in June not absolute assurance of Clinical Negligence Scheme for Trusts • North West Ambulance Service 2006; effectiveness. The system of internal (CNST) Maternity level 1 status that NHS Trust* FINANCING control is based on an ongoing process • An enhanced performance provides assurance on controls. • NHS Litigation Authority designed to: framework, including the use of Public dividend capital received 2,200 21,848 • NHS Litigation Authority (NHSLA) risk robust benchmarking data, has been • NHS Purchasing and Supply Agency. management standards pilot Public dividend capital repaid (not previously accrued) (7,345) 0 • Identify and prioritise the risks to the established within the Trust; achievement of the organisation’s assessment on 19th September 2006 Public dividend capital repaid (accrued in prior period) 0 0 * includes predecessor organisations policies, aims and objectives. • A Turnaround Team has supported resulted in the achievement of Loans received from DH 0 - the achievement of cost General Clinical Negligence Scheme In addition, the Trust has had a • Evaluate the likelihood of those risks Other loans received 0 0 number of material transactions with improvements across the Trust; for Trusts/Risk Pooling Scheme for being realised and the impact should Trusts (CNST/RPST) level 1 status that Loans repaid to DH 0 - other Government Departments and they be realised, and to manage • A Turnaround Director has been other central and local Government provides assurance on controls. Other loans repaid 0 0 them efficiently, effectively and appointed to lead the Turnaround bodies. Most of these transactions economically. Team; • The Head of Internal Audit provides Other capital receipts 0 0 have been with Blackpool Borough significant assurance that there is a • An External audit review of the Capital element of finance lease rental payments 0 0 Council in respect of business rates and The system of internal control has generally sound system of internal Trust’s recovery plan and progress council tax. been in place in Blackpool, Fylde and control designed to meet the against it by PricewaterhouseCooper Wyre Hospitals NHS Trust for the year organisations objectives. Net cash inflow/(outflow) from financing (5,145) 21,848 The Trust has also received revenue ended 31st March 2007 and up to the has validated the Trust’s approach and capital payments from a number Increase/(decrease) in cash 0 2 date of approval of the annual report and confirmed our achievements. There have been no significant of charitable funds. As the Trust is the and accounts. internal control issues identified. corporate trustee of charitable funds, As an employer with staff entitled to all Trust Board members are also membership of the NHS Pension Staff costs and numbers trustees of charitable funds. Capacity to Handle Scheme, control measures are in place Signed ……………….……………………… to ensure all employer obligations (Chief Executive) Staff Costs Risk contained within the Scheme STATEMENT OF THE As Accountable Officer, I lead the risk Regulations are complied with. This Date August 31st 2007 includes ensuring that deductions from 2006/07 2005/06 CHIEF EXECUTIVE'S management process as Chair of the Trust’s Risk Management Committee, salary, employer’s contributions and INDEPENDENT AUDITORS’ Total Permanently Other Total RESPONSIBILITIES AS THE payments into the Scheme are in Employed which meets on a quarterly basis. ACCOUNTABLE OFFICER OF accordance with Scheme rules, and REPORT TO BLACKPOOL, £000 £000 £000 £000 The Director of Nursing and Quality that member Pension Scheme records THE TRUST also provides leadership to the Trust FYLDE AND WYRE Salaries and wages 111,250 109,994 1,256 110,754 are accurately updated in accordance Board for the implementation of with the timescales detailed in the HOSPITALS NHS TRUST ON The Secretary of State has directed Social Security Costs 8,173 8,173 0 8,138 integrated governance and risk Regulations. THE SUMMARY FINANCIAL that the Chief Executive should be the management. The Director of Finance Employer contributions to NHSPA 12,042 12,042 0 11,665 Accountable Officer to the Trust. The is designated as the accountable and An established communications STATEMENTS Other pension costs 0 0 0 0 relevant responsibilities of responsible officer for managing framework is in place in the form of a Accountable Officers, including their Major Incident Plan, and cross We have examined the summary 131,465 130,209 1,256 130,557 financial risk in the Trust. The Trust responsibility for the propriety and Board approved Risk Management community emergency planning financial statements set out on these regularity of the public finances for Strategy clearly defines the arrangements are in place. pages. which they are answerable, and for responsibilities of individual Executive keeping of proper records, are set out Public Stakeholders, which include This report is made solely to the Board Average number of persons employed Directors specifically and generally. The Blackpool Primary Care Trust, North of Blackpool, Fylde and Wyre Hospitals in the Accountable Officers' Risk Management Strategy also applies Memorandum issued by the Lancashire Primary Care Trust, NHS Trust in accordance with Part II of 2006/07 2005/06 to all employees and requires an active Blackpool Overview and Scrutiny the Audit Commission Act 1998 and Department of Health. lead from managers at all levels to Total Permanently Other Total Committee, Lancashire Overview and for no other purpose, as set out in Employed To the best of my knowledge and ensure risk management is a Scrutiny Committee and the Patient paragraph 54 of the Statement of fundamental part of the total Number Number Number Number belief, I have properly discharged the and Public Involvement Health Forum, Responsibilities of Auditors and of responsibilities set out in my letter of approach to quality, corporate and are consulted on service developments Audited Bodies, prepared by the Audit Medical and dental 333 325 8 397 appointment as an accountable officer. clinical governance and controls and changes. These Public Commission. Ambulance staff 0 0 0 0 assurance. The Risk Management Stakeholders are identified within the Strategy is available to all staff via the Board Assurance Framework; this Respective Administration and estates 827 818 9 869 Signed ……………….……………………… Document Library on the Trust ensures that they are involved in responsibilities of Healthcare assistants and other support 340 340 0 408 (Chief Executive) intranet. managing the risks, which impact staff To ensure the successful upon them. directors and auditors Nursing, midwifery and health visiting staff 1,759 1,759 0 1,958 Date August 31st 2007 implementation and maintenance of The directors are responsible for Nursing, midwifery and health visiting 9 9 0 0 the Trust’s approach to risk preparing the Annual Report. Our learners STATEMENT OF Review of management, staff at all levels are responsibility is to report to you our Scientific, therapeutic and technical staff 434 432 2 469 DIRECTORS' appropriately trained in incident Effectiveness opinion on the consistency of the reporting and carrying out a risk summary financial statements with the Social care staff 0 0 0 0 RESPONSIBILITIES IN As Accountable Officer, I have assessment. An ongoing risk statutory financial statements. We also responsibility for reviewing the Other 2 0 2 0 RESPECT OF THE management training programme has read the other information contained effectiveness of the system of internal been developed which includes Clinical in the Annual Report and consider the 3,705 3,684 21 4,101 ACCOUNTS control. My review is informed in a Risk Management/Patient Safety, implications for our report if we number of ways. The Directors are required under the Health and Safety, Fire, Resuscitation, become aware of any misstatements or Management costs National Health Services Act 1977 to Moving and Handling, Child Protection The Head of Internal Audit provides material inconsistencies with the prepare accounts for each financial and Conflict Resolution training and is me with an opinion on the overall summary financial statements. year. The Secretary of State, with the mandatory for appropriate staff. 2006/07 2005/06 arrangements for gaining assurance approval of the Treasury, directs that The Clinical Incident Review through the Assurance Framework and Basis of opinion Management costs 9,083 8,487 these accounts give a true and fair Committee, comprising senior staff, on the controls reviewed as part of the Income 215,149 205,400 view of the state of affairs of the Trust meets on a monthly basis to ensure internal audit work. We conducted our work in accordance and of the income and expenditure of with Bulletin 1999/6 ‘The auditor’s concerns identified from incidents, Executive Directors within the Management costs are defined as those on the management costs website at the Trust for that period. In preparing statement on the summary financial claims and complaints are investigated organisation who have responsibility www.dh.gov.uk/PolicyAndGuidance/OrganisationPolicy/FinanceAndPlanning/ those accounts, the directors are statements’ issued by the Auditing to ensure that lessons are learned and for the development and maintenance NHSManagementCosts/fs/en required to: as a method of sharing best practice. Practices Board for use in the United of the system of internal control Kingdom. • apply on a consistent basis The Trust fosters an environment provide me with assurance. where individuals are treated in a fair Retirements due to ill-health accounting policies laid down by the Opinion Secretary of State with the approval and just way, and where lessons are The Board Assurance Framework itself learned rather than blame being provides me with evidence that the During 2006/07 there were 9 (2005/06, 9) early retirements from the NHS Trust on the of the Treasury, effectiveness of controls that manage In our opinion the summary financial grounds of ill-health. The estimated additional pension liabilities of these ill-health attributed. • make judgements and estimates the risks to the organisation achieving statements are consistent with the retirements will be £905,000 (2005/06 £449,501). The cost of these ill-health statutory financial statements of the retirements will be borne by the NHS Business Services Authority -Pensions Division. which are reasonable and prudent, its principle objectives have been The Risk and Control reviewed. Trust for the year ended 31st March • state whether applicable accounting Framework 2007 on which we have issued an Better Payment Practice Code standards have been followed, My review is also informed by the unqualified opinion. subject to any material departures The Risk Management Strategy is work of the internal auditors via disclosed and explained in the Board approved, covers all risks and is reports on control issues and the 2006/07 Notice of the Trust’ s accounts. subject to an annual review. Staff Executive Directors who have responsibility for the development and Number £000 The Directors are responsible for accountable and responsible for risk Annual Public Meeting management are clearly identified as maintenance of the internal control Total Non-NHS trade invoices paid in the year 50,807 69,864 keeping proper accounting records The Annual Public Meeting of the well as the system for identifying, framework. It also takes account of which disclose with reasonable Blackpool, Fylde and Wyre Hospitals Total Non NHS trade invoices paid within target 42,608 58,938 managing, evaluating and controlling comments made by the external accuracy at any time the financial NHS Trust will be held on Thursday Percentage of Non-NHS trade invoices paid within target 84% 84% individual risk. Risks are identified auditors and other review bodies in position of the Trust and to enable 27th September 2007 at 6pm in the from risk assessments and from the their reports. Total NHS trade invoices paid in the year 1,429 17,231 them to ensure that the accounts Heron’s Suite, De Vere Hotel, comply with requirements outlined in analysis of untoward incidents. The Trust Board, Audit Committee, Risk Total NHS trade invoices paid within target 1,059 13,980 Blackpool. the above mentioned direction of the Risk management is embedded in the Management Committee and the Percentage of NHS trade invoices paid within target 74% 81% Secretary of State. They are also activity of the organisation via Clinical Governance Committee have responsible for safeguarding the assets induction training, regular risk advised me on the implications of the Obtaining the Trust’ s The Better Payment Practice Code requires the Trust to aim to pay all undisputed of the Trust and hence for taking management training and ad hoc result of my review of the Full Accounts invoices by the due date or within 30 days of receipt of goods or a valid invoice, reasonable steps for the prevention training when need is identified. An effectiveness of the system of internal whichever is later. and detection of fraud and other untoward incident reporting system is control. These committees also advise A copy of the Trust’s full set of irregularities. in place and the incidents are entered myself and outside agencies on serious Accounts can be obtained by writing untoward events. to:- The Late Payment of Commercial Debts The Directors confirm to the best of onto a database for analysis. Root their knowledge and belief they have cause analysis is undertaken and A plan to address weaknesses and Miss J A Oates (Interest) Act 1998 complied with the above requirements identified changes in practice are ensure continuous improvement of the Secretary to the Trust in preparing the accounts. implemented. system is in place. Blackpool, Fylde and Wyre Hospitals NHS Trust 2006/07 2005/06 By order of the Board The Corporate Risk Structure consists The process that has been applied in Trust Headquarters £000 £000 of clinical and non-clinical committees, maintaining and reviewing the Blackpool Victoria Hospital which report to the Risk Management effectiveness of the system of internal Amounts included within Interest Payable (Note 9) arising 0 0 Signed ……………….……………………… Whinney Heys Road from claims made under this legislation Committee. control is achieved by: Blackpool (Chief Executive) Compensation paid to cover debt recovery costs under this 0 0 The Risk Management Committee links • The Trust’s self-assessment FY3 8NR legislation Date August 31st 2007 to the Audit Committee and the declaration of compliance against the Clinical Governance Committee and twenty-four Core ‘Standards for The supply of a full set of Accounts also reports direct to the Trust Board. Profit/(Loss) on Disposal of Fixed Assets Better Health’ and two will be subject to an administrative fee Signed ……………….……………………… A Board approved Assurance Developmental standards. This of £5.00. demonstrates continuous Profit/(loss) on the disposal of fixed assets is made up as follows: (Finance Director) Framework has been in place during If you have any comments on our improvement against the standards 2006/07. The Assurance Framework: Annual Report or would like any and supporting evidence is available 2006/07 2005/06 Date August 31st 2007 further information, please write to:- • Covers all of the Trust’s main for all members of the Trust Board to £000 £000 activities. review as a source of assurance and is Mr J Hartley Loss on disposal of plant and equipment (11) 0 • Identifies the corporate objectives an essential part of the Trust’s system Chief Executive STATEMENT ON INTERNAL and targets the Trust is striving to of internal control. Blackpool, Fylde and Wyre Hospitals (11) 0 NHS Trust achieve. • The North West Strategic Health CONTROL 2006/2007 Trust Headquarters Authority (SHA) monitors and • Identifies risks to achievement of Blackpool Victoria Hospital reviews the portfolio of evidence in Interest Payable these objectives and targets. Whinney Heys Road Scope of Responsibility relation to the implementation of Blackpool • Identifies the system of internal Clinical Governance and Standards 2006/07 2005/06 The Board is accountable for internal FY3 8NR control. As Accountable Officer, and control in place to manage the risks. for Better Health to assist in the £000 £000 review of effectiveness of the system Chief Executive of this Board, I have • Identifies review and assurance of internal control. This also ensures Finance leases 0 0 responsibility for maintaining a sound mechanisms, which relate to the continuous improvement of the system of internal control that effectiveness of the system of Late payment of commercial debt 0 0 system in place. supports the achievement of the internal control. Loans 0 0 organisation’s policies, aims and objectives. I also have responsibility for • Covers the core standards on which Other 0 0 safeguarding the public funds and the the Trust has been required to declare its compliance during 0 0 organisation’s assets for which I am Blackpool, Fylde and Wyre Hospitals personally responsible as set out in the 2006/07. Accountable Officer Memorandum. Blackpool, Fylde and Wyre Hospitals
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If you have any comments on our Annual Report, or would like any further information, please write to:- Mr J Hartley, Chief Executive, Blackpool, Fylde and Wyre Hospitals NHS Trust Trust Headquarters, Blackpool Victoria Hospital, Whinney Heys Road Blackpool, Lancashire FY3 8NR If you require a copy of this document in large print, Braille, audio or a different language, please call 01253 306856.