Liverpool Women’s NHS Foundation Trust
annual report & accounts (&&.%&/
Liverpool Women’s NHS Foundation Trust
ANNUAL REPORT AND ACCOUNTS 2008/09
Presented to Parliament pursuant to Schedule 7, paragraph 25(4) of the National Health Service Act 2006 Contents*
C o n t e n t s
Welcome from the Chairman ...... 6 Chief Executive’s Introduction ...... 7 Director’s Report ...... 8 Our Committed Staff – Our Greatest Asset ...... 9 Quality Report ...... 10 How We Performed ...... 12 Our Future Developments ...... 24 Patient Care ...... 26 Stakeholder Relations ...... 28 Finance ...... 30 Going Concern and NHS Foundation Trust Code of Governance ...... 33 Our Board of Directors ...... 34 Our Council of Governors ...... 38 Our Membership ...... 40 Public Interest Disclosures ...... 42 Working with Our Partners ...... 46 Remuneration Report ...... 48 Statement as to disclosure to auditors ...... 49 Statement of Accounting Officer’s responsibilities as the accounting officer of Liverpool Women’s NHS Foundation Trust ...... 50 Statement on Internal Control ...... 51 Annual Accounts 2008/2009 ...... 58 +
Ekhc_ii_ed Jefhel_Z[[nY[bb[dj^[Wbj^YWh[ \ehmec[d"XWX_[iWdZj^[_h \Wc_b_[i_dWiW\["\h_[dZbo WdZYWh_d][dl_hedc[dj$
9b[Whl_i_ed JeX[Wh[Ye]d_i[Zb[WZ[h_d ^[Wbj^YWh[\ehmec[d"XWX_[i WdZj^[_h\Wc_b_[i$ Welcome from the Chairman,
Welcome from the Chairman
I am delighted to welcome you to our also took shape for an ambitious redesign us from strength to strength. Annual Report for 2008/09. Whilst a detailed programme in maternity services which commentary on our performance for the year will be progressed during the coming year. Finally, I would like to pay tribute to our is set out in the Directors’ Report, I wanted Plus, in partnership with the University of dedicated and hardworking staff and to take the opportunity to share some Liverpool, the Trust is developing a new volunteers for their relentless drive to keep reflections and observations of my own. research facility, the Centre for Better Births, on improving services for women, babies and which will come to fruition in 2009/10. their families year after year: I am immensely 2008/09 was another successful year for proud of everyone. Liverpool Women’s. In October 2008 we It was also an eventful year for our were awarded the top rating of ‘excellent’ management team, with three of our I do hope you find the rest of the report both for financial management and ‘good’ Executive Directors moving to pastures new. interesting and informative. for quality of services by the Healthcare Our new Chief Executive, Kathryn Thomson Commission under its Annual Health Check has been with us since September 2008 assessment. Staff, patients and visitors began and is a most talented and able addition to to see the tangible benefits of our strong the Trust. I am confident that our other new
financial performance in the shape of the appointments, to the posts of Director of building of an extension to our reproductive Finance and Director of Nursing, Midwifery Ken Morris medicine department, which once complete and Patient Quality, will be equally successful Ken Morris will be the largest IVF unit in Europe. Plans and that the new team will continue to take Chairman ?dEYjeX[h(&&.m[m[h[WmWhZ[Zj^[jefhWj_d]e\‘ ¼[nY[bb[dj½\ehÅdWdY_WbcWdW][c[djWdZ¼]eeZ½\eh gkWb_joe\i[hl_Y[iXoj^[>[Wbj^YWh[9ecc_ii_edkdZ[h ‘_ji7ddkWb>[Wbj^9^[YaWii[iic[dj$
\Wc_b_[iWdZekh\WdjWij_YijW\\$ ‘ m^oj^[Mec[d½i_iiel[hoif[Y_WbjeekhfWj_[dji"j^[_h
‘I_dY[?jeeakffeij_dI[fj[cX[h?YWdYb[Whboi[[
. Better Births Better Chief Executive Chief measure of their understanding of the future future the of understanding their of measure
Kathryn Thomson Kathryn without their support and it is an excellent excellent an is it and support their without Centre for for Centre with Liverpool University, the the University, Liverpool with
enthusiastically; we could not have done this this done have not could we enthusiastically; maternity pathways and our joint venture venture joint our and pathways maternity Kathryn Thomson Kathryn
our staff for embracing these changes so so changes these embracing for staff our reproductive medicine, the redesign of of redesign the medicine, reproductive
uncertainty and I would like to thank all of of all thank to like would I and uncertainty
terms of realising our ambitious plans for for plans ambitious our realising of terms
always creates additional work and at times times at and work additional creates always
We have some exciting times ahead in in ahead times exciting some have We
special place for our patients. our for place special
fully operational in 2009/10. Change Change 2009/10. in operational fully
possible care, treatment and experience. experience. and treatment care, possible
They are what make Liverpool Women’s a a Women’s Liverpool make what are They
Clinical Business Units. These will become become will These Units. Business Clinical
patients, on every occasion, receive the best best the receive occasion, every on patients,
our crown and I pay great tribute to them. them. to tribute great pay I and crown our a large scale change programme to develop develop to programme change scale large a
those of our staff: to ensure that all of our our of all that ensure to staff: our of those
hey are the jewel in in jewel the are hey t here, work who people autonomy at local level we have undertaken undertaken have we level local at autonomy
my focus is and will remain aligned with with aligned remain will and is focus my
to women. Our reputation is built by the the by built is reputation Our women. to services and provide this flexibility and and flexibility this provide and services
Executive of the Liverpool Women’s and and Women’s Liverpool the of Executive be the number one provider of healthcare healthcare of provider one number the be In order to align our structure to our clinical clinical our to structure our align to order In
support in ensuring that we continue to to continue we that ensuring in support It is a privilege and an honour to be Chief Chief be to honour an and privilege a is It a greater voice for our patients and public. public. and patients our for voice greater a
volunteers and governors for their help and and help their for governors and volunteers receive the best possible care and treatment. treatment. and care possible best the receive increased autonomy, financial flexibility and and flexibility financial autonomy, increased
to all of our staff, partner organisations, organisations, partner staff, our of all to is focussed on ensuring that our patients patients our that ensuring on focussed is Foundation Trust status brings in regards to to regards in brings status Trust Foundation
Finally, I would like to say a big thank you you thank big a say to like would I Finally, e continued to reap the rewards that that rewards the reap to continued e hav We It is clear that everyone who works here here works who everyone that clear is It
a priority for us over the next year. year. next the over us for priority a
waiting times. waiting patients, their families and our fantastic staff. fantastic our and families their patients,
increase our staff satisfaction and this will be be will this and satisfaction staff our increase our staff have worked together to improve improve to together worked have staff our
why the Women’s is so very special to our our to special very so is Women’s the why
We recognise that we need to do more to to more do to need we that recognise We relation to cancer patients and once again again once and patients cancer to relation
up post in September I can clearly see see clearly can I September in post up
had challenging new targets to achieve in in achieve to targets new challenging had
factors for accepting this post. Since I took took I Since post. this accepting for factors
them well in their new roles. new their in well them are seen within four hours. We have also also have We hours. four within seen are
care and that was one of my key motivating motivating key my of one was that and care
Midwifery and Patient Quality and we wish wish we and Quality Patient and Midwifery staff continue to ensure that our patients patients our that ensure to continue staff
has an outstanding reputation for patient patient for reputation outstanding an has
Finance and Gill Core Director of Nursing, Nursing, of Director Core Gill and Finance 18 week promise. Our emergency room room emergency Our promise. week 18
Liverpool Women’s. The Liverpool Women’s Women’s Liverpool The Women’s. Liverpool Executive Directors, Sue Lorimer, Director of of Director Lorimer, Sue Directors, Executive and have successfully delivered on the the on delivered successfully have and
Annual Report as Chief Executive of the the of Executive Chief as Report Annual We bid a fond farewell to two of our our of two to farewell fond a bid We great improvements to access for patients patients for access to improvements great
During the last year we have made some some made have we year last the During first my you to bring to delighted am I challenges and opportunities. and challenges
n o i t c u d o r t n I s ’ e v i t u c e x E f e i h C
- Chief Executive’s Introduction Executive’s Chief Directors’ Report.
J^[8eWhZe\:_h[Yjehi_ifb[Wi[Zjefh[i[dj_jih[l_[me\j^[Jhkij½iZ[l[befc[dj WdZf[h\ehcWdY[Zkh_d]j^[o[Wh(&&.%&/$?dfh[i[dj_d]j^_ih[l_[mj^[ Z_h[Yjehi^Wl[[dikh[Zj^Wjie\WhWij^[Z_h[YjehiWh[WmWh["j^[h[_ideh[b[lWdj WkZ_j_d\ehcWj_ede\m^_Y^j^[WkZ_jehiWh[kdWmWh[WdZZ_h[Yjehi^Wl[jWa[d Wbbe\j^[ij[fij^WjZ_h[Yjehiek]^jje^Wl[jWa[d_dehZ[hjecWa[j^[ci[bl[i WmWh[e\Wdoh[b[lWdjWkZ_j_d\ehcWj_edWdZje[ijWXb_i^j^Wjj^[WkZ_jehiWh[ WmWh[e\j^Wj_d\ehcWj_ed$ About the Trust
Liverpool Women’s NHS Foundation Trust procedures and cares for 1,000 preterm Corporate non-clinical support services are was founded on 1st April 2005 under infants on our Neonatal Unit. provided by the Finance, Human Resources, the Health and Social Care (Community Our clinical services have, in accordance Operational Services, Quality and Information Standards) Act 2003. Operating in its former with our mission, been created and Mangement and Technology teams. The hotel guise as Liverpool Women’s Hospital NHS developed in response to the specific services and security functions of the Trust Trust, the organisation had been created needs of local women and their families. are carried out by contractors working in in 1995 when all services for women and We currently manage our services through partnership with us. babies in Liverpool came together under six directorates, each led by a Clinical one roof in a state of the art building in Staff are kept informed of strategic and Director who is a senior consultant and a the heart of Toxteth. In 2000 the Trust took operational developments through the Directorate Manager who reports to an over the Aintree Centre for Women’s Health, monthly Team Brief which is delivered by the which provides services to the women of Executive Director. Directorate managers, Executive Team in the week following the north Liverpool, Sefton and Knowsley and clinical directors and the executive team Board meeting and is then cascaded through in so doing became the largest women’s sit on the Management Executive Board, each directorate and department. hospital in Europe. which has overall responsibility for the operational management and leadership Each year, the Trust now delivers over 8,000 of the Trust and is accountable to the Board babies, carries out 10,000 gynaecological of Directors. Our Services
Obstetrics Neonatology Critical Care s !NTENATAL CARE n HOSPITAL OR s .EONATAL INTENSIVE CARE s 4HEATRES AND !NAESTHESIA community based s .EONATAL HIGH DEPENDENCY CARE s 2ADIOLOGY s &ETAL MEDICINE s 4RANSITIONAL CARE WITH /BSTETRICS s 0HARMACY s 4WIN CLINIC s .EWBORN HEARING SCREENING s 0HYSIOTHERAPY s (OME BIRTHS s -IDWIFERY LED UNIT s .EWBORN EYE SCREENING s $ELIVERY SUITE s )NFANT FEEDING TEAM s ,INK CLINICS FOR MINORITY Reproductive Medicine ethnic communities Gynaecology s 3MOKING CESSATION MIDWIVES s )6& s 0ARENT EDUCATION s 'ENERAL GYNAECOLOGY s )#3) s 0UBLIC (EALTH s 5ROGYNAECOLOGY s $ONOR INSEMINATION s 4ERMINATION OF PREGNANCY s 3PERM RECOVERY s 'YNAECOLOGICAL CANCER s &REEZING OF EMBRYOS Genetics s &AMILY PLANNING s &ROZEN EMBRYO TRANSFER s #LINICAL 'ENETICS s 2ECURRENT MISCARRIAGE CLINIC s &REEZING OF SPERM s #YTOGENETICS n LABORATORY BASED s %MERGENCY 2OOM s /VUM DONATION s -OLECULAR 'ENETICS n s -ENOPAUSE s %GG FREEZING laboratory based s )NFERTILITY s 3PERM BANK Our Committed Staff – Our Greatest Asset/
Every Person Matters
We spend more than half of our s A TOTAL REDESIGN OF THE GYNAECOLOGY progressed during 2009/10 with the We continue to recognise excellence income on paying our staff; it is administrative service to deliver expectation that we can improve and commitment demonstrated by our therefore critical that we have a effective 18 week pathways working lives in these critical areas. staff through a number of methods. In well-led, skilled, motivated and and provide greater support to 2008/09 this has included: flexible workforce. clinical teams Education, training and development s SUCCESSFUL EXTENSION OF 'YNAECOLOGY activity has progressed at a steady s !LLOCATION OF A a GIFT VOUCHER FOR As at 31st March 2009, we employed Nurse Practitioner roles with a every member of staff in recognition pace throughout the year, as 1,358 staff (1,118.97 whole time number of individuals now replacing of our Healthcare Commission demonstrated by spend against all equivalents) not including contracted medical staff in procedures clinics. assessment for 2007/08 training budgets and the take up of out staff. This includes doctors, nurses, s 3TAFF !WARD 3CHEME WINNERS FOR midwives and other clinically qualified In the 2008 staff survey, the Trust mandatory training and SHA funded those individuals nominated by their professionals as well as support continued to achieve high scores in professional courses for clinically colleagues or patients for “going workers, administrative staff, senior relation to the numbers of staff who qualified staff. The implementation the extra mile” managers and directors and staff had received appraisals, training, of new funding nationally has s @&OCUSING ON %XCELLENCE !NNUAL who provide ancillary and estates learning and development in the enabled the Trust to extend training Awards which recognise high services. 91% of our workforce is previous 12 months and reporting provision to those staff without formal quality and innovative care, female with the remaining 9% being of near misses and incidents. We clinical qualifications and who often research, partnerships and male. 12% of the Trust’s workforce continue to be in the best 20% of have the least opportunity to access workforce initiatives are non-white British. trusts nationally for having very low training and development. It is hoped s 2ECOGNITION OF A NUMBER OF numbers of staff who suffer work staff at the North West It is essential that the Trust utilises that this will continue in 2009/10 to related injury and experience physical Leadership Awards its workforce in the most effective develop improved career structures for violence from patients and visitors. and efficient manner and reviews these groups. are undertaken each year to ensure There have been improvements in the The Trust continues to make progress availability of hand washing materials that the most appropriate staff are The Trust is committed to developing on its Single Equality Scheme and for staff and in the quality of job in-year policy revisions took place employed in the right area in the right strong leadership at all levels of design and the effectiveness of the using the full Impact Assessment time. In 2008/09 this has included: the organisation. In support of appraisal process. tool, which ensures that policies this, the Trust progressed through are written in such a way as not s REDUCING ALL DOCTORS IN TRAINING an accreditation process with the hours of work to the 48 hour EWTD There are however a number of areas to exclude or disadvantage any
University of Leeds in 2008/09 that maximum working week one year where it is clear the Trust needs employees on the basis of race, now enables us to deliver “Workplace ahead of schedule TO IMPROVE ITS PERFORMANCE n IN disability, religious beliefs, sexual s THE SUCCESSFUL RECONlGURATION OF particular the perception of bullying Coaching” programmes which orientation and gender. Progress is
community midwifery services and how the organisation addresses complement the well established monitored by the Trust’s Equality and s THE INTRODUCTION OF A .ORMAL this and how senior management “Leading Empowered Organisations” Diversity Taskforce, membership of Birth Consultant Midwife role communicate with staff. Action plans (LEO) concept that has been running which includes representatives from in Obstetrics have been developed and will be for the past three years. the Council of Governors. ?j_i[ii[dj_Wbj^Wjj^[Jhkijkj_b_i[i_jimeha\ehY[_dj^[ceij[\\[Yj_l[‘ WdZ[\ÅY_[djcWdd[hWdZh[l_[miWh[kdZ[hjWa[d[WY^o[Whje[dikh[ j^Wjj^[ceijWffhefh_Wj[ijW\\Wh[[cfbeo[Z_dj^[h_]^jWh[W_dj^[ ‘h_]^jj_c[$ Quality Report '&
B_l[hfeebMec[d½i_ied[e\jmeif[Y_Wb_ij^eif_jWbi_dj^[KAfhel_Z_d]YWh[\eh mec[dWdZXWX_[i$?j_ij^[bWh][ijfhel_Z[he\ikY^YWh[_d;khef[WdZ_ifhekZ e\_jifei_j_ed"j^[YWh[_jfhel_Z[ijefWj_[djiWdZWXel[Wbb_ji\eYkikfed^_]^ gkWb_joi[hl_Y[i$
J^[Jhkij½iYecc_jc[djje_cfhel_d]WdZikijW_d_d]^_]^gkWb_jo^WiX[[d Z[cedijhWj[Zj^hek]^[nj[hdWbWii[iic[dji\ehWdkcX[he\o[Whi0m[ WY^_[l[Zº)ijWh»hWj_d]i\ehj^h[[Yedi[Ykj_l[o[Whifh_ehjej^[_djheZkYj_ed e\j^[7ddkWb>[Wbj^9^[Ya"kdZ[hm^_Y^m[^Wl[h[Y[_l[Zº[nY[bb[dj»\eh ÅdWdY_WbcWdW][c[djWdZº]eeZ»ehº[nY[bb[dj»\ehgkWb_joe\i[hl_Y[i\ehj^[ bWijj^h[[o[Whi$?dWZZ_j_ed"j^[D>IB7^WiWmWhZ[Z9DIJb[l[b)hWj_d]\eh Xej^º=[d[hWbIjWdZWhZi»WdZWbieºCWj[hd_joIjWdZWhZi»Wj[WY^hekdZe\ Wii[iic[dji_dY[(&&*%&+$M[Wh[ed[e\edboW^WdZ\kbe\jhkiji_dj^[KAje ^Wl[WY^_[l[ZikY^ijWdZWhZiWdZj^[dcW_djW_d[Zj^[c$J^[Jhkij½i=[d[j_Yi bWXehWjeh_[iWh[9F7WYYh[Z_j[ZWdZj^[h[fheZkYj_l[c[Z_Y_d[i[hl_Y[_iXej^?IE /&&'WdZ9F7WYYh[Z_j[Z$
:kh_d](&&.%&/j^[JhkijfheZkY[ZWº9b_d_YWb;nY[bb[dY[IjhWj[]o»[dYecfWii_d] j[deX`[Yj_l[i\ehj^[Z[l[befc[dj"_cfb[c[djWj_edWdZced_jeh_d]e\ekh YehfehWj[Yb_d_YWb[nY[bb[dY[W_ciZkh_d](&&/%'&$J^_im_bbX[b[ZXoj^[9b_d_YWb =el[hdWdY[9ecc_jj[[m^_Y^_iY^W_h[ZXoj^[C[Z_YWb:_h[Yjeh$ Quality Report ''
Trust priorities for quality improvement for 2009/10
)NFECTION RATES debate about optimum staffing at Standards of behaviour and in our ‘Step it Up’ programme on Infection within the neonatal unit midwifery level but equally that ATTITUDE AT WORK customer care. Within the Trust, we has been highlighted as a significant relating to consultant staffing of This is an area of concern which has believe that this area has a significant Trust issue, which is linked to the delivery suites. Standards have been been highlighted via complaints and impact on quality which we need to achievement of BAPM (British proposed by the Royal College PALS reports and anecdotally from assess more rigorously. Association of Perinatal Medicine) of Obstetricians and Gynaecologists patients and staff. We have introduced standards for neonatal nursing ratios. (RCOG) and introduced as a “reflective practice” pilot for In gynaecology our “infection rate” components of NHS Litigation hospital consultants, closer links appears higher than our Dr Foster peer Authority standards. The cost with Midwifery supervisors and group. The topic has local, national effectiveness of these proposals instigated widespread discussion and international significance. requires testing at a local and of the staff survey results with all potentially national level. We have staff groups within the hospital to To influence the national picture found it a challenge to move towards re-energise the Trust’s policy on staff on delivery suite staffing to 98 hours per week consultant cover behaviour and attitude at work. As the largest maternity unit in the and are still significantly short of 168 This will be galvanised by staff country we need to assist in the hours per week as recommended. participation during the coming year
Quality Indicators
Patient Safety but in addition measures other s 3TILLBIRTH RATE OF 4RUST babies. A specific measure will be to s ,OW UMBILICAL CORD P( n organisms causing bacteraemia with booked maternities look at the mortality rate in Very Low less than 7.00 particular relevance to the Neonatal In 2008 this was 6.2 per 1000 Birth Weight (VLBW) babies. There is Unit. Infection rates are benchmarked maternities (7.5 in 2007, 6.2 in national and international data Cord pH is a proxy measure of a with CHKS data (national clinical (Oxford-Vermont) available. baby’s condition immediately after 2006, 5.8 in 2005 and 6.8 in 2004). benchmarking data), which is Benchmark figures from Birmingham birth; the expectation is that healthy available from May 2007 onwards. Patient Experience babies who coped with labour well Women’s are (7.9, 7.3 and 7.5 for 04/05, 06/07 and 07/08). CEMACH would have a cord pH of more s 4WIN LIVE BIRTH RATES FOR ALL s )N PATIENT 3URVEY for 2005 gave a rate of 5.5 per 1000 than 7.2. A very low cord pH of less assisted conception treatments in Gynaecology and for 2006 5.3 per 1000. than 7.00 is regarded as clinically The incidence of antenatal 2007 and 2008 surveys including significant although a large number standard questions across a wide complications and newborn morbidity s 2EADMISSION RATES of babies with such a low cord pH will range patient experiences from associated with multiple pregnancy to gynaecology be entirely normal. The Trust’s rate of communications with clinical staff to has led to Human Fertilisation and CHKS data indicates that in 2007 the cord pH below 7.00 was 3.8 in every quality of food. Latest results showed Embryology Authority (HFEA) guidance Trust’s readmission rate was 3.4% 1000 maternities in 2008 (in 2007 it the Trust as significantly better than which advocates single embryo against the peer group rate of 5.7%. was 2.9 per 1000). At present there transfer. HFEA data for 2006 and the national average on 40 questions. are no agreed national benchmarks. 2007 is available and benchmarked. s (AEMORRHAGE AND The Trust’s twin rate in 2006 was s 2ATE OF EPIDURAL PAIN RELIEF FOR s -ISCARRIAGE FOLLOWING haematoma (blood loss 24.3% and 24.1 % in 2007. obstetric analgesia amniocentesis AND BLOOD CLOTS FOLLOWING Gynaecological surgery The present rate is 16.1% and there is Amniocentesis is an antenatal invasive s -EDICATION ERRORS ACROSS a perception this could and should be procedure that involves taking a CHKS data for 2007 shows the Trust the Trust rate as 0.44% against the peer rate higher. The figure is available for 2 sample of the amniotic fluid that years and is benchmarkable. surrounds the baby after 15 weeks One of the commonest features of of 0.38%. of gestation. Assessment of a baby’s Adverse Clinical Event Reports across all Directorates. Data is available for s /UTCOME OF )6&)#3) TREATMENT The Trust’s Clinical Annual genes to exclude conditions such as eport contains extensive detail at the last 2 years. The pregnancy rate per cycle of Down’s Syndrome is the common about our quality and activity treatment started is a reflection of indication for this procedure. The metrics and can be accessed at Clinical Effectiveness successful clinical practice. HFEA data overall miscarriage rate following WWWLWHORGUK amniocentesis at the Trust was 0.7% s 4RANSFER TO )45 PER is available on an annual basis and in 2008 (2 out of 299 procedures). 1000 maternities benchmarked. Trust data for 2007 The RCOG quotes a procedure related In 2008 the level of transfers was shows a rate of 25.9% and 24.6% miscarriage risk rate of 0.5% to 1%. 0.5 in every 1000 (0.8 in 2007, 1.1 in 2008. in 2006 and 0.4 in 2005). The only s )NFECTION 2ATES benchmark hospital that we have for s .EONATAL MORTALITY RATE The Trust continues to concentrate comparison is Birmingham Women’s, An essential measure of care but with upon MRSA and clostridium difficile, whose figure was 0.96 in 2007/08. a focus upon booked and transferred How We Performed'(
How We Performed
The Trust’s key achievements in 2008/09 To ensure all patients have a positive To promote our status as a premier against our six corporate aims are set experience in our care 5NIVERSITY 4EACHING (OSPITAL AND out below: We have… Centre for Research s Patient survey results which showed the We have… To deliver clinical excellence in all Trust as significantly better than average s Participated in the Academic Health our services on 40 questions Science Centre bid for Liverpool We have… s Implemented our baby diary initiative s Agreed to develop the Centre for Better s Developed five clinical indicators for in Neonates Births with the University of Liverpool to each directorate s Introduced Gynaecology ‘closer to home’ promote research into uterine contractility s Achieved stage 2 practice development for Knowsley patients s Continued international research unit accreditation in clinical genetics s Significantly reduced waiting times for collaborations in Canada, Australia s Published a comprehensive Clinical Assisted Conception services and Uganda Annual Report with supporting summary s Seen steady growth in participation in portfolio studies document as precursor to Quality Accounts To be the provider of 1st choice for s Commenced the ‘Mulago Partnership’ in s Published the Trust Clinical WOMEN AND THEIR FAMILIES 5GANDA n SUPPORTING CLINICAL EXCHANGE IN Excellence Strategy We have… obstetrics and community midwifery s Agreement for Liverpool Women’s to 4O DELIVER OUR AIMS WITH SKILLED To deliver strong financial develop a laser fetoscopy service competent and motivated staff performance necessary to continually s Expanded neonatal supported by effective leadership invest in services parents’ accommodation We have… We have… s Introduced HPV screening in colposcopy s Successfully reconfigured our community s Maintained a monitor risk rating of 5 and s Board approval to fund an ‘End of Life’ midwifery services an Annual Health Check EXCELLENT for suite for cancer patients and their relatives s Enabled a number of staff to use of resources s Begun building works to extend access leadership development s Successfully managed a financial and improve the Hewitt Centre for programmes through the North West
strategy to support planned investment Reproductive Medicine. Leadership Academy in capital developments s Introduced ‘coaching’ for Trust senior s Supported the development of managers and clinical leaders Clinical Business Unit framework for s Successfully reduced sickness absence implementation in April 2009 figures over the last year JeZ[b_l[hYb_d_YWb[nY[bb[dY[_dWbbekhi[hl_Y[i‘ M[^Wl[± FkXb_i^[ZWYecfh[^[di_l[9b_d_YWb7ddkWbH[fehj m_j^ikffehj_d]ikccWhoZeYkc[djWifh[Ykhiehje ‘GkWb_jo7YYekdji How We Performed')
Key Performance Indicators in 2008/09
0ERFORMANCE IN Care Quality Commission 0ERFORMANCE IN TARGET Total time in A&E: 4 hour 99.82% >=98% 99.98% from arrival to admission, transfer or discharge. Elective patients waiting longer 0.00% <=0.03% 0.027% than the standard (26 weeks) Outpatients waiting longer than 0.00% <=0.03% 0.00% the standard (13 weeks) Cancelled Operations for non- 0.289% <=0.8% 0.491% clinical reasons / total number of episodes Cancelled Operations for non 0.00% <=5% 0.00% - clinical reasons not admitted within 28 days / number of last minute cancellation for non- clinical reasons Incidence of MRSA Bacteraemia 2 <=3 0
Incidence of Clostridium difficile 2 <=9 2
18 week referral to 93.44% 90% Jan = 90.19% Treatment times: 90% Feb = 91.09% Admitted; performance against target 90% Mar = 90.19% 18 week referral to NA Not yet confirmed Jan = 100%
Treatment times: Feb = 99% Admitted : data completeness Mar = 97%
18 week referral to 93.44% 95% Jan = 95.03% Treatment times: 95% Feb = 95.78% Non-admitted: performance against target 95% Mar = 95.13% Je[dikh[WbbfWj_[dji^Wl[Wfei_j_l[[nf[h_[dY[_dekh‘ YWh[M[^Wl[± FWj_[djikhl[oh[ikbjim^_Y^i^em[Zj^[JhkijWi ‘i_]d_ÅYWdjboX[jj[hj^WdWl[hW][ed*&gk[ij_edi How We Performed'*
Key Performance Indicators in 2008/09 contd.
0ERFORMANCE IN Care Quality Commission 0ERFORMANCE IN TARGET 18 week referral to NA Not yet confirmed Jan = 99% Treatment times: Feb = 101% Non-admitted: data completeness Mar =91% All Cancers: two week waits 99.88% >=98% 98.60%
All Cancers: one month 100% >=98% 100% diagnosis to 1st definitive treatment: existing commitment (April to December) All Cancers: one month 100% Not yet confirmed 99% diagnosis to 1st definitive treatment: existing commitment *ANUARY TO -ARCH WEEK pause model) All Cancers: one month diagnosis NA Not yet confirmed 100% to subsequent treatment: new cancer strategy (January to March) All Cancers: two month GP 99.56% >=95% 97.35% urgent referrals to treatment:
existing commitment (April to December) All Cancers: two month GP NA Not yet confirmed 82.69%
urgent referrals to treatment: existing commitment *ANUARY TO -ARCH WEEK pause model) JeZ[b_l[hijhed]ÅdWdY_Wbf[h\ehcWdY[d[Y[iiWhoje‘ Yedj_dkWbbo_dl[ij_di[hl_Y[iM[^Wl[± CW_djW_d[ZWced_jehh_iahWj_d]e\+WdZWd7ddkWb ‘>[Wbj^9^[Ya;N9;BB;DJ\ehki[e\h[iekhY[i How We Performed'+
Key Performance Indicators in 2008/09 contd.
0ERFORMANCE IN Care Quality Commission 0ERFORMANCE IN TARGET All Cancers: two month NA Not yet confirmed 100% Consultant Upgrades referrals to treatment: new cancer strategy (January to March) All Cancers: two month NA Not yet confirmed 100% Screening referrals to treatment: new cancer strategy (January to March)
Key Performance Indicators
s WEEK REFERRAL TO TREATMENT targets. This means that we have been deliver 18 week maximum referral to Our staff have built on the success of able to deliver clinical pathways to our treatment times for patients accessing previous years and have continued to patients within 18 weeks of referral from our Assisted Conception Services (IVF) and deliver shorter waiting times and have their GP to our Gynaecology service and our Clinical Genetics Service in line with consistently exceeding national wait time for the first time have also been able to national targets.
Days Wait EkhijW\\^Wl[Xk_bjedj^[ikYY[iie\fh[l_eki‘ o[WhiWdZ^Wl[Yedj_dk[ZjeZ[b_l[hi^ehj[hmW_j_d] j_c[iWdZ^Wl[Yedi_ij[djbo[nY[[Z_d]dWj_edWbmW_j ‘j_c[jWh][ji$ How We Performed',
Key Performance Indicators contd.
Waiting times for IVF treatment times have Overall: - 95.20% of our patients who required reduced from 475 days in March 2007 to 69 - 90.7% of our patients who required outpatient treatment were treated days in March 2009 making these amongst surgery were treated within 18 weeks within 18 weeks of referral from their the lowest in the UK. of referral from their GP. The national GP. The national target was 95% by target was 90%. December 2009 s 7AITING ,ISTS AND 7AITING 4IMES No of Patients
Although we have more patients waiting for inpatient surgery in 2009 than in the previous year, this is as a result of better management of patients and a reduction in the number of patients not on an active waiting list due to their treatment being suspended. We have been able to maintain waiting times at similar levels to 2008. MW_j_d]j_c[i\eh?L<jh[Wjc[djj_c[i^Wl[h[ZkY[Z‘ \hec*-+ZWoi_dCWhY^(&&-je,/ZWoi_dCWhY^(&&/ ‘cWa_d]j^[i[Wced]ijj^[bem[ij_dj^[KA$ How We Performed'-
Key Performance Indicators contd.
In March 2009 we were able to offer 97.5% of patients an outpatient appointment within 5 weeks of referral from their GP. /&$-e\ekhfWj_[djim^eh[gk_h[Z‘ ikh][hom[h[jh[Wj[Zm_j^_d'.m[[aie\ ‘h[\[hhWb\hecj^[_h=F$ How We Performed'.
Key Performance Indicators contd.
At the end of March 2009, we had fewer region and is accessible to women from s -23! AND #LOSTRIDIUM $IFlCILE patients waiting for diagnostic tests than across Cheshire and Merseyside. We have In 2008/09 Liverpool Women’s invested in March of the previous year. Also 70% of been able to develop services in line with additional resources in the preventation patients received their diagnostic test within the new national cancer strategy and that and control of infection. Staff working from 2 weeks of request compared to 67% in the means making sure that all women are all our premises ensure that this is a top
previous year. able to access appropriate services quickly, priority and that our patients are kept as regardless of how or by whom their cancer safe as possible at all times. The Trust is s #ANCER 4REATMENTS or suspicion of cancer was identified. We very proud of our excellent track record in
The Trust continues to deliver high quality have been able to meet all the published this area which means that in the last year services to patients with Gynaecological national standards and perform we have had no reportable cases of Cancer. The service provided at Liverpool exceptionally well when compared to MRSA and only 2 reportable cases of Women’s is the recognised centre for this similar services elsewhere. clostridium difficile. J^[JhkijYedj_dk[ijeZ[b_l[h^_]^‘ gkWb_joi[hl_Y[ijefWj_[djim_j^ ‘=odW[Yebe]_YWb9WdY[h$ The Trust’s Macmillan Team How We Performed'/
Patient Quality Indicators
s 3MOKE &REE .(3 cessation team, based on both sites. Once peer support programmes which have been The Trust continues to be an active partner in women have set a quit date the success shown to be effective in increasing both the the Smoke Free Liverpool Campaign, having rate is around 50% which gives a reduction initiation and duration of breastfeeding and been a smoke free site since January 2006. in pregnancy of around 4%. Our staff are the expectation is for recruitment to this team in the summer of 2009. In particular, the Trust is involved in a great also able to benefit from smoking cessation
deal of collaborative work around smoking services and support. Statistics for initiation of breastfeeding in pregnancy. s "REAST FEEDING at birth and on discharge from hospital continue to improve steadily, with a focus on Across the PCT’s there are wide variations After much hard work, the Trust achieved maintenance of breastfeeding planned for in smoking rates which were highlighted Stage 1 of the UK Baby Friendly Award 2009. Collaborative working with the PCT in the 2007 Health Equity Audit with direct in March 2008 and we plan to be ready Infant Feeding Team has provided support links to deprivation. Although figures in for assessment at stage 2 level by the end and confidence in further developing the some areas are high, they represent the of 2009. service within the community and continues number of women who are smoking at to embrace the aim to improve the short and booking. Women who would like support to The Trust continues to work in partnership long term health and quality of life of the stop smoking are referred to the smoking with local Primary Care Trusts to develop city’s population.
Progress against Service Developments
s -ATERNITY 3ERVICES - We have introduced Consultant a booking appointment. With PCT Liverpool Women’s has worked in close Obstetrician clinics in the community investment, over 75% of women benefit collaboration with our PCT commissioners Consultant delivered antenatal services for from shorter waiting times. to develop a robust strategy for the the management of women with high risk development of maternity services in pregnancies are now up and running in - We have expanded perinatal mental
two community locations within Liverpool. Liverpool. We are committed to the health services Services will be expanded into another two implementation of this strategy and to In conjunction with colleagues in ensure that women receive the highest facilities early in 2009/10. Merseycare NHS Trust we have been possible standards of maternity care. able to increase mental health nurse and
Liverpool Primary Care Trust made - We offer access to booking appointments significant investments in maternity services before 12 weeks gestation consultant psychiatrist input into the in 2008/09. With this investment we The Trust has successfully reduced the service to improve the number of women have been able to achieve the following number of women having to wait until who have access to these services at a enhancements to services:- over 12 weeks gestation before accessing very critical time. 7\j[hckY^^WhZmeha"j^[Jhkij‘ WY^_[l[ZIjW]['e\j^[KA8WXo The Archbishop, Patrick Altham Kelly, of Liverpool visited the Trust on 18th February 2009 How We Performed(& Progress against Service Developments contd. - We have redesigned our triage and plans have been approved and Liverpool will Services provided include gynaecology and assessment service for women in become one of only a few regional centres cosmetic surgery. early labour in mid 2009. This will mean that women will With the help of additional funding we no longer have to travel to Birmingham or s $EVELOPMENT OF THE Centre for have been able to redesign our triage London for treatment. "ETTER "IRTHS and assessment services linked to our Liverpool Women’s and the University of delivery suite. This means that women s (EWITT #ENTRE FOR Liverpool are working together to develop are now able to telephone and speak to Reproductive Medicine a facility at Crown Street which will bring an experienced midwife for advice. This Liverpool Women’s has seen significant together the two organisations as a centre has reduced the number of women who developments within its reproductive of research excellence for the study of previously had to make an unnecessary medicine service during the last year. Waiting factors relating to childbirth and pregnancy journey to the hospital. times for patients have been reduced and we failure. The Centre for Better Births aims to are now able to offer access to IVF treatment significantly increase the number of normal - We are increasing Consultant within 18 weeks of referral - the lowest births and improve survival for pre-term Obstetrician cover on Labour Ward to waiting times ever. We have also introduced babies. Plans for the Centre have progressed 98 hours per week In line with national best practice, our PCT an NHS sperm bank which means that well during 2008/09 and a business case will has supported the Trust to move from 56 couples are able to access sperm donation be put forward for approval in mid 2009. hours of consultant cover on labour ward locally, funded by the NHS. We are also able to 98 hours of cover. The Trust was able to TO OFFER EGG FREEZING AS AN OPTION FOR FERTILITY s 'YNAECOLOGICAL #ANCER 3ERVICES increase cover to 60 hours in 2008/09. We preservation for women undergoing other Building on the success of Liverpool will be finalising plans with our consultant medical treatments such as treatment for Women’s as the Gynaecological Cancer Obstetricians on the model to move to CANCER 7E HAVE ALSO INVESTED aM IN THE Centre for Merseyside and Cheshire, we 98 hour cover in the next year. development of a new reproductive medicine are continuing to improve the services we unit, making Liverpool Women’s the biggest are able to offer to our patients. Two very s $EVELOPMENT OF 3PECIALIST &ETAL IVF unit in Europe. welcome schemes have commenced in Medicine Service 2008/09 that will bring significant benefits s $EVELOPMENT OF A $EDICATED 0RIVATE During 2008/09, Liverpool Women’s has to our patients. worked very closely with regional and 0ATIENT 5NIT national specialist commissioners to Liverpool Women’s has funded the - +INGS &UND )NITIATIVE n #ARE OF THE develop plans to offer a local laser development of a private patient facility Terminally Ill Patient fetoscopy service to treat twin to twin on its Crown Street site. This gives a choice The Trust’s cancer team have secured transfusion within pregnancy. This is a to patients to have their treatment under funding from the King’s Fund and the condition that only affects identical twin the care of experienced consultants and Board of Directors to develop an inpatient pregnancies and if untreated could result healthcare professionals while remaining facility dedicated to the care of the in losing one or both of the babies. These within the safety of the NHS setting. terminally ill patient. The new facility will B_l[hfeebMec[d½i^Wii[[d‘ i_]d_ÅYWdjZ[l[befc[djim_j^_d _jih[fheZkYj_l[c[Z_Y_d[i[hl_Y[ ‘Zkh_d]j^[bWijo[Wh$ ,ORD $ARZI 0ARLIAMENTARY 5NDER 3ECRETARY OF 3TATE FOR (EALTH CENTRE $AVID .ICHOLSON #HIEF Executive of the NHS, meet mums & babies at the Speke Children’s Centre in October 2008 How We Performed(' Progress against Service Developments contd. provide a hotel style suite of rooms for the - On Site Chemotherapy for women with the two hospitals are working together to patient and their close relatives. This will Gynaecological Cancer develop facilities at Crown Street so that include two bedroom areas, a lounge area, Currently any woman requiring chemotherapy can be delivered locally. kitchen area and two ensuite bathrooms. chemotherapy for the treatment of This would be to the benefit of women This will give much needed privacy to gynaecological cancer from Merseyside from across Merseyside. Plans are well patients and their families at this very or Cheshire has to travel to Clatterbridge developed and the service is aimed to be difficult time. Centre for Oncology on the Wirral. Now up and running in 2009. Information Management and Technology The department of Information Management department and individual at the Trust obtain s 4%#(7/2,$ #)/ -AGAZINE #)/ & Technology (IM&T) has remained the full range of connectivity, application of the year (UK) committed to providing connectivity and power, and information skills necessary to be s )3/ ACCREDITION IN access to all information required by the productive in the information age. data security Trust staff to help them meet the strategic goals of the organisation at the point During 2008/09 IM&T has focused its 4O FURTHER DEVELOP OUR )4 SYSTEMS of care. IM&T has continued to enhance energies on: to support service delivery and its services at the Trust through business s (ARDWARE AND NETWORK INFRASTRUCTURE clinical excellence process redesign, innovation and the s -ULTIMEDIA COMMUNICATIONS We have… implementation of cutting-edge technology s 3TANDARDISED WORKSTATION SYSTEMS AND s -AINTAINED FULL DISASTER RECOVERY AND whilst engaging clinical users. The IM&T application environments business continuity for all clinical and team’s goal has remained to deliver flexible, s -OBILE AND REMOTE WORKING FOR STAFF critical information systems efficient and reliable IT services, whenever, s -EDICAL INFORMATION MANAGEMENT s -AINTAINED UPTIME WHILST CREATING wherever needed, to ensure the Trust tools, data warehousing and the next generation virtual infrastructure continues to deliver competitive, world class business intelligence for all key systems women’s medical care. s )NTEGRATION OF MEDICAL INFORMATICS AND s $EPLOYED A NEW STORAGE AND TAPELESS information technology in the day-to-day backup solution for the Trust’s data assets The IM&T department is committed to business process at the Trust s $ELIVERED DIGITAL SIGNAGE AND TELEVISION TO providing quality services to all of our all patient waiting areas users and has been implemented Six Sigma During the year IM&T has received national s 0RODUCED REPORTS IN ACCORDANCE WITH principles to all projects over the last and international accolades, as well Schedule 5 of the Legally Binding Contract operational year to ensure that it delivers achieving international standards: and maintained regular reconciliation QUALITY SERVICES WITH FULL BENElTS REALIZATION s #OMPUTERWORLD 'OLD -EDAL meetings with PCTs to improve data and IM&T has accomplished this by helping each Laureate Winner in Healthcare IT (USA) contract monitoring :kh_d]j^[o[Wh?C J^Wih[Y[_l[Z‘ dWj_edWbWdZ_dj[hdWj_edWb WYYebWZ[i"Wim[bbWY^_[l_d] ‘_dj[hdWj_edWbijWdZWhZi$ Chief Executive Kathryn Thomson (right) officially opened our new Clinical Genetics facility based at Alder Hey Children’s Hospital, with Louise Shepherd, Chief Executive of Alder Hey How We Performed(( Information Management and Technology contd. s )MPROVED DATA QUALITY THROUGH AN s )MPLEMENTED AN UPGRADE TO VERSION ongoing programme of refresher training of the Trust’s healthcare information for all staff system (MEDITECH) s -AINTAINING CODING COMPLETION s #ODING ACCURACY CLASSIlED AS @%XCELLENT IN by the 2nd working day after month end the Payment by Results assurance audit throughout the financial year s )MPLEMENTED POSITIVE PATIENT )$ THROUGH s !CHIEVED A CODING ERROR RATE OF ONLY electronic wristband printing 3.0% for Primary Diagnosis and 0.8% for s )MPROVED THE )NFORMATION 'OVERNANCE .(3 Primary Procedure, as well as a HRG error IG Toolkit score to 83% rate of 1.5% (national averages of 16.5%, 16.5% and 9.4% respectively) s $ELIVERED A NEW HELPDESK SYSTEM FOR s (ALVED MONTH END REPORTING TIMESCALES Technical and Information Systems service for SLAM / Board report from 10 to 5 delivery for 1st and 2nd line support to working days Trust users s 3UCCESSFULLY SUBMITTED THE #OMMISSIONING s 3UCCESSFULLY BUILT A DATA WAREHOUSE TO Datasets in version 6 format house key Trust data How We Performed() Research & Development The Trust makes a significant contribution throughout the Directorates and cover all In order to support this strong portfolio to research in its specialist areas with types of research methodologies and of research activity, the Research projects largely led by members of staff. This phases including development of ideas for & Development Department has research includes projects on the National new treatments. continued to embrace changes in the Institute of Health Research Clinical Research ways that NHS research is commissioned Network (NIHR CRN) portfolio and projects Ultimately, through the conduct of research, and managed. funded by industry. A total of 96 projects we implement change to healthcare practice, are currently in progress with another 20 paying attention to the needs of patients The figure (below) gives an overview of the projects in set-up. These projects are spread and their families. types of research underway: Basic Research Early ClinicalLate Trials Clinical Trials HealthcareEpidemiology Delivery Study PrototypePreclinical Development Development Health ServicesKnowledge Research Management Health Technology Assessment The Trust recruits to 26 NIHR CRN portfolio Trust members have been funded to Staff within the Trust have extensive studies. The R&D Department liaises conduct research following international experience of research that leads to closely with the Cheshire & Merseyside competition for research grant awards. innovation in the patient experience, Comprehensive Local Research Network to Funding has been secured from the quality of care and patient safety. The plan and manage this research activity. The Cochrane Centre; Framework Programme R&D Department has a strong track department is committed to supporting the 6 of the European Commission, safety in record of supporting members of the Trust neonatal care; and Framework 7 of the with innovative research. Our approach national ambition of doubling the number European Commission, Treat Infections in to research as a route to innovation is of patients recruited to clinical research Neonates. Trust staff have also been funded illustrated by the broad range of research over the next five years as stated in the following national competition, and have projects ongoing across the Trust. In NHS Operating Framework 2009/10. R&D secured funding from the Health Technology 2008 this Trust research activity was are continually reviewing Trust research Assessment, NIHR (Applied Health Research communicated and disseminated via processes to ensure researchers across Programme Grant / Research for Patient publications in scientific peer reviewed the Trust get the best possible support in Benefit project), WellBeing of Women, BLISS journals (in excess of 110), national press, conducting good quality research that is the baby charity, the Moulton Trust and the and presentations at research conferences compliant with regulatory requirements. Wellcome Trust. and symposiums. Our Future Developments(* M[Wdj_Y_fWj[j^Wj(&&/%'&m_bbX[Wi_]d_ÅYWdjo[Wh\ehB_l[hfeebMec[d½i$ (&&/%'&_ij^[j^_hZo[Whe\j^[Jhkij½iijhWj[]_YfbWdWdZm_bbi[[j^[ Ykbc_dWj_ede\iec[i_]d_ÅYWdjfhe`[YjiWdZi[hl_Y[Z[l[befc[dji1dejb[Wijj^[ Yecc_ii_ed_d]e\j^[d[mh[fheZkYj_l[c[Z_Y_d[Xk_bZ"j^[WffhelWbe\j^[9[djh[ \eh8[jj[h8_hj^iWdZj^[Z[l[befc[dje\j^[¼8_]Fki^½fhe`[Yjjeh[Z[i_]dekh cWj[hd_joi[hl_Y[$ 7iW^_]^f[h\ehc_d]fhel_Z[he\^[Wbj^YWh[m[WbieÅdZekhi[bl[iedj^[Ykif e\iec[i_]d_ÅYWdjY^Wbb[d][i1j^[ÅdWdY_Wb[dl_hedc[djel[hj^[d[nj\[m o[Whi_ib_a[bojeX[j^[ceijj[ij_d]j^WjB_l[hfeebMec[d½i^Wi[l[h\WY[Z$J^[ YecX_d[ZiYhkj_doedlWbk[\ehced[oWdZ_dYh[Wi[ZgkWb_joe\i[hl_Y[ic[Wdi j^[Jhkij^WijemehaYebbWXehWj_l[boje[dikh[Z[b_l[hoe\j^[i[Z[cWdZ_d]WdZ Wjj_c[iYedÆ_Yj_d]W][dZWi$ C o r p o r a t e Corporate Objectives 2007-2010 S t r a t e g i e s The Trust corporate objectives remain s 7E SHALL DELIVER OUR AIMS WITH SKILLED 2007-2010 unchanged for 2009/10. They are competent and motivated staff supported by effective leadership. s 0URSUING productivity and efficiency - s 7E SHALL DELIVER clinical excellence in 5% below tariff all our services The challenge to achieve strong performance s 0URSUING SERVICE GROWTH - s 7E SHALL DELIVER strong financial against all corporate objectives will be no less in 2009/10 than in previous years. In fact the 8% over 3 years performance across all our services need to maintain high quality services against s 0URSUING WORLD CLASS OUTCOMES - s 7E SHALL ENSURE ALL PATIENTS HAVE A Evidence of best of class a backdrop of tighter finances will require the positive experience in our care Trust to work in different and innovative ways. s 7E SHALL BE THE provider of 1st choice This will be supported in year by the EQUIP for women and their families Programme (Everyone’s Quality Improvement s 7E SHALL PROMOTE OUR STATUS AS A Programme) to look at quality and efficiency PREMIER 5NIVERSITY 4EACHING (OSPITAL in key clinical and non clinical areas across and Centre for Research the Trust. ][d[hWbcWdW][c[djj^hek]^9b_d_YWb8ki_d[iiKd_ji$ ‘ JhkijWdZje\WY_b_jWj[j^[_dj[]hWj_ede\Yb_d_YWbWdZ ‘M[^Wl[WYecc_jc[djjeZ[l[befYb_d_YWbb[WZ[hi^_f_dj^[ Business Units. Business to facilitate the integration of clinical and general management through Clinical Clinical through management general and clinical of integration the facilitate to measures. We have a commitment to develop clinical leadership in the Trust and and Trust the in leadership clinical develop to commitment a have We measures. of that care through clinical outcome measures and patient reported outcome outcome reported patient and measures outcome clinical through care that of continue to deliver the highest standard of clinical care and measure the success success the measure and care clinical of standard highest the deliver to continue we serve and the development of the staff we employ. We have an obligation to to obligation an have We employ. we staff the of development the and serve we the North West”. Our focus will be on responding to the needs of the patients patients the of needs the to responding on be will focus Our West”. North the AND ITS SISTER DOCUMENT PREPARED BY .(3 .ORTH 7EST h(EALTHIER (ORIZONS FOR high performing provider of healthcare not just next year but for the future. the for but year next just not healthcare of provider performing high THE RECOMMENDATIONS OF THE REPORT BY ,ORD $ARZI h(IGH 1UALITY #ARE FOR !LLv efficient. This approach will mean that Liverpool Women’s can continue to be a a be to continue can Women’s Liverpool that mean will approach This efficient. In our plans for 2009/10 we will be considering actions to be taken to build on on build to taken be to actions considering be will we 2009/10 for plans our In to rise to the challenge of improving quality at the same time as being more more being as time same the at quality improving of challenge the to rise to ” l l A r o f e r a C y t i l a u Q h g i H “ position to pursue its planned service and capital developments and needs needs and developments capital and service planned its pursue to position strong a in is Trust The opportunity. and challenge of year a be will 2009/10 previous years, and will commence in the early autumn. early the in commence will and years, previous provider and employer of first choice. first of employer and provider respond positively and quickly to changes. This will be an inclusive process, as in in as process, inclusive an be will This changes. to quickly and positively respond essential. This will place the Trust in a strong position for years to come; as a a as come; to years for position strong a in Trust the place will This essential. HORIZON IN THE NEXT TO YEARS AND MAKING SURE THAT THE 4RUST IS IN A POSITION TO highest quality patient and working environment and its fitness for purpose is is purpose for fitness its and environment working and patient quality highest strategic direction. This will be an opportunity to look at what is coming over the the over coming is what at look to opportunity an be will This direction. strategic site but also on all other sites from which services are provided. Ensuring the the Ensuring provided. are services which from sites other all on also but site The Trust will also take the opportunity in year to refresh its service strategy and and strategy service its refresh to year in opportunity the take also will Trust The be a key theme of the 2009/10 plan. This will not just focus on the Crown Street Street Crown the on focus just not will This plan. 2009/10 the of theme key a be The enhancement of the environment from which our services are provided will will provided are services our which from environment the of enhancement The r a e y n i y g e t a r t s e c i v r e s f o h s e r f e R t n e m n o r i v n E CBUs will have the opportunity to present their plans to the Board. the to plans their present to opportunity the have will CBUs effectively as possible in the improvement of health. of improvement the in possible as effectively governance and assurance processes and structures. As with previous years, years, previous with As structures. and processes assurance and governance widely with partners in health and social care to ensure we are contributing as as contributing are we ensure to care social and health in partners with widely be key to the subsequent monitoring of performance and introduction of robust robust of introduction and performance of monitoring subsequent the to key be Liverpool Women’s has an important role to play and we must engage more more engage must we and play to role important an has Women’s Liverpool development of strong objectives through this operational planning process will will process planning operational this through objectives strong of development health of the populations we serve and reducing the burden on health care. The The care. health on burden the reducing and serve we populations the of health Practice Based Commissioners. An important focus will be on improving the the improving on be will focus important An Commissioners. Based Practice the year, In CBUs. to devolved being accountability and responsibility greater and commissioning priorities that will be made by Primary Care Trusts and and Trusts Care Primary by made be will that priorities commissioning and mean will This hold. take will autonomy earned and (CBUs) Units Business We need to be increasingly aware of our external environment and the service service the and environment external our of aware increasingly be to need We Clinical of introduction the year, financial new the into moves Trust the As s r e v i r d h t l a e h c i l b u P s t i n U s s e n i s u B l a c i n i l C (+ Our Future Developments Future Our Patient Care(, Patient and Public Involvement The Patient Quality Committee has continued groups and direct discussion on a one to one s 2EVIEW OF WAITING AREA PROVISION FOR THE to meet on a quarterly basis. This group basis. Examples include: Colposcopy Department consists of two of the Trust’s governors and s 0ATIENTS VISITORS STAFF VIEWS ON s 2EVIEW OF SIGNAGE IN THE #LINICAL five public members. The committee has enhancing the ‘smoke free site’ Genetics Department provided valuable input to the development s #LOSER TO HOME PROJECT FOR 'YNAECOLOGY and ongoing review of progress of the s WEEK PATHWAY INFORMATION This information has been disseminated Patient Quality Strategy action plans. s %VALUATION OF TELEPHONE TRIAGE SYSTEM widely throughout the Trust and actions in Obstetrics taken as a result displayed on our ‘You said, The committee has assisted in the we did’ notice boards. development and review of strategic The use of ‘exit cards’ provides valuable policies and annual complaints and patient information about patients’ experiences Information reports. The group will highlighting areas of good practice and continue to monitor progress of the occasions when the service could have been associated action plans. improved. As a result a number of changes to practice have been brought about: The Patient Quality Team has engaged in s !MENDED MEDICINE ROUND TIMES discussions with patients and members of in Gynaecology the public to enhance our knowledge of s 2EVIEW OF VISITING ARRANGEMENTS ON how the Trust as a whole is viewed. This Bedford Ward information has been collated through focus s !DDITIONAL CHOICE OF HOT FOOD AT LUNCH TIME Patient Information The patient information group have The findings of a comprehensive Requests for information in other languages reviewed 33 patient information leaflets audit of the policy assure the Trust and formats such as audio version have been during the year. The leaflets have been that all existing patient information processed on request. produced by multidisciplinary teams within leaflets have been reviewed within an the Directorates. The written information agreed timescale specified and this Copies of all leaflets are available on the has been processed using a rigorous information is clearly demonstrated Trust’s intranet, these can be printed on method for ensuring they are easily on each document. All leaflets request and in large font format if patients understood and contain sufficient explaining clinical treatments contain have sight impairment. information by which patients and their information about the associated risks families can make an informed decision and benefits and any alternative about the care they receive. treatment to consider. J^[ki[e\¼[n_jYWhZi½fhel_Z[ilWbkWXb[_d\ehcWj_edWXekj‘ fWj_[dji½[nf[h_[dY[i^_]^b_]^j_d]Wh[Wie\]eeZfhWYj_Y[ ‘WdZeYYWi_edim^[dj^[i[hl_Y[YekbZ^Wl[X[[d_cfhel[Z$ Patient Care(- The Patient Surveys The Healthcare Commission 2008 and investigations and treatment 2007 survey the Trust scored than average for 4 questions and Inpatient Survey results were within the Hewitt Centre for - Significantly better on 5 questions results fell in the average range for released in February 2009. Postal Reproductive Medicine. - Significantly worse on 2 questions 39 questions, when compared to questionnaires were sent to a random - No significant difference on other acute and specialist Trusts sample of 850 patients who attended s PATIENTS COMPLETED AND 73 questions the Gynaecology Ward during 2008. returned the questionnaire, giving a s 4HE BENCHMARKED SURVEY RESULTS The Gynaecology Directorate is Exclusion criteria included women response rate of 51.8% which is the indicated that the Trust was currently preparing an action plan in who had undergone a termination national average. significantly better than average for response to the survey findings. of pregnancy, early pregnancy loss s )N COMPARISON TO THE RESULTS OF THE 40 questions, significantly worse C o m p l a i n t s The Trust responds to all complaints year. The main themes, which have There were no referrals to the Health s !DDITIONAL TRAINING FOR STAFF IN with equal seriousness and attention. emerged during this period were: Service Ombudsman during this period. palliative care Complaints are viewed in a positive s 4REATMENT AND CARE s $EVELOPMENT OF $ISCHARGE manner and are a powerful tool s #OMMUNICATION -EETINGS WITH COMPLAINANTS planning group for learning lessons and changing s &ACILITIES Meeting the complainant is an s 2EVIEW OF ARRANGEMENTS FOR SUPPORT practice and procedures when s !TTITUDE OF STAFF excellent opportunity to learn about person attending with patients on appropriate. By listening to concerns the experience in more detail and this Bedford Unit raised by complaints, the Trust is The Trust aims to deal with all interaction is positively encouraged s 2EVIEW OF PATIENT INFORMATION FOR able to continuously reflect on complaints within 25 days of as part of the procedure. Meetings women attending the Bedford Unit many aspects of the patients’ receiving them and this was achieved are facilitated by the Patient Quality s 2EVIEW OF CONTENT OF CONSENT FORM experience and actively respond to in 79% of cases during 2008/09. Team, who provide a transcript of the in Clinical Genetics Department any concerns constructively. meeting and when necessary provide One complaint was referred to the any follow up action as a result. Work in progress: Complaints can be made by patients, Healthcare Commission during this period. The Trust responded to s 6IRTUAL TOUR OF OUR MATERNITY UNIT FOR relatives or visitors, although Action taken as a result of complaints patient confidentiality is maintained each recommendation made by the this year include: the Trust web site at all times. commission and the outcome was s $EVELOPMENT OF A MULTIDISCIPLINARY s !UDIT OF MANAGEMENT OF PATIENTS WHO shared with the complainant. The group to review management of are Group B Streptococcus positive In the period between April 2008 and Healthcare Commission has not wound care s 2EVIEW OF INFORMATION REGARDING March 2009, the Trust received 109 undertaken any full investigations s !MENDMENT OF DOCUMENTATION TO the effects of treatment to the formal complaints, which is a slight nor held an independent panel demonstrate inspection of epidural cervix and how this may affect increase compared to the previous during this period. administration site during labour future pregnancies Infection Control Liverpool Women’s continues to s $URING FOUR AGED positive laboratory test rather than Acquired Infection following a maintain its excellent record and high over 65 years) patients were a true infection. successful ‘Hygiene Code’ inspection standards of performance in respect identified with clostridium difficile s h%XCELLENTv RATINGS IN THE 0%!4 in July 2008. Following the inspection of infection prevention and control. disease at Liverpool Women’s assessment demonstrating the a small number of minor issues Hospital. Three of these cases high standards we maintain in were identified which the Trust was s 4HERE WERE NO CASES OF -23! BLOOD were admitted to the Trust with cleanliness of the environment. able to rectify quickly to achieve full infection in the Trust during the year; established symptoms and no compliance with the duties set out in only two organisations in the North direct link between the cases was The Trust received unconditional the Health Act 2006. West achieved this result, of which identified. The remaining case registration by the new Care Quality Liverpool Women’s was one most likely represented a falsely Commission in relation to Healthcare Stakeholder Relations(. Liverpool Safeguarding Children Board The Trust has built strong partnerships Through specific training Trust staff have Initiatives include a multi agency training with a number of local agencies, with one a sound understanding of risk factors and seminar for practitioners to enable them to of the most crucial being the Safeguarding recognise children in need of support and/ actively work with new or young parents and Children Board. or safeguarding; they recognise the needs to make them aware of the risks to newborn of parents who may need extra help in and young babies. The Trust adheres to its statutory duties bringing up their children and know where under Section 11 of the Children Act 2004 to refer for help and the risks of abuse to an During the year, in the light of the case and to the expectations of the Liverpool unborn child; they make appropriate referrals of Baby Peter in Haringey, the Trust Safeguarding Children Board in all areas under S17 and S47 of the Children Act commissioned an external review into described in its Safeguarding Policy, which 1989 and contribute to enquiries from other our safeguarding arrangements to ensure adheres to LSCB procedures and that is professionals about a child and their family that current best practice in terms of reviewed on an annual basis. The Trust has or carers. policy, structures, training and supervision a named Safeguarding Lead who together are in place. with other key staff attends and contributes As part of generally safeguarding children to strategy meetings, Child Protection and young people, Trust staff provide conferences and reviews, core groups and ongoing promotional and preventative the development and implementation of support through proactive work with Child Protection Plans. children, families and expectant parents. Hotel Services - Sodexo The Trust continues to work with Sodexo, Catering is providing some cause for initiative with celebrity chef Simon Rimmer delivering cleaning, portering and catering concern, highlighted regularly in feedback to produce new and improved meals to services to the Trust. Joint managerial from patients including the patient survey. enhance the patient experience which will be arrangements have ensured improvement Sodexo has appointed a new catering implemented during 2009/10. in cleaning practice during the year and the manager and head chef who are working Trust was awarded an ‘excellent’ rating for closely with staff and patients to make cleanliness standards in the most recent consistent improvements. The Trust and round of annual inspections. Sodexo have also jointly funded an J^[Jhkij^WiXk_bjijhed]fWhjd[hi^_fim_j^W‘ dkcX[he\beYWbW][dY_[i"m_j^ed[e\j^[ceij ‘YhkY_WbX[_d]j^[IW\[]kWhZ_d]9^_bZh[d8eWhZ$ ‘ 2009 of end the by complete be will which Centre Hewitt new the of image Digital Yedj_dk[ijeef[hWj[ikYY[ii\kbbo$ <[hj_b_joBjZWdZj^[Jhkij ‘J^[fWhjd[hi^_fm_j^Dehj^M[ij repetoire of services. services. of repetoire explore opportunities to increase their their increase to opportunities explore challenging trading year and continue to to continue and year trading challenging successfully. NWF have completed a very very a completed have NWF successfully. through the new capital build. capital new the through Ltd and the Trust continues to operate operate to continues Trust the and Ltd the Hewitt Centre for Reproductive Medicine Medicine Reproductive for Centre Hewitt the The partnership with North West Fertility Fertility West North with partnership The NWF remain committed to the expansion of of expansion the to committed remain NWF ertility Ltd t L y t i l i t r Fe t s e W h t r o N and clinician to clinician relationships. clinician to clinician and with our host to develop quality indicators indicators quality develop to host our with frustrated the development of joint working working joint of development the frustrated contract for 2010/11 however this has not not has this however 2010/11 for contract The Trust will move to the new model model new the to move will Trust The 2008/09, and will not do so for 2009/10. 2009/10. for so do not will and 2008/09, operated the new model contract for for contract model new the operated its host, Liverpool PCT. The Trust has not not has Trust The PCT. Liverpool host, its PCTs through a consortia agreement. consortia a through PCTs Trust has continued to work collaboratively collaboratively work to continued has Trust well in respect of our other commissioning commissioning other our of respect in well Over the course of the previous year, the the year, previous the of course the Over Liverpool PCT have represented the Trust Trust the represented have PCT Liverpool s t n e m e g n a r r a T C P t s o H - ) T C P ( s t s u r T e r a C y r a m i r P (/ Stakeholder Relations Stakeholder Finance)& Performance The Board of Directors is pleased to report as an NHS Foundation Trust. This is annual accounts on pages 58 to 93. achievement of an excellent financial summarised in the key financial measures performance in its fourth year of operation set out below and detailed in full in the Measure Comparative Performance Earnings before Interest, Tax, Depreciation a MILLION a MILLION and Amortisation (EBITDA) 4OTAL )NCOME n 4OTAL /PERATING #OSTS n $EPRECIATION EBITDA Margin 11% (EBITDA/Total Trust Income) EBITDA Achievement of Plan (EBITDA Actual/ 153% EBITDA Plan) Income and Expenditure £4.5 million a MILLION (I & E) Surplus I & E Surplus Margin 7.1% (I&E Surplus/Total Trust Income) Return on Assets 13.7% Liquidity 66 days 77 days Monitor Risk Rating 5 5 Although the overall Trust surplus reduced financial year. The key reasons supporting the gynaecology oncology work. BY aM COMPARED TO THE 4RUST successful financial performance of the Trust ONCE AGAIN EXCEEDED THE PLAN aM for 2008/09 include: - Significant increases in the richness agreed with Monitor at the beginning of the s #ONTINUED DELIVERY OF CONTRACT ACTIVITY (more intensive and high dependency levels above plans agreed with days) of case mix in our Neonatal Commissioners increasing income above unit and maintenance of services to plan assumptions. In particular this was Commissioners outside of Cheshire, related to: Merseyside and Cumbria which increased non contract income. - Gynaecology activity and in particular outpatient activity supporting the - Increased activity relating to the care achievement of 18 week referral of women during their pregnancy in to treatment target and growth in advance of labour. Finance)' Performance contd. - The above areas of over-performance were The continuing development of the national both of which are to be implemented during offset by reduced activity against plan for tariff presents risks to income forecasts. 2009/10 and which provide tools and our NHS IVF services. However the Trust continues to work actively models by which services can be managed. with Commissioners of Trust services the s -AINTENANCE OF BUDGETARY CONTROL Department of Health and other Trusts on The continued national drive to promote the development of tariffs related to the and facilitate Patient Choice continues across the organisation. services we provide. to present a risk to services in particular Gynaecology and Obstetrics. However, As in previous years this surplus will The Trust aims to operate all of our services we continue to see the Choice agenda as provide resources to support planned at costs below tariff and this has been a positive driver for making our services capital expenditure in future years to supported during 2008/09 through as attractive and responsive as possible enhance and expand services in such areas preparations for patient level costing and to women both inside and outside of our as IVF and Obstetrics. the introduction of Clinical Business Units traditional catchment areas. Private Patient Income Performance against the Private Patient Cap is set out below. 07/08 Total patient related income a a Private patient income a a Proportion of private patient income as a percentage 0.13% Private Patient Cap 1.8% Income from private patients remained The Trust continues to provide staffing, in the Trust’s accounts as “Other at a similar level to that recorded in services and accommodation to North Operating Income” consistent with the 2007/08 and whilst the provision of West Fertility Limited a company set up Financial Reporting Manual 2008/09 private inpatient and outpatient services by a number of Consultant Gynaecologists issued by Monitor. The future treatment to gynaecology patients continued, and the reproductive medicine unit’s of private patient income remains the the Trust also extended its services in Scientific Director and is remunerated subject of review and the Trust will respect of fetal medicine. according to the terms of the contract. consider its treatment when any further This income continues to be categorised guidance is issued. Ikhfbkim_bbfhel_Z[h[iekhY[ijeikffehj‘ fbWdd[ZYWf_jWb[nf[dZ_jkh[_d\kjkh[ o[Whije[d^WdY[WdZ[nfWdZi[hl_Y[i_d ‘ikY^Wh[WiWi?L<WdZEXij[jh_Yi$ Finance)( Prudential Borrowing Limit The Trust had a prudential borrowing limit a MILLION TO A WORKING CAPITAL FACILITY 4HE OF a MILLION IN THE YEAR OF WHICH a Trust has not borrowed against the limit million related to long term borrowing and during the year. Capital Expenditure ! CAPITAL PROGRAMME OF aMILLION WAS and provide expanded and upgraded for staff and patients; investment in medical completed during the year. This was financed laboratory facilities and clinical and scientific equipment, and ensuring from a combination of internally generated accommodation. In addition the Trust the most up to date technology possible is funds and earmarked public dividend capital remodelled vacated ward accommodation available to support the delivery of clinical allocations from the Department of Health to provide a centralised facility for delivering and non clinical services. This included for specific projects. All capital expenditure services to private patients which will open replacement of Trust anaesthetic machines; related to protected assets. in May 2009. a hospital wide replacement of beds and deployment of a new telephone system for The financial year 2008/09 saw the In addition to the significant increase in the Trust. commencement of construction works construction activity the Trust was able to associated with the Hewitt Centre maintain traditional areas of investment in Details of the capital programme are set expansion which will complete in 2009 improving and upgrading the environment out below. a a Building Related Hewitt Centre Development 3,727 Clinical Ward and Procedure Accommodation 607 Building Infrastructure and Environment 522 4,856 Medical and Scientific Equipment 1,567 IM&T Infrastructure 973 Energy Saving Scheme 130 Other 6 2,676 Total Capital Expenditure 7,532 WiikhWdY[jeekhijWa[^ebZ[hij^Wjj^[eh]Wd_iWj_edh[cW_diÅj ‘ \ehfkhfei[$ ijefhel_Z[ j^[8eWhZWdZ_jiYecc_jj[[ijhkYjkh[iXo[nj[hdWbeh]Wd_iWj_ed _l[d[iie\ ]el[hdWdY["m^_Y^^Wih[ikbj[Z_dh[]kbWhh[l_[mie\j^[[\\[Yj ehWj[ ‘J^[Jhkij_iYecc_jj[Zjej^[fh_dY_fb[ie\X[ijfhWYj_Y[Yehf mitigate loss mitigate reducing compensation to reflect departing directors’ obligations to to obligations directors’ departing reflect to compensation reducing in the event of early termination…They should take a robust line on on line robust a take should termination…They early of event the in other elements) their directors’ terms of appointment would entail entail would appointment of terms directors’ their elements) other payments including redundancy would apply would redundancy including payments compensation commitments (including pension contributions and all all and contributions pension (including commitments compensation terms and conditions and therefore nationally agreed compensation compensation agreed nationally therefore and conditions and terms The Board has agreed that the Trust would not move away from NHS NHS from away move not would Trust the that agreed has Board The n 4HE REMUNERATION COMMITTEE SHOULD CAREFULLY CONSIDER WHAT E.1.4 turn by the Chairman the by turn agreed objectives by the Chief Executive and the Chief Executive in in Executive Chief the and Executive Chief the by objectives agreed they are however held to account for their performance against against performance their for account to held however are they intervals of no more than five years five than more no of intervals process as this would not be in line with NHS terms and conditions; conditions; and terms NHS with line in be not would this as process n %XECUTIVE DIRECTORS SHOULD BExSUBJECT TO RE APPOINTMENT AT C.2.1 Executive directors will not be subject to a formal re-appointment re-appointment formal a to subject be not will directors Executive to be independent be to holding a casting vote under the Trust’s constitution Trust’s the under vote casting a holding should comprise non-executive directors determined by the board the by determined directors non-executive comprise should executive directors, including the chairman, with the chairman chairman the with chairman, the including directors, executive n !T LEAST HALF THE BOARD EXCLUDING THE CHAIRMAN ! The Board comprises an equal number of executive and non- and executive of number equal an comprises Board The Code provision provision Code Explanation with the following exceptions: exceptions: following the with provide assurance to our stakeholders that that stakeholders our to assurance provide actions required and a statement against statement a and required actions complies with the provisions of the Code Code the of provisions the with complies structures by external organisations to to organisations external by structures in relation to each of the provisions, any any provisions, the of each to relation in for 2008/09, the Trust can confirm that it it that confirm can Trust the 2008/09, for effectiveness of the Board and its committee committee its and Board the of effectiveness included a report on the current position position current the on report a included assessment of its governance arrangements arrangements governance its of assessment has resulted in regular reviews of the the of reviews regular in resulted has assessment within the Trust, which has has which Trust, the within assessment Having undertaken an operational operational an undertaken Having best practice corporate governance, which which governance, corporate practice best been subject to an annual operational operational annual an to subject been Trust is committed to the principles of of principles the to committed is Trust Foundation Trust Code of Governance has has Governance of Code Trust Foundation the organisation remains fit for purpose. purpose. for fit remains organisation the the principle of ‘comply or explain.’ The The explain.’ or ‘comply of principle the Since its publication by Monitor, the NHS NHS the Monitor, by publication its Since e c n a n r e v o G f o e d o C t s u r T n o i t a d n u o F S H N has adequate resources to continue in in continue to resources adequate has the accounts. the adopt the going concern basis in preparing preparing in basis concern going the adopt Trust Foundation NHS Women’s Liverpool future. For this reason, they continue to to continue they reason, this For future. that expectation reasonable a have operational existence for the foreseeable foreseeable the for existence operational directors the enquiries, making After G o i n g c o n c e r n n r e c n o c g n i o G )) Going concern and NHS Foundation Trust Code of Governance of Code Trust Foundation NHS and concern Going Our Board of Directors)* Our Board of Directors The Trust’s constitution provides for a has been centred around change further 3 years. Roy was formerly the Regional Operations Manager in Board of Directors which is comprised and improving overall performance Chief Executive of Rathbone Brothers charge of the Charity Commission’s of six executive and six non-executive in a variety of health and not for Plc and Chairman of the Executive Liverpool office, dealing with charities directors including the Chairman. All profit organisations. He has chaired Committee, which manages the day in the North West. He is the Senior of these roles have been occupied and been a member of a number to day affairs of the Group. Roy had Independent Director on the Board during 2008/09 in accordance with of national committees. In 2008/09 been with Rathbones, involved in and chairs the Charitable Funds the policy developed by the Trust in Ken was elected to the Board of the investment management throughout Committee. He is also a member support of the constitution. The Trust national Foundation Trust Network. He his working career. He was a Partner of the Audit Committee, Human considers that it operates a balanced, is also chair of the Foundation Trust in Rathbone Bros. & Co and in 1988 Resources Committee and Information complete and unified Board with Network in the North West. he became Managing Director. He was Governance Committee. In January particular emphasis on achieving appointed as Group Chief Executive 2008 he was reappointed for a further the optimum balance of appropriate .ON %XECUTIVE $IRECTORS in 1997. He retired as Chairman of period of three years. skills and experience; this is reviewed (OI 9EUNG the Mersey Partnership in March 2008 whenever any vacancy arises and but continues to hold a number of 9VONNE 2ANKIN Hoi Yeung was appointed in March was rigorously tested in 2008/09 non-executive positions with several 2005 for a period of 4 years and Yvonne joined the Board in July 2006 during the process to recruit a new prominent local businesses. Roy following his successful appraisal for a term of three years, bringing Chief Executive. was awarded a CBE in the Queen’s was re-appointed in January 2009 with her a successful leadership track Birthday Honours list in June 2008. record, developed in the service and Since April 2005 non-executive by the Council of Governors for Roy is the Chair of the Trust’s Finance retail industries having spent 10 directors have been appointed by the a further 3 years. Hoi is a retired and Contracts Committee. years with the Co-operative Group Council of Governors at a general senior chartered accountant who has enjoyed a very successful and varied where she was CEO for Specialist meeting, following a selection process Ann McCracken undertaken on behalf of the Council career with the Littlewoods Group Retail businesses. Between 2007 and by its Nominations Committee. The spanning 29 years. He worked his Ann McCracken first joined the 2007 Yvonne was CEO of Central Council of Governors has adopted a way up through the finance function Trust as a non-executive Director in and Southern Europe for A.S. Watson standard term of office of three years to the position of Director of group December 2001 and served two terms (Health and Beauty). In September for all non-executive appointments. finance and accounting. From this of office under NHS arrangements. 2007, Yvonne became CEO of the The Chairman and non-executive role Hoi brings particular skills in Ann was re-appointed in 2006 for Thresher group which encompasses directors can also be removed by audit, management and financial a further three years following a the Wine Rack, Thresher, Local and the Council of Governors through a accounting, treasury management, tax successful performance appraisal and Haddows (Scotland) Retail Brands, process which is described in section and risk management. In addition, Hoi approval by the Council of Governors. with 1650 shops across the UK. She 13 of the constitution. has a wealth of experience in public A former journalist, she now works is also a Companion of the Institute and voluntary sectors which included as Head of Communications for 02 of Management. Yvonne chairs the +EN -ORRIS n #HAIRMAN his roles as a Governor of Liverpool in the north. Her other commitments Trust’s Marketing Committee and is include Mersey Common Purpose’s the non-executive member of the Ken Morris commenced with the Community College, a Trustee of the advisory group. Ann is the Trust’s Vice Clinical Governance Committee. Trust in August 2005. Following a John Moores Liverpool Exhibition Trust Chairman and also chairs the Human successful appraisal process, Ken and an observer at the board of the Resources Committee. In addition, )NDEPENDENCE OF was re-appointed in April 2008 for Liverpool Biennial of Contemporary a further 3 years. Ken has had over Art. Hoi is the Chair of the Trust’s Ann sits on the Marketing, Charitable .ON %XECUTIVE $IRECTORS 20 years experience of working at Audit Committee. Funds and Audit Committees. The Board considers all of its current Executive and Non Executive Director non-executive directors to be level in a variety of organisations in 2OY -ORRIS #"% $, David Carbery independent. All appointments and the public, private and not-for-profit Roy Morris was appointed in February David joined the Board in February re-appointments are made by the healthcare sectors. Immediately 2005 for a period of 4 years and 2004 after a long career in the Council of Governors specifically to prior to joining the Trust he was following his successful appraisal civil service, working in a variety of meet the requirements set out in Chair of a successful PCT. His was re-appointed in January 2009 government departments including Monitor’s ‘NHS Foundation Trust Code management consultancy experience by the Council of Governors for a social security. He was also the of Governance.’ Our Board of Directors)+ Our Board of Directors contd. +ATHRYN 4HOMSON -#)0$ n $AVID 2ENOUF "3C #0&! n !CTING in critical care nursing, attaining a in 1992. She subsequently moved Chief Executive $IRECTOR OF &INANCE number of post registration clinical into generalist Human Resources FROM ST 3EPTEMBER David joined the NHS in 1984 as qualifications; she followed this with and spent 8 years in large London roles in quality management and Teaching Hospitals in a range of Kathryn joined the Trust in September a Regional Financial Management senior HR positions. She returned to Trainee and is a CIPFA qualified operations management adding a BA 2008 from the University Hospital Liverpool in 2005 working as Deputy accountant. Having spent 18 years Hons and diplomas in management of South Manchester NHS Foundation Director of HR for Mersey Care within the Portsmouth Health and education. Since 1999 she Trust where she was a director has worked as Deputy Director of Mental Health Trust and has for six years. During that time she Economy in a variety of senior finance subsequently taken up post as Deputy roles he moved to Liverpool Women’s Nursing in two North West Trusts, supported the Trust through a major most recently at Aintree Hospitals Director of HR at St Helens and in 2003 where as Deputy Director of financial and performance recovery NHS Trust in North Liverpool. She has Knowsley NHS Trust. Finance he helped the Trust achieve plan and subsequent achievement a number of professional interests, foundation status in April 2005. He #AROLINE 3ALDEN -"! of foundation trust status. Kathryn particularly leadership development is currently Acting Director of Finance "! (ONS $IP - n $IRECTOR OF has previously held key posts as a and education and has participated a position he has assumed on two Service Development director of Operations and Human in the development of the national previous occasions. Caroline joined the Trust in April 2004 Knowledge and Skills Framework Resources in a number of Merseyside as its Director of Service Development, (KSF). Gill is a qualified coach and hospital trusts. $AVID 2ICHMOND -$ &2#/' a new post created to reflect the development facilitator but overall n -EDICAL $IRECTOR need to respond more proactively Executive Directors she has a passionate commitment to to the new external environment David became Medical Director of the 3UE ,ORIMER !#-! improving the patients’ experience of within which we will operate and to Trust in September 1993 following $IRECTOR OF &INANCE TO ST their care. establish stronger links with our local his appointment as a Consultant to *ANUARY AND !CTING #HIEF Commissioners and other parties. central Liverpool in 1990. During that +IM $OHERTY -! -#)0$ %XECUTIVE TH -ARCH TO She takes the lead on the Local time he has successfully steered the "! (ONS n $IRECTOR OF ST 3EPTEMBER Delivery Planning process and the Trust through innumerable changes (UMAN 2ESOURCES Modernisation Agenda. In addition, Sue joined the Trust as Director and developments, including the Kim has been the Director of Caroline has Executive responsibilities of Finance in April 2005 shortly amalgamation of the previous Human Resources at the Trust for Information Management and after it gained foundation status. hospitals into a brand new facility in since September 2003. She is Technology. Caroline started her accountable for the development She has the lead on ensuring Toxteth in 1995 and the subsequent career as a Management Trainee and implementation of people sound financial management merger with the Aintree Centre for in the Mersey Region and has management strategies which support Women’s Health in 2000. His main undertaken a range of operational and achievement of contract organisational aims and effectiveness. interests lie in manpower planning posts in both mental health and performance targets. Sue has been Kim started her career as a graduate acute services in Chester. Latterly, an NHS Finance Director since (he currently contributes to local trainee in NHS Human Resources in Caroline held the post of Assistant 1990 and has worked in a variety and national manpower working the West Midlands where she held Director of Service Development at of organisations. Before joining us parties) and education and training. a number of posts. Prior to joining Derbyshire Hospitals NHS Foundation she worked for Cheshire and Wirral He is currently the RCOG Council the Liverpool Women’s Hospital Trust where she played a key role Partnership NHS Trust and for representative for the north west. NHS Trust she held the post of Head David is also Chair of the Trust’s in the development of their Service 2 years helped develop systems of Human Resources & Planning Clinical Governance Committee. at Clatterbridge Centre for Oncology Strategy and application to become and consolidate financial performance NHS Trust. Kim is a member of and a Wave 1 NHS Foundation Trust. Her in the newly formed organisation. 'ILL #ORE 2'. n $IRECTOR OF has previously held roles within management experience has been Prior to that she worked at .URSING -IDWIFERY AND 0ATIENT both the Chartered Institute of supported by the attainment of an MBA (Open University) and a Diploma Clatterbridge Centre for Oncology 1UALITY TO TH &EBRUARY Personnel and Development and the NHS Trust for six years during Association of Healthcare Human in Marketing. Caroline maintains a Gill joined the Trust on the 1st of April which time the Trust enjoyed a Resource Management. close involvement with the Graduate 2006. She is the professional lead for significant expansion of services. Recruitment process. nurses and midwives in the Trust as 2ACHEL 0ATTERSON #)0$ n !CTING Sue is an Associate Member of well as having wider responsibility for $IRECTOR OF (UMAN 2ESOURCES A register of interests of each the Chartered Institute of the quality of care delivered through $ECEMBER n !UGUST member of the Board of Directors Management Accountants and until clinical governance and clinical risk Rachel joined the Trust in December is held by Erica Saunders, Trust recently was a Member of its NHS management, her remit also includes 2007 on secondment to cover Kim Secretary which is accessible to the Project Group producing technical estates and facilities. Gill joined Doherty’s maternity leave. Rachel public through the office of the Trust guidance and support for NHS the NHS as a nurse in 1981 and started her career in the NHS in Secretary at the Trust headquarters, members and students. enjoyed a successful clinical career Training and Development in Liverpool Crown Street, Liverpool. Our Board of Directors), Board Performance The Board of Directors has been mindful of plan, including a third review of the assurance to the Council with regard the importance of evaluating its effectiveness Trust’s committee structure to reflect the to the contribution of individuals to during the year and to that end has reviewed move towards implementation of Clinical the performance of the organisation as its performance in the following ways: Business Units in 2009/10. a whole s Board Effectiveness Review n AN IN DEPTH s Non-Executive Directors n THE APPRAISAL s Executive Directors n AN APPRAISAL SYSTEM review of the Board and its operation system for non-executive directors for executive directors, including the and processes was commissioned from agreed by the Remuneration Committee Trust Secretary, has been in operation Independent Audit Ltd during the year. of the Council of Governors in April during the year and a report on The findings detailed in the resulting 2006 has continued to operate individuals’ performance presented to the report were developed to form an action effectively during the year, providing Remuneration Committee of the Board. Board Operation and Decision-making The Board of Directors operates to clear of delegation and schedule of matters framework. It is responsible for all key terms of reference which underpin the Trust’s reserved for the Board. business decisions but delegates the constitution and which are in turn supported operationalisation of these to an appropriate by a Corporate Governance Manual that It is the role of the Board to set the committee, Management Executive Board includes detailed Standing Financial organisation’s strategic direction in the or project board. Instructions and Standing Orders, a scheme context of an overall operational planning Board Meetings and Attendance The Board of Directors met formally eleven s *ULY n APOLOGIES FROM s *ANUARY n APOLOGIES FROM +EN -ORRIS times during 2008/09. Attendance by Yvonne Rankin and Roy Morris directors is reported by exception below: s 3EPTEMBER n APOLOGIES FROM s &EBRUARY n FULL ATTENDANCE s !PRIL n APOLOGIES FROM David Richmond and Ann McCracken s -ARCH n FULL ATTENDANCE David Richmond s /CTOBER n FULL ATTENDANCE s -AY n FULL ATTENDANCE s .OVEMBER n APOLOGIES FROM s *UNE n APOLOGIES FROM Caroline Salden Ann McCracken s $ECEMBER n FULL ATTENDANCE ?j_ij^[heb[e\j^[8eWhZjei[jj^[‘ eh]Wd_iWj_ed½iijhWj[]_YZ_h[Yj_ed_d j^[Yedj[nje\Wdel[hWbbef[hWj_edWb ‘fbWdd_d]\hWc[meha$ Our Board of Directors)- Audit Committee The Audit Committee is chaired by Hoi s /RGANISATION HAS SELF ASSESSED AGAINST THE assessment and review, requesting Yeung; other members are David Carbery Standards for Better Health. assurances from Trust officers and directing and Ann McCracken. The Committee met s /RGANISATION HAS ROBUST SYSTEMS OF and receiving reports from the auditors four times during 2008/09. Members’ financial control and fraud specialists. During the year the attendance was as follows: Committee have complied with ‘good s (OI 9EUNG n FULL ATTENDANCE The work of the Audit Committee practice’ recommended through:- s $AVID #ARBERY n THREE MEETINGS during 2008/09 has been to review the s !GREEMENT AND MONITORING OF AN ANNUAL s !NN -C#RACKEN n FULL ATTENDANCE effectiveness of the organisation in the work programme. following key areas: s 0REPARED AN !NNUAL 2EPORT OF ITS ACTIVITIES The key role of the Committee is to establish s )NTERNAL #ONTROL AND 2ISK -ANAGEMENT and reviewed similar reports from other the following: s )NTERNAL !UDIT Board Sub-Committees s !SSURANCE &RAMEWORK IS lT FOR PURPOSE s %XTERNAL !UDIT s 5NDERTAKEN A REVIEW OF THE PERFORMANCE s 3YSTEMS FOR RISK MANAGEMENT IDENTIFY AND s &INANCIAL 2EPORTING of internal and external service providers allow for the management of risk s /RGANISATION HAS ROBUST In discharging its duties the Committee governance arrangements meets its responsibilities through self Nominations Committees The Trust has established separate the re-appointment of Roy Morris and to the post under consideration. The Nominations Committees to oversee Hoi Yeung as a non-executive directors, committee met twice during 2008/09 in the appointment of executive and non- making recommendations to the Council of relation to the appointments of the Chief executive directors. Governors that these should be approved Executive and the Director of Finance. for a further three years. s 4HE Nominations Committee of the Council of Governors is responsible s 4HE Nominations Committee of the for the appointment of non-executive "OARD OF $IRECTORS is responsible for the directors. It is chaired by Ken Morris; other appointment of executive directors. It is members are Leanne Bricker, Godfrey chaired by Ken Morris; other members are -AZHINDU AND $EIRDRE 7OOD $URING a minimum of three other non-executives 2008/09 the Committee considered and the Chief Executive as appropriate J^[Jhkij^Wi[ijWXb_i^[Zi[fWhWj[‘ Dec_dWj_edi9ecc_jj[[ijeel[hi[[ j^[Wffe_djc[dje\[n[Ykj_l[WdZ ‘ded#[n[Ykj_l[Z_h[Yjehi$ The Trust’s Board of Directors Our Council of Governors). Our Council of Governors The Trust’s Membership Council was established between the Board and the celebration with several generations of established on 1st April 2005 and has chairs of the Council of Governors sub- families of ‘IVF babies’. operated very effectively since that time. committees; discussions focused on the During 2008/09 the Council took the Trust’s corporate social responsibility agenda s 4HE Nominations Committee decision that the name ‘Council of and strengthening membership engagement. considered the re-appointment of two of Governors’ better reflected its role and the non-executive directors, Roy Morris activities and as a consequence a resolution Public and staff members of the Council of and Hoi Yeung in January 2009. was put to the Annual Members’ meeting Governors are elected by the membership. in September 2008 to make this change in Elections are held in accordance with the s 4HE Remuneration Committee accordance with the requirements of the rules appended to the constitution using has continued its work to review the Trust’s constitution. a single transferable vote system. The final appraisals of non-executive directors ‘transitional’ set of elections were held in and in-year undertook a comprehensive The Council of Governors has continued to 2008 for six public and three staff seats; exercise to review non-executive directors’ develop its relationship with the Board, in three of the public seats were contested and remuneration based upon extensive market particular its advisory function and its level voter turnout was around 6%. The term of research and comparator data. of involvement and participation in setting office for all Council members is three years. Trust strategy. It continues to carry out its s 4HE Public Engagement Committee functions as set out in the constitution with During the year the Council has been actively took the lead on the consultation with a pleasing sense of clarity and purpose and involved in many areas of the Trust’s work. members and the public in relation to understands explicitly that this means that it Councillors have been co-opted on to a the Trust’s plan to redesign maternity does not involve itself in operational matters number of committees and working groups services, in particular the design of the or decisions as these fall within the remit covering a variety of areas including patient questionnaire and collation of results. of the Board of Directors. The Council met quality, the Trust’s ‘Front of House’ Group, formally four times during the year; details Standards for Better Health and marketing. s 4HE Corporate Social Responsibility of individual attendance are contained Committee gave its support to the within appendix 1 to this report. The formal sub-committees of the Council of Liverpool-Mulago Partnership an initiative Governors have continued to operate during established by Dr Andrew Weeks, one The Council of Governors is comprised of the year: of the Trust’s consultant Obstetricians to 33 governors under the leadership of Trust provide resources and expertise to the Chairman Ken Morris. Angela Douglas has s 4HE Membership Strategy Committee Mulago Hospital in Kampala, Uganda. remained as Deputy Chairman of the has been proactive in taking forward the The Mulago Hospital is the largest Council during the year. All Board members Trust’s Membership Strategy and was maternity unit in Africa providing 33,000 have a standing invitation to attend Council responsible for organising the successful deliveries each year. The Board and of Governors meetings and the Chairman Trust Open Day and Annual Members’ Council of Governors agreed to match also uses the regular non-executive directors’ meeting held in September 2008. This funding from an NHS North West meetings to brief the NEDs on the work event was attended by around 600 people Leadership Academy bursary to enable a of the Council and its committees. During and focused on the theme of ’30 years formal twinning programme to be set up 2008/09 a more formal meeting was of IVF’ which was turned into a real by the partnership. :kh_d]j^[o[Whj^[9ekdY_b^WiX[[dWYj_l[bo_dlebl[Z‘ ‘_dcWdoWh[Wie\j^[Jhkij½imeha$ Our Council of Governors)/ Composition of the Council of Governors 05",)# '/6%2./23 34!&& '/6%2./23 %,%#4%$ 3%!43 %,%#4%$ 3%!43 $OCTORS n ,EANNE "RICKER #ENTRAL ,IVERPOOL .URSES n $IANNE "ROWN ELECTED Morag Day -IDWIVES n $ORCAS !KEJU /"% Shivakuru Selvathurai (resigned 3CIENTISTS 4ECHNICAL STAFF n !NGELA $OUGLAS RE ELECTED December 2008) .ON CLINICAL STAFF n (ELEN 'AVIN $ENISE #ARTER ELECTED Betty Stopforth Maggi Williams (re-elected 2008) Anees Paracha 0#4 '/6%2./23 Annette James !00/).4%$ 3%!43 Dr Janet Atherton, Director of Public Health, Sefton PCT .ORTH ,IVERPOOL Dr Paula Grey, Director of Public Health, Liverpool PCT Angela Parker (re-elected 2008) One vacant seat Brenda McGrath 3OUTH ,IVERPOOL ,/#!, !54(/2)49 '/6%2./23 Irene Drakeley !00/).4%$ 3%!43 Janine Wooldridge Councillor Jane Aston, Knowsley Borough Council Councillor Marilyn Fielding, Liverpool City Council Sefton Patricia Jones Maureen Kelly (elected 2008) 5.)6%23)49 /& ,)6%20//, Geoff McKeating (elected 2008) !00/).4%$ 3%!4 Professor Susan Wray +NOWSLEY Ronnie Kehoe (re-elected 2008) Anne Smith #/--5.)496/,5.4!29 /4(%2 0!24.%23()0 /2'!.)3!4)/.3 2EST OF %NGLAND 7ALES !00/).4%$ 3%!43 Sheila Foley Sue Ryrie, Brook Merseyside (resigned September 2008) Deirdre Wood 0ROFESSOR 'ODFREY -AZHINDU ,IVERPOOL *OHN -OORES 5NIVERSITY Anna Banks (elected 2008) Margaret Hogan, Down’s Syndrome Liverpool A register of interests of each member of the Council of Governors is held by the Trust Secretary which is accessible to the public through the office of the Trust Secretary at the Trust headquarters, Crown Street, Liverpool. J^[9ekdY_be\=el[hdehi^WiYedj_dk[Z‘ jeZ[l[bef_jih[bWj_edi^_fm_j^j^[8eWhZ" _dfWhj_YkbWh_jiWZl_ieho\kdYj_edWdZ _jib[l[be\_dlebl[c[djWdZfWhj_Y_fWj_ed ‘_di[jj_d]JhkijijhWj[]o$ The Trust’s Council of Governors Our Membership*& Our Membership It is important to us that membership our membership reflects the social and a large, genuine membership from all parts is relevant to all sections of the cultural mix of the Liverpool conurbation. the community served by the Trust. greater Liverpool community and we The membership community of Liverpool continue to make every effort to reach We also need to ensure that our Council of Women’s NHS Foundation Trust is drawn all groups within our membership Governors reflects our membership and we from our public and staff constituencies constituencies. We seek to ensure that aim to address this challenge by encouraging which are defined follows: Constituency type 3UB CONSTITUENCIES Rationale and eligibility Public s #ENTRAL ,IVERPOOL 60% of our activity is derived from within Liverpool. s .ORTH ,IVERPOOL A further 31% comes from the boroughs of Knowsley s 3OUTH ,IVERPOOL and Sefton. The remaining 9% of activity relates s +NOWSLEY to our specialist services and can bring in patients s 3EFTON from across the country. Membership is open to any s %NGLAND 7ALES member of the public over the age of 12 who live within any of the local authority areas described. Defined by local authority electoral boundaries Staff s $OCTORS Our staff constituency is defined by those who have a s .URSES permanent employment contract or who have worked s -IDWIVES for the trust for at least 12 months. Staff who are s 3CIENTISTS 4ECHNICIANS !LLIED (EALTH 0ROFESSIONALS employed by contractors to the trust or who are based s !DMINISTRATIVE #LERICAL -ANAGERIAL STAFF at the trust but employed by another NHS organisation s #LINICAL 3UPPORT !NCILLARY-AINTENANCE STAFF are also eligible for membership. Membership Strategy The Trust’s Membership Strategy is led active during the year and has continued to step up the level of engagement by a committee of the Council of to refine its approach to how the activities with our existing members. Governors called the Membership Strategy Trust should develop as a membership One of the key vehicles for this was the Committee. This group has been very organisation in the context of our population Annual Members’ meeting and Open Day and the profile of our members. held on 13th September 2008; this event was very successful with around The Committee is chaired very effectively 600 people coming in to the hospital, by Janine Wooldridge, a public governor creating a positive and enjoyable representing south Liverpool. During atmosphere. The Trust also held an 2008/09 the Committee’s main aim was interactive membership event based on M[i[[aje[dikh[j^Wjekhc[cX[hi^_f‘ h[Æ[Yjij^[ieY_WbWdZYkbjkhWbc_ne\ ‘j^[B_l[hfeebYedkhXWj_ed$ Our Membership*' Membership Strategy contd. the topic of infection control; the followed by a lively discussion with with members has continued to be via The Committee plans to maintain its Trust’s Director of Infection Prevention those members present. Foundation Express, which was published broad focus during 2009/10 on the and Control gave an entertaining and twice during the year, each with a focus principles of the membership strategy informative talk entitled ‘A Bug’s Life’ The main communication method on a particular clinical service. set out below. Building and sustaining a representative membership Liverpool Women’s NHS Foundation Membership targets s "LACK AND -INORITY %THNIC 'ROUPS s 3OCIAL CLASS THERE IS A SOCIAL Trust primarily serves local residents The public section of the membership again, according to population data, class correlation with regard to in Liverpool, Sefton and Knowsley. community should include as diverse a Asian, Black, Chinese and other community engagement, which Our ongoing focus needs to be on range as possible and be ethnic groups make up 5.7% of the in turn correlates with health continuing to build and engage representative of the local area. The local population. Again, we seek to disadvantage. This makes it with the membership community following specific cohorts were our ensure that the public constituency particularly important that we from these areas. Given the socio- focus during 2008/09: is comprised of a similar percentage. ensure that the Trust membership economic structure of the local area, s n YEAR OLDS THIS IS ALMOST s -EN WHILST THE SERVICES PROVIDED BY properly reflects the socio-economic an additional challenge is presented the most difficult cohort with which the Trust are primarily aimed at strata of the local area. by the need to ensure that under- to engage and remain in contact women, it is critical to ensure that represented populations, such as as many are extremely mobile. men are also active members of young people, black and minority ONS statistics for Liverpool the Foundation Trust community. ethnic groups and those from more indicate that people of this age Therefore, we will seek to attain a disadvantaged backgrounds, are comprise approximately 23% of balance of 85% women and approached and included. the local population. 15% men. Membership Profile Constituency Public Staff Total reflective of our activity profile: )N WRITING care of the Foundation s OF OUR MEMBERS ARE RESIDENT Trust Team, Liverpool Women’s NHS Number at year start 8,442 1,365 9,807 in Liverpool Foundation Trust, Crown Street, (1st April 2008) s OF OUR MEMBERS ARE RESIDENT Liverpool L8 7SS Number at year end 7,971 1,655 9,626 in Knowsley (31st March 2009) s OF OUR MEMBERS ARE RESIDENT "Y TELEPHONE on in Sefton 0800 073 0825 (FREE) s OF OUR MEMBERS ARE FROM OTHER Public membership numbers again members aged between 16 and 29. parts of England and Wales "Y EMAIL at [email protected] fell slightly during the year. We The number of members from black continue to find this disappointing; and minority ethnic communities was In the coming year therefore we investigations have confirmed that the approximately 4.6% by the end of will aim to recruit and retain more problem is due to the mobile nature the year which is somewhat below members from the younger segments of certain sections of our population. target (however 32% of our members of our population, specifically those The Membership Strategy Committee have opted not to disclose their under 21 and from our local black is mindful of needing to find an ethnicity) and our gender balance and minority ethnic communities. The effective way to address this problem was steady at 16% men and 83% Trust is also seeking to grow overall to minimise ‘churn’ of this nature on women (a small number have not membership numbers by around 2.5% an ongoing basis. disclosed their gender). during 2009/10. In terms of our diversity targets we Geographically, membership in our Members can contact governors and have maintained just over 20% of public constituencies is broadly directors by the following routes: Public Interest Disclosures*( About our Staff Anti-Bullying Campaign Following feedback from staff and the results Trust and the agreement of behavioural bullying and harassment in the workplace, of two staff surveys focussing on bullying, standards for all staff. Formal evaluation of a number of workplace “Buddies” have a significant Anti-Bullying Campaign the campaign will be undertaken taking into been recruited and trained. The aim of was launched in the Autumn with the account the results from the Staff Survey. the Buddy Scheme is to provide staff with establishment of a Task Force to develop This will inform the next phase of actions an informal and confidential route to and deliver recommendations for action. going into the new financial year. raise concerns and to receive support and This has been hugely successful with high signposting where appropriate. levels of interest displayed across the As part of the Trust’s strategy of tackling Employment Partnership goes from strength to strength Our Partnership for Patients Project that the benefits to both staff and patients improvements in staff survey response rates with the accredited Trade Unions has alike will be demonstrated through joint in 2008. Efforts continue to increase the now come to fruition and with two working and collaboration. Partnership number of staff representatives and learning representatives working full time as a working relationships between managers representatives across the Trust. job share on employment relations and at all levels in the organisation and staff communications issues, we are confident side representatives lead to significant The Trust promotes Equality & Human Rights The Trust has a well established Single progression of actions outlined in local plans Employees developing disabilities during Equality Scheme which incorporates the take place through the quarterly meetings of employment are supported in line with the requirements of the current Race Equality the Equality and Diversity Task Group. Trust’s Rehabilitation and Redeployment Scheme, the Disability Scheme and the policy which ensures compliance with Gender Equality Scheme. Monitoring and The Trust’s recruitment and selection Disability Discrimination Act (DDA) process is designed to minimise potential obligations on employers. bias, through exclusion of personal data at short listing and the use of selection Access to Work grants have been sourced panels for all interviews. Good practice for employees to ensure that they are able in recruitment and selection is promoted to continue in their job role, and the Trust’s through provison of educational sessions Disability Adviser Midwife is on hand to for staff. provide advice in individual cases. 7ifWhje\j^[Jhkij½iijhWj[]oe\jWYab_d]Xkbbo_d]‘ WdZ^WhWiic[dj_dj^[mehafbWY["WdkcX[he\ ‘mehafbWY[º8kZZ_[i»^Wl[X[[dh[Yhk_j[ZWdZjhW_d[Z$ Public Interest Disclosures*) Recognising Excellence The Trust held its fourth annual categories including: s )MPROVING THE PATIENT EXPERIENCE Manager Gail Holding and members ‘Focussing on Excellence’ Awards in s 3UPPORTING WORKFORCE DEVELOPMENT of the Family Support Team for their 2008/09, which are aimed at and welfare 4HERE IS ALSO AN OVERALL AWARD n THE ‘Precious Time’ project aimed at celebrating the efforts and innovations s )MPLEMENTING BEST PRACTICE @&OUNDATION !WARD n WHICH IS IN THE helping bereaved parents after the of staff in finding new ways to s 7ORKING IN PARTNERSHIP gift of the Council of Governors for devastating loss of a baby. improve patient care and the patient s 3UPPORTING HEALTHCARE THROUGH outstanding achievements in care. experience. Entries were invited from technological change In 2008/09 this was won by PALS The Staff Award Scheme - A Big Thank You to our Committed Staff Each year the Trust pays tribute to winners in 2008/09 were drawn from the manner in which they had Once again this year, all staff received staff who have made an exceptional across the organisation and included especially touched the lives of A a VOUCHER IN RECOGNITION OF THEIR contribution or “gone the extra mile” porters, domestic staff, nurses and individual patients at a moment of contribution to the achievement of the for colleagues or patients. Award MIDWIVES n THEY WERE ALL UNITED BY great joy or sadness. Trust’s Healthcare Commission ratings. V o l u n t e e r s Recruitment of volunteers continued Excellence Award Ceremony, Love Focussing on Excellence Awards. People volunteer for an endless during the year via local Councils your Community Event at Liverpool ‘Expanding the Boundaries’ received variety of reasons. Some want to for Voluntary Service, community University, the Annual Nursing and SECOND PRIZE IN THE &OUNDATION gain experience, acquire new skills, groups, universities, existing Midwifery Conference, Adult Learners Award category. meet new people or expand their volunteers, staff and former Event, Breakthrough UK’s Open knowledge of the NHS as a way to a patients, carers and word of mouth. Day, exhibited at the Town Hall in All our volunteers were offered new job or career. Others want to give All our volunteers are supported by St Helens and the Student Union Fair free training opportunities in NVQ something back to their community. a full induction programme and at Liverpool John Moores University. levels 1 and 2 Customer Care and Volunteers are no ordinary people: training opportunities. Our volunteers regularly participate in Business Administration plus a they are very special individuals of Trust group/meetings including Patient all ages and backgrounds who come certificate in Volunteering. The total number of recorded hours Information Groups, Patient Quality from all walks of life. Each volunteer of voluntary work coordinated by Meetings, Chaplaincy Meetings and brings something special and unique We successfully launched a quarterly the Volunteer Services Manager the Labour Ward Forum. to the role, but what they all have in this year was 1162 hours. This award for recognising the hard work common is that they give freely of figure is for the Trust’s Volunteer Volunteers supported fundraising and commitment of our volunteers. their time to benefit our patients and Scheme only and excludes the activities for the Liverpool Women’s Staff and patients can nominate the hospital. For this, the Trust is truly independent organisations. Charitable Trust Fund and helped raise their favourite volunteer helpers to indebted and values and appreciates OVER a receive the prestigious ‘Volunteer of the contribution that they make. Throughout the year the volunteers the Season Award’. The successful have supported a number of Trust The ‘Terracotta Army’ and ‘Expanding recipient is presented with an and public events including: the the Boundaries’ were two entries engraved glass paperweight by Ken Trust’s Open Day, Focussing on submitted by the volunteers in the Morris, Chairman of the Trust Public Interest Disclosures** Blair Bell Conference Centre – Part of the Community The Blair bell Education Centre is a multi- art clinical skills laboratory, library and IT purposes. Some examples of this include: disciplinary conference and educational training facilities, so that the Trust is able the NSPCC, Mersey Region Group for Family facility housed within the Liverpool Women’s to offer it out as a venue to a wide variety Planning Training, The Advocacy Project, Hospital. It has been considerably extended of local organisations and partners as well Learning Partnerships and Integrated and upgraded to include a state of the as for internal training and development Radiological Services. Health and Safety The Health and Safety department is The work to continually improve health and free/safe devices Trust wide. Subsequently, committed to providing a safe environment safety performance throughout the Trust a working party was set up and a detailed and delivering a quality service at every level has also been achieved through systematic action plan was developed. At present the of the organisation. review and revision of the Health and sharps awareness group is in the process of Safety Risk Register reducing risks arranging the trial of needle free/safe devices Assurance is provided in terms of stringent accordingly. This involves each department for taking blood. health and safety standards which are carrying out health and safety risk monitored through rigorous risk assessments assessments; auditing; action planning and Since September 2008 Safety Alerts and an audit programme. The outcomes of ongoing monitoring and review of incidents Broadcast System (SABS) and Chief assessments and audits including action and trends, ensuring risks are addressed Medical Officer Public Health Link alerts plans are reported and monitored locally effectively and escalated appropriately. have been sent through a new web-based within directorate and departmental risk SYSTEM #!3 n #ENTRAL !LERTING 3YSTEM committees and centrally at the Health and Furthermore, work to enhance health and CAS is using a more robust technology for Safety Committee. safety awareness throughout the Trust has distributing NPSA Rapid Response Reports, also been achieved through systematic and NICE, DH & MHRA safety alerts, emergency A key objective during the year has been continued review of mandatory health and alerts, drug alerts and medical device alerts. to continue the process of auditing Trust safety training for all staff groups. compliance with health and safety polices This new web-based system has been in order to meet both internal and external In line with best practice security principles implemented to replace the email system requirements including the standards set the Trust undertook a comprehensive security with a more applicable and robust system in the Trust’s Risk Management Strategy, risk assessment of Trust premises, assets and which has the ability to effectively analyse the NHSLA standards for level 3, Standards people. This resulted in an extensive action statistics and monitor Trust’s compliance for Better Health and Health and Safety plan being developed, which continues to with the safety alerts. CAS is centrally Executive. A comprehensive policy audit plan be progressed and monitored through the administered and managed by the Health was developed with particular attention Health and Safety Committee. and Safety manager. Compliance with CAS given to the ‘slips, trips and falls’ policy and alerts is monitored externally by the Care the manual handling policy. The aim is to A ‘sharps awareness’ campaign was Quality Commission and within the Trust identify deficiencies and develop action plans commenced in July 2008 with the aim to by the Clinical Governance Committee via to prioritise and initiate changes accordingly. review, evaluate and implement needle quarterly CAS reports. J^[>[Wbj^WdZIW\[joZ[fWhjc[dj_i‘ Yecc_jj[Zjefhel_Z_d]WiW\[[dl_hedc[djWdZ Z[b_l[h_d]WgkWb_joi[hl_Y[Wj[l[hob[l[be\ ‘j^[eh]Wd_iWj_ed$ Public Interest Disclosures*+ S t r e s s A u d i t Security Management In relation work related stress, a Trust wide stress audit was a carried to The Local Security Management Specialist (the Health and Safety Manager) has ascertain the Trust’s performance against the Health and Safety Executive’s and continues to develop both proactive and reactive initiatives with in the Trust stress management standards. The aim of the audit was to provide a broad in relation to security management work across a range of actions. The overall indication on how staff rate the Trust’s performance in managing risks objective of the LSMS is to work on behalf of the Trust to deliver an environment associated with work related stress. The report identified Trust and departmental that is safe and secure so that the highest standards of clinical care can be recommendations. This was published in May 2008 and will be used in made available to patients. The LSMS provides a comprehensive and professional conjunction with the results of the national staff survey to further improve trust security management service for the Trust working towards the creation of the performance in reducing sickness and absence due to work related stress. Trust’s pro-security culture. Zero Tolerance and Conflict Resolution Counter Fraud Activities The Health and Safety department is working towards implementing more robust procedures and systems to better protect staff from violence and The Trust obtains effective support in this area from the NHS Counter Fraud aggression, especially lone workers. A lone worker business case has been and Security Management Service with local counter fraud specialists being developed and has been submitted to the NHS Security Management Services to part of our internal audit service. The Trust’s policies are set out in our Standing apply for funding for lone worker devices to help protect staff who work alone in Financial Instructions and we also operate a ‘Raising Concerns’ policy via our the community and within the Trust premises from violence and aggression. The Senior Independent Director. funding is due to be released in April 2009. In the interim period the Trust has also implemented a buddy system to ensure that all staff are home safe after their shift has finished. The Trust has funded six members of staff to complete a ‘train the trainer” conflict resolution training course. Subsequently, a comprehensive training Creditors’ Payment Policy programme has commenced with the aim to train all frontline staff by the end of March 2009 with all remaining staff being given the opportunity to attend It is the policy of the Trust to settle all expenses on a timely basis in the ordinary when this is complete. The purpose being to ensure all staff are facilitated with course of business. It is the Trust’s policy to agree appropriate terms and the knowledge and skills to address any situation of conflict they may encounter conditions in advance with it suppliers and to make payment in accordance with while working for the Trust. those terms and conditions, provided the supplier has complied with them. J^[el[hWbbeX`[Yj_l[e\j^[BICI_ijemehaed‘ X[^Wb\e\j^[JhkijjeZ[b_l[hWd[dl_hedc[dj j^Wj_iiW\[WdZi[Ykh[iej^Wjj^[^_]^[ij ijWdZWhZie\Yb_d_YWbYWh[YWdX[cWZ[ ‘WlW_bWXb[jefWj_[dji$ Working with our partners*, Environmental Issues The Trust has once again continued with its The Trust has also shown its commitment The Trust has, similar to all NHS commitment towards Environmental issues to developing its Environmental policies Organisations, experienced significant WITH A a INVESTMENT IN ITS h)NVEST TO by approving the appointment of a financial pressures during the year but save” initiative. During 2008/09 the majority permanent Environmental Manager, with a combination of the work previously of this money was spent on improving with appointment to the post scheduled undertaken and the appointment of the lighting systems within the Trust providing for June 2009. This post will be responsible Environmental Manager role it is expected “High Frequency” modern fittings with for driving forward all the Trust’s that these pressures can be reversed improved control systems to optimise usage Environmental agenda. during 2009. IN ALL AREAS n THIS PROJECT IS SET TO CONTINUE during 2009. The Trust continues to work with its chosen )N -AY THE 4RUST AS PART OF A a waste provider in improving its recycling million development, commissioned the The Trust’s Environmental management initiatives. One significant development is review of the Travel Plan. The plan was group has become more established during the announcement by the Trust’s domestic approved by The Management Executive the latter part of the year and now has waste contractor that they have signed an Board in November 2008 and a project scheduled meetings three times per year to agreement with a company providing new team under the leadership of the Patient plan the Trust’s Environmental Strategy. The technology that will ensure recycling of Facilities Manager was established. This main focus of the group during 2008 was to 100% of all the domestic waste produced by group will lead the development of this review the Trust’s Environmental policy which the Trust during 2009. This will ensure none plan in the coming years. is set for ratification during the early part of of Liverpool Women’s produced waste goes the coming reporting year. to Landfill. :kh_d](&&/"ded[e\B_l[hfeebMec[d½i‘ ‘fheZkY[ZmWij[]e[ijeBWdZÅbb$ Working with our partners*- Consultations During 2008/09 we have again undertaken scrutinised by those individuals in order that proposed core pathway which in turn was consultation with local partners in relation the Trust’s level of compliance with a range the result of some initial work with patients; to the declaration required by the Healthcare of standards could be objectively tested. the focus for this was ensuring choice at all Commission as part of its Annual Health stages of the pathway, for high risk as well Check assessment. The Trust submitted 4HE "IG 0USH as low risk pregnancies. The Trust received information for consultation with the Health The Council of Governors led a detailed a very positive response to this exercise and Care Scrutiny Panel of Liverpool City consultation with our members and the Council. In addition, the Trust undertook a general public to inform the plans for the and the results will be used to develop more detailed consultation on the standards redesign of our maternity services, known the business case for the estates element with members of its Council of Governors as the ‘Big Push’ project. The consultation of the redesign which will enable the full whereby the evidence portfolio was questionnaire was shaped around the implementation of the pathway. J^[9ekdY_be\=el[hdehib[ZW‘ Z[jW_b[ZYedikbjWj_edm_j^ekh c[cX[hiWdZj^[][d[hWbfkXb_Yje _d\ehcj^[fbWdi\ehj^[h[Z[i_]d ‘e\ekhcWj[hd_joi[hl_Y[i$ Staff enjoyed taking part in the “Nourish” project to promote healthy eating Remuneration Report*. Remuneration Report The Remuneration Committee of the Board The Committee met twice during 2008/09 as agreed by the Remuneration Committee of Directors is chaired by the Trust Chairman and although not all members were in of up to 5% of basic salary, based on (Ken Morris) and comprises all non-executive attendance at the second meeting, those the Trust’s performance in Healthcare directors: David Carbery, Hoi Yeung, who were unable to attend provided their Commission ratings and achievement of Roy Morris, Ann McCracken and Yvonne comments via the Committee chair. The Trust individual and team objectives. Rankin. This Committee is responsible for Chairman is responsible for assessing the determining the remuneration and terms and performance of the non-executive directors. For non-executive directors comparative conditions of the Chief Executive, Executive The Chairman’s appraisal is reviewed by the data was provided to the Remuneration Directors and Trust Secretary, taking into Remuneration Committee in accordance with Committee from other Foundation Trusts, account the results of the annual appraisal their policy which has been developed to mutual organisations and the private sector. process. The Chairman undertakes the reflect best practice nationally. annual appraisal of the Chief Executive; The remuneration and retirement benefits of who in turn is responsible for assessing the Executive Directors and the Chief Executive all directors are set out within notes 5.4.1 performance of the Executive Directors and are employed on permanent contracts of and 5.4.2 of the annual accounts. Trust Secretary. The Committee met twice employment, subject to three months notice during 2008/09 and all non-executives were on either side. Signed in attendance. Rates of pay for all senior managers are The Remuneration Committee of the Council BASED ON JOB SIZE MARKET INTELLIGENCE of Governors comprises three public, one (including published remuneration surveys) staff and one appointed members. This and performance. Chief Executive and Kathryn Thomson Committee is responsible for determining Executive Director remuneration packages the remuneration of the Chairman and Non comprise annual basic salary and normal Kathryn Thomson Executive Directors, taking into account NHS pension contributions plus a non- Chief Executive the results of the annual appraisal process. consolidated performance related payment 5th June 2009 Statement as to disclosure to auditors*/ Statement as to disclosure to auditors The directors who were in office as at 5th June 2009 confirm that: s AS FAR AS THEY ARE AWARE THERE IS NO relevant audit information of which the auditors are unaware and s THE DIRECTORS HAVE TAKEN ALL OF THE STEPS that they ought to have taken as directors in order to make themselves aware of any relevant audit information and to establish that the auditors are aware of that information. Signed Kathryn Thomson Kathryn Thomson Chief Executive 5th June 2009 Statement of Accounting Officer’s responsibilities as the +& accounting officer of Liverpool Women’s NHS Foundation Trust The National Health Service Act 2006 (The In preparing the accounts the Accounting time the financial position of the NHS Act) states that the Chief Executive is the Officer is required to comply with the foundation trust and to enable her to ensure accounting officer of the NHS foundation requirements of the NHS foundation that the accounts comply with requirements trust. The relevant responsibilities of trust Financial Reporting Manual and in outlined in the above mentioned Act. accounting officers including their particular to: The accounting officer is also responsible responsibility for the propriety and regularity s /BSERVE THE !CCOUNTS $IRECTION ISSUED for safeguarding the assets of the NHS of public finances for which they are by Monitor, including the relevant foundation trust and hence for taking answerable and for the keeping of proper accounting and disclosure requirements, reasonable steps for the prevention and accounts are set out in the accounting and apply suitable accounting policies on a detection of fraud and other irregularities. officers’ Memorandum issued by the consistent basis; Independent Regulator of NHS Foundation s -AKE JUDGEMENTS AND ESTIMATES ON A To the best of my knowledge and belief I Trusts (‘Monitor’). reasonable basis; have properly discharged the responsibilities s 3TATE WHETHER APPLICABLE ACCOUNTING set out in Monitor’s NHS Foundation Trust Under The Act, Monitor has directed the standards as set out in the NHS foundation Accounting Officer Memorandum. Liverpool Women’s NHS Foundation Trust to trust Financial Reporting Manual have prepare for each financial year a statement been followed, and disclose and explain Signed of accounts in the form and on the basis set any material departures in the financial out in the Accounts Direction. The accounts statements; and are prepared on an accruals basis and must s 0REPARE THE lNANCIAL STATEMENTS ON A give a true and fair view of the state of going concern basis Kathryn Thomson affairs of Liverpool Women’s NHS Foundation Trust and of its income and expenditure, The accounting officer is responsible for Kathryn Thomson total recognised gains and losses and cash keeping proper accounting records which Chief Executive flows for the financial year. disclose with reasonable accuracy at any 5th June 2009 J^[WYYekdj_d]e\ÅY[h_ih[ifedi_Xb[\eh‘ a[[f_d]fhef[hWYYekdj_d]h[YehZim^_Y^Z_iYbei[ m_j^h[WiedWXb[WYYkhWYoWjWdoj_c[j^[ ‘ÅdWdY_Wbfei_j_ede\j^[D>I\ekdZWj_edjhkij$ feb_Y_[i"W_ciWdZeX`[Yj_l[i ‘ WY^_[l[c[dje\j^[D>I\ekdZWj_edjhkij½i ioij[ce\_dj[hdWbYedjhebj^Wjikffehjij^[ ^Wl[h[ifedi_X_b_jo\ehcW_djW_d_d]WiekdZ ‘7i7YYekdj_d]E\ÅY[hWdZ9^_[\;n[Ykj_l["? detailed in the Regulations. the in detailed place at Liverpool Women’s NHS Foundation Foundation NHS Women’s Liverpool at place effectively and economically. and effectively updated in accordance with the timescales timescales the with accordance in updated The system of internal control has been in in been has control internal of system The realised, and to manage them efficiently, efficiently, them manage to and realised, pension scheme records are accurately accurately are records scheme pension realised and the impact should they be be they should impact the and realised with the scheme rules, and that member member that and rules, scheme the with compliance framework criteria. criteria. framework compliance EVALUATE THE LIKELIHOOD OF THOSE RISKS BEING s payments into the scheme are in accordance accordance in are scheme the into payments mandatory services in accordance with the the with accordance in services mandatory Foundation Trust; Foundation from salary, employer’s contributions and and contributions employer’s salary, from the key areas of finance, governance and and governance finance, of areas key the objectives of Liverpool Women’s NHS NHS Women’s Liverpool of objectives This includes ensuring that deductions deductions that ensuring includes This Monitor utilises a risk based approach across across approach based risk a utilises Monitor achievement of the policies, aims and and aims policies, the of achievement the Scheme regulations are complied with. with. complied are regulations Scheme the returns and discussions with Monitor. Monitor. with discussions and returns IDENTIFY AND PRIORITISE THE RISKS TO THE s all employer obligations contained within within contained obligations employer all been considered in the quarterly monitoring monitoring quarterly the in considered been process designed to: designed process control measures are in place to ensure ensure to place in are measures control responsibilities for internal control have have control internal for responsibilities internal control is based on an ongoing ongoing an on based is control internal membership of the NHS pension scheme, scheme, pension NHS the of membership organisation. During 2008/09 the Trust’s Trust’s the 2008/09 During organisation. assurance of effectiveness. The system of of system The effectiveness. of assurance As an employer with staff entitled to to entitled staff with employer an As of strategic and operational risks to the the to risks operational and strategic of only provide reasonable and not absolute absolute not and reasonable provide only Department level, which address the totality totality the address which level, Department policies, aims and objectives; it can therefore therefore can it objectives; and aims policies, report and accounts. and report registers generated at Directorate and and Directorate at generated registers than to eliminate all risk of failure to achieve achieve to failure of risk all eliminate to than and up to the date of approval of the annual annual the of approval of date the to up and Board Assurance Framework and risk risk and Framework Assurance Board to manage risk to a reasonable level rather rather level reasonable a to risk manage to Trust for the year ended 31st March 2009 2009 March 31st ended year the for Trust The principal mechanisms for this is the the is this for mechanisms principal The The system of internal control is designed designed is control internal of system The l o r t n o c l a n r e t n i f o m e t s y s e h t f o e s o p r u p e h T the safeguarding whilst objectives, trust is administered prudently and and prudently administered is trust foundation trust’s policies, aims and and aims policies, trust’s foundation Accounting Officer Memorandum. Memorandum. Officer Accounting foundation NHS the that ensuring for supports the achievement of the NHS NHS the of achievement the supports out in the NHS Foundation Trust Foundation NHS the in out responsible also am I me. to assigned in accordance with the responsibilities responsibilities the with accordance in that control internal of system sound acknowledge my responsibilities as set as responsibilities my acknowledge responsible, personally am I which for a maintaining for responsibility have I applied efficiently and effectively. I also also I effectively. and efficiently applied assets departmental and funds public Executive, Chief and Officer Accounting As economically and that resources are resources that and economically y t i l i b i s n o p s e r f o e p o c S +' Statement on Internal Control Internal on Statement Statement on Internal Control+( Capacity to handle risk The Trust’s Risk Management Strategy sets s 0ROVIDE ASSURANCE THAT $IRECTORATES Ward, departmental and directorate risk out the responsibility and role of the Chief and departments are meeting national registers have been in place for the full Executive in relation to risk management. standards and are prepared for assessment year and continue to be promulgated During the year 2008/09, delegated e.g. Healthcare Commission, NHS by robust systems for ensuring effective responsibility operated through the Clinical Litigation Authority management of operational risks across all Governance Committee and the Board of s %NSURE THAT TRAINING IN RISK MANAGEMENT IS areas of the organisation. Significant work Directors, which together provide the Trust implemented and evaluated in the Trust was undertaken during the year on the with a formal structure for addressing risk development of the operational risk register, at the corporate level, embracing strategic The Trust built upon and developed its to ensure that risks are being identified, risk issues, implementation of the Standards Board Assurance Framework during scored and treated in a consistent and for Better Health, the Board Assurance 2008/09, contributing towards the systematic way throughout the Trust. Framework and key risk performance achievement of an overall category ‘A’ rating indicators. The Trust’s committee structure defined as “An Assurance Framework has There is an escalation process whereby is based upon principles of integrated been established which is designed and risks that cannot be managed locally are governance and is designed to better operating to meet the requirements of reviewed at the appropriate level within support the Trust’s operation as an NHS the SIC and provide reasonable assurance the organisation to ensure that reasonable Foundation Trust. that there is an effective system of internal measures are taken. This is a continuous control to manage the principal risks process that assists with the development The Trust Risk Committee underpins the identified by the organisation.” The Director of an organisation-wide risk-aware culture, corporate arrangements by undertaking the of Internal Audit Opinion for the year rated sharing of lessons learned and enables risk following functions: the Trust as having ‘significant assurance’ as management decision making to occur as s 0ROVIDE SUPPORT DIRECTION AND TRAINING FOR did a review of assurances carried out by the near as practicable to the risk source. directorate and departmental risk leads Trust’s internal auditors. s %NSURE CONSISTENT AND APPROPRIATE RISK In 2007/08 the Trust was successful in systems and processes are established and The NHS Counter Fraud and Security gaining re-accreditation at CNST Level 3 for evaluated throughout the Trust Management Service reported for the maternity standards and in securing Level s %VALUATE AND FURTHER DEVELOP THE 4RUSTS second time in January 2009 its Compound 3 against the new, more broadly based Risk Management Strategy Indicator Assessment. This assessed the general NHS Litigation Authority standards s 2EPORT PROGRESS IN MANAGING RISK AND Trust for 2007/08 at a Level 2 “Adequate which have now replaced the CNST general implementing the Trust’s Risk Performance”. This represented an scheme. These are the highest possible Management Strategy enhancement on the 2006/07 assessment levels of accreditation for risk management s -ONITOR THE IMPLEMENTATION OF THE that had assessed the Trust at Level 1 nationally and continued to be in place Directorate Risk Management “Inadequate Performance”. The Compound throughout 2008/09. strategies and the effectiveness of risk Indicator Assessment is used to inform management in Directorates and non decisions as to the investment in the Risk management, risk assessment and clinical departments Counter Fraud Plan. incident reporting are included in core J^[:_h[Yjehe\?dj[hdWb7kZ_jEf_d_ed\ehj^[o[Wh‘ hWj[Zj^[JhkijWi^Wl_d]¼i_]d_ÅYWdjWiikhWdY[½Wi Z_ZWh[l_[me\WiikhWdY[iYWhh_[ZekjXoj^[Jhkij½i ‘_dj[hdWbWkZ_jehi$ X[[dWffhel[ZXoj^[8eWhZe\:_h[Yjehi$ ‘ feb_Y_[iWdZfheY[Zkh[i\ehh_iacWdW][c[dj"m^_Y^^Wl[ CWdW][c[djIjhWj[]oWdZ_ikdZ[hf_dd[ZXoj^[ ‘J^[h_iacWdW][c[dj\hWc[meha_ii[jekj_dj^[H_ia s )MPLEMENTATION PLAN through the year the through new projects new s 0LANNING RESOURCING AND PRIORITISATION progress and actual assurances identified identified assurances actual and progress 2ISK ASSESSMENT INBUILT WITHIN ALL s terms of reference of terms address control and assurance gaps, with with gaps, assurance and control address to the Clinical Governance Committee Governance Clinical the to including management, risk support 2ECORDS THE ACTIONS TAKEN BY THE 4RUST TO s ! TIMETABLE OF DIRECTORATE PROGRESS REPORTS s 'OVERNANCE STRUCTURES IN PLACE TO s internal control internal governance framework governance risk treatment risk relate to the effectiveness of the system of of system the of effectiveness the to relate integrated the of support in and assessment risk identification, risk review and assurance mechanisms which which mechanisms assurance and review Board the of committees appropriate 4HE RISK MANAGEMENT PROCESS INCLUDING s )DENTIlCATION AND DESCRIPTION OF THE s 0OLICY APPROVAL AND RATIlCATION BY s s 2OLES RESPONSIBILITIES AND ACCOUNTABILITIES to manage the risks the manage to throughout the organisation the throughout delegated authority to act to authority delegated place in control internal of mechanisms %DUCATION AND TRAINING PROGRAMMES s !CCEPTABLE LEVELS OF RISK AND THE LEVELS OF s )DENTIlCATION AND DESCRIPTION OF s National Patient Safety Agency Safety Patient National across the organisation the across Better Health Better the Trust and enable direct reporting to the the to reporting direct enable and Trust the 3TRATEGIC VISION FOR RISK MANAGEMENT s mapped to the relevant relevant the to mapped Standards for for Standards integrated risk management system across across system management risk integrated management systems management achievement of objectives and goals, goals, and objectives of achievement for risk management is used to support an an support to used is management risk for of our corporate objectives, goals and and goals objectives, corporate our of )DENTIlCATION OF THE PRINCIPAL RISKS TO THE s 4HE 5LYSSES SYSTEM A SOFTWARE PACKAGE s to risk management as an integral part part integral an as management risk to s #ORPORATE OBJECTIVES AND GOALS on an annual basis annual an on organisational philosophy in relation relation in philosophy organisational Assurance Framework covers the following: the covers Framework Assurance assessments which are formally updated updated formally are which assessments 4HE 4RUSTS POLICY STATEMENT AND s corporate performance report. The Board Board The report. performance corporate 7ARD DEPARTMENT AND DIRECTORATE RISK s s ! DElNITION OF RISK MANAGEMENT been reported on a monthly basis via the the via basis monthly a on reported been management and assurance agenda: assurance and management strategy document strategy the priority risks identified by the Board have have Board the by identified risks priority the control mechanisms which support the risk risk the support which mechanisms control ! STATEMENT OF THE PURPOSE OF THE s in full twice during the year and in addition addition in and year the during twice full in In addition, the Trust has in place a range of of range a place in has Trust the addition, In The key elements of the strategy include: strategy the of elements key The Framework has been reviewed by the Board Board the by reviewed been has Framework reviewed and updated. The Assurance Assurance The updated. and reviewed in May 2008. 2008. May in approved by the Board of Directors. Directors. of Board the by approved within the foundation trust and is regularly regularly is and trust foundation the within against the core standards in its Declaration Declaration its in standards core the against for risk management, which have been been have which management, risk for at corporate level has been embedded embedded been has level corporate at submitted a position of full compliance compliance full of position a submitted underpinned by the policies and procedures procedures and policies the by underpinned focuses on identifying the principal risks risks principal the identifying on focuses Standards for Better Health Better for Standards , the Trust Trust the , in the Risk Management Strategy and is is and Strategy Management Risk the in The Board Assurance Framework, which which Framework, Assurance Board The The risk management framework is set out out set is framework management risk The In terms of the Healthcare Commission’s Commission’s Healthcare the of terms In k r o w e m a r f l o r t n o c d n a k s i r e h T NHSLA level 3 across all staff groups. staff all across 3 level NHSLA exceptional the maintaining on emphasis be will approach This programme. training standards of training required for CNST/ for required training of standards specific with 2009/10 during continued mandatory Trust’s the within and induction . d t n o c k s i r e l d n a h o t y t i c a p a C +) Statement on Internal Control Internal on Statement Statement on Internal Control+* Review of economy, efficiency and effectiveness of the use of resources As Accounting Officer, I am responsible achievement of savings targets, contract Management as a result of risks to for ensuring that the organisation has activity, human resource indicators and key performance identified from the arrangements in place for securing value for service performance indicators. The Finance performance management system. These money in the use of its resources. To do this I and Contracts Committee of the Board also reviews have included: have implemented systems to: meets monthly to provide dedicated time to s !N EXTENSIVE REVIEW OF IMAGING s 3ET REVIEW AND IMPLEMENT STRATEGIC AND review financial and contract performance in services within the Trust resulting in operational objectives detail prior to Board meetings. the establishment of a service s %NGAGE WITH PATIENTS MEMBERS AND improvement project other stakeholders to ensure key Reports on specific issues relating to s 4HE DEVELOPMENT OF SERVICE LINE REPORTS messages about services are received economy, efficiency and effectiveness are to better understand the financial and and acted upon commissioned by the Audit Committee service performance of Trust activities s -ONITOR AND REVIEW within the Internal Audit plan and the leading to the implementation of Clinical organisational performance implementation of recommendations made Business Units within the organisation s $ELIVER EFlCIENCY GAINS AND SAVINGS TARGETS by Internal Audit is overseen by the Audit from April 2009 Committee. Within the 2008/09 risk based s 0ARTICIPATION IN A NATIONAL BENCHMARKING Annually, the Trust produces a service Internal Audit Plan specific resource has exercise in relation to the development of strategy which incorporates a supporting been utilised in evaluating the effectiveness the tariff for Obstetric services financial plan for approval by the Board of of committee structures and governance s ! REVIEW OF /BSTETRICS PATHWAYS RESULTING Directors. This informs the annual detailed arrangements within the Trust, both at Board in the development of a business case operational plan and budget which is also level and within the clinical directorates. to enhance further the service model for approved by the Board. Views of the Trust’s maternity services 9,000 members are gained through their During the year the Trust was subject to the s $EVELOPMENT OF hONE STOPv CLINICS TO representatives on the Trust’s Council of national PbR Data Assurance Framework support the delivery of waiting time targets Governors. In 2008/09 members of the Audit of its clinical coding systems which and enhance services to patients Council of Governors were involved in the identified a number of areas of good s ! REVIEW OF ALL 'YNAECOLOGY PATHWAYS development of the Trust’s clinical service practice which were also reflected within to support the achievement of the strategy. The resulting plan informs the a comparative audit report undertaken 18 week target Trust’s corporate objectives and provides by Cheshire and Mersey data Quality and s 4HE DEVELOPMENT OF 'YNAECOLOGY @CLOSER the basis for quarterly performance reviews Clinical Coding Unit. to home’ in partnership with Knowsley at directorate level. The Board of Directors Primary Care Trust monitors performance monthly through the Specific management reviews have also corporate report which provides integrated been identified by the Board of Directors, information on financial performance, Executive Directors and Directorate L_[mie\j^[Jhkij½i/"&&&c[cX[hiWh[‘ ]W_d[Zj^hek]^j^[_hh[fh[i[djWj_l[i ‘edj^[Jhkij½i9ekdY_be\=el[hdehi$ h[YehZ_dj^_iWh[W$ ‘ _d\[Yj_ed"Wi[l_Z[dY[ZXoekhjhWYa ]h[Wj[cf^Wi_ied_jiYedjhebe\ ‘B_l[hfeebMec[d½iYedj_dk[ijefbWY[ risk management generally and clinical risk clinical and generally management risk process required by the new Care Quality Quality Care new the by required process further improvement. improvement. further of the Hygiene Code for the registration registration the for Code Hygiene the of can be learned and identify any areas for for areas any identify and learned be can the effectiveness and assure the Board of of Board the assure and effectiveness the to declare compliance with all aspects aspects all with compliance declare to by the Trust to determine the lessons that that lessons the determine to Trust the by components by which I am able to assess assess to able am I which by components been addressed and the Trust was confident confident was Trust the and addressed been commissioned been has review wider A 4HE #OMMITTEES OF THE "OARD ARE KEY s to documentation. Both areas have now now have areas Both documentation. to patients. all for expected care of quality of the system of internal control internal of system the of identified for improvement, which related related which improvement, for identified to be satisfied that they have received the the received have they that satisfied be to in advising the Board on the effectiveness effectiveness the on Board the advising in however there were two sub-section areas areas sub-section two were there however number of patients in order for the Trust Trust the for order in patients of number integrated governance structure, is pivotal pivotal is structure, governance integrated control. The Trust was overall compliant, compliant, overall was Trust The control. its consultants. This led to the recall of a a of recall the to led This consultants. its 4HE !UDIT #OMMITTEE AS PART OF AN s in respect of infection prevention and and prevention infection of respect in review the surgical practices of one of of one of practices surgical the review enable risk to be assessed and managed and assessed be to risk enable assurance systems, processes and practices practices and processes systems, assurance During the year the Trust had cause to to cause had Trust the year the During of prudent and effective controls that that controls effective and prudent of inspection in July 2008 looking at the the at looking 2008 July in inspection leadership of the Trust within a framework framework a within Trust the of leadership Commission carried out an unannounced unannounced an out carried Commission measures put in place. in put measures 4HE "OARD OF $IRECTORS PROVIDES ACTIVE s in the Health Act 2006 the Healthcare Healthcare the 2006 Act Health the in in-year by the Board and appropriate control control appropriate and Board the by in-year following elements: following Infections (‘the Hygiene Code’), as set out out set as Code’), Hygiene (‘the Infections Framework have been regularly reviewed reviewed regularly been have Framework of the system of internal control includes the the includes control internal of system the of and Control of Health Care Associated Associated Care Health of Control and risks identified within the Board Assurance Assurance Board the within identified risks maintaining and reviewing the effectiveness effectiveness the reviewing and maintaining in the Code of Practice for the Prevention Prevention the for Practice of Code the in identified during 2008/09. All significant significant All 2008/09. during identified The process that has been applied in in applied been has that process The Trust’s compliance with the standards set out out set standards the with compliance Trust’s no significant internal control issues issues control internal significant no ). In order to test the the test to order In ). difficile Chlostridium appropriate Committee. There have been been have There Committee. appropriate system is in place. place. in is system of MRSA this year and just two cases of of cases two just and year this MRSA of would be reported to the Board via the the via Board the to reported be would and ensure continuous improvement of the the of improvement continuous ensure and area (there have been no reportable cases cases reportable no been have (there area issues control internal significant Any Directors and a plan to address weaknesses weaknesses address to plan a and Directors as evidenced by our track record in this this in record track our by evidenced as system of internal control by the Board of of Board the by control internal of system great emphasis on its control of infection, infection, of control its on emphasis great the Assurance Framework. Assurance the of my review of the effectiveness of the the of effectiveness the of review my of Liverpool Women’s continues to place place to continues Women’s Liverpool against key areas of control, as set out in in out set as control, of areas key against advised on the implications of the result result the of implications the on advised and a range of independent assessments assessments independent of range a and been have I reports. other and letter core standards. core frameworks linked to the Operational Plan Plan Operational the to linked frameworks management their in auditors external and continues to declare compliance with all all with compliance declare to continues and mechanisms include Directorate assurance assurance Directorate include mechanisms framework and comments made by the the by made comments and framework undertaken by Mersey Internal Audit Agency Agency Audit Internal Mersey by undertaken /THER EXPLICIT REVIEW AND ASSURANCE s and maintenance of the internal control control internal the of maintenance and Health Better for Standards Audit Manager Audit Commission’s Commission’s have responsibility for the development development the for responsibility have the with regularly meets also Finance undertaken in relation to the Healthcare Healthcare the to relation in undertaken within the NHS foundation trust who who trust foundation NHS the within of previous audit work. The Director of of Director The work. audit previous of performed well in a bench-marking exercise exercise bench-marking a in well performed internal auditors and the executive managers managers executive the and auditors internal outstanding following any follow up up follow any following outstanding standards in February 2008. The Trust Trust The 2008. February in standards control is informed by the work of the the of work the by informed is control receives details of actions that remain remain that actions of details receives accreditation at CNST Level 3 for maternity maternity for 3 Level CNST at accreditation the effectiveness of the system of internal internal of system the of effectiveness the Trust Officers. The Audit Committee also also Committee Audit The Officers. Trust general standards in March 2008 and re- and 2008 March in standards general system of internal control. My review of of review My control. internal of system to the Director of Finance and other other and Finance of Director the to assessors who awarded the Trust Level 3 for for 3 Level Trust the awarded who assessors for reviewing the effectiveness of the the of effectiveness the reviewing for to the Audit Committee and full reports reports full and Committee Audit the to provided by the NHS Litigation Authority Authority Litigation NHS the by provided As Accounting Officer, I have responsibility responsibility have I Officer, Accounting As )NTERNAL !UDIT PROVIDES QUARTERLY REPORTS s Independent assessment has been been has assessment Independent s s e n e v i t c e f f e f o w e i v e R ++ Statement on Internal Control Internal on Statement Statement on Internal Control+, Review of effectiveness contd. Commission in February 2009. The Trust throughout the year and embedded across s (EALTHCARE #OMMISSIONS Annual Health has subsequently received confirmation the organisation. On completion of this Check 2007/08 (reported in October 2008) of unconditional registration by the Care programme of scrutiny, the Trust was unable resulted in ratings of ‘excellent’ for use of Quality Commission. to fully satisfy the Board of Directors that the resources and ‘good’ for quality of services full range of evidence had been in place for s !CHIEVEMENT OF @EXCELLENT CATEGORY IN In 2008/09 the Trust reviewed its approach the full year against two of the Standards: PEAT assessment s 3UCCESSFUL JOINT INSPECTION BY THE to the process for providing assurance in C4c - Healthcare organisations keep Healthcare Commission and the relation to the Healthcare Commission’s patients, staff and visitors safe by having Human Embryology and Fertilisation Standards for Better Health. This was in systems to ensure that all reusable medical devices are properly decontaminated prior Authority of the Hewitt Centre for response to the new approach being taken to use and that the risks associated with Reproductive Medicine by the Healthcare Commission in ensuring decontamination facilities and processes are s ! RATING OF EXCELLENT FROM THE EXTERNAL that the standards are consistently applied well managed, and clinical coding audit undertaken as part of C4d - Healthcare organisations keep the Audit Commission’s Payment by Results patients, staff and visitors safe by having Data Assurance Framework in 2008/09 systems to ensure that medicines are s 4HE 'ENETICS LABORATORIES WERE handled safely and securely. subject to CPA review in December Consequently, the Trust has declared that to determine continued compliance it has ‘insufficient assurance’ in relation with standards. This determined that to these Standards within its declaration accreditation was maintained. against the Core Standards as part of the Annual Health Check for 2008/09. The Trust Conclusion has evidence that both aspects of service are Based on the above, I can confirm that fully safe for patientss, however the requisite no significant internal control issues have documentation has not been evidenced for been identified. the full reporting period. Action plans are in Signed place to address these deficits. During the year the I receive reports from the Royal Colleges and following Deanery Kathryn Thomson visits. In addition, there are a range of other Kathryn Thomson independent assessments against key areas Chief Executive of control, for example: 5th June 2009 Statement on Internal Control+- Attendance at Council of Governors meetings 2008/09 RD !PRIL TH *ULY 22nd October ST *ANUARY Public members Anna Banks (from Sept 08) Morag Day Irene Drakeley Appendix 1 Sheila Foley Annette James Patricia Jones Ronnie Kehoe Maureen Kelly (from Sept 08) Brenda McGrath Geoff McKeating (from Sept 08) Anees Paracha Angela Parker Shivakuru Selvathurai (until Dec 08) Anne Smith Betty Stopforth Maggi Williams Deirdre Wood Janine Wooldridge Staff Members Dorcas Akeju OBE Leanne Bricker Dianne Brown (from Sept 08) Denise Carter (from Sept 08) Angela Douglas Helen Gavin Paul Young (until May 08) Appointed members Jayne Aston Janet Atherton Marilyn Fielding Paula Grey Margaret Hogan 'ODFREY -AZHINDU Sue Ryrie (until Sept 08) Susan Wray Attendance at meetings marked with Annual Accounts 2008/2009+. FOREWORD TO THE ACCOUNTS These accounts for the year-ended 31st March 2009 have been prepared by the Liverpool Women’s NHS Foundation Trust under schedule 7 sections 24 and 25 of the National Health Service Act 2006 in the form which Monitor, the Independent Regulator of NHS Foundation Trusts has, with the approval of the Treasury directed. Kathryn Thomson Kathryn Thomson Chief Executive 5th June 2009 Annual Accounts 2008/2009+/ Income and Expenditure Account for the financial year ended 31st March 2009 Note £000 £000 )NCOME FROM ACTIVITIES 3.1 - 3.3 73,049 Other operating income 4.1 9,417 Operating expenses 5.1 (75,481) /0%2!4).' 3520,53 6,985 Profit/(Loss) on disposal of fixed assets 7.1 7 3520,53 "%&/2% ).4%2%34 6,992 Interest receivable 646 Interest payable 8.1 0 (7) /THER lNANCE COSTS n UNWINDING OF DISCOUNT 8.1 (20) (23) 3520,53 &/2 4(% &).!.#)!, 9%!2 7,608 Public Dividend Capital (PDC) dividends payable (1,721) 2%4!).%$ 3520,53 &/2 4(% 9%!2 5,887 Income and operating surpluses are derived from the Foundation Trust’s continuing operations. ‘ ‘H[jW_d[Zikhfbki\ehj^[o[Wh*"+*&a$ Annual Accounts 2008/2009,& Balance Sheet at 31st March 2009 Note ST -ARCH 31st March 2008 £000 a &)8%$ !33%43 Intangible assets 11.1 76 78 Tangible assets 11.2 51,931 4/4!, &)8%$ !33%43 52,009 #522%.4 !33%43 Stocks and work in progress 12.1 662 491 Debtors 13.1 3,813 Current Asset Investments 2,500 Cash at bank and in hand 12,440 4/4!, #522%.4 !33%43 19,244 #2%$)4/23 Amounts falling due within one year 14.1 (9,937) .%4 #522%.4 !33%43,)!"),)4)%3 9,307 4/4!, !33%43 ,%33 #522%.4 ,)!"),)4)%3 61,316 02/6)3)/. &/2 ,)!"),)4)%3 !.$ #(!2'%3 15.1 (2,185) 4/4!, !33%43 %-0,/9%$ 59,131 &).!.#%$ "9 4!80!9%23 %15)49 21.1 Public dividend capital 21.2 35,333 Revaluation reserve 15,616 Donated asset reserve 16.1 246 196 Income and expenditure reserve 7,986 4/4!, 4!80!9%23 %15)49 59,131 The financial statements were approved by the Board of Directors and authorised for issue on 5th June 2009 and are signed on its behalf by: ‘ Kathryn Thomson Kathryn Thomson Chief Executive ‘JejWbWii[ji[cfbeo[Z,)"+)'a Annual Accounts 2008/2009,' Statement of total recognised gains and losses for the financial year ended 31st March 2009 £000 £000 Surplus for the financial year before dividend payments 7,608 5NREALISED 3URPLUS ON &IXED !SSET REVALUATIONS 0 (702) )NCREASE IN THE DONATED ASSET RESERVE DUE TO RECEIPT OF DONATED ASSETS 0 0 2EDUCTIONS IN THE DONATED ASSET RESERVE DUE TO DEPRECIATION IMPAIRMENT (17) (17) ANDOR DISPOSAL OF DONATED ASSETS 4/4!, 2%#/'.)3%$ '!).3 !.$ ,/33%3 &/2 4(% &).!.#)!, 9%!2 6,889 JejWbh[Ye]d_i[Z]W_diWdZbeii[i\eh‘ ‘j^[ÅdWdY_Wbo[Wh,"+&/a Annual Accounts 2008/2009,( Cash flow statement for the financial year ended 31st March 2009 Note 2007/08 £000 £000 a Operating Activities Net cash inflow from operating activities 18.1 8,290 2ETURNS ON )NVESTMENTS AND 3ERVICING OF &INANCE Interest received 620 Interest paid 0 (7) .ET #ASH INmOW FROM RETURNS ON INVESTMENTS AND 613 servicing of finance #!0)4!, %80%.$)452% Payments to acquire tangible fixed assets (3,135) Receipts from sale of tangible fixed assets 1 16 .ET CASH OUTmOW FROM CAPITAL EXPENDITURE (3,119) $)6)$%.$3 0!)$ (1,721) .ET CASH INmOW BEFORE lNANCING 4,063 -!.!'%-%.4 /& ,)15)$ 2%3/52#%3 Movement in short-term deposits 18.2 0 .ET CASH INmOW FROM MANAGEMENT OF LIQUID DEPOSITS 0 .ET CASH INmOW BEFORE lNANCING 4,063 &).!.#).' Public dividend capital received 0 2,200 Public dividend capital repaid 0 .ET CASH INmOW FROM lNANCING 2,200 Movement in cash 18.3 6,263 ‘ ‘Cel[c[dj_dYWi^("()&a Annual Accounts 2008/2009,) Notes to the accounts 1. Accounting policies and 1.2 Acquisitions and )NCOME RECOGNITION other information discontinued operations Income is accounted for applying the Monitor has directed that the financial Activities are considered as accruals convention. The main source of statements of NHS foundation trusts shall ‘discontinued’ where they meet all of income for the Trust is under contracts meet the accounting requirements of the the following conditions: from commissioners in respect of NHS Foundation Trust Financial Reporting healthcare services. Manual, which shall be agreed with HM s THE SALE THIS MAY BE AT NIL CONSIDERATION Treasury. Consequently, the following for activities transferred to another Income is recognised in the period in which financial statements have been prepared public sector body) or termination is services are provided. Where income is in accordance with the 2008/09 NHS completed either in the period or before received for a specific activity, which is to be Foundation Trust Financial Reporting the earlier of three months after the delivered in the following financial year, that income is deferred. Manual issued by Monitor. The accounting commencement of the subsequent period policies contained in that manual follow UK and the date on which the financial Where it is reasonably certain that the Trust generally accepted accounting practice for statements are approved; will receive the income for a treatment companies (UK GAAP) and HM Treasury’s s IF A TERMINATION THE FORMER ACTIVITIES HAVE or spell once the patient is admitted and Financial Reporting Manual to the extent ceased permanently; treatment begins then the income relating s THE SALE OR TERMINATION HAS A MATERIAL that they are meaningful and appropriate to those spells that are partially completed effect on the nature and focus of to NHS foundation trusts. The accounting at the financial period end is apportioned on the reporting NHS foundation trust’s policies have been applied consistently in a pro-rata basis. The apportioned amounts operations and represents a material dealing with items considered material in are disclosed as “amounts recoverable on reduction in its operating facilities resulting relation to the accounts. contracts” and disclosed within debtors. either from its withdrawal from a particular activity or from a material reduction in 1.1 Accounting convention Expenditure income in the NHS foundation trust’s These accounts have been prepared under continuing operations; and Expenditure is accounted for applying the the historical cost convention modified s THE ASSETS LIABILITIES RESULTS OF OPERATIONS accruals convention. to account for the revaluation of fixed and activities are clearly distinguishable, 1.4 Tangible fixed assets assets and in accordance with applicable physically, operationally and for financial Capitalisation accounting standards. NHS foundation reporting purposes. trusts, in compliance with HM Treasury’s Operations not satisfying all these Tangible assets are capitalised if they are Financial Reporting Manual, are not required conditions are classified as continuing. capable of being used for a period which to comply with the FRS 3 requirements to Activities are considered as ‘acquired’ exceeds one year and they: report “earnings per share” or historical whether or not they are acquired from s INDIVIDUALLY HAVE A COST OF AT LEAST profits and losses. outside the public sector. a OR J^[WYYekdj_d]feb_Y_[i^Wl[X[[dWffb_[ZYedi_ij[djbo_dZ[Wb_‘ d] ‘m_j^_j[ciYedi_Z[h[ZcWj[h_Wb_dh[bWj_edjej^[WYYekdji$ Annual Accounts 2008/2009,* Notes to the accounts contd. s FORM A GROUp of assets which individually Valuations are carried out by professionally $EPRECIATION AMORTISATION HAVE A COST OF MORE THAN a COLLECTIVELY qualified valuers in accordance with the and impairments HAVE A COST OF AT LEAST a WHERE THE Royal Institute of Chartered Surveyors Tangible fixed assets are depreciated at rates assets are functionally interdependent, (RICS) Appraisal and Valuation Manual. calculated to write them down to estimated they had broadly simultaneous The last asset valuations were undertaken residual value on a straight-line basis over purchase dates, are anticipated to have in 2008 as at the prospective valuation date their estimated useful lives. No depreciation simultaneous disposal dates and are under of 1 April 2008. The revaluation undertaken is provided on freehold land, and assets single managerial control; or at that date was accounted for on 31st surplus to requirements. s FORM PART OF THE INITIAL SETTING UP COST OF A March 2008. An asset in the course of construction and new building or refurbishment of a ward residual interests in off-balance sheet PFI or unit, irrespective of their individual or The valuations are carried out primarily on contract assets are not depreciated until the collective cost. the basis of depreciated replacement cost for asset is brought into use or reverts to the specialised operational property and existing trust, respectively. 6ALUATION use value for non-specialised operational Buildings, installations and fittings are Tangible fixed assets are stated at the property. The value of land for existing use depreciated on their current value over the latest revaluation amount or in the case purposes is assessed at existing use value. estimated remaining life of the asset which of newly acquired assets, at cost. On initial For non-operational properties including has been assessed by the trust’s professional recognition they are measured at cost surplus land, the valuations are carried out valuers DTZ. Leaseholds are depreciated over (for leased assets, fair value) including at open market value. the primary lease term. any costs, such as installation, directly Equipment is depreciated on current cost Additional alternative open market value attributable to bringing them into working evenly over the estimated life utilising the figures have only been supplied for condition. The carrying values of tangible following lives: fixed assets are reviewed for impairment in operational assets scheduled for imminent periods if events or changes in circumstances closure and subsequent disposal. Years indicate the carrying value may not be Medical equipment and 5 to 15 Assets in the course of construction are recoverable. The costs arising from financing engineering plant and valued at cost and are valued by the construction of the fixed asset are not equipment capitalised but are charged to the income professional valuers as part of the five or and expenditure account in the year to three-yearly valuation or when they are Furniture 10 which they relate. brought into use. Mainframe information 8 technology installations All land and buildings are revalued using Operational equipment is valued at net Soft Furnishings 7 professional valuations in accordance with current replacement cost. Equipment FRS 15 every five years. A three yearly surplus to requirements is valued at net Office and information 5 technology equipment interim valuation is also carried out. recoverable amount. J^[lWbkWj_ediWh[YWhh_[Zekjfh_cWh_boedj^[XWi_ie\‘ Z[fh[Y_Wj[Zh[fbWY[c[djYeij\ehif[Y_Wb_i[Zef[hWj_edWb fhef[hjoWdZ[n_ij_d]ki[lWbk[\ehded#if[Y_Wb_i[Z ‘ef[hWj_edWbfhef[hjo$ Annual Accounts 2008/2009,+ Notes to the accounts contd. Fixed asset impairments resulting from Donated fixed assets 1.6 Government Grants losses of economic benefits are charged Donated fixed assets are capitalised at Government grants are grants from to the income and expenditure account. their current value on receipt and this Government bodies other than income All other impairments are taken to the value is credited to the donated asset from primary care trusts or NHS trusts for revaluation reserve and reported in the reserve. Donated fixed assets are valued the provision of services. Grants from the statement of total recognised gains and and depreciated as described above for Department of Health, and grants from losses to the extent that there is a balance purchased assets. Gains and losses on the Big Lottery Fund, are accounted for as on the revaluation reserve in respect of the revaluations are also taken to the donated Government grants. Where the Government particular asset. asset reserve and, each year, an amount grant is used to fund revenue expenditure equal to the depreciation charge on the it is taken to the Income and Expenditure )NTANGIBLE lXED ASSETS asset is released from the donated asset account to match that expenditure. Where reserve to the income and expenditure the grant is used to fund capital expenditure Intangible assets are capitalised when account. Similarly, any impairment on the grant is held as deferred income and they are capable of being used in a donated assets charged to the income and released to the income and expenditure trust’s activities for more than one year; expenditure account is matched by a transfer account over the life of the asset on a basis they can be valued; and they have a cost from the donated asset reserve. On sale consistent with the depreciation charge for OF AT LEAST a of donated assets, the net book value of that asset. the donated asset is transferred from the Intangible fixed assets held for donated asset reserve to the income and 0RIVATE &INANCE )NITIATIVE operational use are valued at historical expenditure Reserve. 0&) 4RANSACTIONS cost and are amortised over the estimated There have been no such transactions life of the asset on a straight line basis. )NVESTMENTS during 2008/09. The carrying value of intangible assets is The Trust does not have investments reviewed for impairment at the end of the in subsidiary undertakings, associates or 3TOCKS AND WORK IN PROGRESS first full year following acquisition and joint ventures. Stocks and work-in-progress are valued at in other periods if events or changes in the lower of cost and net realisable value. circumstances indicate the carrying value Deposits and other investments that are Work-in-progress comprises goods and may not be recoverable. readily convertible into known amounts of services in intermediate stages of production. cash at or close to their carrying amounts Purchased computer software licences are treated as liquid resources in the #ASH BANK AND OVERDRAFTS are capitalised as intangible fixed assets cashflow statement. These assets, and Cash, bank and overdraft balances are WHERE EXPENDITURE OF AT LEAST a IS other current assets, are valued at cost less recorded at the current values of these incurred and amortised over the shorter any amounts written off to represent any balances in the NHS foundation trust’s of the term of the licence and their useful impairments in value, and are reviewed cashbook. These balances exclude monies economic lives. annually for impairments. held in the NHS foundation trust’s bank ?djWd]_Xb[Ån[ZWii[ji^[bZ\ehef[hWj_edWbki[Wh[‘ lWbk[ZWj^_ijeh_YWbYeijWdZWh[Wcehj_i[Zel[hj^[ ‘[ij_cWj[Zb_\[e\j^[Wii[jedWijhW_]^jb_d[XWi_i$ Annual Accounts 2008/2009,, Notes to the accounts contd. account belonging to patients (see “third the project. It is revalued on the basis uncertain timing or amount at the balance party assets” below). Account balances of current cost. Expenditure that does sheet date on the basis of the best estimate are only set off where a formal agreement not meet the criteria for capitalisation is of the expenditure required to settle the has been made with the bank to do so. treated as an operating cost in the year in obligation. Where the effect of the time In all other cases overdrafts are disclosed which it is incurred. value of money is significant, the estimated within creditors. Interest earned on bank s 7HERE POSSIBLE .(3 FOUNDATION TRUSTS risk-adjusted cash flows are discounted accounts and interest charged on overdrafts disclose the total amount of research using HM Treasury’s discount rate of 2.2% in is recorded as, respectively, “interest and development expenditure charged real terms. receivable” and “interest payable” in the in the Income and Expenditure account periods to which they relate. Bank charges separately. The Trust’s NHS Research Contingencies are recorded as operating expenditure in the Strategy is underpinned by the Contingent assets (that is, assets arising periods to which they relate. Department of Health national health from past events whose existence will only research strategy for England: Best be confirmed by one or more future events 1.10 Research and Development Research for Best Health (DH2006). not wholly within the entity’s control) are not This has had the impact of fundamentally recognised as assets, but are disclosed as a Expenditure on research is not capitalised. changing the funding regime for research note where an inflow of economic benefits Expenditure on development is capitalised if with the withdrawal of block Research is probable. it meets the following criteria: and Development monies phased over the last three years. Funding to Contingent liabilities are provided for where s THERE IS A CLEARLY DElNED PROJECT support research is now allocated by the a transfer of economic benefits is probable. s THE RELATED EXPENDITURE IS Comprehensive Local Research Network Otherwise, they are not recognised, but are separately identifiable; (CLRN) on the basis of research activity, disclosed in note 15 unless the probability s THE OUTCOME OF THE PROJECT HAS BEEN with recruitment specific to studies on of a transfer of economic benefits is remote. assessed with reasonable certainty as to their portfolio. The majority of the Trust’s Contingent liabilities are defined as: its technical feasibility and its resulting in a research is related to its involvement product or services that will eventually be with the UKCRN portfolio trials and the s 0OSSIBLE OBLIGATIONS ARISING FROM PAST brought into use; and Trust is able to identify both income and events whose existence will be confirmed s ADEQUATE RESOURCES EXIST OR ARE REASONABLY expenditure and this is shown separately only by the occurrence of one or more expected to be available, to enable the from patient care activity. uncertain future events not wholly within project to be completed and to provide any Fixed assets acquired for use in research and the entity’s control; or consequential increases in working capital. development are amortised over the life of s 0RESENT OBLIGATIONS ARISING FROM PAST s EXPENDITURE SO DEFERRED IS LIMITED TO THE the associated project. events but for which it is not probable value of future benefits expected and that a transfer of economic benefits will is amortised through the income and 1.11 Provisions arise or for which the amount of the expenditure account on a systematic basis The NHS foundation trust provides for obligation cannot be measured with over the period expected to benefit from legal or constructive obligations that are of sufficient reliability. M^[h[feii_Xb["D>I\ekdZWj_edjhkijiZ_iYbei[j^[jejWb‘ Wcekdje\h[i[WhY^WdZZ[l[befc[dj[nf[dZ_jkh[Y^Wh][Z ‘_dj^[?dYec[WdZ;nf[dZ_jkh[WYYekdji[fWhWj[bo$ Annual Accounts 2008/2009,- Notes to the accounts contd. Clinical negligence costs scheme that covers NHS employers, by the Government Actuary for the period The NHS Litigation Authority (NHSLA) general practices and other bodies, 1 April 1999 to 31 March 2004. The operates a risk-pooling scheme under allowed under the direction of Secretary conclusion of the valuation was that the which the NHS foundation trust pays an of State, in England and Wales. As a scheme continues to operate on a sound annual contribution to the NHSLA, which, in consequence it is not possible for this NHS financial basis. return, settles all clinical negligence claims. foundation trust to identify its share of the Although the NHSLA is administratively underlying scheme liabilities. Therefore, Employer contribution rates are reviewed responsible for all clinical negligence cases, the scheme is accounted for as a defined every four years following the scheme the legal liability remains with the NHS contribution scheme under FRS 17. valuation, on advice from the actuary. At foundation trust. The total value of clinical the last valuation, it was recommended that negligence provisions carried by the NHSLA Employers pension cost contributions are employer contribution rates should continue on behalf of the NHS foundation trust is charged to operating expenses as and when at 14% of pensionable pay. From 1 April disclosed at note 15.1. they become due. 2009, employees’ contributions will be on a tiered scale from 5% to 8.5% of their .ON CLINICAL RISK POOLING Additional pension liabilities arising from pensionable pay. early retirements are not funded by the The NHS foundation trust participates in the scheme except where the retirement is due 6ALUE !DDED 4AX Property Expenses Scheme and the Liabilities to ill-health. The full amount of the liability Most of the activities of the NHS foundation to Third Parties Scheme. Both are risk pooling for the additional costs is charged to the trust are outside the scope of VAT and, schemes under which the trust pays an income and expenditure account at the time in general, output tax does not apply annual contribution to the NHS Litigation the trust commits itself to the retirement, and input tax on purchases is not Authority and in return receives assistance regardless of the method of payment. with the costs of claims arising. recoverable. Irrecoverable VAT is charged to the relevant expenditure category or The NHS pension scheme is subject to The annual membership contributions, a full valuation every four years by the included in the capitalised purchase cost of and any ‘excesses’ payable in respect of Government Actuary. The latest published fixed assets. Where output tax is charged or particular claims are charged to operating valuation relates to the period 1 April input VAT is recoverable, the amounts are expenses when the liability arises. The 1999 to 31 March 2004 which was stated net of VAT. Trust has also taken out “top up” property published in December 2007 and is insurance via a commercial insurer with available on the Pensions Agency Website: #ORPORATION 4AX premiums charged to operating expenses. http://www.nhspa.gov.uk/nhspa_site/foi/ The Trust has determined that it has no foi1/Scheme_Valuation_Report/NHSPS_ corporation tax liability having reviewed Pension costs Valuation_report.pdf “Guidance on the tax treatment of non core The provisions of the NHS Pensions Scheme health care commercial activities of NHS cover all past and present employees. The 4HE NOTIONAL DElCIT OF THE SCHEME WAS a Foundation Trusts” issued by HM Revenue scheme is an unfunded, defined benefit billion as per the last scheme valuation and Customs supplemented by access to J^[WddkWbc[cX[hi^_fYedjh_Xkj_edi"WdZWdo‘ ¼[nY[ii[i½fWoWXb[_dh[if[Yje\fWhj_YkbWhYbW_ciWh[ ‘Y^Wh][Zjeef[hWj_d][nf[di[im^[dj^[b_WX_b_joWh_i[i$ Annual Accounts 2008/2009,. Notes to the accounts contd. specific specialist advice when necessary. the period of the lease at a constant rate in &INANCIAL )NSTRUMENTS AND Corporation tax will be introduced for relation to the balance outstanding. Other &INANCIAL ,IABILITIES Foundation Trusts from the financial year leases are regarded as operating leases and starting on 1 April 2010. This means that the rentals are charged to the income and Recognition the first payment of any tax due will be in expenditure account on a straight-line basis Financial assets and financial liabilities January 2012 over the term of the lease. which arise from contracts for the purchase or sale of non-financial items &OREIGN %XCHANGE 1.17 Public Dividend Capital (PDC) (such as goods or services), which are Transactions that are denominated in a Public dividend capital (PDC) is a type of entered into in accordance with the foreign currency are translated into sterling public sector equity finance based on the Trust’s normal purchase, sale or usage at the exchange rate ruling on the dates of excess of assets over liabilities i.e. the net requirements, are recognised when, and to the transactions. Resulting exchange gains assets of a public benefit corporation. the extent which, performance occurs i.e. and losses are taken to the income and when receipt or delivery of the goods or expenditure account. A charge, reflecting the forecast cost of services is made. capital utilised by the NHS foundation 1.15 Third Party Assets trust, is paid over as public dividend capital All other financial assets and financial Assets belonging to third parties (such as dividend. The charge is calculated at the real liabilities are recognised when the Trust money held on behalf of patients) are not rate set by HM Treasury (currently 3.5%) on becomes a party to the contractual recognised in the accounts since the NHS the average relevant net assets of the NHS provisions of the instrument. foundation trust has no beneficial interest foundation trust. in them. However, they are disclosed in a $E RECOGNITION separate note to the accounts in accordance Relevant net assets are calculated as the All financial assets are de-recognised with the requirements of the HM Treasury value of all assets less the value of all when the rights to receive cashflows from Financial Reporting Manual. liabilities, except for donated assets and the assets have expired or the Trust has cash held with the Office of the Paymaster transferred substantially all of the risks and ,EASES General. Average relevant net assets are rewards of ownership. Where substantially all risks and rewards calculated as a simple mean of opening and of ownership of a leased asset are borne closing relevant net assets. Financial liabilities are de-recognised by the NHS foundation trust, the asset is when the obligation is discharged, recorded as a tangible fixed asset and a debt ,IQUID 2ESOURCES cancelled or expires. is recorded to the lessor of the minimum Deposits and other investments that are lease payments discounted by the interest readily convertible into known amounts Classification and Measurement rate implicit in the lease. The interest element of cash at or close to their carrying amounts Financial assets are categorised as Loans of the finance lease payment is charged to are treated as liquid resources in the and receivables. Financial liabilities are the income and expenditure account over cashflow statement. classified as ‘Other Financial liabilities’. :[fei_jiWdZej^[h_dl[ijc[djij^WjWh[h[WZ_bo‘ Yedl[hj_Xb[_djeademdWcekdjie\YWi^Wjeh Ybei[jej^[_hYWhho_d]WcekdjiWh[jh[Wj[ZWi ‘b_gk_Zh[iekhY[i_dj^[YWi^ÆemijWj[c[dj$ Annual Accounts 2008/2009,/ Notes to the accounts contd. ,OANS AND RECEIVABLES Other financial liabilities those held at ‘fair value through income and Loans and receivables are non-derivative All other financial liabilities are recognised expenditure’ is impaired. Financial assets financial assets with fixed or determinable initially at fair value, net of transaction costs are impaired and impairment losses are payments which are not quoted in an active incurred, and measured subsequently at recognised if, and only if, there is objective market. They are included in current assets. amortised cost using the effective interest evidence of impairment as a result of one or method. The effective interest rate is the more events which occurred after the initial The Trust’s loans and receivables comprise: rate that discounts exactly estimated future recognition of the asset and which has an current investments, cash at bank and in cash payments through the expected life of impact on the estimated future cashflows of the asset. hand, NHS debtors, accrued income and the financial liability or, when appropriate, a ‘other debtors’. shorter period, to the net carrying amount of For financial assets carried at amortised the financial liability. Loans and receivables are recognised cost, the amount of the impairment loss is measured as the difference between initially at fair value, net of transactions They are included in current liabilities except the asset’s carrying amount and the costs, and are measured subsequently at for amounts payable more than 12 months amortised cost, using the effective interest present value of the revised future cash after the balance sheet date, which are method. The effective interest rate is the flows discounted at the asset’s original classified as long-term liabilities. rate that discounts exactly estimated future effective interest rate. The loss is recognised cash receipts through the expected life of in the income and expenditure account Interest on financial liabilities carried at the financial asset or, when appropriate, a and the carrying amount of the asset is amortised cost is calculated using the shorter period, to the net carrying amount of reduced directly. effective interest method and charged to the the financial asset. income and expenditure account. Deposits and other investments that are Interest on loans and receivables is readily convertible into known amounts calculated using the effective interest )MPAIRMENT OF lNANCIAL ASSETS of cash at or close to their carrying amounts method and credited to the income and At the balance sheet date, the Trust assesses are treated as liquid resources in the expenditure account. whether any financial assets, other than cashflow statement. BeWdiWdZh[Y[_lWXb[iWh[h[Ye]d_i[Z_d_j_WbboWj‘ \W_hlWbk["d[je\jhWdiWYj_ediYeiji"WdZWh[ c[Wikh[ZikXi[gk[djboWjWcehj_i[ZYeij"ki_d] ‘j^[[\\[Yj_l[_dj[h[ijc[j^eZ$ Annual Accounts 2008/2009-& Segmental Reporting 2.1 The Liverpool Women’s NHS Foundation Trust (The Trust) is not required to complete a segmental analysis of its accounts as the totality of its operations relate to Healthcare. Income from Activities 3.1 Income from Activities comprises 2007/08 £000 a Elective income 11,191 Non elective income 21,408 Outpatient income 13,329 Other type of activity income 25,029 Accident and Emergency income 1,494 4OTAL )NCOME 72,451 PbR relief or (clawback) 0 503 )NCOME FROM !CTIVITIES BEFORE PRIVATE PATIENT INCOME 72,954 Private patient income 116 95 4/4!, ).#/-% &2/- !#4)6)4)%3 73,049 Sources of Income 2007/08 £000 a Income from mandatory services 71,795 Income from non mandatory services 241 1,254 Total Income from Activities 73,049 From 1 April 2008 the Trust no longer received transitional relief from the shortfall arising from the introduction of Payment by Result (PbR) in accordance with national policy. Annual Accounts 2008/2009-' Income from Activities contd. 3.2 Private Patient Income "ASE 9EAR 2007/08 £000 £000 a Private patient income 116 95 Total patient related income 73,049 Proportion of private patient 0.13% income as a percentage Section 44 of the National Health Service Act 2006 requires that the proportion of private patient income to the total patient related income of an NHS Foundation Trust should not exceed it’s proportion whilst the body was an NHS Trust in 2002/03. The Trust was compliant with this requirement in 2008/09. 3.3 Income from Activities comprises 2007/08 £000 a NHS Foundation Trusts 754 331 NHS Trusts 2,192 Primary Care Trusts 65,153 $EPARTMENT OF (EALTH n OTHER 3,840 NHS other 1,336 .ON .(3 n 0RIVATE PATIENTS 116 95 .ON .(3 n /VERSEAS PATIENTS NON RECIPROCAL 0 6 Road Traffic Act (RTA) 1 12 .ON .(3 n OTHER 84 4/4!, ).#/-% &2/- !#4)6)4)%3 73,049 ‘ ‘JejWb_dYec[i\hecWYj_l_j_[i-,"''-a Annual Accounts 2008/2009-( Other Operating Income 4.1 Other operating income comprises 2007/08 £000 a Research and development 554 528 Education and training 4,536 Transfers from the donated asset reserve 17 17 Other 4,336 4/4!, /4(%2 /0%2!4).' ).#/-% 9,417 The Education and Training income arises from the provision of mandatory education and training set out in the Trust Terms of Authorisation. All other operating income is non protected and includes: 2007/08 £000 a Provision of clinical support services to North West Fertility Ltd 1,798 LIS Monies 603 Car Parking Income 321 Provison of Laboratory Services 138 Catering 151 Perinatal Audit 250 268 Deep Clean Monies 0 131 Annual Accounts 2008/2009-) Operating Expenses 5.1 Operating expenses comprise: 2007/08 £000 a Services from NHS Foundation Trusts 2,916 Services from NHS Trusts 3,707 Services from other NHS bodies 124 Purchase of healthcare from non NHS bodies 100 14 Executive director costs 677 645 Non-executive director costs 110 106 Staff costs 48,032 Drug costs 2,504 3UPPLIES AND 3ERVICES n CLINICAL EXCLUDING DRUG COSTS 3,371 3UPPLIES AND 3ERVICES n GENERAL 2,768 Establishment 1,009 Research and development 522 0 Transport 61 Premises 2,653 Bad debts 71 0 Depreciation and amortisation 2,082 Fixed asset impairments and reversals 0 75 Audit fees 47 41 Clinical negligence 2,996 Other 2,377 4/4!, /0%2!4).' %80%.3%3 75,481 ‘ ‘JejWbef[hWj_d][nf[di[i-/",,-a Annual Accounts 2008/2009-* Operating Expenses contd. 5.2 Operating Leases: 5.2.1 Operating expenses include: 2007/08 £000 a Hire of plant and machinery 24 26 Other operating lease rentals 28 Total operating lease rentals 55 54 5.2.2 Annual commitments under non-cancellable operating leases are: /THER ,EASES Other Leases 2007/08 Operating leases which expire: £000 a Within 1 year 2 2 Between 1 and 5 years 16 18 After 5 years 0 0 4/4!, /0%2!4).' ,%!3% 2%.4!,3 20 The Trust held no operating leases in respect of land and buildings during both 2008/09 and 2007/08. J^[Jhkij^[bZdeef[hWj_d]b[Wi[i_d‘ h[if[Yje\bWdZWdZXk_bZ_d]iZkh_d] ‘Xej^(&&.%&/WdZ(&&-%&.$ Annual Accounts 2008/2009-+ Operating Expenses contd. 5.3 Audit fees comprise: 2007/08 £000 a !UDIT SERVICES n STATUTORY AUDIT 41 !UDIT SERVICES n AUDIT RELATED REGULATORY REPORTING 0 0 Other auditors’ remuneration - further assurance services - IFRS 10 0 Other auditors’ remuneration - other services 0 0 4/4!, !5$)4 &%%3 47 41 ‘ ‘JejWbWkZ_j\[[i*-a Annual Accounts 2008/2009-, Operating Expenses contd. 5.4 Salary and Pension Entitlements of Senior Managers: 5.4.1 Salary entitlements: Salary Other Salary Other Remuneration BANDS OF a Remuneration BANDS OF a BANDS OF a a BANDS OF a a a Name and position held a Kathryn Thomson Chief Executive 70 - 75 0 0 0 with effect from 1 September 2008 David Richmond Medical Director n 155 - 160 n 155 - 160 Gill Core Director of Nursing 80 - 85 0 75 - 80 0 Midwifery and Patient Quality Left 22 Feb 2009 Christine Hedley Director of Nursing 5 - 10 0 0 0 Midwifery and Patient Quality with effect from 26 January 2009 Caroline Salden Director of 80 - 85 0 n 0 Service Development Kim Doherty Director of 45 - 50 0 50 -55 0 Human Resources Susan Lorimer Acting Chief Executive to 90 - 95 0 90 - 95 0 31 August 2008 Director of Finance left 1 Feb 2009 David Renouf Acting Director of Finance 45 - 50 0 0-5 0 to 31 August 2008 Acting Director of Finance from 1 Feb 2009 Ken Morris Chair 30 - 35 0 30 -35 0 David Carbery Non executive director n 0 n 0 Roy Morris Non executive director n 0 n 0 Hoi Yeung Non executive director n 0 n 0 Ann McCracken Non executive director n 0 n 0 Yvonne Rankin Non executive director 10 - 15 0 10 - 15 0 Note: * The Director of Human Resources returned from maternity leave 1 August 2008. The post was covered up to this date by Rachel Patterson on secondment from -ERSEY #ARE 4RUST 4HE 4RUST HAS PAID a TO THIS ORGANISATION There were no benefits in kind payable to senior managers, and there were no compensation payments for loss of office. Annual Accounts 2008/2009-- Operating Expenses contd. 5.4.2 Pension entitlements: Real increase Total accrued Real increase (CETV) at Cash Equivalent in pension and pension IN #%46 31st March 2009 Transfer Value (CETV) related lump sum and related lump £000 a at 31st March 2008 at age 60 (bands sum at age 60 a OF a ST -ARCH BANDS OF a Executive Directors £000 £000 Kathryn Thomson Chief Executive n n 71 614 429 David Richmond Medical Director n 225 1,077 Sue Lorimer Director of Finance n 361 left 1 Feb 2009 David Renouf Acting Director n 71 272 of Finance Gill Core Director of Nursing n 351 Midwifery and Patient Quality Caroline Salden Director of Service 47 214 143 Development Kim Doherty Director of n 161 111 Human Resources As non executive directors do not receive pensionable remuneration there are no entries in respect of pensions for non executive directors. The Cash Equivalent Transfer Value (CETV) is the actuarially assessed capitalised value of the pension scheme benefits accumulated by a member at a particular point in time. The benefits valued are the member’s accumulated benefits and any contingent spouse’s pension payable from the scheme. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries. Real increase in CETV reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation contributions paid by the employee (including the value of any benefits transferred from another pension scheme or arrangement) and uses common market valuation factors for the start and end of the period. Annual Accounts 2008/2009-. Staff Costs and Numbers 6.1 Staff costs including director costs: 2007/08 £000 a Salaries and wages 40,869 Social Security costs 2,741 Employer contributions to the NHS pensions agency 4,396 Agency and contract staff 644 Seconded-in staff 27 27 4/4!, 34!&& #/343 48,677 6.2 Average number of persons employed: 4/4!, Senior Others Number Staff on Inward Agency, TOTAL Managers Secondment Temporary and 2007/08 Number Number Contract Staff Number Number Medical and Dental 1 127 0 0 137 Administration & Estates 266 5 252 0 9 259 Healthcare Assistants & 156 0 156 0 0 122 Other Support staff Nursing, Midwifery & 0 554 0 39 658 Health visiting staff Nursing, Midwifery, & 0 0 0 0 0 0 Health visiting learners Scientific, Therapeutic & 106 0 105 0 1 97 Technical staff 4/4!, 6 0 1,273 ‘ ‘JejWbijW\\Yeiji+&"*++a =el[hdc[dj7YjkWho$ ‘ \kbblWbkWj_ed[l[ho\ekho[WhiXoj^[ ‘J^[D>If[di_ediY^[c[_iikX`[YjjeW Valuation_report.pdf Valuation_report.pdf Practices and other bodies, allowed under under allowed bodies, other and Practices foi1/Scheme_Valuation_Report/NHSPS_ scheme that covers NHS employers, General General employers, NHS covers that scheme http://www.nhspa.gov.uk/nhspa_site/foi/ The Scheme is an unfunded, defined benefit benefit defined unfunded, an is Scheme The pensionable pay. pay. pensionable Pensions Agency Website: Agency Pensions the provisions of the NHS Pensions Scheme. Scheme. Pensions NHS the of provisions the a tiered scale from 5% to 8.5% of their their of 8.5% to 5% from scale tiered a in December 2007 and is available on the the on available is and 2007 December in Past and present employees are covered by by covered are employees present and Past 2009, employees’ contributions will be on on be will contributions employees’ 2009, to 31 March 2004 which was published published was which 2004 March 31 to 6.5 Pension Costs: Pension 6.5 at 14% of pensionable pay. From 1 April April 1 From pay. pensionable of 14% at valuation relates to the period 1 April 1999 1999 April 1 period the to relates valuation employer contribution rates should continue continue should rates contribution employer Government Actuary. The latest published published latest The Actuary. Government provided by NHS Pensions. Pensions. NHS by provided the last valuation, it was recommended that that recommended was it valuation, last the a full valuation every four years by the the by years four every valuation full a a 4HIS INFORMATION HAS BEEN valuation, on advice from the actuary. At At actuary. the from advice on valuation, The NHS pension scheme is subject to to subject is scheme pension NHS The AT AN ADDITIONAL COST OF a every four years following the scheme scheme the following years four every year. There were 3 (2007/08 7) retirements retirements 7) (2007/08 3 were There year. Employer contribution rates are reviewed reviewed are rates contribution Employer accounting period. accounting retired early on ill-health grounds during the the during grounds ill-health on early retired contributions payable to the scheme in the the in scheme the to payable contributions additional pension costs for individuals who who individuals for costs pension additional financial basis. basis. financial the cost of the scheme is equal to the the to equal is scheme the of cost the This note discloses the number and and number the discloses note This scheme continues to operate on a sound sound a on operate to continues scheme for as a defined contribution scheme and and scheme contribution defined a as for 6.4 Retirements due to ill-health: to due Retirements 6.4 conclusion of the valuation was that the the that was valuation the of conclusion liabilities. Therefore the scheme is accounted accounted is scheme the Therefore liabilities. 1 April 1999 to 31 March 2004. The The 2004. March 31 to 1999 April 1 share of the underlying scheme assets and and assets scheme underlying the of share 2008/09 (2007/08 nil) (2007/08 2008/09 by the Government Actuary for the period period the for Actuary Government the by is not possible for the Trust to identify its its identify to Trust the for possible not is attributable to individual employees during during employees individual to attributable a BILLION AS PER THE LAST SCHEME VALUATION England and Wales. As a consequence it it consequence a As Wales. and England There were no employee benefits benefits employee no were There The notional deficit of the scheme was scheme the of deficit notional The the direction of the Secretary of State, in in State, of Secretary the of direction the 6.3 Employee benefits: Employee 6.3 . d t n o c s r e b m u N d n a s t s o C f f a t S -/ Annual Accounts 2008/2009 Accounts Annual Annual Accounts 2008/2009.' Disposal of Fixed Assets 7.1 Profit and (Loss) on disposal of fixed assets comprises: 2007/08 £000 a Profit on disposal of other tangible fixed assets (equipment) 0 13 Loss on disposal of other tangible fixed assets (equipment) (6) 4/4!, 02/&)4,/33 /. $)30/3!, /& &)8%$ !33%43 7 Assets disposed of were unprotected there being no disposals of protected assets in the period. Interest Payable and Similar Charges 8.1 Interest payable: 2007/08 £000 a Overdrafts 0 0 Finance leases 0 0 Other - other interest payable 0 (7) - unwinding of discount (20) (23) 4/4!, ).4%2%34 0!9!",% (20) (30) 8.2 The late payment of commercial debts (interest) Act 1998: 2007/08 £000 a Amounts included within other interest payable arising from claims made under 0 0 this legislation Compensation paid to cover debt recovery costs under this legislation 0 0 Public Dividend Capital Dividend 9.1 The Trust is required to pay a dividend to the Department of Health at a rate of 3.5% of average relevant net assets. The rate is calculated AS THE PERCENTAGE THAT DIVIDENDS PAID ON 0$# TOTALLING a a BEARS TO THE AVERAGE RELEVANT NET ASSETS OF a a THAT IS Losses and Special Payments 10.1 NHS Foundation Trusts are required to record cash payments and other adjustments that arise as a result of losses and special payments. )N THE YEAR THE 4RUST HAD SEPARATE LOSSES AND SPECIAL PAYMENTS TOTALLING a a 4HE BULK of these were in relation to the write-off of bad debts. Annual Accounts 2008/2009.( Fixed Assets 11.1 Intangible fixed assets at the balance sheet date comprise the following: 3OFTWARE ,ICENCES £000 'ROSS #OST AT ST !PRIL !DDITIONS n PURCHASED 51 #OST OR 6ALUATION AT ST -ARCH Amortisation at 1st April 2008 254 Provided during year 53 !MORTISATION AT ST -ARCH Net book value: 4OTAL 0URCHASED AT ST !PRIL 4OTAL 0URCHASED AT ST -ARCH 76 JejWbFkhY^Wi[ZWj‘ ‘)'ijCWhY^(&&/-,a Annual Accounts 2008/2009.) Fixed Assets contd. 11.2 Tangible fixed assets at the balance sheet date comprise the following elements: Land Buildings Dwellings Assets under Plant & Information Furniture & Total a ex dwellings a construction Machinery Technology Fittings £000 a a a a a Cost or Valuation at 1st April 2008 4,365 39,078 420 1,640 14,631 2,679 232 !DDITIONS n PURCHASED 0 378 0 6,202 657 231 12 !DDITIONS n DONATED 0 0 0 0 0 0 0 0 Impairments 0 0 0 0 0 0 0 0 Reclassifications 0 221 0 (934) 457 256 0 0 Other Revaluations 0 0 0 0 0 0 0 0 Disposals 0 0 0 0 (12) 0 0 (12) #OST OR 6ALUATION AT 420 244 ST -ARCH Accumulated depreciation at 0 0 0 0 10,038 946 130 1st April 2008 Provided during year 0 541 5 0 1,246 466 41 Impairments 0 0 0 0 0 0 0 0 Other Revaluations 0 0 0 0 0 0 0 0 Disposals 0 0 0 0 (2) 0 0 (2) Accumulated depreciation 0 541 5 0 171 AT ST -ARCH Net book value Purchased at 1st April 2008 4,365 38,958 420 1,640 4,524 1,733 95 Donated at 1st April 2008 0 120 0 0 69 0 7 4OTAL AS AT ST !PRIL 420 102 Purchased at 31st March 2009 4,365 38,935 415 6,908 4,411 1,754 68 Donated at 31st March 2009 0 201 0 0 40 0 5 246 4OTAL AT ST -ARCH 415 Annual Accounts 2008/2009.* Fixed Assets contd. There are no restrictions on the use of donated assets. 11.3 The net book value of land, buildings, and dwellings at 31st March 2009 comprises: 2007/08 £000 a Freehold 43,443 Long Leasehold 415 420 Total 43,863 The assets are used in the provision of mandatory services and are therefore classified as protected Stocks and Work in Progress 12.1 Stocks and work in progress comprise: 2007/08 £000 a Raw materials and consumables 662 491 Debtors 13.1 Debtors comprise: 2007/08 £000 a !MOUNTS FALLING DUE WITHIN ONE YEAR NHS Debtors 2,127 Amounts recoverable on contracts 100 193 Provision for irrecoverable debts (231) Other Debtors 1,565 Other Prepayments and Accrued Income 159 4/4!, $%"4/23 3,813 Annual Accounts 2008/2009.+ C r e d i t o r s 14.1 Creditors comprise: 2007/08 £000 a !MOUNTS FALLING DUE WITHIN ONE YEAR NHS creditors 1,233 Tax and Social Security 1,460 Other creditors 4,760 Accruals and deferred income 2,484 4/4!, #2%$)4/23 9,937 Provisions for Liabilities and Charges 15.1 Provisions for liabilities and charges comprise: 4/4!, Pensions Other Legal Claims Other TOTAL £000 Other Staff a a 31st March 2008 a a As at 1st April 2008 2,075 Arising during the year 67 54 13 0 236 Utilised during the year (76) (59) (8) (9) (70) Transfer to accruals 0 0 0 0 0 Reversed unused (108) (24) 0 (79) Unwinding of discount 20 20 0 0 23 !S AT ST -ARCH 60 2,185 %XPECTED TIMING OF CASHmOWS - within one year 120 50 60 10 388 - between one and five years 250 0 1,012 997 - after five years 682 0 0 800 ‘ ‘JejWbYh[Z_jehi'("+)/a Annual Accounts 2008/2009., Provisions for Liabilities and Charges contd. Pensions relating to other staff are for early Other provisions comprise amounts provided 15.2 Contingent Liability retirements and reflect actuarial forecasts in for legal claims for back pay from the The Trust has a contingent liability of respect of the duration of payments. implementation of Agenda for Change. a AT THE ST -ARCH IN RESPECT of liabilities to third parties claims for which Other Legal Claims comprises amounts a IS INCLUDED WITHIN THE no provision has been made. due as a result of third party and employee provisions of the NHS Litigation Authority liability claims. The values are informed by as at the 31st March 2009 in respect of information provided by the Trust’s insurer, the clinical negligence liabilities of the Trust the NHS Litigation Authority. ST -ARCH a Movement on Reserves 16.1 Movements on reserves in the year comprise: Revaluation Donated Other Income and 4/4!, Reserve Asset Reserves Expenditure £000 a Reserve a Reserve a a As at 1st 15,616 196 0 7,986 April 2008 Transfer 0 0 0 4,540 from the income and expenditure account Surplus 0 0 0 0 0 on other revaluations Other (67) 67 0 0 0 transfers between reserves Transfers 0 (17) 0 0 (17) to the Income and Expenditure Account for depreciation, impairment and disposal of donated assets !S AT ST 246 0 March Annual Accounts 2008/2009.- Prudential Borrowing Limit 17.1 The Liverpool Women’s NHS Foundation Borrowing Code further details of which TO LONG TERM BORROWING AND aM aM TO A Trust is required to comply and remain within can be found on the website of Monitor; working capital facility. The Trust has not yet a Prudential Borrowing Limit (PBL). b) the amount of any working capital facility borrowed against this limit and thus the only This is made up of two elements: approved by Monitor. ratio of relevance is that of the Minimum a) the maximum cumulative amount of long The Trust had a prudential borrowing limit Dividend Cover. The table below confirms term borrowing, set by reference to five 0", OF a MILLION aMILLION IN that the Trust was within the approved ratios. ratio tests set out in Monitor’s Prudential OF WHICH aM aM RELATED 2007/08 2007/08 Actual Ratio Approved Ratio Actual Ratio Approved Ratio Maximum Debt/Capital Ratio - 25% Minimum Dividend Cover 4.5 1 5.6 1 Minimum Interest Cover - 3 Minimum Debt Service Cover 2 - 2 Maximum Debt Service to Revenue - 3% /N ST -ARCH THE 4RUST HAD IN PLACE AN ACTUAL WORKING CAPITAL FACILITY OF aMILLION Ed)'ijCWhY^(&&/j^[Jhkij^WZ‘ _dfbWY[WdWYjkWbmeha_d]YWf_jWb ‘\WY_b_joe\+c_bb_ed$ Annual Accounts 2008/2009.. Notes to the Cash Flow Statement 18.1 Reconciliation of operating surplus to net cash flow from operating activities 2007/08 £000 a Total Operating Surplus 6,985 Depreciation and amortisation 2,082 Fixed asset impairments 0 75 Transfer from donated asset reserve (17) (17) Other Movements 0 0 (Increase)/Decrease in Stocks (171) (53) (Increase)/Decrease in Debtors (446) Increase/(Decrease) in Creditors (423) Increase/(Decrease) in Provisions (141) 87 .ET #ASH INmOW FROM OPERATING ACTIVITIES 8,290 18.2 Reconciliation of net cash flow to movement in cash and liquid resources 2007/08 £000 a Increase in cash in the year 6,263 Cash used to decrease liquid resources 0 Cash and Liquid resources 1st April 2008 8,677 Cash and Liquid Resources 31st March 2009 14,940 9Wi^WdZB_gk_ZH[iekhY[i‘ ‘)'ijCWhY^(&&/',"'-&a Annual Accounts 2008/2009./ Notes to the Cash Flow Statement contd. 18.3 Analysis of changes in cash and liquid resources As at Cash Changes As at 31st March 2008 ST -ARCH IN 9EAR a £000 £000 Cash at bank and in hand 12,440 Liquid resources 2,500 Total 14,940 Capital Commitments !T THE BALANCE SHEET DATE OF ST -ARCH THE 4RUST HAD CAPITAL COMMITMENTS OF a a Post Balance Sheet Events 20.1 There are no disclosable post balance sheet events. J^[h[Wh[deZ_iYbeiWXb[feij‘ ‘XWbWdY[i^[[j[l[dji$ Annual Accounts 2008/2009/& Movements in Taxpayers Equity 21.1 Movement in taxpayers equity comprises. £000 4AXPAYERS EQUITY AT ST !PRIL Surplus for the financial year 6,526 Public dividend capital dividends (1,986) Public dividend capital repaid in year (123) Gains from revaluation/indexation of purchased fixed assets 0 New public dividend capital received 0 Movement on Donated Asset reserve (17) 4AXPAYERS EQUITY AT ST -ARCH 21.2 Movement in Public dividend capital comprises. £000 Public dividend capital at 1st April 2008 35,333 Public dividend capital repaid in year (123) 0UBLIC DIVIDEND CAPITAL AT ST -ARCH ‘ FkXb_YZ_l_Z[dZYWf_jWbWj ‘)'ijCWhY^(&&/)+"('&a Annual Accounts 2008/2009/' Related Party Transactions 22.1 The Liverpool Women’s NHS Foundation Trust is a public interest body authorised by Monitor, the Independent Regulator for NHS Foundation Trusts. During the year the Trust has undertaken the following material transactions with North West Fertility Limited with whom senior clinical and scientific managers within the Trust hold directorships and shareholdings: )NCOME a Expenditure £000 Provision of clinical support services to North West Fertility Limited 1,799 28 Non material transactions were also The Trust has also received a number of non material revenue payments reimbursing staff undertaken with the Liverpool John Moores expenditure from a number of charitable funds for which the Trust acts as Corporate Trustee. University, and Mace and Jones Solicitors as part of the normal day to day running 22.2 At the 31st March 2009 the following balances were held by the Trust in respect of of the Trust with whom a non executive related parties: director of the Trust holds a directorship and chairmanship respectively. Debtors Creditors £000 £000 During the year the Trust had a number of MATERIAL TRANSACTIONS OVER a MILLION WITH North West Fertility Ltd. 49 5 other NHS entities which are listed below: £000 Liverpool PCT 33,427 Western Cheshire PCT 13,005 Sefton PCT 9,039 Knowsley PCT 6,175 North West Strategic Health Authority 4,960 Halton & St Helens PCT 2,757 Warrington PCT 1,073 J^[Jhkij^WiWbieh[Y[_l[ZWdkcX[he\dedcWj[h_Wb‘ h[l[dk[fWoc[djih[_cXkhi_d]ijW\\[nf[dZ_jkh[\hec WdkcX[he\Y^Wh_jWXb[\kdZi\ehm^_Y^j^[JhkijWYji ‘Wi9ehfehWj[Jhkij[[$ Annual Accounts 2008/2009/( Annual Accounts 2008/2009/) Financial Instruments 23.1 FRS 25 requires disclosure of the role delivery of patient care services. Price Risk that financial instruments have had during The contracts from NHS commissioners in the period in creating or changing the risks The Trust finances its capital expenditure respect of healthcare services have a pre- an entity faces in undertaking its activities. from internally generated funds or Public determined price structure which negates Dividend Capital made available by the the risk of price fluctuation. ,IQUIDITY 2ISK Department of Health. The Trust is therefore The Liverpool Women’s NHS Foundation Trust not exposed to significant liquidity risks. Credit Risk net operating costs are incurred under legally The contracts form NHS commissioners )NTEREST 2ATE 2ISK binding contracts with local Primary Care in respect of healthcare services are Trusts. The Trust receives regular monthly All of the Trust’s financial assets carry nil agreed annually and take into account the payments from PCTs based on an agreed or fixed rates of interest. The Trust is not commissioners’ ability to pay and hence the contract value with adjustments made for exposed to significant interest rate risk. credit risk is minimal. actual services provided. The availability of a working capital facility with the Trust’s &OREIGN #URRENCY 2ISK bankers mitigates the risk arising from The Trust has negligible foreign currency potential variations in income arising from income or expenditure. 23.2 Financial Assets 4/4!, Floating Rate Fixed Rate Non Interest Fixed Rate £000 a a Bearing Weighted Weighted a Average average period interest rate % for which fixed At 31st March 2009 Sterling 16,111 0 59 Gross financial Assets 0 At 31st March 2008 Sterling 14,691 0 249 Gross financial Assets 0 J^[Jhkijh[Y[_l[ih[]kbWhcedj^bofWoc[dji‘ \hecF9JiXWi[ZedWdW]h[[ZYedjhWYjlWbk[m_j^ ‘WZ`kijc[djicWZ[\ehWYjkWbi[hl_Y[ifhel_Z[Z$ Annual Accounts 2008/2009/) Financial Instruments contd. 23.3 Financial Liabilities 4/4!, Floating Rate Fixed Rate Non Interest Fixed Rate £000 a a Bearing Weighted Weighted average a Average interest period for rate % which fixed At 31st March 2009 Sterling 0 (2,064) (35,210) 2.2% indeterminate 'ROSS lNANCIAL ,IABILITIES 0 At 31st March 2008 Sterling 0 (1,075) (35,333) 2.2% indeterminate 'ROSS lNANCIAL ,IABILITIES 0 The non-interest bearing financial liability relates to PDC and so is of unlimited term although the Secretary of State can require repayment of PDC at any time. 23.4 Fair values "OOK 6ALUE a &AIR 6ALUE a "ASIS OF FAIR VALUATION &INANCIAL !SSETS Cash 14,670 14,670 Investments 1,500 1,500 Total &INANCIAL ,IABILITIES Provisions under contract (2,064) (2,064) a) Public Dividend Capital (35,210) (35,210) Total a) Fair value is not significantly different from book value since in the calculation of book values the expected cashflows have been discounted by the treasury discount rate of 2.2% Third Party Assets 24.1 The Trust‘ held no cash or other assets on behalf of patients at 31st March 2009. J^[Jhkij^[bZdeYWi^ehej^[hWii[jied ‘X[^Wb\e\fWj_[djiWj)'ijCWhY^(&&/$ Annual Accounts 2008/2009/* Independent Auditor’s report to the Council of Governors of Liverpool Women’s NHS Foundation Trust We have audited the financial statements This report is made solely to the Council required to state to it in an auditor’s report of Liverpool Women’s NHS Foundation of Governors of Liverpool Women’s and for no other purpose. To the fullest Trust, which comprise the Income and NHS Foundation Trust (“the Trust”), as a extent permitted by law, we do not, in giving Expenditure Account, the Balance Sheet, body, in accordance with the National our opinion, accept or assume responsibility the Statement of Total Recognised Gains Health Service Act 2006. Our audit work to anyone other than the Trust and the and Losses, the Cash Flow Statement has been undertaken so that we might Trust’s Governors, as a body, for our audit and the related notes. state to the Council of Governors of the work, for this report, or for the opinions we Trust, as a body, those matters we are have formed. Respective responsibilities of Directors and Auditors The Accounting Officer’s responsibilities accordance with relevant legal and with Monitor’s guidance issued in the for preparing the financial statements regulatory requirements and International NHS Foundation Trust Financial in accordance with directions issued Standards on Auditing (UK and Ireland). Reporting Manual. We report if it does by Monitor and United Kingdom not meet the requirements specified by Accounting Standards (United Kingdom We report to you our opinion as to Monitor or if the statement is misleading Generally Accepted Accounting Practice) whether the financial statements give or inconsistent with other information we are set out in the Statement of Accounting a true and fair view and are properly are aware of from our audit of the financial Officer’s Responsibilities. prepared in accordance with directions statements. We are not required to consider, issued under paragraph 25(2) of Schedule nor have we considered, whether the Our responsibility is to audit the financial 7 of the National Health Service Act 2006 Statement on Internal Control covers all risks statements and the part of the Directors’ and whether the accounts comply with and controls. We are also not required to Remuneration report to be audited in the requirements of all other provisions form an opinion on the effectiveness of the contained in, or having an effect under, any Trust’s corporate governance procedures or enactments which are applicable to the its risk and control procedures. accounts. We also report to you whether in our opinion the information given in We read other information contained in the Directors’ report is consistent with the the Annual Report and consider whether financial statements. it is consistent with the audited financial statements. The other information comprises In addition, we report to you if, in our only the Chair’s and Chief Executive’s opinion, the Trust has not kept proper Statements, the Directors’ Report, the accounting records, we have not received sections on the Board of Directors, the all of the information and explanations Council of Governors, Membership we require for our audit, or if information and Public Interest Disclosures and the specified by law regarding directors’ Remuneration Report. We consider the remuneration and other transactions is implications for our report if we become not disclosed. aware of any apparent misstatements or material inconsistencies with the financial We review whether the Statement on statements. Our responsibilities do not Internal Control reflects compliance extend to any other information. Annual Accounts 2008/2009/+ Basis of audit opinion We conducted our audit in accordance fraud or other irregularity or error. In forming Certificate with International Standards on Auditing our opinion we also evaluated the overall We certify that we have completed the audit (UK & Ireland) issued by the Auditing adequacy of the presentation of information of the accounts in accordance with the Practices Board and the Audit Code for NHS in the financial statements. requirements of the National Health Service Foundation Trusts issued by Monitor. An Act 2006 and the Audit Code for NHS audit includes examination, on a test basis, Opinion Foundation Trusts issued by Monitor. of evidence relevant to the amounts and In our opinion: disclosures in the financial statements. It also - the financial statements give a true and includes an assessment of the significant fair view, in accordance with the NHS estimates and judgements made by the Foundation Trust Financial Reporting Baker Tilly UK Accountable Officer in the preparation of Manual, of the state of Liverpool Women’s the financial statements, and of whether the NHS Foundation Trust’s affairs as at accounting policies are appropriate to the 31 March 2009 and of its income and Audit LLP Trust’s circumstances, consistently applied expenditure for the year then ended; Baker Tilly UK Audit LLP and adequately disclosed. - the financial statements and the part of Chartered Accountants the Directors’ Remuneration report to 3 Hardman Street We planned and performed our audit be audited have been properly prepared Manchester so as to obtain all the information and in accordance with the National Health M3 3HF explanations which we considered necessary Service Act 2006 and directions made in order to provide us with sufficient thereunder by Monitor; and 5th June 2009 evidence to give reasonable assurance - the information given in the that the financial statements are free from Directors’ report is consistent with material misstatement, whether caused by the financial statements M[Y[hj_\oj^Wjm[^Wl[Yecfb[j[Zj^[WkZ_je\j^[‘ WYYekdji_dWYYehZWdY[m_j^j^[h[gk_h[c[djie\j^[ DWj_edWb>[Wbj^I[hl_Y[7Yj(&&,WdZj^[7kZ_j9eZ[ ‘\ehD>I