Epsom and St Helier University Hospitals NHS Trust

Annual Report 2008-09 If you or someone you know cannot read this document, please advise us of your/their specific needs and we will do our best to provide the information in a suitable format or language. Contact the communications department on 020 8296 2406 or email [email protected].

St Helier Hospital Epsom Hospital Sutton Hospital Wrythe Lane Dorking Road Cotswold Road Carshalton Epsom Sutton Surrey Surrey Surrey SM5 1AA KT18 7EG SM2 5NF

Tel: 020 8296 2000 Tel: 01372 735 735 Tel: 020 8296 2000

These are the main hospitals that we run our services from. However, our doctors, nurses and other staff also work from a number of other sites, as well as 11 renal centres for patients needing dialysis.

For more information, visit www.epsom-sthelier.nhs.uk.

2 Epsom and St Helier University Hospitals NHS Trust Annual Report 2008-09 Contents

Introduction from the Chairman 4

About us 6

Executive and Non-Executive Directors 8

Looking back over the past 12 months 11

Priority 1: Delivering safe clinical services including meeting all central targets 18

Priority 2: Improving the patient experience, including ensuring that healthcare acquired infections are kept to a minimum 20

Priority 3: Improving the staff experience to ensure that the Trust becomes an employer of choice 24

Priority 4: Ensuring that the Trust provides safe and secure services for the future 28

The accounts 32

New doctors Natalie Watson and Rajiv Sharma

www.epsom-sthelier.nhs.uk 3 Introduction from the Chairman

Welcome to our 2008-09 Annual Report. Here you Additionally, C. difficile rates dropped by 45% in will learn more about our work over the last year and 2008-09 compared to the previous year. plans for the future. Meeting the standards proves that our decision to 2008-09 will be recorded as one of our best years to make infection control our number one priority has date, with the Trust meeting all of the key standards paid off. It will also reassure local people about how that the government sets for hospitals. Doing well seriously we take keeping our hospitals safe and clean, against these is great for the Trust and, more as this is an issue we know they are concerned about. importantly, excellent news for our patients. Extra efficient A&Es The table below shows how we scored against some The emergency access target ensures that people who of the key standards: use our A&E departments are not having to wait too long to be treated. As such, the government expects Standard 98% of patients to be treated, discharged or admitted Finances – end year with ACHIEVED within a maximum of four hours. This is a huge balanced books (with £4.9 million challenge, especially when you consider how busy our surplus) A&Es were over the winter as a result of the cold Infection control – have ACHIEVED weather and record snowfall. no more than 44 cases (34 MRSA/ Achieving 98.1% against this standard was an of MRSA bacteraemia and 156 C. difficile) excellent achievement. Our A&E teams, as well as all 290 C. difficile the other staff who help to make sure things run Emergency access – 98% of ACHIEVED smoothly, should be extremely proud. all patients attending Accident (98.1%) & Emergency (A&E) to be Patients wait less time treated, admitted or The 18 week wait standard is one of the government’s discharged in four hours newest targets. Patients referred to the Trust should start 18 week wait – the time from ACHIEVED their treatment within 18 weeks which, as those who know the NHS well will agree, is an astounding GP referral to treatment time (92%) improvement on years gone by. A lot of hard work went for patients who have surgery into helping the Trust exceed the targets for both (target 90%) admitted and non-admitted patients. 18 week wait – the time from ACHIEVED GP referral to treatment time (96%) Money matters for patients who are not I am extremely pleased to report that the Trust ended admitted to hospital the financial year with a surplus of just over £4.9 million. This is an excellent turnaround on previous years and will (target 95%) allow us to pay off most of our historic debt.

Reducing infections to a minimum However, we must continue to work hard to make our The commitment our staff and volunteers have shown services even more efficient so that we can ensure we in reducing the number of infections aquired in our are getting best value for public money. This will allow hospitals has been amazing. This helped us meet the us to clear our remaining debt and invest millions of government’s standards and, as figures released by the pounds redeveloping our hospitals. Health Protection Agency show, the number of cases of MRSA (bacteraemia) at the Trust’s three hospitals during Investing in our hospitals 2008-09 were the lowest since records began. We have continued to invest in improving our buildings and infrastructure, as well as replacing vital equipment.

4 Epsom and St Helier University Hospitals NHS Trust Annual Report 2008-09 At Epsom, we have completed a £1.2 million Valuing our staff and volunteers refurbishment of Croft and Britten wards and opened We know that our staff and volunteers are our most a cutting-edge neutral pressure room which will be valuable asset and that we would not have achieved used for treating patients with infectious diseases like so much without their hard work, commitment tuberculosis (TB). At St Helier, we are investing and dedication. £2.8 million on a much needed refurbishment of the maternity unit and have recently unveiled a new We continue to work hard to make the working lives £650,000 state-of-the-art gamma camera to detect of our staff and volunteers better and were pleased illnesses such as prostate and cervical cancer. that the results of our 2008 annual staff survey showed significant signs of improvement. For example, such a In addition, we will spend a further £9.2 million high number of our staff feel satisfied with the quality improving our hospitals over the next year, including a of work and patient care they are able to deliver that £500,000 extension to the A&E observation ward at we are in the top 20% of trusts across England. St Helier and the refurbishment of Alex and Buckley wards at Epsom. We will also invest £250,000 to Working in partnership make our IT facilities even better. We work closely with many partners, both in the NHS and outside. We have very good relationships with Whilst this investment is vital, we will need to spend a our two local primary care trusts – Sutton and Merton lot more if we are to radically improve the Primary Care Trust and NHS Surrey – and with our environment in which we treat our patients. It is for strategic health authority, NHS London. We continue this reason that, in October, the Board agreed plans to work with our educational partners at Merton to invest millions of pounds on a redevelopment of College, Kingston University and St George’s Hospital St Helier. These plans include demolishing Ferguson Medical School to develop the NHS workforce of House and replacing it with a brand new building the future. which will house the majority of the hospital’s wards and clinics. All going well, we would expect to see We also receive invaluable support from a number of building work start in 2012. charities and voluntary groups who contribute a huge amount to many aspects of life at the Trust, from Epsom Hospital also needs investment, so we are befriending and supporting patients to running the developing a vision for the site which will be ready by hospitals' shops and radio stations. This includes the the autumn. Once finalised, we will be able to put League of Friends at Epsom, Sutton, St Helier and together detailed plans to spend up to £70 million Queen Mary’s hospitals. on the hospital, making it fit for the future. I would like to take this opportunity to formally thank Improving the patient experience all of our staff and volunteers, as well as our partners, The experience that patients have in our hospitals is of for their continued support, enthusiasm and the utmost importance. As well as being treated commitment to further improving the care we give quickly and safely, they must receive a personalised our patients. service, enhanced by good communication and a commitment to ensuring their privacy and dignity are respected at all times.

We have worked hard on improving the experience our patients have and were pleased with the results of this year’s 2008 annual inpatient survey, which showed we had made significant improvements in a number of John Davey key areas. This includes being in the top 20% of Chairman hospitals in England for patients feeling there were enough nurses on duty to provide care and patients not wanting to complain about their care. www.epsom-sthelier.nhs.uk 5 About us

Our values and priorities The Trust has four key values which describe how the organisation operates as well as four key priorities to ensure our services are of the highest quality:

Our values • Put the patient first; • Work as one team; • Respect each other; • Strive for continuous improvement.

Our priorities • Deliver safe clinical services, including meeting all Staff and supporters of Queen Mary’s Hospital for central government targets; Children celebrate the hospital’s 100th birthday • Improve the patient experience, including keeping healthcare acquired infections to a minimum; • Improve the staff experience to ensure that the Trust is an employer of choice; Our hospitals • Ensure that the Trust provides safe and secure The Trust’s two main acute sites, both of which have services for the future. 24-hour A&E departments, are: Background to the Trust • Epsom Hospital – the hospital serves the southern Epsom and St Helier University Hospitals NHS Trust part of the catchment area and provides an extensive provides a range of secondary acute hospital services range of inpatient, day and outpatient services. The for approximately 420,000 people living across A&E department sees about 44,000 patients per southwest London and northeast Surrey. In addition, year. tertiary level renal services and neonatal intensive care • St Helier Hospital – the hospital is the largest site services are provided to a wider catchment, which within the Trust. It has a comprehensive range of extends to parts of Sussex and Hampshire. The Trust diagnostic facilities within pathology and radiology, employs 4,800 staff, supported by almost 500 a range of outpatient facilities and the busy A&E volunteers, across its three main sites – Epsom, department deals with about 80,000 patients St Helier and Sutton hospitals. per year.

The Trust serves a vibrant area that is rich in diversity. The Trust also provides services at: There is a mix of urban and rural areas with differing • Queen Mary’s Hospital for Children – this is the levels of quality of life with some of the most Trust's dedicated children's hospital, sharing the prosperous postcodes in the country, as well as some St Helier site. It was originally based on a separate deprived areas. site in Carshalton, starting life as The Children’s Infirmary in 1909. It is well recognised that deprivation contributes to ill • Sutton Hospital – the hospital houses a day surgery health and to address this issue, the Trust and its unit with dedicated theatre facilities and 32 beds. colleagues in NHS Surrey and Sutton and Merton There are also departments of lithotripsy, Primary Care Trust continue to work together to dermatology laser care, pain management and a ensure local services are delivered to where they are large ophthalmology (eye) outpatient service. most needed – in the hearts of the communities we serve. In addition, we provide services from a number of other local hospitals. We also have 11 renal centres throughout the area.

6 Epsom and St Helier University Hospitals NHS Trust Annual Report 2008-09 The Trust also manages the infection control and Support services microbiology teams which are based at West Park The Trust also comprises of a variety of support Hospital on the outskirts of Epsom. services, including: Our services • communications; Our clinical services are delivered by seven directorates • corporate infrastructure; assisted by support departments. The clinical • education; directorates are: • estates; • finance; • Critical care and anaesthetics; • human resources; • Diagnostics and pharmacy; • information services; • General and emergency medicine; • research and development. • Renal and cancer services; • Specialty medicine; The Trust Board • Surgery; The Trust is governed by a Board of Executive and • Women and children’s services. Non-Executive Directors.

In addition, the Trust operates the Elective Orthopaedic The role of the Trust Board is to: Centre (the EOC, which was formerly known as the South West London Elective Orthopaedic Centre) in • set the strategic direction of the Trust and conjunction with neighbouring trusts on a partnership associated plans; basis from Epsom Hospital. For more information • monitor performance; about the EOC, please see page 17. • ensure high standards of clinical and corporate governance; • oversee financial stewardship; • ensure effective dialogue with the local community.

Edith Rann has been a volunteer at the Trust for 55 years. Filming for the ITV1 documentary Surgery School gets She was honoured at a special celebration in October underway at St Helier Hospital

www.epsom-sthelier.nhs.uk 7 Executive and Non-Executive Directors

* Trust Board member

Non-Executive Directors

John Davey, Chairman * Professor David Oliveira, John was educated at Cambridge Non-Executive Director * University and Manchester Business David joined the Trust in 2004, School and has served at Board prior to which he was Professor of level in various companies, Renal Medicine at St George’s including telecoms and consumer Hospital Medical School. David is a product sectors. He is a qualified renal physician and has also had a accountant and joined the Trust as key role in research. Since 2001, he a Board member in February 2006. has been in the position of Dean He became Acting Chair in April 2007 and Chair in for Research and Development at St George's Hospital September 2007. He is a committee member and Medical School. David’s position at St George's director of a local charity, Carers Support Merton and Hospital Medical School also includes teaching lives in Wimbledon. medical students.

Nilkunj Dodhia, Peter Rawlinson, Non-Executive Director * Non-Executive Director * Nilkunj was appointed as a Peter was appointed in December Non-Executive Director of the Trust 2007. He has more than 30 years on 1 January 2009. He has worked experience at Board and senior internationally as a management management level in global consultant and currently works information technology companies with venture-funded technology mainly in business development, businesses. Nilkunj has an MBA strategy, marketing and project from INSEAD and qualified as a chartered accountant management roles. Peter is a Fellow of the Royal with PricewaterhouseCoopers (PwC). He is a member Society of Arts, a Chartered Member of the Institute of of the Institute of Chartered Accountants in England Marketing and a Fellow of the Institute of Engineering and Wales. and Technology. He lives in Farnborough, Hampshire.

Susan Marshall OBE, Jan Sawkins, Non-Executive Director * Non-Executive Director * Sue joined the Trust in 2000 and Jan was educated at Reading has headed up committees dealing University and the Sorbonne, and with equality, diversity and older subsequently qualified as an people and chaired a housing Associate of the Chartered Institute association. She currently leads of Bankers. She spent a successful clinicians and patients as Chair of two decades working in the City, the Practice Based Commissioning firstly in international banking and Steering Group and heads up the Patient Liaison finance and then in investment banking, specialising in Group in local General Practice. Sue was awarded the corporate finance and venture capital. She joined the OBE in 1998 for services to housing whilst Director of Trust in December 2006 and lives in Oxshott, Surrey. Housing Services at Brighton Borough Council. Sue lives in southwest London.

8 Epsom and St Helier University Hospitals NHS Trust Annual Report 2008-09 Executive Directors

Samantha Jones, Shane Degaris, Director of Chief Executive * Operations (Emergency Samantha started with the Trust in Care)/Deputy Chief July 2007 prior to which she was Executive * the Acting Chief Executive at North Shane joined the Trust in March Middlesex Hospital NHS Trust. 2008 from Barnet and Chase Farm Samantha has had a career in Hospitals NHS Trust, where he was operational management and the Director of Operations for originally trained as a nurse at Planned Care and before that, the Director of Great Ormond Street Hospital for Sick Children. Emergency Access. He joined Barnet and Chase in 2001 Samantha started maternity leave in February. and has held a number of senior management posts leading different service areas. Australian by birth, he Peter Coles, Interim Chief began his healthcare career in 1990 after training as a Executive* (covering physiotherapist in Adelaide, South Australia. Samantha Jones’ maternity leave) Peter Gill, Director of Peter previously worked for the Information Services Department of Health as Director Peter started at Epsom and for Intervention Strategies. Before St Helier in August 2006. Before this, he was Chief Executive of a that he was Director of IT and number of large hospital trusts, including Brighton and Service Improvement at West Sussex, Homerton and Whipps Cross. Peter has Middlesex University Hospital for worked in the NHS for more than 25 years, starting his four years, during which time he career at Leeds General Infirmary. Peter was born in was also joint Director of IT for Bradford, Yorkshire and lives in Kent. Hounslow Primary Care Trust. Peter has worked continuously in the NHS since 1991 when he started Michael Burden, Director as a management trainee in a Manchester Hospital. In of Human Resources his spare time he manages a smallholding in Dorset. Michael joined the Trust in January 2008 from Sutton and Merton Nick Gorvett, Director of Primary Care Trust, where he had Corporate Infrastructure been the Director of Human Nick began his career in the NHS Resources since 2003. Michael's in 1977, starting as a NHS career began at St Helier management trainee. He has been Hospital training as a general with the Trust since 1999. Nick nurse, after which he undertook further training to has worked in a wide variety of qualify as a registered mental health nurse. He then operational and strategic roles altered his career path to take up a position in HR within NHS organisations in management at Mid-Surrey Health Authority. Bristol, Cheltenham, Redhill, Brighton and Epsom.

www.epsom-sthelier.nhs.uk 9 Pippa Hart, Director of Jon Sargeant, Director of Nursing * Finance * Pippa has been Director of Nursing Jon began his NHS career in 1989 since January 2008. She trained at as a trainee accountant at East St Thomas' Hospital and worked in Birmingham Health Authority. He critical care at both St Thomas' and moved to Sutton in 1991 and took St Mary's hospitals. She joined up a post at Epsom. He has St Helier in 1988 as a sister in remained in the area since 1991, intensive care, and has been and held a number of strategic working in the Trust in a variety of critical care and level posts within the NHS, including being Director of senior nursing roles across both hospitals since they Finance for both Lewisham and Mayday hospitals. Jon merged in 1999. She recently completed a masters in lives in Sutton. health ethics at Brighton University. Antony Tiernan, Director Sue Jones, Director of of Communications Service Improvement Antony started at Epsom and Sue started work at the Trust in St Helier in January 2008. Before March 2008. Prior to this she was that he was Deputy Director of Divisional Manager for General and Communications at Guy's and Emergency Medicine at King's St Thomas' NHS Foundation Trust College Hospital where she worked for nearly five years. Prior to for 20 years. Sue originally trained working in the NHS, he worked in as a nurse in Manchester and press, public relations and public affairs at a number of specialised in renal nursing at St James' Hospital in health-related public sector organisations. He also Leeds, following which she worked on the renal unit managed communications for the charitable arm of at King's for over seven years. Since 1994 she has British Waterways, The Waterways Trust. Antony lives worked in roles which incorporate operational in Banstead. management, service development and professional leadership. Sue lives in Epsom. • Karen Breen was appointed as Director of Dr Jonathan Kwan, Operations (Planned Care) in June 2009. Medical Director * (replacing Dr Lindy Steven The Board comprises of a number of committees, including an audit committee and a remuneration from July 2008) committee. The membership of these is as follows: Jonathan took up the position of Medical Director in July 2008 and Audit Committee: has been working at the Trust since Sue Marshall, Non-executive Director (Chair); 1994. He graduated in the early Peter Rawlinson, Non-executive Director; 1980s from King's College Hospital Medical School. Nilkunj Dodhia, Non-executive Director. From there, he trained at various teaching hospitals across London including King's College, St George's Remuneration Committee: and the Royal London hospitals. Dr Kwan has won a number of accolades for his work since starting at the All Non-Executive Directors (chaired by Trust Trust, including 'Hospital Doctor of Year in Innovation' Chairman, John Davey) in 2004 and runner-up in 'Hospital Doctor of Year (Renal)' in 2007. Full details of senior managers’ remuneration are given on page 41.

10 Epsom and St Helier University Hospitals NHS Trust Annual Report 2008-09 www.epsom-sthelier.nhs.uk 11 Looking back over the past 12 months News from the clinical directorates

General and emergency medicine The general and emergency medicine directorate includes general medicine, A&E, care of the elderly and clinical assessment services. Over the past year, the directorate’s achievements include the following: • the Trust’s A&E units were within the top 20% of A&E departments across London for patient satisfaction. The Healthcare Commission’s Emergency Department Survey 2008 found that 80% of 800 randomly selected patients were satisfied overall with the service they received in our A&E departments and almost 90% felt they were treated with respect and dignity. The departments also received high scores for the care and treatment provided by staff, low waiting times, and communication between doctors and patients; • a number of key targets have been met by the directorate. These include the Door to Needle for A patient undergoes some tests patients needing urgent thrombolysis treatment (100%), Call to Needle (75% against a 60% target) as well as the emergency access target (see 'Our performance' section on page 18 for further details); • the directorate has appointed a sixth A&E consultant • The Royal College of Physician’s National Sentinel to further enhance the service and levels of support Organisational Audit of Stroke placed St Helier given to patients. Hospital in the top quartile of UK trusts for the way it organised its stroke care (an improvement on 2006 Specialty medicine – the last time the audit was undertaken) and Epsom Hospital in the lower quartile (the same as 2006). The specialty medicine directorate includes audiology, cardiology (including the coronary care units), centre Since the audit was undertaken, the directorate has of pain education/fatigue, diabetic medicine, made significant progress in improving the service at dermatology, gastroenterology, neurology, respiratory, Epsom Hospital. For instance, the directorate has: rheumatology and stroke services. - appointed a specialist stroke physician to run additional clinics and provide clinical leadership to the staff who work in the service; - refurbished Britten Ward, which houses our stroke services, as part of a £1.2 million improvement programme; - appointed a clinical nurse specialist for stroke; - further improved the training given to staff. Over the past year: • staff in the audiology department were praised after dramatically reducing waiting times to ten weeks, allowing patients faster access to the service. Over One of our pharmacists at work the past year, staff have provided hundreds of extra clinics for patients;

12 Epsom and St Helier University Hospitals NHS Trust Annual Report 2008-09 • monitoring equipment for the coronary care units • a renal nurse from the department walked for nine has been completely upgraded with financial help miles through snow in early 2009 to treat a patient from the Leagues of Friends; who could have died without dialysis. Debbie Noble • introduced daily Rapid Access Chest Pain clinics walked 4.5 miles (and back) from her home in where patients are seen and undergo exercise Ashtead to Ewell to treat a patient after heavy testing within two weeks of referral. This has led to snowfall meant there was no other way of getting to faster and more accurate diagnoses for patients; her. Debbie was praised for her efforts, winning • introduced follow-up and additional heart failure NHS London’s Chairman’s Award for outstanding clinics. A nurse-led arrthymia clinic service has also achievement; had a positive impact in further reducing waiting • a Dragons’ Den judge, a well known publicist and the times for patients needing elective cardioversion; architect of the 02 joined leading clinicians from • waiting times for a first appointment to the across London to celebrate the anniversary of the dermatology service have been dramatically cut South West Thames Institute for Renal Research. The thanks to a greater number of clinics that have been ceremony, which marked 10 years of the institute, arranged over the past year. The service is now saw Theo Paphitis, Max Clifford and Lord (Richard) three per cent ahead of the national benchmark for Rogers rubbing shoulders with doctors, consultants, dermatology referrals; politicians and patients and their families during the • a new chest physician has been appointed at Epsom reception at the House of Lords; Hospital to further enhance the quality of care • since new cancer targets were implemented in provided to patients. The service has also appointed January 2009, the Trust’s cancer services department a tuberculosis nurse specialist to provide clinical is seeing and treating more patients who have been expertise to patients with the condition. diagnosed with the condition. The new 31 and 62 day cancer targets, set by the Department of Health, Renal and cancer services ensure the department sees new patients suspected This directorate includes renal, cancer and palliative of having cancer as quickly as possible; care services. Recent achievements include: • appointed a lead cancer nurse specialist to ensure the Trust and its nurses are following national • over £160,000 has been spent improving clinical guidelines for treating patients; areas, including refurbishing Beacon ward, a • in an effort to meet demand from patients, the specialist renal dialysis unit at St Helier Hospital; department has appointed a skin cancer/dermatology • £100,000 has been given to the Trust by volunteers consultant as well as a nurse specialist. These positions from the St Helier and Surrey Kidney Patients will ensure that patients are seen quicker and have Association so a new water purification plant could greater levels of access to the service; be installed on the ward; • a renal dietitian issued new dietary guidelines for patients from ethnic groups who suffer from kidney problems and high blood potassium levels across the country. Produced by Ruple Patel, the booklets provide dietary advice for the African-Caribbean, South Asian and Chinese communities. They serve as a guide on how people can continue to enjoy traditional foods whilst following a low potassium diet; • high numbers of patients are now using the Trust’s renal satellite dialysis centres. In October 2008, the figure topped 400 for the first time. The 11 centres include Crawley, Croydon, Farnham, West Byfleet and Kingston, and are used by patients from across Dietician Ruple Patel (right) launched new national healthy southwest London, Surrey, Sussex and Hampshire eating guidelines for people from ethnic communities and save them from having to travel to hospital unnecessarily; www.epsom-sthelier.nhs.uk 13 • due to increased demand, the Trust has developed • a new sexual health centre has been launched to nurse led clinics in its colorectal service which treats educate young people in Carshalton about sex and patients with a cancer in the bowel or lower relationships. The new clinic, which is known as The intestine. These new clinics allow more patients to Point, is a ‘one stop shop’ for all of the sexual health be seen more quickly; advice and support that young people in the area • developed closer links with the Royal Marsden could need. Specialist staff offer screening for Hospital to share expertise and nursing sexually transmitted infections (STIs), contraception appointments in an effort to provide high quality and impartial advice; services to local people with cancer at the best value • celebrations marking the centenary of Queen Mary’s for money. Hospital for Children kicked off in style in January. Former and current members of staff gathered at the Women and children’s services site to celebrate the service, which opened as The The women and children’s services directorate includes Children’s Infirmary one hundred years ago. The obstetrics, genito-urinary medicine, gynaecology, original hospital gained a reputation for treating general and specialist paediatric medicine, children’s children with polio and cerebral palsy; surgery and neonatology services. • the assessment unit at Ebbisham Ward at Epsom is now open to young patients every day of the week. Over the past year: It re-opened during the year because of an increase in local demand. The unit treats children with a • nearly £2.8 million is being spent on completely variety of medical conditions who do not need refurbishing the maternity unit at St Helier Hospital, inpatient admission; which will improve the environment in which • a comfortable, homely space was created for parents patients are treated and further enhance the care who have just experienced a stillbirth at Epsom they receive. The works include building a high Hospital. The Surrey branch of the Stillbirth and dependency unit, which will be used to care for Neonatal Death Society (SANDS) donated £2,500 mothers who need extra attention, for instance, if which paid for the refurbishment work in the room they have had a difficult birth which involved at Epsom Hospital’s maternity unit. The initiative surgery; formed part of a major county-wide project by the society and the unit was the first to benefit; • Fulham Football Club became top of the league on the children’s ward at Queen Mary’s Hospital for Children after three players visited sick children. Goalkeepers Mark Schwarzer and Pascal Zuberbuhler joined defender Fredrik Stoor in giving presents to the ward’s 16 children and spending time chatting to their families; • managers and staff expressed their delight following the announcement in January 2009 that NHS Surrey would continue to commission maternity services at Epsom Hospital; • the maternity departments at Epsom and St Helier hospitals held a number of open days to make mums-to-be and their partners aware of the different options for where and how to give birth, in particular having their baby at home. Community midwives, as well as parents who have experienced Players from Fulham Football Club visited Queen Mary's Hospital home births, spoke to prospective parents about the for Children at Christmas options available.

14 Epsom and St Helier University Hospitals NHS Trust Annual Report 2008-09 A mother and baby in the maternity unit at St Helier. The unit is undergoing a multi-million pound refurbishment

Surgery • worked with a film crew for an ITV documentary The surgery directorate includes ear, nose and throat that has been charting the experiences of three services, general surgery, Northey Ward (private trainee surgeons. Surgery School, which is due to be patients), ophthalmology, oral surgery, orthodontics, broadcast in September 2009, will feature Nicola plastic surgery, trauma/orthopaedics and urology Robertson, Rose Johns and Andrew Al-Reis who services. Over the past year, the directorate has: worked within the directorate; • appointed three new orthopaedic consultants and a • introduced a new laser technique that is now urologist to enhance services, knowledge and skills. transforming the treatment given to local men suffering from an enlarged prostate. Specialist urologists have started to use GreenLight Laser Therapy – an endoscopic (keyhole) procedure which uses a high powered green laser that vaporises the prostate tissue and seals the prostatic blood vessels in the process; • established a ten-bedded day case bay at the Chuter Ede ward at Epsom Hospital. This facility now treats those people who are having planned surgery in a separate bay with nurses trained to discharge patients ensuring a shorter stay in hospital; • re-organised ward B3 at St Helier so patients needing treatment for hip fractures are all cared for on one ward. The benefits of this approach are that patients can now receive care from a dedicated team of professionals, which will shorten the length of time patients need to remain in hospital;

www.epsom-sthelier.nhs.uk 15 Critical care and anaesthetics The critical care and anaesthetics directorate includes anaesthetics, endoscopy, intensive treatment / high dependency units, pain management, theatres and day surgery services. Over the past year, the directorate has: • developed more cross-site working amongst consultants in anaesthetics. This has led to a more flexible service aimed at better meeting the needs of local patients; • expanded the Trust’s pain management service and The Trust's pharmacy department is responsible for all our inpatients' added four additional clinics and theatre lists to and outpatients' medicines meet extra demand; • developed ways to identify and manage patients who are considered to be ‘high risk’ before they are admitted for an operation. This has allowed those Diagnostics and pharmacy patients with any severe medical problems to be The diagnostics and pharmacy directorate includes identified and managed earlier, with the aim of radiology, pathology, clinical haematology, pharmacy, preventing operations being cancelled; clinical immunology and metabolic medicine services. • increased the number of patients seen by the Recent achievements include the following: endoscopy department. Staff have increased the theatre lists over the past year which has resulted in • patients needing scans to detect cancers or organ a reduction in waiting times for the service; problems are benefiting from a faster and more • appointed three consultants to assist in the delivery accurate service, thanks to a new hi-tech gamma of obstetrics and trauma services. These camera that has been unveiled at St Helier Hospital. appointments will lead to increased consultant input The £650,000 camera is reducing the time it takes to into patients’ care; detect illnesses such as cervical and prostate cancer. • been presented with eight new infusion pumps, paid This means that patients can start their treatment for by the Epsom and St Helier Leagues of Friends. earlier, which it is hoped will help save lives; These state-of-the-art pumps deliver the anaesthetic • a clinical nurse specialist in immunology established to the patient. a home treatment service for people who have a genetically linked disorder of their immune system. Amena Warner introduced the primary immunodeficiency home treatment service which saves patients from a lengthy stay in hospital whilst they receive treatment; • staff in the Trust’s pathology department assisted UK Sport to monitor the health and wellbeing of the UK’s Olympic athletes during their training. They analysed blood samples to check athletes’ fitness levels and for allergies or infections; • the directorate has increased its screening process of new born babies to check for signs of a rare genetic disorder – Medium Chain Acyl Dehydrogenase Deficiency. This inherited disease can be fatal in A patient using the Trust's new £650,000 CT/SPECT young children but can be treated effectively as long gamma camera. as it is identified early.

16 Epsom and St Helier University Hospitals NHS Trust Annual Report 2008-09 The Elective Orthopaedic Centre (EOC) The Elective Orthopaedic Centre, formerly known as the South West London Elective Orthopaedic Centre (SWLEOC), is operated by the Trust in conjunction with neighbouring trusts on a partnership basis from Epsom Hospital.

This NHS treatment centre provides orthopaedic services to patients from St George’s, Mayday and Kingston hospitals in addition to patients from Epsom and St Helier.

Further services are provided through a network of community hospitals, managed by Sutton and Merton Primary Care Trust and NHS Surrey. These include day surgery, a range of outpatient clinics and intermediate care services.

Since being opened by Her Majesty the Queen in 2004, the EOC has rapidly grown to become the largest hip and knee replacement centre in the UK and one of the biggest in Europe.

The EOC is also rapidly becoming a major centre for shoulder surgery and hip arthroscopies as well as undertaking more than 1,000 minor orthopaedic procedures, most as day cases or short stay. Over the past year, the EOC has: • been recognised as a centre of excellence by many both nationally and internationally for hip and knee replacement surgery and research and development; • achieved 5th place in the prestigious Healthcare 100 list. The influential list includes the top UK healthcare employers and is compiled by the Health Service Journal and Nursing Times. The award is open to all healthcare organisations across the UK from GP surgeries and primary care trusts to hospitals up and down the country; • experienced no episodes of MRSA cross contamination although the EOC does treat patients with MRSA; • led the NHS on the shortest length of stay for patients needing hip and knee surgery and has performed over 3,000 hip and knee replacements – more than any other hospital in the UK; • supported the clinical trials of blood clot busting drug Rivaroxaban. EOC staff celebrate the centre's 5th birthday

www.epsom-sthelier.nhs.uk 17 PRIORITY 1 - Delivering safe clinical services including meeting all central targets

Further improvements to patient services were made Annual Health Check during 2008-09. 98.1% of our patients were treated The Trust was awarded a rating of ‘good’ for the within the maximum of four hours in our A&E quality of services it provides to local people and ‘fair’ departments against the target of 98%. As well as for the way it manages its resources in the 2007-08 this achievement, the Trust also significantly reduced Healthcare Commission’s Annual Health Check. This is MRSA (bacteraemia) and C. difficile infections at all an improvement on 2006-07, when we were rated hospitals and experienced fewer cases of the ‘good’ for our services, but ‘weak’ for use of infections than our target level for the past year. resources.

The Annual Health Check assesses the performance Our performance of every trust in England and Wales, giving a score of ‘excellent’, ‘good’, ‘fair’ or ‘weak’ for the two areas. Standard Epsom and St Helier The ratings provide patients, local people and staff Finances – end year with ACHIEVED with a public assurance about the state of health balanced books (with £4.9 million services, and help drive improvements locally and surplus) nationally. Infection control – have no ACHIEVED more than 44 cases of (34 MRSA/ The quality of services score is made up of a number of targets set by the government. We were awarded MRSA bacteraemia and 156 C. difficile) the top rating of 'fully met' for the way we meet core 290 C. difficile and existing standards and 'good' for meeting new Emergency access – 98% of ACHIEVED targets. all patients attending A&E to (98.1%) be treated, admitted or These targets look at a whole range of standards, from discharged in four hours how quickly we see patients referred to us for treatment to how easily patients can access sexual 18 week wait – the time from ACHIEVED health services when they need them. They also GP referral to treatment time (92%) include our safety standards. for patients who have surgery (target 90%) Our 'fair' rating in the use of resources reflects the 18 week wait – the time from ACHIEVED improvements we have made in the way we manage GP referral to treatment time (96%) our finances, including how well we plan and monitor the money we spend, and whether we make sure that for patients who are not our services offer value for money. One of the biggest admitted to hospital drivers for the move from ‘weak’ to ‘fair’ was the hard (target 95%) work of our staff and volunteers in moving the Trust Cancer related targets ACHIEVED from a deficit of £5.5 million in 2006-07 to a surplus - 2 week rule (wait from (99.97%) of more than £820,000 in 2007-08. urgent referral) Information about the Annual Health Check is - 2 months to treatment (98.7%) available from www.cqc.org.uk. Full details of the (wait from urgent referral) Trust’s declaration can be found on the Trust website - 1 month from confirmed (100%) www.epsom-sthelier.nhs.uk. diagnosis Rapid access chest pain clinic ACHIEVED Our Annual Health Check for 2008-09 will be (99.6%) announced in the autumn.

18 Epsom and St Helier University Hospitals NHS Trust Annual Report 2008-09 www.epsom-sthelier.nhs.uk 19 PRIORITY 2 - Improving the patient experience, including ensuring that healthcare acquired infections are kept to a minimum

Infection control and prevention the Care Quality Commission (CQC) (formerly the The commitment our staff and volunteers have shown in Healthcare Commission). The Inpatient survey 2008 reducing the number of infections acquired in our revealed that patients rated us as showing “significant” hospitals has been amazing. This helped us meet the improvements in over a third of the areas covered. government’s standards and, as figures released by the Health Protection Agency show, we recorded our lowest The survey also showed that the Trust is in the top 20% number of MRSA (bacteraemia) ever during 2008-09, of all hospitals in England for: with C. difficile rates dropping by 45% in 2008-09 compared to the previous year. • there being enough nurses on duty to provide care; • patients being given a choice of admission date; In order to help the Trust further reduce instances of • there being minimal disturbance at night by other healthcare acquired infections, a campaign was patients; launched: ‘The gloves are off – help us beat infections’. • patients not wanting to complain about the care they The initiative aimed to increase awareness amongst received. staff, volunteers, patients, visitors and local people about what they can do to help the Trust to further reduce the Patients gave the Trust a better score than last year in 48 incidence of infections. out of the 61 questions asked with a significantly better score in 23 areas. In November 2008 and February 2009, the Healthcare Commission made unannounced visits to inspect the The areas highlighted by the CQC where the Trust Trust under the Department of Health’s Hygiene Code scored “significantly better than the previous survey” and we were declared fully compliant. The code include: stipulates the actions NHS trusts must take to ensure • patients feeling they were treated with respect patients are cared for in a clean environment, where the and dignity; risks of infections are kept as low as possible. These • how clean the hospital room or ward was that they actions cover all aspects of infection control, not only were in; cleanliness. • whether patients of different sexes ever had to share sleeping areas; During March 2008, the Trust completed its biggest ever • how well our doctors and nurses work together; total deep clean of wards and clinical areas at Epsom, • how they rate the care they received overall. Sutton and St Helier hospitals. The project was considered so successful that the Trust decided to continue it, with the team rotating between wards and The gloves are off – on call if needed. help us beat infections

Members of staff who have front line clinical contact All visitors and patients are encouraged to: with patients continue to adhere to the Trust’s bare • wash their hands or use alcohol rub when entering and on leaving a ward or clinical area. below the elbows policy. This was introduced last year And remember, it’s okay to ask our staff if when and works on the principle that if short sleeves are providing clinical care: worn, it is much easier to wash hands effectively with • you believe they have not washed their hands soap and water or alcohol rub. As part of the policy, or used alcohol rub wristwatches, bracelets and stoned rings are also not • they are not bare below the elbows. allowed to be worn by staff providing clinical care. This For more information, please visit our website is because they can harbour bacteria and make hand (www.epsom-sthelier.nhs.uk) or speak to a member of staff. hygiene more difficult. Join us in our fight against infections and help us knock ’em out forever. Inpatient survey 2008 The Trust's infection control campaign informs staff and visitors of the importance of good hand hygiene The Trust is showing significant improvement in the experience patients have in our hospitals, according to

20 Epsom and St Helier University Hospitals NHS Trust Annual Report 2008-09 Investing in our hospitals The PEAT – which includes patients and members of the During 2008-09, we spent £10.1 million improving the public – awarded the Trust a rating of ‘good’. The buildings and infrastructure across the Trust, as well as possible scores are ‘excellent’, ‘good’, ‘acceptable’, replacing vital equipment. Approximately £9.2 million ‘poor’ and ‘unacceptable’. will be invested during 2009-10. Emergency Department Survey 2008 Nearly £2.8 million is being spent on giving the The Trust is within the top 20% of trusts across London maternity unit at St Helier Hospital a radical facelift that for patient satisfaction in its Accident and Emergency will drastically improve the environment in which (A&E) departments. The Healthcare Commission’s patients are treated and further enhance the care they Emergency Department Survey 2008 found that 80% of receive. The work, which will be completed by the 800 randomly selected patients were satisfied overall autumn, will create a dedicated midwifery-led unit and a with the service they received in the Trust’s A&E completely refurbished neonatal unit. departments and almost 90% felt they were treated with respect and dignity. A major £1.2 million refurbishment was conducted on two stroke wards at Epsom Hospital. The work at Britten The A&Es at Epsom and St Helier hospitals (and the eye and Croft wards means that patients being treated by casualty at Sutton Hospital) also received high scores for the general medicine and stroke teams can be seen in the care and treatment provided by staff, pain wards which have more single rooms and improved management, waiting times, and communication en-suite facilities. A physiotherapy gym, shared between doctors and patients. between the two wards, also formed part of the refurbishment programme. Interpreting service The Trust provides a comprehensive range of services to A state-of-the-art neutral pressure room which allows support anyone who has communication difficulties or patients with severe respiratory diseases such as because English is not their first language. tuberculosis to be isolated from other patients was also unveiled at Epsom Hospital. The single bedded room has Staff are able to access face-to-face interpreters in over full en-suite facilities and a pressurised lobby which 40 of the most commonly spoken languages and protects other patients on the ward from infections and, interpreters in many other languages are available via where patients are prone to infection, protects them telephone. from the outside world. The facility cost £240,000 – half of which was funded by the Friends of Epsom By breaking down language barriers and promoting Hospital, the rest through the Trust’s capital investment better understanding between health professionals and programme. patients, the service ensures the patient has the best possible treatment and care whilst in hospital. The Trust has also spent £400,000 on replacing roofs and windows across the hospital sites and has started to Improving patients’ stays in hospital upgrade the McKenzie unit at St Helier Hospital which The Trust has introduced a range of initiatves to should be completed by the end of 2009. further improve patients' stays in hospital. Over the past year, with assistance from the Disability Clean hospitals, good food Information Centre Epsom (DICE) and lead nurses, the Figures from this year’s PEAT (Patient Environment Action Trust has introduced folders called ‘Patients with Team) assessment, which was undertaken in February, additional needs’ in each ward and outpatient area so show that the Trust scored highly across a number of that patients who have additional needs, e.g. physical, standards relating to the hospital’s environment. learning, visual or hearing impairment, are given the The survey looks at a wide range of issues that could extra support they need. affect a patient’s experience during their stay at the hospitals, including cleanliness, the catering service, access and car parking. www.epsom-sthelier.nhs.uk 21 Over the past year, the Trust has received 467 formal written complaints – a slight increase on the previous year. Out of the complaints received, over 95% were acknowledged within two working days and 84% were concluded within 25 working days. This is an improvement on the previous year, when the response rate was 78% and it is also higher than the national average response rate of 75%.

The Trust received seven requests for independent review by the Healthcare Commission during the year. A midwife performs an ultrasound scan Out of those requests, five were deemed by the convenor as needing further action to be taken to make improvements. A further two are still being reviewed and we do not yet have the outcome.

Improving the way we communicate The main category of complaint was regarding clinical with patients care and treatment which accounted for 42% of all In February 2009, the Trust launched its brand new complaints. Over the past year, the Trust has embarked website, which includes a wealth of information for on a programme to ensure complaints are handled by patients. The new site includes: staff responsible for the relevant service, to ensure that changes are made where necessary. • directions to all our hospitals and maps to help patients find their way around; Research and development • a ward directory with visiting times; Quality research and development is vital to further • information to help patients prepare for their visit; improve patient services. Over the past year, the Trust has: • a full A-Z of our clinical services; • our latest news. • been commended by the Department of Health for its strong and active research performance, in Easy colour-coded sections make navigation easier response to the annual report the department than ever before, with clear information at the touch produced last year; of a button. To find out more, visit • continued to undertake clinical research in cancer, www.epsom-sthelier.nhs.uk. renal services, diabetes, stroke, immunology, maternal medicine, orthopaedics and other areas. Complaints and compliments This is to ensure the Trust is kept abreast of the latest The Trust welcomes feedback and correspondence clinical developments to enhance patient care. As a from patients, their families, carers and friends, much result of the immunology research, the department of which is used to help shape future service delivery. is applying for a patent to develop a process where allergic reactions can be more accurately tested. Over the past year, the Trust’s Chief Executive’s office has received many letters and cards praising staff for high standards of patient care they provide. Service managers themselves received many more and there was an even greater number of expressions of appreciation to frontline staff across the three sites.

When we do receive a complaint or feedback from patients, staff, visitors or their families on how we could improve, the Trust works hard to ensure issues are addressed and do not reoccur.

22 Epsom and St Helier University Hospitals NHS Trust Annual Report 2008-09 www.epsom-sthelier.nhs.uk 23 PRIORITY 3 - Improving the staff experience to ensure that the Trust becomes an employer of choice

diversity. In this way, the Trust can help redress inequality. Our equal opportunities and managing diversity policy is a key document that describes what is expected from staff to ensure equality in the work place and in the services they deliver.

The Trust’s duties and responsibilities around disability are included in our single equality scheme, published on our website. It ensures we promote a positive environment for people with a disability who access our services as well as our employees.

Over the past year, the Trust has been reaccredited with the two ticks symbol. This demonstrates that the Trust meets the five commitments for accreditation: • to interview all applicants with a disability who meet A doctor examines an x-ray the minimum criteria for a job vacancy and consider them on their ability; • to ensure there is a mechanism in place to discuss with disabled employees what can be done to Our staff and volunteers ensure they can develop and use their abilities; Staff and volunteers are the most important asset of • to make every effort when employees become any organisation and as such, the Trust is committed disabled to make sure they stay in employment; to valuing its 4,800 employees and 500 volunteers, • to take action to ensure all employees develop the promoting a healthy workforce and encouraging a appropriate level of disability awareness needed to good work-life balance. Over the past year, the Trust make the commitments work; has continued to achieve this, including: • to review each year the five commitments and what has been achieved to plan ways to improve on them • offering childcare support, advice and a playscheme and to let employees and the job centre know about for children of staff; progress and future plan. • introducing flexible working arrangements that suit the service and employees; • inviting employees, teams as well as members of the public and patients to nominate who they feel should receive the monthly Chief Executive’s Award of Excellence. This recognises outstanding practice within the workplace.

Equal opportunities The Trust is committed to building a workforce that is valued and whose diversity reflects the communities it serves.

It is keen to promote and encourage an environment where all employees or potential employees are given equal opportunity in matters relating to employment. The Trust is in the top 20% in England for staff who understand their It also values the diverse talents of its employees and role and where it fits in continues to recruit on the basis of enriching this

24 Epsom and St Helier University Hospitals NHS Trust Annual Report 2008-09 Communicating with staff and Along with the positive results, there are areas where volunteers we need to improve, including reducing the number of The Trust places a great deal of importance on its staff working extra hours. ability to communicate with staff and continually looks at ways in which to improve. Over the past year, we Out of 35 key findings, 13 of our results were better have introduced new ways to communicate to our than average, whilst 13 were average and nine areas staff, and build on those already in place. These were below average. include: An action plan is being developed in partnership with • Senior Team Brief – the Chief Executive briefs the staff side, teams and individuals to build upon these 150 most senior managers within the Trust at successes and to implement further improvement. A monthly meetings. The delegates then pass on full copy of the survey is available at www.cqc.org.uk. information to their staff; • Meet the Chief Executive – this is an opportunity for Tackling violence and aggression all staff to meet the Chief Executive and share views, against staff opinions and ask questions; Violence and aggression against staff will not be • intranet – this internal website for staff and tolerated within the Trust. Over the past year, the volunteers acts as an information sharing tool and is Trust established a group which addressed all of the available across all the sites; key issues associated with violence and aggression. • Steps – this is the new magazine for staff and volunteers at St Helier, Epsom and Sutton hospitals An action plan has been produced and implemented and is produced every month. As well as the latest and its effectiveness continues to be monitored at the news and developments, readers can find out about Trust’s Health and Safety Committee. One of the awards, achievements, policies and patient feedback; group’s key aims was to encourage greater levels of • Team Brief – this monthly document is circulated to reporting and management of each incident to ensure staff and volunteers and provides the latest news staff welfare and support was maintained. and regular updates on projects, as well as the Trust’s latest results for clinical and financial Conflict resolution training is mandatory for all performance. frontline staff; however the Trust actively encourages all its staff to undertake the training which provides 2008 annual staff survey staff with the relevant skills and knowledge about how The 2008 annual NHS staff survey was commissioned to defuse a situation before it escalates. Internal by the Healthcare Commission and undertaken facilitators are trained to standards stipulated by the between October and December 2008. Questionnaires NHS Security Management Service. were sent to a randomly-selected sample of 809 staff, of which 453 questionnaires were completed - giving a response rate of 57%.

The results were published in late March, showing the Trust has done well in many areas. For example, such a high number of our staff feel satisfied with the quality of work and patient care they are able to deliver we are in the top 20% of trusts across the country. We are also in the top 20% for the percentage of staff who understand their role and where it fits in.

Our training figures have also improved upon last year, Physiotherapists help a patient to regain independence with 80% of our staff regularly undergoing training, learning or career development programmes. www.epsom-sthelier.nhs.uk 25 Corporate training Our volunteers The Trust has continued to make significant progress As always, the Trust is extremely grateful to its to implement its new corporate training programme volunteers who give up so much of their own time to for all staff. benefit patients and staff within the hospitals with their boundless levels of energy and enthusiasm. These This programme reflects the training needs identified organisations are: from staff appraisals and opinion surveys carried out • The Friends of Epsom Hospital; over the past year and is managed by the corporate • The League of Friends for St Helier and training department. Over the last year, corporate Sutton hospitals; training has assisted the Trust to: • The League of Friends for Queen Mary’s Hospital • recognise staff who had successfully completed NVQ for Children; and vocational programmes relevant to their • The Macmillan Butterfly Centre; profession within the Trust. Around 150 staff were • DICE (Disability Information Centre Epsom); present with their families to receive certificates of • The Chaplaincy; merit in February 2009 from Chief Executive • Epsom Medical Equipment Fund; Samantha Jones; • WRVS (formerly known as the Women’s Royal • commissioned a leadership programme as part of Voluntary Service); the Trust’s organisational development strategy for • Radio St Helier; clinical directors, heads of nursing and senior • Epsom Hospital Radio; managers within the Trust aimed at further • St Helier Kidney Patient Association (SHAK). enhancing skills and best practice. In total, the Trust has more than 500 volunteers who Staff sickness deliver a range of services that amount to almost The graph below shows staff sickness absence as a 1,800 hours per week of working time. Thousands of percentage throughout the year as full time equivalent pounds have also been raised by them over the past (FTE) days lost. Over the course of 2008-09, the year which has, or is in the process of going towards average sickness absence was 4.36%. the purchase of new equipment for patient services.

Sickness levels are reviewed on a monthly basis at Volunteers also play a variety of roles in the provision performance meetings and the Trust has a plan in of patient services. About 50% of wards now have place to actively monitor staff sickness, which is volunteers who assist with meeting and talking to already seeing improvements. patients as well as serving food at meal times.

12.00% In recognition of their hard work and effort, the Trust held a tea party at Epsom Racecourse on 2 October. 10.00% Almost 200 volunteers attended the event, which also

Trustwide celebrates the contributions of people who have been 8.00% volunteering for a long time with special awards.

6.00% 5.37% There was a special recognition for Edith Rann, a 5.08% 4.27% 4.40% volunteer with 55 years’ association with our Trust. 4.15% 4.26% 4.06% 4.00% 4.40% 4.08% 4.16% 3.97% 4.16% Anyone wishing to volunteer at the Trust should 2.00% contact Lesley Scott, Voluntary Services Manager on 020 8296 2221. 0.00% APR 08 MAY 08 JUN 08 JUL 08 AUG 08 SEP 08 OCT 08 NOV 08 DEC 08 JAN 09 FEB 09 MAR 09

26 Epsom and St Helier University Hospitals NHS Trust Annual Report 2008-09 www.epsom-sthelier.nhs.uk 27 PRIORITY 4 - Ensuring that the Trust provides safe and secure services for the future

The Trust continues to implement its clinical strategy – • to meet the increasingly high standards place on Shaping Our Future 2012 – which was launched in us by a number of professional bodies; January 2008. This provides the over-arching direction • our ability to deliver services within the finite to help ensure the Trust is able to provide safe and resources available to us. secure services for the future. Associated projects include: 3. To see if there is a better way for us to meet the challenges posed by: Local Needs, Local Health • the mandatory need to reduce the number of In summer 2008, we announced plans with our hours staff can work under the European Working strategic health authority, NHS London, to review the Time Directive; way the Trust is managed. The review is called Local • our ability to recruit certain types of clinicians; Needs, Local Health and also involves Sutton and • Patient Choice, the national NHS initiative which Merton Primary Care Trust, NHS Surrey and South East gives patients a choice of where they receive Coast Strategic Health Authority. treatment.

Local Needs, Local Health is looking at the way the The partners have agreed to assess a range of options, Trust is configured, with a view to establishing whether including, but not limited to: there is a better way of managing the hospitals. • status quo: the Trust remaining as it is; There are three main reasons for the review: • de-merger: Epsom and St Helier hospitals 1. To see if there is a better way for us to meet the de-merging to become two new NHS trusts; diverse health needs of the local community. • divestment: the Trust transferring ownership of part of the organisation to another body, for instance, 2. To see if there is a better way to meet the demands another hospital, primary care trust or independent placed on us by our primary care trusts, in provider. particular: • for patients to be able to access services locally; It is anticipated that a final report will be presented to the Trust steering group and Project Board in the autumn. The Project Board would then make a recommendation to the Trust Board, who would be expected to discuss it at a meeting in mid-autumn.

St Helier redevelopment The Trust Board met in September 2008 and approved proposals for a multi-million pound redevelopment of St Helier Hospital. The plans, which include demolishing Ferguson House and replacing it with a brand new, state-of-the-art building which will house the majority of the hospital’s wards and clinics.

If the plans go ahead, there will be nearly 350 beds in the new building, 50% of which will be in single rooms. All going well, work should start in 2012.

The plans are part of the Better Healthcare Closer To Home initiative which is being run in partnership with Consultant urologists Pieter LeRoux (left) and Stephen Gordon with the Trust’s new GreenLight laser, which is used to treat Sutton and Merton Primary Care Trust. men with an enlarged prostate.

28 Epsom and St Helier University Hospitals NHS Trust Annual Report 2008-09 • new standards in the treatment of patients, including those aimed at reducing the incidence of healthcare acquired infections and ensuring patients are treated with privacy and dignity; • the impact of the recession on available finances and opportunities to attract new investment.

It is anticipated that the strategic outline case will be completed by October 2009. It will then need to be agreed by the Trust Board before being sent to our strategic health authority for approval.

After this, we will develop an outline business case, bringing the process in line with our work at St Helier Hospital.

The £2.8 million refurbishment of the maternity unit at Women and children’s services review St Helier includes 3 new birthing pools In late 2007, the Trust, Sutton and Merton Primary Care Trust and NHS Surrey launched a review of women and children's services at Epsom and St Helier hospitals. The main reasons for the review are: A vision for Epsom Hospital As well as the investment at St Helier Hospital, work • to assess the health needs of the local population for continues on the development of a vision (also known women and children's services and to make sure that as a strategic outline case (SOC)) for the future of the any proposals we put forward to change the services Epsom Hospital site, including where we need to continue to meet these needs; invest money to make sure we have the right buildings • to help us meet the increasingly high standards for and infrastructure in place to meet the needs of the care rightly demanded by professional bodies; local population. • to meet the challenges posed by the European Working Time Directive which is limiting the time The strategic outline case for Epsom Hospital will staff can work. consider: In late 2008, the project cabinet agreed that Sutton • our need to ensure patients are able to receive the and Merton Primary Care Trust should take overall best possible care in a clean and welcoming control for running the review for the future of environment; services at St Helier Hospital and NHS Surrey for • what opportunities there are to further develop the Epsom Hospital. services offered at Epsom Hospital; • the commissioning intentions published by NHS For Sutton and Merton Primary Care Trust, the review Surrey (formerly Surrey Primary Care Trust) earlier this has linked in with their Better Healthcare Closer to year, i.e. the services they want the Trust to provide Home initiative, whilst for NHS Surrey it is part of to the people of Epsom and surrounding areas; their Assuring Access for Epsom and Surrounding • the increasing trend for more services to be provided Area programme. in the community; • updated planning assumptions for future growth of the local population and the changing health needs of patients;

www.epsom-sthelier.nhs.uk 29 • closely monitored the Trust’s violence and aggression action plan to ensure its effectiveness amongst staff and patients.

Information technology Between 2008 and 2009, the information services directorate has achieved:

• more than 300 GP surgeries are now receiving electronic discharge summaries for patients who have finished treatment at Epsom, Sutton and St Helier hospitals. This new system has led to a faster, more reliable and secure service. A copy is also stored on the Trust’s system for future reference by clinical staff; • new wireless networks have been installed in all clinical areas across the Trust to allow clinical staff to view x-rays, results and records of patients at their bedside; • the directorate is now fully compliant with national information security standards. This ensures that all electronic data that is stored by the Trust is password protected and secure when transmitted from one organisation to another; • information services has supported the pathology department to ensure almost 70% of all radiology Renal nurse Debbie Noble (right) walked 18 miles in heavy snow tests of patients are sent and received electronically. to help dialysis patient Steph Crawford at home Clinical governance The term ‘clinical governance’ is used to describe the systems and processes by which trusts lead, direct and Managing risk and health and safety control their functions whilst delivering high standards The Trust is committed to ensuring the health and of patient care. Governance is the responsibility of all safety of its patients, staff and visitors is maintained at Trust staff: to work to improve the safety, efficiency all times. Over the past year, the Trust has: and effectiveness of the systems they operate and to report poor practice so that corrective action can • continued to produce a risk management newsletter be taken. which is circulated within the Trust. This informs staff about important developments concerning health Accountability and safety advice in the workplace; The Trust continues to implement the codes of • secured approximately £150,000 for occupational conduct, accountability and practice on openness. It health and safety training and operational risk also follows standing orders (SOs) and standing management training for ward and departmental financial instructions (SFIs). All of these are aimed at managers. To date, 70 people are going through preventing risks of fraud or misuse of public money. and some have achieved NVQ level 3 already; They also provide staff with clear guidelines so that • established a risk management intranet site to transactions are carried out in accordance with the law inform staff about how they can support the Trust’s and government policy. efforts to identify and manage risk. Here, staff can download the latest guidance;

30 Epsom and St Helier University Hospitals NHS Trust Annual Report 2008-09 Emergency planning The Trust, in line with all other NHS organisations The Trust also possesses and maintains plans for the across the country, has a statutory duty under the Civil following key areas: Contingencies Act, NHS Emergency Planning Guidance 2005, Department of Health and Healthcare • business continuity; Commission standards to ensure arrangements are in • winter; place for managing emergencies. • flu pandemic; • mass casualty. Considerable progress has once again been made across the organisation to improve resilience over the These are regularly tested and awareness training is past 12 months. given to staff at regular intervals.

The Trust has an up-to-date emergency plan which is reviewed twice a year and amended in light of evolving national guidance and lessons learned from incidents and exercises.

The Trust's volunteers were thanked at a special celebration in their honour

www.epsom-sthelier.nhs.uk 31 The accounts

The Trust’s financial performance Scope of responsibility This section summarises the financial performance for As accountable officer, and Chief Executive of this 2008-09 and the position of the Trust as of 31 March Board, I have responsibility for maintaining a sound 2009. The Trust’s summarised accounts for 2008-09 system of internal control that supports the have been examined by our external auditors, the achievement of the organisation’s policies, aims and Audit Commission, and their unqualified report is set objectives. I also have responsibility for safeguarding out opposite. the public funds and the organisation’s assets for which I am personally responsible as set out in the A full set of the accounts and the funds held on trust accountable officer memorandum. can be obtained free of charge from Jean Harrison, PA to the Director of Finance, St Helier Hospital, Wrythe In signing the statement on internal control, I am Lane, Carshalton, Surrey. SM5 1AA. It can also be stating that the Trust Board has considered all of the downloaded from the Trust’s website organisation’s risks (clinical and non clinical) which www.epsom-sthelier.nhs.uk. might jeopardise the successful functioning of the organisation, and that appropriate steps have been taken to minimise them. It is the role of the Trust Board to review the risks and the steps being taken to manage them, and decide whether they are satisfactory.

The statement also describes the systems and processes the organisation has put in place to reach the conclusions made about risks. The role of the auditors is to provide the assurance to the public and the Department of Health that the systems, processes and arrangements for identifying and managing risks are robust, and sufficiently embedded into the day to day practice of the organisation.

Peter Coles Interim Chief Executive

32 Epsom and St Helier University Hospitals NHS Trust Annual Report 2008-09 Independent auditor’s statement to Opinion the Board of Directors of Epsom and In my opinion the summary financial statement is St Helier University Hospitals NHS Trust consistent with the statutory financial statements of the Trust for the year ended 31 March 2009. I have examined the summary financial statement which comprises the income and expenditure account, balance sheet, statement of total recognised gains and losses and cash flow statement. 10 June 2009 This report is made solely to the Board of Directors of Epsom and St Helier University Hospitals NHS Lindsey Mallors, Trust in accordance with Part II of the Audit Engagement Lead Commission Act 1998 and for no other purpose, as Audit Commission set out in paragraph 49 of the Statement of Millbank Tower Responsibilities of Auditors and of Audited Bodies Millbank prepared by the Audit Commission. London SW1P 4HQ Respective responsibilities of directors and auditor The directors are responsible for preparing the annual report.

My responsibility is to report to you my opinion on the consistency of the summary financial statement within the Annual Report with the statutory financial statements.

I also read the other information contained in the annual report and consider the implications for my report if I become aware of any mis-statements or material inconsistencies with the summary financial statement.

Basis of opinion I conducted my work in accordance with Bulletin 1999/6 ‘The auditors’ statement on the summary financial statement’ issued by the Auditing Practices Board. My report on the statutory financial statements describes the basis of our audit opinion on those financial statements.

www.epsom-sthelier.nhs.uk 33 Statement of internal control The Trust hopes to make a surplus of £2.8 million in The statement of internal control (SIC) is part of the 2009-10, before impairment charges as a result of the annual report and statutory accounts. It is a statement asset valuation due in 2009-10, and £2.6 million in signed by the Chief Executive and is subject to external 2010-11 and thereafter breakeven in following audit. In signing the SIC, the Chief Executive has financial years. stated that the Trust Board has considered all of the organisation's risks (clinical and non clinical) which To achieve the surplus next year, the Trust has may jeopardise the successful functioning of the identified the requirement to deliver savings of organisation, and that appropriate steps have been £16 million (4% of turnover) in 2009-10. taken to minimise them. The statement also describes the systems and processes that the Delivery in 2008-09 was short of the Trust’s target, organisation has put in place to reach the conclusions partially due to workload being higher than plan, but made about risks. The statement of internal control is also due a time lag caused by the implementation of available on request from the Trust Secretary. the new management structure. This was anticipated by the Trust Board, but the longer term benefits were Financial performance 2008-09 deemed to outweigh the short term impacts. and beyond The Trust commissioned PricewaterhouseCoopers In 2008-09, the Trust made a surplus of £4.9 million, (PwC) to facilitate the development of the Trust’s which was £0.6 million behind the planned surplus of savings and service improvement plan for 2009-10. £5.5 million. Notwithstanding the shortfall, the achievement of this surplus has meant that the Trust The plan spans the whole Trust and consists of a has met its cumulative breakeven duty. combination of projects under common themes and directorate specific projects. The largest opportunities The reasons for the improvement, year on year, are relate to: higher income, up 6% coupled with a lower rise (4%) in operating expenses. 1. Improving theatre utilisation – during 2009-10 we will improve theatre utilisation by: As well as achieving breakeven, the Trust also met its other key financial targets, the capital resource and • developing a robust and timely performance data external finance limit. process; • introducing a robust problem solving management The Trust did not meet the target to pay 95% of process; suppliers within 30 days but its performance is within • establishing clear roles and responsibilities for critical the range achieved by other NHS trusts. The Trust has theatre pathway activities; shown a small improvement on last year. • coaching theatre management in behaviours required for performance management; At the end of 2006-07, the Trust took out a working • introducing a robust theatre planning process. capital loan of £14 million to give it the liquidity it needed over the next three financial years, two of 2. Length of stay – we have already started work on which it forecast a deficit. However, in 2006-07 the improving length of stay (to reduce the length of deficit was less than plan and in 2007-08 there was a time patients spend in our hospitals unnecessarily). surplus rather than a deficit; meaning the Trust’s liquidity has significantly improved. For example, we have focused on reducing our fractured neck of femur length of stay during The loan outstanding at the end of 2008-09 was 2008-09. In 2009-10 we will continue the progress £2.4 million and this will be repaid as scheduled by we have made on fractured neck of femur and also March 2010.

34 Epsom and St Helier University Hospitals NHS Trust Annual Report 2008-09 focus on key areas in medicine, including stroke and The Trust has prepared for this by commissioning care of the elderly. PricewaterhouseCoopers (PwC) to conduct an impact assessment for us and prepare a high level plan. In In order to continue reducing length of stay we preparing this, they have held two workshops with key require support from our local primary care trusts staff in the Trust, which not only raised awareness of and social services in the form of community-based IFRS but highlighted specific actions required and service provision. started information gathering.

3. Bank and agency spend – in 2008-09 the Trust The Trust set up a project team to review all these spent a significant amount of money on temporary areas and to reproduce its opening balance sheet as of staff. There have been a number of valid reasons for 1 April 2008 under IFRS rules. The revised balance this but during 2009-10 we will implement a sheet was submitted to the Department of Health by number of initiatives to reduce this spend. The work the end of December 2008 as part of a national will focus on: exercise in preparing for IFRS transition.

• accelerating the roll out of nurse e-rostering; The Trust’s process to produce the revised balance • converting as many agency arrangements into bank sheet has been subject to review by the Audit as possible; Commission and we are awaiting a formal report. • re-establishing the controls on the use of bank and agency staff; As part of the review some policies and procedures • monitoring and managing holiday leave to ensure were revised especially in regard to leasing, review of staff take their allotted amount of leave; contracts and accounting for leased assets. • managing and reducing sick leave; • improving the Trust’s recruitment process and The Trust has to restate its 2008-09 accounts by marketing to improve the attractiveness of the 9 September 2009. Draft proforma financial Trust as an employer. statements and accounting policies have been issued by the Department of Health and these will be used The Trust has introduced a new management structure to change the Trust’s chart of accounts and associated in order to move to a better focused management reporting. effort that can deliver the savings required and to prepare for Foundation Trust status in the future.

International financial reporting standards (IFRS) In order to prepare IFRS compliant accounts in 2009-10, the Trust will need to revise its accounting policies, change the format of its financial statements and include a significant number of additional disclosures. It will need to restate its 2008-09 comparative figures and report these together with its 2009-10 figures on an IFRS basis.

www.epsom-sthelier.nhs.uk 35 Income and expenditure account for the year ended 31 March 2009

2008-09 2007-08 £000 £000

Income from activities 274,112 260,405

Other operating income 40,908 36,093

Operating expenses (301,279) (289,314)

OPERATING SURPLUS/(DEFICIT) 13,741 7,184

Profit/(loss) on disposal of fixed assets (434) (285)

SURPLUS/(DEFICIT) BEFORE INTEREST 13,307 6,899

Interest receivable 737 1,118 Interest payable (1,813) (694) Other finance costs - unwinding of discount (78) (79)

SURPLUS/(DEFICIT) FOR THE FINANCIAL YEAR 12,153 7,244

Public dividend capital dividends payable (7,251) (6,417)

RETAINED SURPLUS/(DEFICIT) FOR THE YEAR 4,902 827

All income and expenditure is derived from continuing operations.

36 Epsom and St Helier University Hospitals NHS Trust Annual Report 2008-09 Balance sheet as at 31 March 2009

31 March 2009 31 March 2008 £000 £000 FIXED ASSETS Intangible assets 896 0 Tangible assets 181,335 202,883 TOTAL FIXED ASSETS 182,231 202,883

CURRENT ASSETS

Stocks and work in progress 3,452 3,358 Debtors 18,078 24,353 Cash at bank and in hand 5,031 4,169 TOTAL CURRENT ASSETS 26,561 31,880

CREDITORS: Amounts falling due within one year (29,590) (33,284) -

NET CURRENT ASSETS/(LIABILITIES) (3,029) (1,404)

TOTAL ASSETS LESS CURRENT LIABILITIES 179,202 201,479

CREDITORS: Amounts falling due after more than one year (2,046) (4,668) -

PROVISIONS FOR LIABILITIES AND CHARGES (5,937) (7,430)

TOTAL ASSETS EMPLOYED 171,219 189,381

FINANCED BY:

TAXPAYERS' EQUITY Public dividend capital 133,585 134,980 Revaluation reserve 33,075 56,095 Donated asset reserve 5,155 4,990 Income and expenditure reserve (596) (6,684)

TOTAL TAXPAYERS' EQUITY 171,219 189,381

The revaluation reserve has been restated for the prior period adjustment. The financial statements were approved by the Board on 5 June 2009 and signed on its behalf by:

Peter Coles Interim Chief Executive 5 June 2009

www.epsom-sthelier.nhs.uk 37 Statement of total recognised gains and losses for the year ended 31 March 2009

2008-09 2007-08 £000 £000

Surplus/(deficit) for the financial year before dividend payments 12,153 7,244

Fixed asset impairment losses 0 0

Unrealised surplus/(deficit) on fixed asset revaluations/indexation (21,973) 13,364

Increases in the donated asset and government grant reserve due to receipt of donated and government grant financed assets 693 154

Defined benefit scheme actuarial gains/(losses)

Additions/(reductions) in "other reserves" 0 0

Total recognised gains and losses for the financial year (9,127) 20,762

Prior period adjustment (5,973) (1,718)

Total gains and losses recognised in the financial year (15,100) 19,044

38 Epsom and St Helier University Hospitals NHS Trust Annual Report 2008-09 Cash flow statement for the year ended 31 March 2009 2008-09 2007-08 £000 £000 OPERATING ACTIVITIES Net cash inflow/(outflow) from operating activities 29,111 19,623

RETURNS ON INVESTMENTS AND SERVICING OF FINANCE Interest received 737 1,118 Interest paid (463) (690) Interest element of finance leases (1,367) 0

Net cash inflow/(outflow) from returns on investments and servicing of finance (1,093) 428

CAPITAL EXPENDITURE (Payments) to acquire tangible fixed assets (11,051) (7,837) Receipts from sale of tangible fixed assets 0 0 (Payments) to acquire intangible assets (336) 0 Receipts from sale of intangible assets 0 0 (Payments to acquire)/receipts from sale of fixed asset investments 0 0 (Payments to acquire)/receipts from sale of financial instruments 0 0

Net cash inflow/(outflow) from capital expenditure (11,387) (7,837)

DIVIDENDS PAID (7,251) (6,417)

Net cash inflow/(outflow) before management of liquid resources and financing 9,380 5,797

MANAGEMENT OF LIQUID RESOURCES (Purchase) of financial assets with the Department of Health 0 0 (Purchase) of other current financial assets 0 0 Sale of financial assets with the Department of Health 0 0 Sale of other current financial assets 0 0

Net cash inflow/(outflow) from management of liquid resources 0 0

Net cash inflow/(outflow) before financing 9,380 5,797

FINANCING Public dividend capital received 364 2,502 Public dividend capital repaid (1,759) (271) Loans received from the Department of Health 0 0 Loans repaid to the Department of Health (6,966) (4,666) Other loans repaid 0 0 Other capital receipts 0 0 Capital element of finance lease rental payments (157) 0

Net cash inflow/(outflow) from financing (8,518) (2,435)

Increase/(decrease) in cash 862 3,362 www.epsom-sthelier.nhs.uk 39 5.4 Management costs: 2008-09 2007-08 £000 £000

Management costs 13,080 11,540

Income 313,746 295,733

Management costs are defined as those on the management costs website at www.dh.gov.uk/PolicyAndGuidance/OrganisationPolicy/FinanceAndPlanning/NHSManagementCosts/fs/en.

6.1 Better payment practice code - measure of compliance 2008-09 Number £000 Total Non-NHS trade invoices paid in the year 62,219 96,143 Total Non NHS trade invoices paid within target 51,165 76,980 Percentage of Non-NHS trade invoices paid within target 82% 80%

Total NHS trade invoices paid in the year 3,122 21,752 Total NHS trade invoices paid within target 2,531 17,210 Percentage of NHS trade invoices paid within target 81% 79%

The better payment practice code requires the Trust to aim to pay all undisputed invoices by the due date or within 30 days of receipt of goods or a valid invoice, whichever is later.

External audit The Trust appointed the Audit Commission as its external auditor for 2008-09 at a cost of £200,000. Within the services, provided the Audit Commission only carried out statutory activities under the code of practice and related to the audit of the Trust's financial statements.

40 Epsom and St Helier University Hospitals NHS Trust Annual Report 2008-09 Senior managers’ remuneration report (salary)

2008-09 Other 2007-08 Other Salary (bands Remuneration Benefits in Kind Salary (bands Remuneration Benefits in Kind Name and title of £5,000) (bands of £5000) (nearest £000) of £5,000) (bands of £5000) (nearest £000)

John Davey 20-25 20-25 Chairman Sue Marshall OBE 5-10 5-10 Non-Executive Professor David Oliviera 5-10 5-10 Non-Executive Michael Sadler 0-5 5-10 Non-Executive Janet Sawkins 5-10 5-10 Non-Executive Peter Rawlinson 5-10 0-5 Non-Executive Nilkunj Dodhia 0-5 Non-Executive Samantha Jones 155-160 105-110 Chief Executive Peter Coles 40-45 Interim Chief Executive Jon Sargeant 120-125 110-115 Director of Finance Shane Degaris 105-110 0-5 Director of Operations/Deputy Chief Executive Pippa Hart 90-95 30-35 20-25 Director of Nursing Dr C M (Lindy) Steven 10-15 120-125 35-40 120-125 Medical Director Dr Jonathan Kwan 45-50 140-145 Medical Director Michael Burden 85-90 20-25 Director of Human Resources Nicholas Gorvett 90-95 85-90 Director of Corporate Infrastructure Candace Imison 95-100 30-35 95-100 Director of Strategy Sue Jones 75-80 0-5 Director of Service Improvement Antony Tiernan 65-70 10-15 Director of Communications

Michael Sadler left the Trust on 31 July 2008. Nilkunj Dodhia joined the Trust as Non-Executive Director on 1 January 2009. Samantha Jones has been on maternity leave since 15 March 2009 and Peter Coles is Interim Chief Executive. Peter Coles is on secondment from Brighton and Sussex University Hospitals Trust, via the Department of Health. Michael Burden became the Director of Human Resources from 1 January 2008. Shane Degaris joined the Trust on 17th March 2008. Pippa Hart became Director of Nursing from 1 January 2008. Dr C M (Lindy) Steven ceased to be a Medical Director from 30 June 2008. Dr Jonathan Kwan became Medical Director on 1 July 2008. Sue Jones joined the Trust as the Director of Service Improvement on 3 March 2008. Antony Tiernan became the Director of Communications on 21 January 2008.

www.epsom-sthelier.nhs.uk 41 Senior managers’ remuneration report (pensions)

Real Real Total Lump sum at Cash Cash Real Employer’s increase in increase in accrued age 60 equivalent equivalent increase in contribution pension at pension pension at related to transfer transfer cash to age 60 lump sum at age 60 at 31 accrued value at 31 value at 31 equivalent stakeholder (bands of age 60 March 2009 pension at March 2009 March 2008 transfer pension £2,500) (bands of (bands of 31 March £000 £000 value £000 £000 £2,500) £5,000) 2009 (bands Name and title of £5,000)

Samantha Jones 0-2.5 0-2.5 15-20 50-55 222 167 36 N/A Chief Executive Peter Coles 0-2.5 0-2.5 55-60 175-180 1140 838 16 N/A Interim Chief Executive Jon Sargeant 2.5-5 7.5-10 25-30 80-85 428 293 89 N/A Director of Finance Shane Degaris 0-2.5 5-7.5 5-10 15-20 75 40 23 N/A Director of Clinical Operations/ Deputy Chief Executive Pippa Hart 12.5-15 40-42.5 30-35 90-95 509 225 194 N/A Director of Nursing Dr C M (Lindy) Steven N/A N/A 50-55 160-165 0 N/A N/A N/A Medical Director Dr Jonathan Kwan 2.5-5 12.5-15 45-50 135-140 906 620 190 N/A Medical Director Michael Burden 7.5-10 25-27.5 30-35 95-100 577 304 186 N/A Director of Human Resources Nicholas Gorvett 0-2.5 2.5-5 35-40 110-115 801 579 146 N/A Director of Corporate Infrastructure Candace Imison 0-2.5 2.5-5 20-25 65-70 432 312 79 N/A Director of Strategy Sue Jones 0-2.5 5-7.5 20-25 60-65 346 246 66 N/A Director of Service Improvement Antony Tiernan 0-2.5 2.5-5 0-5 10-15 56 31 18 N/A Director of Communications

Cash equivalent transfer values individual has transferred to the NHS pension scheme. A cash equivalent transfer value (CETV) is the They also include any additional pension benefit actuarially assessed capital value of the pension accrued to the member as a result of their purchasing scheme benefits accrued by a member at a particular additional years of pension service in the scheme at point in time. The benefits valued are the member’s their own cost. CETVs are calculated within the accrued benefits and any contingent spouse’s pension guidelines and framework prescribed by the Institute payable from the scheme. A CETV is a payment made and Faculty of Actuaries. by a pension scheme or arrangement to secure pension benefits in another pension scheme or Real increase in CETV arrangement when the member leaves a scheme and This reflects the increase in CETV effectively funded by chooses to transfer the benefits accrued in their the employer. It takes account of the increase in former scheme. The pension figures shown relate to accrued pension due to inflation, contributions paid the benefits that the individual has accrued as a the employee (including the value of any benefits consequence of their total membership of the pension transferred from another scheme or arrangement) and scheme, not just their service in a senior capacity to uses common market valuation factors for the start which disclosure applies. The CETV figures and the and end of the period. other pension details include the value of any pension benefits in another scheme or arrangement which the

42 Epsom and St Helier University Hospitals NHS Trust Annual Report 2008-09 Tom Brake MP (right) officially opens the Trust's new £650,000 gamma camera with Mina Deved, radiology service manager If you require this report in a larger print, as spoken word or translated into a different language, please contact us on 020 8296 2406.

We welcome any comments on this report or our services. Please call our Patient Advice and Liaison Service (PALS) at St Helier Hospital on 020 8296 2508, at Epsom Hospital on 01372 735 393 or email [email protected].

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