Annual Report and Accounts 2005/06

Present to Parliament pursuant to Schedule 1, paragraph 25 (4) of the Health and Social Care (Community Health and Standards) Act 2003 Annual Report and Accounts 2005/06 Welcome 14

Sheffield Teaching We became an NHS Foundation population of approximately Trust on 1st July 2004 as part of 2.2 million people. Some of Hospitals NHS Trust the first wave of hospital trusts our clinical services are came into existence to achieve this new status. The national or international centres 2 5 in 2001 when the Trust now has greater freedom of excellence. from central government, two pre-existing enabling us to set local health Sheffield Teaching Hospitals adult acute trusts in targets and invest more in employs more than 13,000 patient care whilst still staff. Each year, more than Sheffield merged. upholding the ethos of the NHS 175,000 operations and day by providing healthcare free at case procedures are performed the point of delivery. and over 797,000 outpatient appointments are provided The Trust manages the five across the hospitals. adult NHS hospitals in Sheffield; the Northern General, Royal The Trust also has a strong 3 Hallamshire, Charles Clifford, commitment to teaching and Weston Park and Jessop Wing research and is closely linked hospitals, which are situated on with the Universities of two campuses, one centrally Sheffield and Sheffield Hallam. 1 Northern General Hospital located and the other in the north of the city. The Trust 2 Royal Hallamshire Hospital provides general hospital 3 Weston Park Hospital services to the people of Sheffield and more specialist 4 Charles Clifford Dental Hospital services to a regional 5 Jessop Wing 02 Annual Report and Accounts 2005/06 03 Contents Welcome 4 Chairman’s foreword 6 Chief Executive’s foreword 10 Board of Directors 13 Celebrating Foundation Trust status 16 Investing in our buildings and equipment 18 Performance overview 19 The year at a glance 20 Our staff 22 Improving safety for our patients Operational review 05/06: ten key aims 24 Extra beds for our hospitals 26 Reduced hospital infections 28 Shorter waiting times 30 Investment in new buildings 32 Improved cancer care 34 Fewer cancelled operations 36 Faster diagnostic tests 38 More convenient chronic disease care 40 Research and new treatments 42 Playing our part in the local community 44 Learning from our patients 46 Finance review 50 Public interest disclosure 52 Remuneration report 54 Independent auditor’s report 56 Statement of responsibilities During the year a Visitors’ 57 Financial statements Code was introduced which 92 Statement on Internal Control includes new visiting times and infection control guidance. Annual Report and Accounts 2005/06 Chairman’s foreword

A challenging year The last year has presented us and reduce our costs. We have David Baldwin has retired after improvements and developing with many new challenges which introduced a three year nearly 42 years with the innovations to keep Sheffield that has tested us we have successfully tackled with programme of change – hospitals. David has worked in at the forefront of modern but produced very vigour and determination. Adding Value - which will help many roles from administration to healthcare. good outcomes Financially, we have achieved us to build on our excellent Assistant Chief Executive of the balance for the 5th year in a row track record. Central Sheffield University Our services are going from whilst treating more patients than Hospitals before becoming the strength to strength whilst still ever before. We also became the We have experienced changes in Director of Legal and Corporate meeting the changing needs of Dr Foster “Hospital of the Year”, our management team too. I Services on the merger of the patients. Amongst many other demonstrating our commitment would like to take this two trusts in 2001. On behalf of achievements, which are detailed to providing high quality, patient- opportunity to wish Heather the Trust I would like to thank in the operational review on centred care. These are great Tierney-Moore well in her new him for the lifetime of dedication pages 24-43, we introduced a achievements, which would not important role in Scotland and he has shown the hospitals and new clinical management unit in have been possible without the thank her for many years of wish him health and happiness the accident and emergency hard work and dedication of our dedication in taking the hospitals for the future. department that is already staff and I would like personally forward, most recently in her role improving the transition of to thank them all for their as Chief Nurse. I am very pleased This annual report focuses on the patients through the department. valuable contributions. that Hilary Scholefield has joined ten priorities which we believe us as the Trust’s new Chief Nurse. are key to providing the We have been delighted to Many challenges lie ahead and Hilary has had an excellent career healthcare that the people of receive national recognition for the NHS faces some financial so far and is no stranger to our Sheffield and beyond need and our hard work: Ward Orderly difficulties over the coming years. hospitals, having trained and want. Some of the excellent work Peggy Brownall was invited to In order to further improve worked at the Northern General carried out is highlighted in this Downing Street to meet Prime patient care and remain a Hospital for a number of years. report. It shows that our Minister Tony Blair to explain the successful organisation we need We look forward to working professional and enthusiastic work that goes on behind the to become even more efficient with her. staff are constantly making scenes at our hospitals and > 04 Annual Report and Accounts 2005/06 05

> Clinical Scientist Dr Peter to be involved in the shaping of Metherall was recognised for his our services. achievements in helping to improve patient safety at the first Over the coming year we will ever National Chief Scientific receive the outcome of the new Officer Awards. Many more staff Annual Health Check conducted have received the recognition by the Healthcare Commission, they deserve for their work in which replaces the star ratings healthcare and innovation. Well system for 2005/06 and prepare done to everybody. for the introduction of developmental standards which Our Governors’ Council, will form part of this assessment representing as they do our from 2006/07 onwards. patients, staff, populations and partners, has developed its role I am confident that whilst we will significantly and is increasingly certainly be put to the test, our influencing the direction of Trust dedicated staff at STH will ensure strategy. Trust membership has that our standards of care remain continued to grow and we are amongst the best in the country. looking to increase membership further to enable more people to have a bigger say in the way their hospitals are run. We look forward to further strengthening these relationships and hope David Stone OBE David Stone that our members will continue Chairman Chairman Annual Report and Accounts 2005/06 Chief Executive’s foreword

This year has been It’s been nearly two years since for 2005/06. critical care and general surgery and waiting times for bone Sheffield Teaching Hospitals to name but a few. We have mineral density tests have been a year of success became one of the first NHS The data in the hospital guide, refurbished the breast screening reduced from six months to just for Sheffield Foundation Trusts and we have which concentrates mainly on unit so women are able to have 4-6 weeks. This shows huge Teaching Hospitals already achieved great things patient satisfaction and clinical their routine diagnostic tests improvements have been made under this new and exciting outcome measures, shows high carried out in a relaxing and in just one year. Behind the NHS Foundation status. All of these achievements levels of performance across a comfortable environment. Our scenes, the introduction of a Trust which was are directly attributable to our wide range of clinical and non- major developments; the national Liquid Based Cytology excellent members of staff, who clinical services. For example, we Hadfield Wing, Chesterman pilot programme across Sheffield named “Hospital of have a pioneering spirit and score very well in areas such as Wing extension and renal has seen waits for cervical smear the Year” eagerness to undertake new cardiac surgery, general surgery service development are all test results reduced from a high challenges whilst still ensuring and orthopaedics. Similarly, our coming along well and are close of 40 days to just five days. safe and effective care. care for patients with long term to completion. Great strides have also been conditions is amongst the best made in improving histology As referred to in the Chairman’s in the country with specialist Massive improvements have services and this includes for foreword, this superb nurse support and many been made in waiting times. By example speeding up the commitment to patient care was developments to train patients the end of December 2005 all processing of biopsies for highlighted by the Dr Foster to care for themselves at home. our inpatients and day case patients with suspected cancer. Hospital Guide, an independently Importantly, the Dr Foster patients were being treated produced guide to hospital Independent Hospital Guide within six months and all new A recent National Cancer Peer services across the country shows that patients feel they are outpatient appointments took Review of the Trust’s services has sponsored by the government, treated with dignity and respect place within 13 weeks. People praised the high calibre of staff which earlier this year awarded and rate our staff very highly. undergoing radiotherapy for and the excellent delivery of Sheffield Teaching Hospitals NHS cancer are being treated faster cancer services, in particular in Foundation Trust the prestigious This year we have expanded and in Sheffield than almost radiotherapy. In terms of waiting title of “Hospital of the Year” improved services in urology, anywhere else in the country times for cancer > 06 Annual Report and Accounts 2005/06 07

Andrew Cash OBE Chief Executive

> treatment; during the final missed our target to reduce the quarter of 2005/2006 all number of patients with MRSA patients urgently referred by bacteraemia. We increased their GP were seen within two work to test patients for MRSA weeks and the Trust achieved at their pre-operation the target of 31 days from assessments and screened over diagnosis to first definitive 11,000 patients throughout the treatment for non-urgent year. We continued our referrals in all cancers. intensive teaching programme with staff and students and In relation to the 62 day target maintained our campaign to – which states that 95% of highlight the importance of patients referred urgently by hand hygiene to visitors. their GP should have started Although we still reported 90 their treatment within 62 days - cases of the infection over 12 the Trust ensured that 92% of months – around eight more patients were treated within the than anticipated - this is still a target time. This was one of the reduction of 12.6% from best results of any cancer 2004/05 and we will endeavour centre in England, nevertheless to further reduce the number falling slightly short of the of patients acquiring the national target. infection in the years to come. On both these issues there are We have also made great significant challenges faced by improvements in infection Teaching Hospitals such as control; even so, we narrowly ourselves that need to be > Annual Report and Accounts 2005/06

Chief Executive’s foreword continued

This year has been > acknowledged in treating carried out, regardless of cost to major challenge, we have us I remain certain that we will patients with complex needs. the organisation. The implemented a new continue to be one of the a year of success uncertainty of our position and improvement programme – premier-performing NHS, for Sheffield This year we reached the end of that of the NHS in a national Adding Value - which we hope academic and teaching centres Teaching Hospitals our first three-year strategic context is also compounded by; will enable us to improve in the UK. direction from 2002-2005 and the cost of reducing waiting efficiency and make savings of NHS Foundation we are now looking to meet the times, the choice initiative and around £90million over three Trust which was challenges of the next three competition from other years; approximately five years. The environment in hospitals including the percent of our budget each named “Hospital of which we function is changing; independent sector; NHS Pay year. The programme looks at a the Year” it will undoubtedly remain Reforms such as Agenda for number of key areas where we Andrew Cash OBE uncertain over the next few Change and the GP and can make best use of the Chief Executive years and so our new three consultant contracts; and the resources available whilst year strategy, which will be new emphasis on NHS care continuing to maintain the published in September 2006, being delivered in the quality of care we provide to is being drawn up to reflect community. This, we anticipate, patients in terms of the best these difficulties. will leave us with financial possible clinical outcome, shortfalls that we will need to patient experience and value for We have met all our financial address by becoming more money. Some of the steps we duties. However, we have been productive and efficient. We will are taking include looking at faced with many new all be working together to ways to reduce the length of challenges through the achieve these savings and patient stays and reducing introduction of the payment by ensure we remain ahead of the amount we spend on results tariff system which the game. agency staff. awards a fixed national fee for each procedure or operation In order to accomplish this Despite the challenges ahead of 08 Annual Report and Accounts 2005/06 09

Ward Orderly Peggy Brownall meets Prime Minister Tony Blair at 10 Downing Street in May. Peggy is to the left of the Prime Minister. Annual Report and Accounts 2005/06 Board of Directors

The Board of The Non-Executives (including Steels. Mr Stone was awarded Sheffield working at both the Trust on 6th March 2006 as the Chairman) are not full-time the OBE in 1997. Royal Hallamshire and Northern Chief Nurse. Hilary began her Directors comprises employees of the Teaching General Hospitals. She has held nursing career at the Northern the Chairman, six Hospitals. They are people who Executive Directors previous posts in executive General Hospital, where she Non-Executive live or work in the area and Andrew Cash OBE - management and clinical undertook her training and have shown a genuine interest Chief Executive services. Mrs Tierney-Moore worked as Staff Nurse and Directors and six in helping to improve the Andrew Cash was a graduate was awarded the OBE in 2002. then Sister in both the Executive Directors. health of local people. entrant to the NHS on the cardiothoracic and critical national management training Alison Smith – Acting Chief care areas. Non-Executive Chairman scheme. In his earlier career he Nurse from December 2005 Directors have a David Stone OBE - Chairman worked for the Nuffield Centre until March 2006 Hilary previously held the post majority on the David Stone has been for Health Service Studies at the Alison trained as a nurse in of Chief Nurse at the University Chairman of the Board since University of Leeds. He has West Sussex and specialised in Hospitals Coventry and Trust Board the formation of Sheffield been an NHS chief executive for renal nursing, contributing to Warwickshire NHS Trust. She Teaching Hospitals in 2001. He 18 years and has worked at the National Service Framework chairs the National Association was previously Chairman of regional and national level. He for renal services. Her of UK University Hospitals Weston Park Hospital and is currently the chair of the substantive post is deputy Nurse Directors Group. Central Sheffield University national Foundation Trust Chief Nurse at the Trust Hospitals NHS Trusts. His Network. Mr Cash was working locally and nationally Chris Linacre - Director of professional career was in the awarded the OBE in 2001. in a number of areas including Service Development steel industry and he has held Essence of Care standards and Chris Linacre joined the NHS in posts in several Sheffield steel Heather Tierney-Moore OBE Infection Control. 1971 and has worked in manufacturing companies - Chief Nurse until hospital management and including Managing Director of December 2005 Hilary Scholefield - Chief specialist personnel British Steel Engineering Steels Heather Tierney-Moore Nurse from March 2006 management wholly within and Stocksbridge Engineering originally trained as a nurse in Hilary Scholefield joined the Sheffield since that time. > 10 Annual Report and Accounts 2005/06 11

The Board of > He has held posts as John Watts - Director of Non-Executive Directors Director of Organisational Human Resources Ony Bright Directors comprises Development at the Royal John Watts has a 30-year Onyema Bright had a the Chairman, six Hallamshire Hospital and career in NHS personnel and background in Mental Health Non-Executive General Manager of Lodge executive management and Nursing before becoming Project Moor and King Edward has held senior posts in NHS Manager for a management Directors and six Hospitals prior to becoming organisations around the and professional training Executive Directors. Director of Corporate Strategy country. Prior to joining the initiative for black and asian for the former Central team at Sheffield Teaching people. Ms Bright is also part of Non-Executive Sheffield University Hospitals Hospitals, Mr Watts was the ethnic programmes team at Directors have a NHS Trust when it was formed Director of Human BBC Radio Sheffield where she majority on the in 1992. Resources at the Northern presents a weekly show. She General Hospital. was formerly a Non-Executive Trust Board Neil Priestley - Director director at the Central Sheffield of Finance Professor Chris Welsh - University Hospitals NHS Trust. Neil Priestley previously held Medical Director the post of Head of Finance at Professor Chris Welsh trained John Donnelly the NHS Executive Trent as a Vascular Surgeon and was Before retiring, John Donnelly Regional Office. He had been appointed to a consultant post was a Chief Superintendent seconded to the Northern at the Northern General with South Yorkshire Police and General Hospital prior to the Hospital in 1984. Commander for the district that Trust merger where he was Before becoming Medical covers the Trust’s hospitals. He acting as Director of Finance. Director, Professor Welsh held joined the Police as a cadet in Mr Priestley is a Fellow of the the post of Regional 1966 and, in time, headed up Chartered Association of Postgraduate Dean for the NHS the Force’s Research & Certified Accountants. Trent Region for six years. Development, Community > Annual Report and Accounts 2005/06

Board of Directors continued

The Board of > Relations, and Police involved in the management of Dean of the Medical School at 1st July 2009 Vickie Ferres Traffic Departments. the North-East Region in the University of Sheffield and is and Anthony Weetman Directors comprises general and the Sheffield office the appointed academic the Chairman, six Vickie Ferres in particular where he was representative on the Trust The Chairman’s Term of Non-Executive Vickie Ferres is Director of Age Business Unit Managing Partner Board. Professor Weetman is Office will finish on Concern in Doncaster - a for nine years until retiring. Professor of Medicine and an 1st July 2007. Directors and six position held since 1983. Honorary Consultant at the Executive Directors. During this time the John Stoddart CBE Trust with a special interest in Recommendations for Non-Executive organisation’s annual turnover Trust Vice Chairman John thyroid disease and appointments are made by the has grown from £20,000 to Stoddart has a background in autoimmune endocrine Foundation Trust’s over £1.25 million. A Sheffield higher education and was Vice Directors have a disorders. He was formerly a Appointments Committee and resident, Vickie has extensive Chancellor of Sheffield Hallam majority on the Non-Executive Director with approved by the Governors’ experience in working with University until his retirement. both Sheffield Health Authority Council. Remuneration for Non- Trust Board elderly people and He holds honorary degrees from and the Northern General Executive Directors (including understanding the health and both the University of Sheffield Hospital NHS Trust. the Chairman) is recommended social care issues that affect and Sheffield Hallam University. them. Mrs Ferres was formerly He is a Director of Sheffield by the Remuneration a Non-Executive Director at the Assay Office. Mr Stoddart was The Non-Executive Directors’ Committee and approved by Northern General Hospital previously a Non-Executive Terms of Office are for a set the Governors’ Council. NHS Trust. Director at the Northern period and will finish as follows: General Hospital NHS Trust. He Remuneration of Executive Vic Powell was appointed a CBE in 1995 1st July 2006 John Donnelly Directors is carried out through Victor Powell is an accountant for services to higher education. and John Stoddart the Trust Board’s Remuneration by profession and worked for Committee. Further details are KPMG in Sheffield throughout Professor Anthony Weetman 1st July 2007 Vic Powell and given in the remuneration his professional career. He was Professor Anthony Weetman is Ony Bright report on page 52. 12 Annual Report and Accounts 2005/06 13 Celebrating Foundation Trust status

In our first full The Governors’ Council is made invaluable resource to the Trust. Approving the appointment services as well as an up of 36 governors who have They have a duty to represent or removal of the Trust’s opportunity to meet staff from financial year as a volunteered to represent the the views of their constituency auditor following a across the hospitals who give Foundation Trust, views of public, patients and and are expected to actively recommendation from a advice on all sorts of health- Sheffield Teaching staff who are members of the seek the views of other nominated sub-group of the related issues. Over the coming Foundation Trust. Six governors Foundation Trust members and Board of Directors year, the Trust is also introducing Hospitals has faced are elected to represent report back their opinions on other members’ events including and overcome many patients who have used the key developments. Members of the Foundation talks and lectures on popular hospitals’ services within the Trust are invited to become health topics by our expert new challenges last five years; the public are Other statutory duties of the involved in the hospitals by nurses and doctors. thanks to the represented by 12 governors; Governors’ Council include: attending the Annual Health support of everyday five staff groups each have Fair. Each year, around 500 Membership of the Foundation their own governor; and there Appointing Non-Executive people attend the Health Fair, Trust is completely free of local people are also 13 representatives who Directors, including the Trust which incorporates the Annual charge. To become a member, who have taken an act for the interests of our key Chairman, via an General Meeting and provides please contact our membership partner organisations. Appointment Committee members with information manager Jane Pellegrina on active interest in the supported by an about their local hospital 0114 2714322. way their hospitals So far, the Governors’ Council Independent Assessor are run. has proven to be a great Currently, membership of the Foundation Trust stands at: success; meeting formally four Determining the times every year, the governors remuneration of the Chair Public Constituency: 1870 members have had a great deal of input and Non-Executive Directors Patient Constituency: 3475 members into specific projects and via a Remuneration initiatives where their own Committee advised by Staff Constituency: 12,823 members particular experience or the Director of Total membership: 18,168 members expertise has proved an Human Resources Annual Report and Accounts 2005/06 Our Governors’ Council

The Governors’ Governors are elected to stand and three patient vacancies. All Public Members have an option categories: medical & dental, for office by members of the Governors elected from May to become Patient Members nursing & midwifery, allied Council is made up constituency they are interested 2005 onwards will serve a providing they have been a health professionals, scientists of everyday people in representing. Each election is three year term of office. patient in the Trust in the & technicians, managerial, who represent the held in accordance with the period since 1998. There are administrative & clerical and election rules as stated in The Governors cover the currently 1889 public members. ancillary, works & maintenance. interests of our the Foundation Trust following constituencies: Any member of staff employed patients, the public Constitution, using an Patient on a Sheffield Teaching independent electoral service. Public Patient Members are those Hospitals contract is eligible to and our partner This constituency currently has patients who live outside the become a staff member of the organisations. The first set of governors was 1870 members and is Sheffield electoral ward Foundation Trust. There are elected in May 2004 when represented by twelve boundaries and those within currently 12,823 staff members terms of office ranging from Governors. The Public Sheffield who opt to be a of the Foundation Trust. one to three years were Constituency is divided into patient rather than public allocated. Since then, there has four areas which mirror the member and have been Representing our been a subsequent election to Primary Care Trusts in patients of the Trust in the Communities find three patient governors Sheffield: Sheffield North, period since 1998. The patient The Foundation Trust continues and four public governors. In Sheffield South West, Sheffield constituency has seven to strengthen the size and total, there were 24 candidates West and Sheffield South representatives on the diversity of its membership for these posts, the terms of East, but is defined by electoral Governors’ Council who through a number of key which will run for three years. ward boundaries. currently represent initiatives. The Trust is working 3,475 members. with its Disability Steering Further elections being held in Public Membership is open to Group and local disability May 2006 will aim to fill 13 all members of the Sheffield Staff charities to increase positions including five staff public living within the The staff constituency is further membership among disabled vacancies, five public vacancies electoral ward boundaries. broken down into five users and is also working > 14 Annual Report and Accounts 2005/06 15

> closely with the UK Youth The Governors’ Council as at the end of March 2006: Parliament and Voice and Influence Team of Sheffield Patient Governors Susan Wilson Bob Kerslake/ Jan Wilson Futures to encourage younger Diana Chadwick Sheffield City Council people to take an active Susan Coldwell Sheffield West interest in their local hospitals. John Holden Martin Colclough Alan Wittrick Kenneth Murta James Smith South Yorkshire Strategic Health In the public constituencies Heather Gordon Beryl Wilson Authority black and minority ethnic Helen Wilde representation has increased South East Sheffield Chris Bentley from 7.3% to 11%. The Trust Staff Governors Richard Chapman South Yorkshire Public Health Network is committed to further Mike Collins Hazel Hughes increasing the number of black Rose Bollands Edwin Speight Diana Green and minority ethnic members Stephen Westby Sheffield Hallam University and has formed links with the Mark Hattersley Partner Organisations Black Community Forum in Dave Weston Paul Schatzberger Bob Boucher Sheffield - a community North Sheffield Primary Care Trust University of Sheffield organisation representing 90 Public Governors membership organisations from North Sheffield Nicholas Steele Sylvia Yates across the ethnic communities. Chris Suddes Sheffield South West Primary Care Trust Sheffield First Partnership Sharon Tabberer Margaret Whiteley Simon Gilby Beryl Seaman Sheffield West Primary Care Trust Voluntary Action Sheffield Sheffield South West Sylvia Bennett Lynne Young Cathy Edwards Philip Seager South East Sheffield Primary Care Trust NORCOM (Commissioning Consortium) Annual Report and Accounts 2005/06 Investing in buildings and equipment

Through our The total capital expenditure Expenditure £000 £000 continued for the year was £45.7 million, Medical Equipment 9,837 which was used to purchase MRI Scanner (NGH) 1,415 investment we are new and replacement Digital Imaging Equipment in A&E (NGH) 1,162 ensuring that equipment, support initiatives Replacement Linear Accelerator (WPH) 1,116 to meet statutory compliance Multi-slice CT Scanner (RHH) 1,175 Sheffield Teaching and improve waiting list and Multi-slice CT Scanner (NGH) 976 Hospitals continues access, and a number of Other 3,993 infrastructure improvements. Statutory Compliance 3,545 to change and grow We also introduced a number Upgrade of Ward J2 to Firecode compliance (RHH) 2,027 of new service developments to offer first class Other Firecode Works 611 associated with the Trust’s patient services in a Bone and Tissue Bank 308 Service Development Strategy. Other (eg Health & Safety, Disability Discrimination, Legionella etc) 599 comforting A breakdown of capital environment. expenditure is shown here. Information Technology 839 Theatre Computer System 228 Other 611 Infrastructure 11,073 Basic Sciences Project (RHH) 4,781 The Trust has entered into a Private Finance Initiative (PFI) Expansion of Electrical Capacity and Infrastructure (NGH) 3,910 agreement with an estimated capital value of £25.7million Sterile Services Facilities (RHH) 200 which will enable the construction of the Hadfield wing, a Other 2,182 new medical ward block on the Northern General Hospital Service Development 20,419 site. The full annual payment in relation to this scheme is Cardiology Capacity Expansion (NGH) 8,262 £2.5m and the project has a length of 30 years. Renal Facilities Expansion (NGH) 5,916 16 Annual Report and Accounts 2005/06 17

The new Cancer Information and Support Centre opened in April 2005.

Expenditure £000 £000 WPH Site Redevelopment 1,138 Stem Cell Research Facilities (JW) 1,130 Office Accommodation (NGH & RHH) 681 Dental Clinical Skills Facility (CCDH) 603 Critical Care Expansion (NGH) 598 Post Operative Surgical Unit (NGH) 535 Expansion Neurosciences Critical Care Capacity (RHH) 219 Relocation Patient Discharge Lounge (NGH) 155 Dental School Expansion (CCDH) 124 Post Operative Surgical Unit (RHH) 118 Car Parking (NGH/WPH) 68 Other smaller schemes 872 Total Expenditure 45,713

Total capital income available to the Trust for the year was £55 million, including £7.1 million from donations and other contributions towards capital expenditure. The capital income is analysed as shown here.

Income £000 Resources available from the Department of Health/Internally Generated 47,912 Sheffield University investment (largely in respect of Basic Sciences Project) 5,801 Other Donations/Contributions 1,331 Total Income 55,044 Annual Report and Accounts 2005/06 Performance overview

During 2005-2006, There has been an increase in The number of patients on Target Actual Actual % Actual the Trust reduced the number of patients our inpatient waiting list 2005/06 Activity Activity Activity undergoing inpatient and day decreased by 3% 2005/06 2004/05 Increase waiting times even case treatments and more Inpatient and 168,918 174,932 165,070 +6% further to new low patients are coming for 99% of patients with outpatient appointments than suspected cancer who were day case episodes levels whilst still ever before. referred by their GP for an Outpatient 773,475 797,295 766,586 +4% managing to treat urgent appointment were attendances During the year, there was a seen within two weeks. more patients than period of sustained pressure During 2005/06 the number of patients attending for outpatient ever before. due to a rise in emergency appointments increased by 4%, again this is an impressive admissions to the hospital. achievement in the current challenging times in which we operate. Despite these pressures, the Trust still managed to meet its targets and reduce Target 31 March 31 March % Change waiting times: 2006 2005 between 2005 & 2006 No patients waited more Total inpatient 9477 11414 11727 -3% than six months for inpatient waiting list or day case treatment Inpatients waiting 0 0 708 -100% No patients waited more 6 months & over than 13 weeks for an outpatient appointment Outpatients 0 0 703 -100% waiting 13 weeks and over 18 Annual Report and Accounts 2005/06 19 The year at a glance

So much has April commended by education October January 2006 The new Cancer Information watchdog OFSTED. Domestic assistant Janice A £2.2million refurbishment happened over the and Support Centre opens to Swords takes centre stage of the urology department to last twelve months provide advice and July at the Trust’s annual provide better consulting and that it is difficult to information for patients Staff in the gastroenterology Thank You Awards after examination facilities is diagnosed with cancer and department launch a winning the prestigious officially opened. mention even a few Clinical scientists Dr Paul campaign to raise awareness Chief Executive’s Award of our success Bacon and Dr Ben Heller take of coeliac disease. for Excellence. February first prize in the “Innovative A New Visitors’ Code with stories. Here are Device or Technology” August November infection control guidance some of the category of the prestigious Nurse Simon Palfreyman is Clinical Scientist Dr Peter for visitors and set visiting highlights. Medipex Innovations Awards. awarded £90,000 by the Metherall is named as one times is approved by the Smith and Nephew of the top two healthcare Trust Board. May Foundation to study the scientists in England for Ward Orderly Peggy quality of life of patients innovation and development March Brownall is invited to meet with venous leg ulcers. at the first ever Chief Expanded renal services Prime Minister Tony Blair at Scientific Officer awards. including a brand new, a 10 Downing Street September dedicated outpatient reception and the Trust Laughter is the order of the December department are opened announced a further day when local poet and TV Doctors at the Northern at the Northern £1million investment in personality Ian McMillan General hospital undertake General hospital. improving cleanliness. visits to host some poetry a research project that could workshops to help patients help improve the safety of June find new ways of expressing some treatments given to The day nursery, which cares their thoughts and feelings patients at risk of having for employees’ children, is about their health. a stroke. Annual Report and Accounts 2005/06 Our staff

This year’s annual All of these priorities are part of the Trust’s zero tolerance hospital. Other patients have any such actions.” underpinned by our ongoing policy on abusive behaviour to been given warnings and asked report is based on commitment to improving the teach 8000 frontline staff how to follow “contracts of care” - One of our core objectives is to our achievements quality of care by providing the to diffuse potentially aggressive agreements between the continually improve the working in meeting 10 Key best training and medical situations before they escalate. hospital and the patient that lives of our staff and ensure education, and recruiting, spell out acceptable behaviour. they have access to policies that Aims: our top developing and retaining the Over the last year, the Trust has can help them to balance their priorities which we very best workforce that reflects made clear its intention to Director of Human Resources, home and work lives the diverse community we reduce incidents of verbal and John Watts, says, “These successfully. One such policy know are serve. Without our staff, the physical abuse against staff. measures are important because ensures that staff from all levels important to the Trust would not be able to Reports of this behaviour have they ensure our staff are able to of the organisation can access people we serve. provide the best in hospital care decreased year on year since carry out their jobs to the best training and personal whilst leading the field in the Trust first started collating of their ability and provide high development opportunities. research and new treatments. and reporting the data to the quality care without feeling Counter Fraud and Security threatened. We always take Anthony Brookes first began One way of ensuring our staff Management Service (CFSMS) into consideration a patient’s working at the Northern are happy and feel secure in in 2003. condition or the medication General hospital in 1992 as a their work is by making sure they are taking which in a porter with the Diagnostic they are safe. The Trust has Work is continuing to reduce significant number of cases Imaging Department and, spent around £400,000 on these assaults further and this makes them confused, although he enjoyed this role improving security by adding year the Trust has used its policy disorientated and more for nearly five years, working extra closed circuit television on violence and aggression to likely to lash out. However, closely with the X-ray team had cameras and increasing security protect staff and patients by there are a small number of made Anthony realise that he patrols around the sites. Two excluding a deliberately and people who are deliberately wanted to develop a career in personal safety training advisors persistently violent patient from abusive and we take a hard radiography. Through the have also been employed as receiving treatment at the line on the perpetrators of support and training provided > 20 Annual Report and Accounts 2005/06 21

> by the Trust, he became a qualified radiographer and support worker with the have gained a place at Derby department before undertaking University. All this would not training to secure a job as a have been possible without all radiography assistant in 2000. the support given to me by my departmental colleagues and Under a new four-tier system the Trust’s Improving Working introduced to relieve Lives team.” recruitment problems in radiography across the country, Anthony, who has two young Anthony became eligible to children, is continuing to juggle study for the post of assistant his home life with his role as a practitioner and was soon able radiography assistant to undertake limited practitioner whilst studying radiography tasks such as at university for two or taking some X-rays. His three half days a week, burning ambition to become a supported by the Diagnostic fully qualified radiographer led Imaging Department. him to enrol at university where, with the support of his training manager, he is on the way to obtaining his ultimate goal. He said, “I was encouraged by my training manager to fulfil my desire to Trainee Radiographer go on to become a fully Anthony Brookes. Annual Report and Accounts 2005/06 Improving safety for our patients

The safety of our Staff in the pharmacy with the treatment whilst The Trust has also been very at the hospital, which means a department have introduced a in hospital. involved in working to improve lot of people with this allergy patients is also of new system to improve safety for patients and staff by could potentially come into great importance to communication between day Previously, the absence of a reducing the risk of allergic contact with latex during their us and much work is duty and on-call staff and separate logging facility for reactions to latex. work or treatment. To improve ensure that some patients are these types of medicines - safety for patients and staff, carried out behind able to access their specialist which aren’t usually supplied by Around six percent of the UK particularly those who receive the scenes to medication in a timely manner. the Trust and therefore don’t population are allergic to latex regular hospital care, we have automatically come under the protein or the chemicals used to recently introduced latex-free improve our services, To improve convenience for Trust’s rigorous medicines process natural rubber products examination gloves across all of reduce clinical risks patients and ensure there is no management system- meant and the allergic reactions they our hospitals.” and ensure patients break in their medicine-taking that staff working out of experience can be mild, routine, the pharmacy normal hours weren’t always moderate or severe and in rare An innovative approach receive the best department makes aware of when the delivery was cases may even cause fatalities. thought up by a team of staff possible care. arrangements for certain taken or where the medicines People who come into regular has improved patient safety and patients with long term were stored, which could lead contact with latex can also communications with general conditions, such as multiple to a slight delay in the patient become “sensitised” meaning practitioners (GPs) by making sclerosis or those receiving receiving their medication. A that they develop an allergy to the best use of existing hospital dialysis, to receive certain new system was introduced in the product. resources and without added specialised medicines via a July 2005 that ensures that cost to the Trust. home delivery service. If the medicines awaiting collection or Clinical procurement specialist, patient is admitted to hospital, delivery are logged and can be David Newton, is one of the Previously, patients being the hospital’s pharmacy team easily located by on-call staff at team leading the introduction discharged from hospital were will take delivery of the any time of the day or night to of latex-free gloves. He said, given a discharge sheet on medicines on the patient’s ensure the patient receives their “Each year we get through leaving hospital with important behalf so they can continue medication on time. around 19 million latex gloves details of their stay and the > 22 Annual Report and Accounts 2005/06 23

> medication they were team of “specimen drivers” - prescribed. However, an audit porters who already collect and found that only 26% of deliver mail, samples and patients remembered to inform swabs from GP surgeries and their GP of their hospital stay clinics to the hospitals for and pass on the discharge testing. By utilising this well- sheet. To improve safety by established service, the team ensuring GPs have the most up has relieved the burden on to date information on their patients by ensuring that now patient’s condition, a team over 80% of GPs are directly from the Trust set about receiving their patients’ looking at ways to improve the discharge information in a communication between the timely manner. hospitals and primary care services. A number of options were considered, including an expensive and complicated electronic system. However, the team used their knowledge and innovative thinking to make the best use of resources available.

Now, patients’ discharge sheets The specimen drivers’ service are delivered on time to GP has helped improve surgeries across the city by a communication with GPs. Annual Report and Accounts 2005/06 Extra beds for our hospitals

This time last year, With limited space for winter planning to provide extra discharged from hospital in a successful in reducing the expansion, innovative ways of inpatient facilities when we timely manner. Over the last year average length of stay of the Trust pledged using existing facilities had to be know the service is under more the system has been patients on the stroke ward by to increase the found to ensure this demand. During the summer implemented on eight wards around 15 days and has number of development could take place; months, when there is a lull in which care for patients with improved the flow of patients to Ward J2 proved to be one of demand for medical inpatient stroke, dementia or older people the dedicated stroke unit so hospital beds these new ways. care, the ward will be used to with orthopaedic problems to more patients are receiving across the Trust. “decant” other wards, to enable help reduce the length of stay of specialist care on the ward much The ward, on J floor of the Royal the Trust’s infection control some patients and free up beds more quickly. This work has Hallamshire hospital, had been programme of wall washing to for other patients. freed up hospital beds which turned into offices many years continue quickly and efficiently. can be used to care for ago to accommodate clinical and Each ward has a team of staff patients undergoing elective administration & clerical staff. It Providing “extra beds” isn’t just working alongside a discharge care thus reduce waiting times was fully re-commissioned and about the physical space but the liaison nurse, who co-ordinates for treatment. opened on 2nd January with a ability to better manage each each patient’s care with other total of 28 beds which are used patient’s care to ensure they departments and outside Advances in medical technology for acute medical patients. remain in hospital only as long agencies such as social services have meant that many as is necessary. It is well to ensure occupational therapy operations and procedures can A distinct advantage of the new recognised that medical patients, assessments are carried out and now be carried out in a day case ward, which has been fully re- particularly those with other the correct care package is in setting rather than requiring wired and updated with new conditions such as dementia, are place to support the patient patients to stay overnight. Less security and patient call systems, likely to spend more time in once they return home or to than fifteen years ago, a person is that it has been developed hospital. A case management residential care. undergoing surgery to remove specifically to enable a flexibility system has now been set up on symptomatic gallstones would of service like no other. The ward some wards to address this issue The case management have spent around five days was opened as part of the Trust’s and ensure patients are programme has so far been very recovering in hospital. 24 Annual Report and Accounts 2005/06 25

These new developments have meant that most patients undergoing a day case procedure can return home the same day, improving their experience and reducing the need for a hospital bed thus freeing extra beds for other patients. Since the introduction of a day case laparoscopic cholecystectomy service at the Royal Hallamshire hospital in 2005, more than 30 patients have undergone keyhole surgery to remove their gallstones. One third of people needing their gallstones removed are eligible to undergo the procedure, which is much less invasive, more comfortable for the patient and also means that, in over 90% of cases, the patient is able to return home within 8-9 hours of coming to hospital. A new environment for ward J2. Annual Report and Accounts 2005/06 Reduced hospital infections

At Sheffield Teaching August 2005 also saw the first reported at the Trust, giving a antibiotics when absolutely resistant it makes any infection set of figures published by the rate of 1.15 cases per 1000 bed necessary and for the shortest they cause more difficult to Hospitals, the control Health Protection Agency days and ranking the Trust amount of time possible for treat (although MRSA can be of infection is taken showing rates of the eighth best nationally compared their particular condition.” treated with other antibiotics). very seriously by staff bacterium Clostridium Difficile to other specialist hospitals. reported in patients over 65 The last twelve months have Many infections such as MRSA, in every occupation across the country. Cases of the condition have seen new developments in which has been widely reported and at all levels of been successfully managed by infection control with the onus in the news, are spread through Clostridium difficile lives introducing thorough hand very much on involving and direct human contact and can the organisation. naturally in the gut of around hygiene and cleaning empowering staff at the affect people who are already 3% of healthy adults where it procedures as well as frontline to tackle infection risks very unwell such as people in rarely causes problems. developing a strict policy for the head on. This has helped us to hospital. In order to tackle these However, when certain prescription and use of reduce rates of Methicillin infections the Trust announced antibiotics disturb the balance antibiotics. Tim Gleeson, an Resistant Staphylococcus Aureus an extra investment of £1million of 'normal' bacteria in the gut antibiotic pharmacist, says, (MRSA) infection by 12.6%. to be used to improve Clostridium difficile can cause “Clostridium difficile does occur cleanliness. We also introduced illness. It can also be spread naturally in the gut of some Staphylococcus Aureus is a very alcohol hand rub – which kills from person to person on the people. When we use common type of bacteria. In 99.9 percent of the most hands, and spores can antibiotics, the balance of the fact, it lives on the skin and in commonly found germs – to contaminate the environment, bacteria (flora) in the gut can the nose of around a third of us every ward entrance and such as beds and equipment, if change which can lead to without causing infection or hospital bedside across our not correctly cleaned. diarrhoea or severe doing any harm at all. hospitals and we are actively inflammation of the bowel. Methicillin is a type of antibiotic encouraging visitors and staff to In 2004 - the latest full year for One way we tackle this that some Staphylococcus use the hand rub before and which figures are available - problem is to ensure that Aureus have become resistant after visiting patients to reduce 464 cases of C. difficile were patients are only given to over time. If the bacteria are the risk of cross infection. > 26 Annual Report and Accounts 2005/06 27

> Hospital head porter Graham Biggins became the first member of staff to volunteer as a local hand hygiene champion and inform colleagues of the importance of using correct hand-washing techniques and alcohol hand rub. Graham has been fully trained by infection control nurses to ensure he is able to demonstrate the correct hand cleaning techniques to colleagues across the hospitals.

Since then, around 100 members of staff have pledged to spread the word by becoming local hand hygiene champions in their areas. A ward accreditation scheme introduced in March 2006 has also been very successful with two wards already receiving a certificate for excellence in infection prevention and control. Annual Report and Accounts 2005/06 Shorter waiting times

We recognise that Waiting times for cancer have complemented by specific changes without the support of showed that many scanning always been a high priority for higher aims: to treat patients all levels of staff.” appointments were wasted by being ill is a stressful Sheffield and nationally there requiring curative treatment patients cancelling at the last experience, which is are a number of targets that within 28 days, palliative An initiative within the minute and that scanning times why we’ve worked need to be met to ensure patients within 14 days, and metabolic bone centre has led could be reduced if the correct that patients are receiving the emergency patients within 48 to a dramatic reduction in support team was in place to hard to reduce the best care. hours. Over 90% of patients waiting times for the help prepare patients for time people spend requiring radiotherapy are now measurement of bone mineral their scan. In radiotherapy, which is used treated within these time density, which is used to assess waiting for to treat some cancer patients, frames: some of the highest an individual’s risk of sustaining In May 2005 the team put diagnostic tests Sheffield has become one of rates in the country. a fracture. In June 2003 the these and other changes into and treatments. the premier performing centres metabolic bone centre moved practice by slightly increasing for providing this treatment in a Clinical Director for Radiation into newly refurbished premises the hours worked by the timely manner. In January 2006, Services, Dr Peter Kirkbride, adjacent to the Sorby Wing. support workers and appointing the government introduced a says, “Fundamental to this However, the move caused a clerk to prevent a backlog of set of waiting time targets that success has been visionary and some disruption to the service reports as the scanning activity state 95% of cancer patients sustained investment. Since and by January 2005 the wait increased. Thanks to these referred urgently by GPs should 1999 we have undergone two for a routine bone scan had changes and the hard work of be treated within 62 days of expansions to the service and reached six months. staff in all areas of the referral and 98% of all cancer have increased the number of department, waiting times by patients should receive their linear accelerators – the Clinical staff and the centre’s the end of September 2005 first definitive treatment within machines used to deliver management team worked were at an all time low of just 31 days of the decision to treat. radiotherapy - from four to together to map out the 4-6 weeks. seven as well as increasing CT “patient pathway” to identify However, the Trust felt that and MRI facilities. However it is where a number of changes It isn’t just waiting times for these targets needed to be impossible to implement these could be made. The results treatment that have been > 28 Annual Report and Accounts 2005/06 29

> reduced. In an effort to transport patients are given a ensure patients waiting for red card to enable them to be hospital transport are made ‘fast-tracked’ though the more comfortable and dealt various clinical procedures for with more efficiently and example X-ray, to help make effectively during their sure they are ready to be appointment at the Charles collected on time and minimize Clifford Dental Hospital, an time spent in the waiting areas. Ambulance Liaison desk and designated waiting area has When their treatment has been been created. completed the patient waits in comfort for their transport to This new feature, on the arrive in a new waiting area, ground floor main reception which has been specifically area, has been specifically designed to provide a quiet rest designed for use by patients area, away from draughts and and their escorts attending by the activity of the main waiting hospital transport. On arrival area. Reception staff are on the patient reports to the hand to monitor patients reception desk where a during their wait and to member of reception staff then provide blankets and hot drinks informs the appropriate to keep patients warm. department. If necessary a nurse will be asked to come and escort the patient to the Peter Kirkbride, Clinical Director for department for treatment. All Radiation Services. Annual Report and Accounts 2005/06 Investment in new buildings

Continued The Trust’s newly refurbished have been improved with real dedicated centre. The new from Sheffield – the biggest urology outpatient department benefit for our patients. The facilities have also increased individual orthopaedic unit in investment has at the Royal Hallamshire changes have also enhanced the number of clinics that are the country – and other improved services Hospital was official opened in the working environment for held to cater for approximately centres across the country to for patients in January by Sheffield born actor our staff in terms of light and 13,000 patients a year and request donated bone for use Thomas Craig, who starred as space, making the department have enabled special services in surgery. wards and Tommy Harris in the popular a much brighter and happier such as anaemia clinics, departments as ITV soap Coronation Street. place to work.” peritoneal home dialysis Bone is actually the second training and counselling most commonly transplanted well as “behind The department underwent a A £10.5 million development sessions to be held in a relaxing tissue after blood and performs the scenes”. £2.2 million refurbishment to of renal services at the and comforting environment. a vital role in many orthopaedic provide more space for Northern General hospital is operations. Bone can be consulting and examination underway and will almost Further developments will donated by patients rooms as well as quiet rooms double the number of inpatient improve inpatient facilities by undergoing orthopaedic where patients can spend time beds on the unit. The first providing a further 34 beds for operations - such as hip with clinicians and counselling phase of the work has renal patients and seven replacement - when a piece of staff discussing their diagnosis. already been completed and a dialysis “stations” for patients their bone is removed which Deputy outpatient manager brand new, dedicated undergoing kidney dialysis. would otherwise go to waste. and refurbishment project lead outpatients building opened in The bone bank holds stores of Sue Beaumont said, “The March 2006. A little known yet vital service donated bone which is tested, refurbishment project has been was reopened at the Northern prepared and deep frozen at a a great success and has made a The outpatients department General hospital in October temperature of around minus real difference for both staff provides a much improved after undergoing a full 80ºC in the special freezer and patients. Accommodation environment, enabling patients refurbishment. The new, state units for use in future space has been increased by to undergo their entire of the art facility was officially surgery such as hip two thirds and as a result clinics outpatient care in one opened to enable surgeons replacement operations. 30 Annual Report and Accounts 2005/06 31

Donated bone is stored at -80ºC.

“Many people are aware of organ donation and are very supportive of it but very few people know much about donation of bone and the role it plays in thousands of operations carried out in hospitals each year,” says Mr Bob Kerry, orthopaedic surgeon, “Sheffield surgeons helped pioneer the use of donated bone in joint replacement surgery and as one of the biggest specialised joint replacement centres nationwide, I think it is vital that we have a facility like this which is one of the best in the country." Annual Report and Accounts 2005/06 Improved cancer care

In Sheffield, we Patients with colorectal cancer Jill Dean says, “I think the service screening unit at the Royal away from the main hospital are very satisfied with the care really works well because we are Hallamshire hospital. building, which helps women are constantly they receive from the Trust’s able to offer more than just the having a routine mammogram to pioneering new ways unique follow-up service which medical perspective. Colorectal In Sheffield around 16,000 feel less anxious about the test. of delivering cancer is provided by two colorectal cancer can have a huge impact women attend the unit each nurse specialists. on a person’s life. Not just year for a mammogram – a form The unit has been named care that truly meet A recent satisfaction survey physically but emotionally and of x-ray for each breast. Around Marsden House in memory of a the physical, showed more than 97% of financially too. The service was five percent of women are former breast cancer patient, patients think the service is set up to help ensure that recalled for further tests and last Jayne Marsden, and to thank her psychological and “good”, “very good” or patients undergoing surgery for year the unit found 67 invasive husband and family for their emotional needs of “excellent”. Nurse specialists Jill colorectal cancer are able to cancers and 25 pre-invasive tireless charitable work raising the patient. Dean and Viv Goodfellow access the information and cancers that may have otherwise funds for the unit and also for provide a holistic service, support that they need to help gone undiscovered. This enabled Weston Park Hospital. including psychological support, them cope after surgery and we the women involved to start to over 300 bowel cancer spend as much time as they potentially lifesaving treatment We are continually improving our patients for five years after need talking through the as quickly as possible. services to make sure our surgery. The team manage the challenges they face.” patients receive high quality care patients’ care, organising The £135,000 makeover has in the best environment. Earlier investigations and monitoring Cancer detection and prevention enabled staff to screen an extra this year, two services were their progress with the support are also a high priority and 4000 patients in the last year by introduced to reduce the time of colorectal cancer surgeons. particularly so for breast cancer, providing larger scanning rooms, cancer patients wait for their They also work closely with the which is one of the government’s extra changing facilities and vital chemotherapy treatment. Cancer Support and Information key targets. Last July, local MP training and clerical space. The Chemotherapy is the use of a Centre to help patients regain Meg Munn joined staff and new development also boasts combination of drugs to their confidence and cope with patients to officially unveil the better disabled access and is help treat many different types lifestyle changes. newly refurbished breast housed in a non-clinical building of cancer. > 32 Annual Report and Accounts 2005/06 33

> Around 700 patients a month new pre-assessment service who undergo their splits the patient’s appointment chemotherapy treatment as an over two days so that all tests outpatient are now able to start can be carried out at the first their treatment in a timely part of the appointment and manner after the service was re- the chemotherapy prepared in designed to reduce the time readiness to be administered to patients spend waiting for the patient at the second part chemotherapy sessions to of the appointment, usually the begin. Previously, patients following day. This eliminates would come to one the long wait for patients and appointment where they would means that around 85% of be assessed and have their patients now receive their bloods and other tests carried chemotherapy within 30 out and a chemotherapy minutes of their appointment prescription written up which start time. An admission clinic would then be delivered to the has also been introduced for pharmacy department to be inpatients; they are now made up whilst the patient assessed before admission to waited for as much as a few hospital so that their hours for the chemotherapy chemotherapy can be made drugs to be ready. available for treatment avoiding an extra wait for the patient To streamline the process and whilst in the hospital bed and reduce the amount of time reducing the demand on Local MP Meg Munn (left) with patients spend in hospital, the inpatient beds. the breast screening team. Annual Report and Accounts 2005/06 Fewer cancelled operations

The Trust’s rate of In previous years, some planned surgery involves a procedure have all of their pre-operative infection control. operations have had to be where extra support is needed tests carried out in advance of cancelled operations cancelled because more during recovery. coming in for their surgery and Patients planned to undergo hip is one of the lowest emergency patients were simply need to come to the unit and knee replacement in the country but brought in needing high Staff from various occupations on the morning of their operations are screened for dependency care leading to jointly designed the unit which operation for final preparation. MRSA before admission and we are still striving higher demand for critical care caters solely for surgical patients This saves the patient spending those without the bacterium to reduce this beds. Last year the Trust who have been booked and the traditional night in hospital can be treated on the ward. introduced a new Post- screened for infection in before an operation, enabling Patients who may test positive number even further. Operative Surgical Unit (POSU) advance therefore making the them to remain in the comfort for MRSA, or who have providing seven dedicated high unit an MRSA-free facility. of their own home and, as a previously had MRSA are dependency beds for people bed is not needed overnight, it admitted to another undergoing planned surgery. A 36 bed theatre admissions also reduces the risk of surgery orthopaedic ward, where they unit which opened at the being cancelled due to pressure can be cared for appropriately. The POSU opened in August beginning of last year has also on beds from emergency cases. The ward does not accept and is designed specifically for played a key role in providing emergencies, non-orthopaedic patients who are expected to more surgical procedures to Another initiative that has or medical patients, which need higher dependency care patients and in reducing the helped to reduce the number of means patients having planned after their surgery. This is often number of operations that are cancelled operations is the operations are guaranteed a bed when a patient needing cancelled due to emergency Huntsman 3 project at the for their recovery and best use is relatively routine surgery also pressures on hospital beds. The Northern General hospital site, made of the time in theatre. has an underlying health ward enables patients to come which involved the This also helps to ensure that condition (such as breathing in to hospital on the day of their refurbishment of a 34 bed the ward is kept free from problems or diabetes) that operation rather than needing a orthopaedic ward and MRSA, and the very careful means they will need extra care hospital bed the night before. the introduction of control of infection procedures as part of their recovery, or their As part of the service, patients nationally accredited methods of ensures that there is a very > 34 Annual Report and Accounts 2005/06 35

> low incidence of all other forms of infection as well.

Since the ward opened in its new format in October 2005 the number of patients planned to be admitted who had to be cancelled has been reduced, and in the first three months 44% fewer patients had their operations cancelled. The Huntsman 3 project has also reduced the length of time patients spend in hospital and there has been a significant reduction in the cost of treating infections with antibiotics.

A new POSU has been planned for the Royal Hallamshire hospital, which will open in 2007 to provide 14 dedicated critical care beds for patients undergoing planned operations at the hospital. Annual Report and Accounts 2005/06 Faster diagnostic tests

Ground-breaking The Trust has introduced an technique is four times better at minimum intervention.” quickly than in the past. award winning service for early detecting cancers than diagnostic tests and bowel cancer detection that can traditional endoscopy and the A new national project piloted The histology service plays a new ways of show results in as little as six service is so successful that in Sheffield last year has also crucial role in providing an working have been hours without the need for 96% patients followed up after shown vast improvements in accurate and timely diagnosis major surgery. Using new their treatments have no diagnostic tests which will for patients undergoing tests to introduced to reduce advances in magnification and recurrence of cancer. improve services for more than find out if they have cancer. The the time patients ultrasound not available Patients undergo a single 2200 local women. Previously department is responsible for anywhere else in the UK, colonoscopy procedure rather around 6% of cervical smear reporting back the results of spend waiting for a endoscopists are able to than diagnosis then a separate tests could not be read. samples or biopsies to the diagnosis. diagnose, stage (detect how far surgical procedure to remove Introducing the Liquid Based consultant in charge of the a cancer has spread) and treat any cancerous tissue, reducing Cytology programme - which is patient’s care. early colonic bowel cancers in anxieties and the possible risk a new way of taking and one go under sedation and as a of complications during surgery. managing cervical smear tests - Like many departments in the day case procedure, meaning Paul says, “It’s fantastic that we has ensured that 99% of smear Trust the histology team were patients can normally return are able to use modern tests can now be analysed first under pressure to meet the ever home within six hours. technology such as this to time without the patient increasing numbers of samples detect and treat early colonic needing to undergo a repeat and biopsies for processing and The service, developed by cancers which previously could test. The new system has also overcoming the mounting pioneering Consultant only be treated by major caused a dramatic reduction in complexity of tests they perform Endoscopist and abdominal surgery. It means the laboratory turnaround time whilst also increasing the speed Gastroenterologist, Paul that people are treated much for results which had been at which they produce results. Hurlstone, provides a one-stop quicker and more easily running at over 40 days, but is By July 2005, only 78% of shop enabling patients to enabling them to get back now down to less than five days samples and biopsies were receive fast, effective treatment and enjoy their lives as soon so that women get the result of being reported within two for early colonic cancers. The as possible, with the their screening test much more weeks – an unacceptable > 36 Annual Report and Accounts 2005/06 37

> wait for patients and one pathologists, the department which didn’t meet the high has already reduced the professional standards of the turnaround time for 95% of staff in the department. specimens to around 19 days. Further developments including Immediate action was taken to a refurbishment of the address the situation - laboratory and introduction of department staff together with a state of the art tissue colleagues in cancer care and processor have been planned, service improvement set about which will ensure 95% of mapping the journey of a future specimens will be specimen through the processed in a maximum of department to see where six days. improvements could be made. A business plan was then developed to ensure that the service would be able to speed up the processing of specimens and meet the new National Cancer Waiting Times coming In 2005, the histology into effect in December 2005. service processed over 40,000 cases - often made With seven additional up of more than one biomedical scientists, two specimen. The new equipment can support staff and five process a tissue sample in additional consultant only two hours. Annual Report and Accounts 2005/06 More convenient chronic disease care

Having an illness The neurology department based of patients. based clinic for the care of with more severe COPD, who are at the Royal Hallamshire Hospital patients with a common deemed to be at high risk of doesn’t always mean has always been pro-active in its The re-designed service has since respiratory condition. their health declining to the point that a patient needs approach and delivery of care to developed to include supporting of needing hospital care, to be to be in hospital. In a people with chronic neurological the Multiple Sclerosis (MS) The clinic, which was opened in looked after by a dedicated team conditions and over the last specialist nursing service in Nether Edge, provides a holistic in the community. This team large number of decade or so has developed providing an MS nurse-led clinic approach to care for patients provides advice and care for cases people can sophisticated teams of nurse to local patients in each of the with Chronic Obstructive patients with the option to specialists, physiotherapists and district general hospitals Pulmonary Disease (COPD) – a consult a chest physician from receive more occupational therapists who alongside the consultant disease associated with smoking the Royal Hallamshire hospital for convenient provide more convenient chronic neurologists who already run and industry which takes the further specialist advice as treatment and care disease care in the community. neurology clinics locally, lives of more than 1000 Sheffield required, particularly where more making it more convenient for people every year. As well as complicated cases are involved. in the comfort of Over the last year, a review of some patients who in the past affecting the lungs directly, The specialist also regularly their own homes. the Neurology Outreach Therapy have had to travel long causing breathlessness and assesses patients in the Service (NOTS) has been carried distances to reach the Royal limiting activity, COPD often community and can arrange out to examine the service from Hallamshire Hospital. leads to weight loss, loss of rapid access to emergency clinics a wide range of perspectives. muscle mass, and poor in hospital when secondary care The review acknowledged the Nationally, emphasis has been cardiovascular conditioning; is appropriate. important role in the delivery of given to the importance of bringing on a spiral of decline in care that the NOTS service providing more hospital services health which can result in As well as redesigning services to provides to over 1000 patients in the community; an ideology patients being admitted to bring them up to speed with across South Yorkshire and the supported by the Trust, which hospital for significant periods the ever-changing needs of potential to deliver a specialist recently joined the city’s South of time. patients, the Trust is also one of service in future which West Primary Care Trust to the first in the country to trial a meets the needs and wishes open an innovative community- The new service enables patients pioneering project to > 38 Annual Report and Accounts 2005/06 39

> provide intravenous (IV) term therapy are offered the antibiotics in an outpatient choice of antibiotics being setting for appropriate patients. delivered by community nurses or being trained to self- The Outpatient and Home administer the antibiotics. In Parenteral Antibiotic Treatment such cases, patients/carers Project (OHPAT) is enabling undergo a rigorous training earlier discharge of patients programme and are being from hospital and started in assessed for competence. The January 2006 as a six month IV self care is integrated into pilot project. The project is the patients care package and being run through the the team liaises with carers and Department of Infection and other health professionals in Tropical Medicine and will treat the community as necessary. patients requiring a short course of therapy for illnesses It is hoped that the project will such as severe skin infections, prove an important addition to or for appropriate patients with health care delivery in Sheffield, deeper infections such as brain enabling patients to go to work infections requiring a longer and live life normally whilst period of treatment. continuing their care with Patients requiring short term support from members of therapy have their antibiotics the team. delivered by the OHPAT nurses, OHPAT nurse Kathryn and their condition monitored Eaves talks a patient daily. Patients requiring longer through their treatment. Annual Report and Accounts 2005/06 Research and new treatments

Sheffield’s hospitals Since April, Sheffield has been have all contributed to an the UK, doctors and medical as it will reduce the costs of the focal point for a new increase of around 10 percent of engineers at the Trust have the national screening are pioneers of research project which could people being at risk of having developed a pioneering new programme. We are also facing research, and many have a far reaching influence on kidney problems.” piece of equipment that will a national shortage of new treatments and the detection and treatment of provide a more accurate, on-the- histopathologists so replacing early stage kidney disease across It is believed that the results of spot method of identifying smear tests could ensure that techniques are the nation. Two separate studies; the research, which will test abnormal cervical cells then the waiting times for test results are derived from the The Kidney Evaluation and more than 1000 residents of traditional “smear test”. kept to a minimum.” Awareness Programme for Sheffield, will enable health care work carried out in Sheffield (KEAPS) and the Kidney professionals to provide medical Consultant Gynaecologist, Mr The cervical probe has been so the city’s NHS Evaluation of Obese Population treatment at the earliest John Tidy, has been leading successful that the Trust has organisations. of Sheffield (KEOPS) will look at opportunity to prevent the the development: formed a partnership with the incidences of early kidney progression of the disease and Medipex, the NHS Innovation disease in the general avoid the need for kidney “Our aim was to develop a Hub that manages the population as well as groups of dialysis treatment later in life for method of diagnosis that could commercial exploitation of people at risk of the condition to many people. provide doctors with accurate, good ideas on behalf of the NHS ascertain how widespread on-the-spot results. This will cut in Yorkshire & Humber. Medipex kidney conditions are. Another condition that requires the time between diagnosis and are raising finance to further early detection to aid successful treatment and avoid causing evaluate the probe’s potential Renal consultant, Professor treatment is cervical cancer, a women to worry, often and eventually hope to market Meguid El-Nahas, says, “An devastating condition which kills unnecessarily, whilst they wait the cervical probe to other ageing population and lifestyle around 1500 women each year. for results. healthcare providers across the factors such as smoking and Although the NHS cervical UK and overseas. high blood pressure as well as screening programme has been “The introduction of a probe the type of diabetes brought on very effective in reducing the instead of smear testing may A significant amount of the by being severely overweight number of cases diagnosed in prove beneficial in the future research carried out at the > 40 Annual Report and Accounts 2005/06 41

> Trust is funded through The care he got made him feel charitable donations and public very special. I am pleased that fundraising. Some patients are his wishes will be carried out so overwhelmed with the and that the money he has left treatment they received that will be used to help other they even leave substantial patients either through legacies to the hospitals to research or equipment.” enhance services for other patients. One such patient was Mr Robertshaw, who was from Clifford Robertshaw who Hoyland, Barnsley, left a wanted to show his substantial part of his estate – appreciation of the care he around £45,000 – which will received for a brain tumour by be used to fund laboratory leaving a legacy to the research looking at the genetic Sheffield Hospitals Charitable component of particular types Trust, who manage and co- of brain tumour; work by Mr ordinate legacies and Robertshaw’s consultants, Mr donations on behalf of David Jellinek and Dr David the hospitals. Levy, into the use of MRI scans to assess tumours and their Cheryl Halder, Mr Robertshaw’s suitability for surgery; and daughter, said her father had research into the needs of really appreciated the care he patients with brain had received. “He was very tumours and their carers to appreciative of the care he help improve the service Consultant gynaecologist John received throughout his illness. they receive. Tidy with the cervical probe. Annual Report and Accounts 2005/06 Playing our part in the local community

As one of the largest We have become a full partner Young people play a significant a strategic steer for future Co-ordinator, Alan Smith says, in the regeneration of the role in our community and its regeneration proposals in areas “The project really has a dual organisations in region by participating in the future development. The Trust is such as housing, employment purpose: youth volunteering is Sheffield we have a Yorkshire and Humberside keen to encourage the and social inclusion. an excellent way to develop a responsibility to Regional Assembly’s development of these young potential future workforce for Employability Programme to people to ensure the workforce This year, the Trust launched a the NHS as well as enabling us involve and enrich help unemployed people back of the future have access to young people’s volunteering to equip young people with the communities we to work. Under this scheme, five experiences that will help them project to reduce social isolation both work and general life skills. people who were previously out develop skills that will be and provide people aged However, we are also really serve, which have of work completed the first 24 beneficial to them in life and 16-24 years the chance to committed to developing some of the highest week accredited training in work. experience the many different hospital services to incorporate levels of deprivation programme that has enabled opportunities available within young people’s views and we’ll them to go into full, paid The Trust has also joined the Fir the health service. be using this as an opportunity and unemployment employment at the Trust. Vale Strategic Partnership Board to see what they think of in the UK. which is committed to local The Trust hopes to recruit the hospital by launching a Shaun Bent, one of the first regeneration of the area around around 300 young volunteers youth parliament.” trainees on the scheme, said: “I the Northern General hospital; on an open access policy from a wanted to get back to work to an area which has been variety of backgrounds; Under the new scheme show my kids that there are identified as an area of high unemployed people, people volunteers will be able to draw opportunities out there. I want priority for change due to from black and minority ethnic up a personal development plan to be a role model for them. housing market failure and is communities and people with and will have access to The course is good and you the focus of regeneration disabilities as well as those from accredited training opportunities have to put in the effort, but it investment activity. The socially excluded areas are all to make sure they gain the most is all worth it. I’m hoping to stay partnership board is made up of encouraged to join the scheme. benefit from their experiences. at the hospital now because it’s major employers and public a good place to work.” bodies in the area who provide Young People’s Volunteer Playing our part in the > 42 Annual Report and Accounts 2005/06 43

Student Cheryl Jackson and dentist Amit Vora with a young patient.

> community also means Chesterfield have jointly ensuring a future workforce developed a successful that is fully equipped to programme of outreach understand the health needs of placements that has increased people in the community as confidence and competence in well as in a hospital setting. treatment planning as well as During their training, student introducing students to a dentists, hygienists and greater range of patients. therapists at Charles Clifford now undertake several weeks Professor Peter Robinson says, of outreach work placements in “Together with other community settings that developments, outreach has enables them to develop enabled the dental school to their skills. triple the number of hygiene and therapy students on the Unlike medical students, dental course and substantially students routinely both increase the number of diagnose and undertake full dental students we take in each clinical procedures on patients year. However, it is not just during their training but about numbers; this will previously their experience had undoubtedly help to build a centred on the work of the dental workforce better dental hospital. Now the dental prepared to meet the needs of school and salaried dental local communities.” services in Sheffield, Mexborough, Rotherham and Annual Report and Accounts 2005/06 Learning from our patients

We are focused on The Trust is committed to skills workshops within the each year. Each hospital has for many years and was then addressing complaints raised by Obstetrics, Gynaecology, been highlighted in emails, transferred for care at the ensuring our hospital patients. During the year the Neonatology and Urology letters and telephone calls from Northern General Hospital’s services are truly Trust received 672 complaints of Directorate. These workshops grateful patients, many of whom plastic surgery department. I patient-centred to which 86% were resolved within will initially be for midwives have been treated by the Trust always found that both hospitals our target of 20 working days. but could later be extended for many years and are pleased and staff were very caring and give the best 43 requests for independent to include other grades and with the excellent standards of could not do enough for me. possible experience review were received this year staff disciplines. care they continue to receive to Thank you all.” Patient, Sheffield from the Healthcare Commission this day. Here are just a few of at what we realise is and two were accepted. Creating a Clinical their comments: “Although I was apprehensive often a difficult time. Management Unit for the before going into hospital for my We always try to learn from A&E department. This is a “From entering the building operation I can honestly say I complaints and this year we have designated area where (Northern General Hospital) to almost “enjoyed” the week I used these patient comments to patients needing non urgent leaving I was treated with the spent at the Royal Hallamshire make improvements including: tests are assessed and utmost respect by everyone I Hospital. Everyone I was in monitored. We also now encountered. The organisation contact with was so kind to me Providing a mobile phone for admit Bed Bureau patients was first class as was the – nothing was too much trouble. the hearing services directly to a Medical cleanliness. My husband was also They made what was on the department so that patients Assessment Unit rather a patient. He was taken to A&E face of it a very frightening who cannot use the than through A&E which via ambulance and the attention experience into a bearable one. telephone normally due to has eased the pressure on he received from everyone was The overall care and their hearing problems are the department. professional and very reassuring – accommodation was excellent, able to send text messages to an excellent place to be looked like a 5 star hotel with room communicate with staff The Trust also receives a great after.” Patient, Sheffield service. Can I book in for a week many compliments about the of rest and recuperation after Carrying out communication hospitals, our staff and services “I was a patient at Weston Park Christmas?!” Patient, Sheffield 44 Annual Report and Accounts 2005/06 45

Chemotherapy services have been re-designed following suggestions from patients. Annual Report and Accounts 2005/06 Finance review

The Trust achieved a This reflects a good balance Delivery of key central contingencies and other remains a key challenge for between management of risk to service targets and one-off funding sources offset the organisation. small Income and achieve financial balance whilst quality standards. the pressures and enabled the Expenditure (I&E) maximising use of available Uncertainties over potential small surplus to be achieved. Cash balances were £22.1m at Account surplus of resources. The 2005/06 financial impairment charges on new the year-end and the Trust had year was again a build capital schemes The Trust’s capital investment in net current assets of £14.8m. £602.5k in 2005/06 very challenging one with key brought into use. the year totalled a very sizeable However, in both cases the which equates to issues being: Uncertainty over the £45.7m. Planning and other position will be much less implications of the new delays on a number of centrally favourable when the £9.3m of just under 0.1% of The general NHS financial requirement to account for funded schemes resulted in a capital funding referred to annual turnover of environment. partially completed spells, i.e. £9.3m undershoot but these above is utilised and provisions £611.6m. Income uncertainty arising inpatient episodes where resources have been carried of £9.9m for Agenda for from the relatively new discharge had not taken forward to 2006/07 to enable Change and Consultant Payment by Results funding place at 31 March 2006. completion of the relevant Contract salary uplifts system and disputed schemes. The Trust’s capital crystallise. However, the shortfalls on Education and In the event, the major out-turn investments reflected a balance underlying working capital Training contract values. issues were overspends of between the need to enhance position has again shown a Ongoing funding shortfalls £2.7m and £3.3m respectively the basic infrastructure of its small improvement and on national pay reforms. in the General Surgery and buildings, equipment and IT presentationally the position is Massive increases in Orthopaedics Directorates and whilst developing capacity to further improved by the energy prices. an overspend of £3.4m on improve services for patients. recognition of an asset for Major productivity and energy and utilities. Income More detailed information is partially completed spells. efficiency savings to from patient services activity provided elsewhere in the be achieved. was £2.75m above the Trust’s Annual Report. As always there At no stage during the year did Particular financial difficulties plan. Strong performance by a were many competing demands the Trust need to borrow in key specialties. number of Directorates plus and prioritisation of investments money, either for short term > 46 Annual Report and Accounts 2005/06 47

The Trust achieved a > working capital purposes or reducing waiting times commissioners. Clearly, such From a positive perspective the for longer term investments. for treatment. requirements also have to be Trust continues to provide a small Income and Clearly, therefore, the Trust was Satisfying other critical achieved within the resource good range of high quality Expenditure (I&E) at all times compliant with the demands for key constraints, whether they be secondary and tertiary services Account surplus of Prudential Borrowing Limit set patient services. financial, manpower or from good facilities, is a key by Monitor, the Foundation Meeting NHS qualitative facilities, faced by the Trust. provider of services for the £602.5k in 2005/06 Trust Regulator. On Monitor’s standards. people of Sheffield and North which equates to financial risk rating of 1 to 5, Delivering other qualitative In the main, the Trust was very Trent and is likely to continue to where 1 represents very high improvements to the successful in reconciling the grow as investment in faster just under 0.1% of risk and 5 represents very low patient experience. many competing demands in access times and other service annual turnover of risk, the Trust was assessed as a Meeting external 2005/06. However, for 2006/07 improvements continues. £611.6m. 4 at the 2005/06 plan stage regulatory standards. and beyond it is clear that and at every quarter during Achieving governance these challenges will become The high level challenge for the the year. standards for Research and even greater as the Trust is to deliver the required Development (R&D). requirements are increased ongoing patient service, Operational issues Meeting accreditation whilst baseline funding is teaching and R&D The Trust’s many achievements standards for teaching. reduced. This will require the improvements within a very in terms of services provided Trust to be ever more constrained financial position. during 2005/06 are recorded in All of this has to be achieved in innovative in improving services The key factors causing this detail elsewhere in the Annual the context of a complex NHS at the same time that it has to financial constraint are: Report. The Trust faces ever environment, particularly where become more cost effective. increasing requirements in policy initiatives such as patient Annual national efficiency terms of: choice and competition from Looking ahead requirements which for new providers can appear to be There are many risks, challenges 2006/07 resulting in a Meeting healthcare targets, at odds with financial pressures and opportunities facing the 2.5% reduction to the particularly in respect of experienced by the Trust and its Trust in 2006/07 and beyond. Trust’s income. > Annual Report and Accounts 2005/06

Finance review continued

The Trust achieved a A moderate level of internal savings requirement. These constrained financial position, new independent sector pressures and investments include an expectation that the key issues are likely to be: treatment centres. small Income and each year for which no developments to national tariffs Expenditure (I&E) external funding is received. will better reflect the complex The currently difficult Additional unplanned costs Account surplus of treatments undertaken by overall NHS environment arising from areas such as Income losses arising from Teaching Hospitals and that which will influence areas pay reform and escalating £602.5k in 2005/06 the transition from historic there will be changes to the such as policy, tariff energy prices. which equates to levels of funding for patient Market Forces Factor, which setting and commissioner services to the tariff based reduces the Trust’s tariff income funding flexibility. Unsatisfactory development just under 0.1% of funding system of “Payment by around 6% largely due to of national tariffs and annual turnover of by Results”. perceived lower labour costs The specific financial inadequate annual uplifts to £611.6m. despite there being national pressures facing the reflect true nationally driven As a result of these issues the NHS payscales. However, there Sheffield Primary Care Trusts NHS cost inflation. Trust has identified a need to are just as many issues which which will influence their deliver productivity and could further damage the ability to afford required Inability within the Trust to efficiency gains of £90m over position. The Trust has, activity levels. deliver sufficient cultural the three years from 2006/07 to therefore, launched a three change and capacity to 2008/09 to offset these funding year productivity and efficiency Demand Management achieve sizeable productivity gaps. This equates to around programme to identify the initiatives by PCTs which, if and efficiency gains 15% of current turnover over £90m of gains which it is successful, could reduce the whilst continuing to the three years. currently assumed will Trust’s income whilst leaving improve services and be required. it with limited ability to maintain standards. There are many issues which reduce fixed costs. may change over the next three In terms of the key risks facing A likely less favourable NHS years which could influence this the Trust in trying to deliver the Increasing competition from funding settlement from assumed level of efficiency demands on it within the other NHS providers and 2008/09. > 48 Annual Report and Accounts 2005/06 49

Potential changes to current competing pressures in a great funding systems for R&D many areas. and Education and Training which could again impact on the Trust’s income.

The ongoing process of medical advancement Neil Priestley running ahead of Director of Finance NHS resources. May 2006

The Trust will continue to identify the key risks, challenges and opportunities it faces and to develop its business planning and governance processes to ensure that it is equipped to manage key issues and optimise its delivery of high quality and cost effective services. The Trust is clear that this can only be achieved with the full engagement of its entire staff and external partners as it will require innovative solutions to Annual Report and Accounts 2005/06 Public interest disclosure

The Trust Board of The following interests have been declared by the Directors and the Ms V Ferres Chief Executive, Age Concern Doncaster Board are satisfied that there are no conflicts of interest indicated Director and Chair, Disability Doncaster Directors comprises by any external involvement. This disclosure is updated regularly Director and Chair, South Yorkshire Centre the Chairman, six and is available on our Internet site for public access at for Integrated Living Non-Executive www.sth.nhs.uk. Director, Doncaster Energy Services Director and Chair, John William Directors and six Chairman Chapman Trust Executive Directors. Mr D Stone Trustee, Weston Park Cancer Appeal Independent Assessor for CHAI Trustee, Freshgate Trust Trustee, Sheffield Botanical Gardens Trust Mr V Powell Governor, Sheffield College Guardian, Sheffield Assay Office Member of FTFF Credit Committee Honorary Consul, Republic of Finland Chairman, Cutlers Hall Presentation Trust Professor A Weetman University Representative Medical Advisor and Trustee, British Non-Executive Directors Thyroid Foundation Mr J Stoddart National Extension College Private Medial Practice at Bolton Institute Thornbury Hospital Guardian, Sheffield Assay Office Executive Directors Ms O Bright Mr A Cash Chief Executive Visiting Professor Mr J Donnelly Trustee, Sheffield Hospitals Charitable Trust University of York Health Services Associate Investigator, Parliamentary and Development Unit Health Service Ombudsman Non Executive Director of Medilink Lay Member of GMC Fitness to (Yorkshire and Humber) Ltd Practice Panel Chair of Foundation Trust Network > 50 Annual Report and Accounts 2005/06 51

1 4

Mrs H Tierney-Moore Chief Nurse (to 16 December 2005) Trustee, Cavendish Centre for Cancer Care, Sheffield

Ms A Smith Acting Chief Nurse (17 December 2005 2 5 to 5 March 2006)

Ms H Scholefield Chief Nurse (from 6 March 2006)

Mr CC Linacre Director of Service Development Non Executive Director, Medipex Ltd

Professor C Welsh Medical Director Private Medical Practice at Claremont Hospital Tutor, Medical Leadership Programme – 3 6 Keele University Part Owner and Director of CL Welsh and Company Ltd 1 Andrew Cash 2 Chris Linacre Mr N Priestley Director of Finance 3 Chris Welsh Mr J Watts Director of Human Resources 4 Neil Priestley 5 John Watts 6 Hilary Scholefield Annual Report and Accounts 2005/06 Remuneration report

The Pay and The membership of the Incomes Data Services Ltd. performance review of the The Chairman and Non- Committee comprises the Chief Executive and non- Executive Director appointments Remuneration Non-Executive Directors of Assessment of performance Executive Directors. are due for renewal as follows: Committee is a the Trust Board, together with All Executive and Non- Individual performance review is formally appointed the Chairman. Executive Directors are subject well established in the Trust, Chairman to individual performance and is an integral part of Mr D.R. Stone committee of the The Directors of Finance and review. This involves the developing the Executive and 1st July 2007 Trust Board. Its terms Human Resources, and the setting and agreeing of Non-Executive Directors’ Chief Executive are in objectives for a 12 month Personal Development Plan. Non-Executive Directors of reference comply attendance at all meetings to period running from 1st April Mrs O. Bright with the Secretary of advise the Committee and to the following 31st March. Performance pay 1st July 2007 State’s “Code of ensure that an appropriate During the year regular No element of the Executive and record of proceedings is kept. reviews take place to discuss Non-Executive Directors’ Mr J. Donnelly Conduct and progress, and there is an end remuneration is 1st July 2006 Accountability for Remuneration of senior of year review to assess performance related. managers achievements and Ms V. Ferres NHS Boards”. In determining the Pay and performance. The Executive Duration of contracts 1st July 2009 Conditions of Employment for Directors are assessed by All Executive Directors have a Senior Managers, the the Chief Executive, substantive Contract of Mr V.G.W. Powell Committee takes account of following which there is a Employment with a 12 month 1st July 2007 National Pay Awards given to meeting between the notice provision in respect of the Pay and Non-Pay Review Chairman and each of the termination. This does not affect Mr J. Stoddart staff groups, together with Executive Directors to discuss the right of the Trust to 1st July 2006 the “NHS Board Room Pay their performance. terminate the contract without Report” findings for Executive notice by reason of the conduct Professor A.P. Weetman Directors produced by The Chairman undertakes the of the Executive Director. 1st July 2009 52 Annual Report and Accounts 2005/06 53

1 4

Early termination liability Increase in the cash equivalent transfer value Depending on the circumstances of the early during 05/06. termination the Trust would, if the termination was due to redundancy, apply redundancy terms under Section 45 of the General Whitley Council 2 5 Handbook or consider severance settlements in accordance with HSG94(18) and HSG95(25). In addition, there may be an entitlement to early Andrew Cash OBE retirement benefits under the provisions of the Chief Executive NHS (Compensation for Premature Retirement) 15 June 2006 Regulations 1981 if the dismissal is on grounds of redundancy and the individual is over 50 with at least 5 years’ service in the Superannuation Scheme.

Other information 3 6 Please refer to the notes in the 05/06 Accounts contained in the Annual Report in respect of the following: 1 John Donnelly 2 Ony Bright Salaries and Allowances Benefits in Kind 3 Vic Powell Increases in Pension at age 60 during 05/06 4 John Stoddart Value of the cash equivalent transfer value at the beginning of the year 5 Anthony Weetman 6 Vickie Ferres Annual Report and Accounts 2005/06 Independent Auditor’s Report

I have audited the financial Standards) Act 2003. My work Officer’s Responsibilities. requirements specified by the statements of Sheffield Teaching was undertaken so that I might My responsibility is to audit the Independent Regulator or if the Hospitals NHS Foundation Trust state to the Governors’ Council financial statements in statement is misleading or for the year ended 31 March those matters I am required to accordance with statute, the inconsistent with other 2006 under the Health and state to it in an auditor’s report Audit Code for NHS Foundation information I am aware of from Social Care (Community Health and for no other purpose. In Trusts and International my audit of the financial and Standards) Act 2003, which those circumstances, to the Standards on Auditing (UK and statements. I am not required to comprise the Income and fullest extent permitted by law, I Ireland). I report to you my consider, nor have I considered, Expenditure Account, the do not accept or assume opinion as to whether the whether the Accounting Balance Sheet, the Cash Flow responsibility to anyone other financial statements give a true Officer’s statement on internal Statement, the Statement of than the Foundation Trust as a and fair view in accordance control covers all risks and Total Recognised Gains and body, for my audit work, for the with the accounting policies controls. Neither am I required Losses and the related notes. audit report or for the opinions directed by the Independent to form an opinion on the These financial statements have I form. Regulator as being relevant to effectiveness of the Trust's been prepared under the NHS Foundation Trusts. corporate governance accounting policies set out Respective responsibilities of procedures or its risk and within them. Directors, the Accounting I review whether the control procedures. Officer and auditor Accounting Officer’s statement This report is made solely to the The Accounting Officer’s on internal control reflects I read the other information Governors’ Council of Sheffield responsibilities for preparing the compliance with the contained in the Annual Report Teaching Hospitals NHS financial statements in requirements of the and consider whether it is Foundation Trust as a body in accordance with directions Independent Regulator consistent with the audited accordance with paragraph made by Monitor, the contained in the NHS financial statements. This other 24(5) of Schedule 1 of the Independent Regulator of NHS Foundation Trust Financial information comprises only the Health and Social Care Foundation Trusts, are set out in Reporting Manual 2005/06. I Chairman’s Statement, the (Community Health and the Statement of Accounting report if it does not meet the Chief Executive’s Statement, > 54 Annual Report and Accounts 2005/06 55

> Background Information, Auditing (United Kingdom and financial statements are free requirements of the Health and Operating and Financial Review, Ireland) issued by the Auditing from material misstatement, Social Care (Community Health the sections on the Governors’ Practices Board. whether caused by fraud or and Standards) Act 2003 and Council, the Board of Directors, An audit includes examination, other irregularity or error. In the Audit Code for NHS membership and public interest on a test basis, of evidence forming my opinion I also Foundation Trusts issued by the disclosures and the un-audited relevant to the amounts and evaluated the overall Independent Regulator. part of the Remuneration disclosures in the financial adequacy of the presentation Report. I consider the statements. It also includes an of information in the implications for my report if I assessment of the significant financial statements become aware of any apparent estimates and judgments made misstatements or material by the directors in the Opinion inconsistencies with the preparation of the financial In my opinion the financial financial statements. My statements, and of whether the statements give a true and fair responsibilities do not extend to accounting policies are view of the state of affairs of any other information. appropriate to the Trust's Sheffield Teaching Hospitals circumstances, consistently NHS Foundation Trust as at 31 Basis of audit opinion applied and adequately March 2006 and of its income J G Prentice FCCA I conducted my audit in disclosed. and expenditure for the year Officer of the Audit accordance with the Health and then ended in accordance with Commission Social Care (Community Health I planned and performed my the accounting policies adopted and Standards) Act 2003 and audit so as to obtain all the by the Trust. 19 June 2006 the Audit Code for NHS information and explanations Foundation Trusts issued by the which I considered necessary in Certificate Littlemoor House Independent Regulator, which order to provide me with I certify that I have completed Littlemoor requires compliance with sufficient evidence to give the audit of the accounts in Eckington International Standards on reasonable assurance that the accordance with the Sheffield S21 4EF Annual Report and Accounts 2005/06 Statement of responsibilities

The Health and The relevant responsibilities give a true and fair view of make judgements the accounts comply with of accounting officer, the state of affairs of and estimates on a requirements outlined in the Social Care including their responsibility Sheffield Teaching Hospitals reasonable basis; above mentioned Act. The (Community Health for the propriety and NHS Foundation Trust and of accounting officer is also and Standards) Act regularity of public finances its income and expenditure, state whether applicable responsible for safeguarding for which they are total recognised gains and accounting standards as the assets of the NHS 2003 states that the answerable, and for the losses and cash flows for the set out in the NHS Foundation Trust and hence Chief Executive is keeping of proper accounts, financial year. Foundation Trust Financial for taking reasonable steps are set out in the accounting Reporting Manual have for the prevention and the accounting officers' Memorandum In preparing the accounts, been followed, and disclose detection of fraud and officer of the NHS issued by the Independent the Accounting Officer is and explain any material other irregularities. Foundation Trust. Regulator of NHS Foundation required to comply with the departures in the financial Trusts (“Monitor”). requirements of the NHS statements; and To the best of my knowledge Foundation Trust Financial and belief, I have properly Under the Health and Social Reporting Manual and in prepare the financial discharged the responsibilities Care (Community Health and particular to: statements on a going set out in Monitor's NHS Standards) Act 2003, Monitor concern basis. Foundation Trust Accounting has directed the Sheffield observe the Accounts Officer Memorandum. Teaching Hospitals NHS Direction issued by The accounting officer is Foundation Trust to prepare Monitor, including responsible for keeping proper for each financial year a accounting records which statement of accounts in the the relevant accounting disclose with reasonable Signed form and on the basis set out and disclosure accuracy at any time the in the Accounts Direction. requirements, and apply financial position of the NHS Mr Andrew Cash OBE, The accounts are prepared on suitable accounting policies Foundation Trust and to Chief Executive an accruals basis and must on a consistent basis; enable him/her to ensure that 15 June 2006 56 Annual Report and Accounts 2005/06 57

INCOME AND EXPENDITURE ACCOUNT FOR THE 12 MONTHS ENDED 31 MARCH 2006 Foreword 9 Months to 31/3/05 2005/06 (restated) to the NOTE £000 £000 Income from activities 3 505,482 351,590 accounts Other operating income 4 106,090 75,358 Operating expenses 5-7 (599,324) (418,546)

OPERATING SURPLUS 12,248 8,402

Surplus on sale of fixed assets 8 103 23 These accounts for the year ended 31 March 2006 have been prepared by the Sheffield Teaching Hospitals NHS SURPLUS BEFORE INTEREST 12,351 8,425 Foundation Trust in accordance with schedule 1 paragraphs 24 and 25 of the Health and Social Care (Community Interest receivable 1,078 627 Health and Standards) Act 2003 in the form which Monitor, Interest payable 9 0 (45) the Independent Regulator of NHS Foundation Trusts, has, Other finance costs - unwinding of discount (45) (69) with the approval of HM Treasury, directed. Other finance costs - change in discount rate on provisions (253) 0

SURPLUS FOR THE YEAR / PERIOD 13,131 8,938

Public Dividend Capital dividends payable (12,529) (8,645)

Signed: RETAINED SURPLUS FOR THE YEAR / PERIOD 602 293

Mr Andrew Cash OBE, Chief Executive The notes on pages 57 to 95 form part of these accounts. All income and expenditure is derived from continuing operations. 15 June 2006 Annual Report and Accounts 2005/06

BALANCE SHEET AS AT 31 MARCH 2006 31 March 2005 31 March 2005 (restated) (restated) NOTE £000 £000 NOTE £000 £000 FINANCED BY: FIXED ASSETS TAXPAYERS' EQUITY Intangible assets 10 798 900 Public Dividend Capital 18.2 305,119 280,275 Tangible assets 11 434,091 416,019 Revaluation reserve 18.3 86,022 90,082 Investments 12 0 0 Donated asset reserve 18.3 40,208 38,213 434,889 416,919 Government grant reserve 18.3 0 0 CURRENT ASSETS Income and expenditure reserve 18.3 5,004 1,118 Stocks 13 8,097 8,931 Debtors 14 34,791 30,403 TOTAL TAXPAYERS' EQUITY 436,353 409,688 Investment 15 0 0 Cash 19.3 22,055 8,957 64,943 48,291

CREDITORS: Amounts falling due within one year 16 (50,151) (48,693) Signed:

NET CURRENT ASSETS / (LIABILITIES) 14,792 (402) Mr Andrew Cash OBE Chief Executive TOTAL ASSETS LESS CURRENT LIABILITIES 449,681 416,517 15 June 2006

PROVISIONS FOR LIABILITIES AND CHARGES 17 (13,328) (6,829)

TOTAL ASSETS EMPLOYED 436,353 409,688 58 Annual Report and Accounts 2005/06 59

STATEMENT OF TOTAL RECOGNISED GAINS AND LOSSES FOR THE 12 MONTHS ENDED 31 MARCH 2006 9 Months to 31/3/05 2005/06 (restated) £000 £000

Surplus for the year / period before dividend payments 13,131 8,938

Fixed asset impairment losses 0 (2,916)

Unrealised (loss) / surplus on fixed asset revaluations/indexation (3,186) 22,394

Increases in the donated asset reserve due to receipt of donated assets 6,864 2,897

Reductions in the donated asset reserve due to depreciation, impairment, and / or disposal of donated assets (2,459) (2,333)

Total recognised gains for the year / period 14,350 28,980

The restated surplus for the nine month period incorporates a prior period adjustment of £192k in respect of the recognition of income due from partially completed patient spells. The accounting policy regarding income recognition is detailed in note 1.4 to the Accounts. Annual Report and Accounts 2005/06

CASH FLOW STATEMENT FOR THE 12 MONTHS ENDED 31 MARCH 2006 MANAGEMENT OF LIQUID RESOURCES 9 Months 9 Months 2005/06 to 31/3/05 2005/06 to 31/3/05 NOTE £000 £000 £000 £000 OPERATING ACTIVITIES Net cash inflow from operating activities 19.1 39,899 24,696 (Purchase) of current asset investments (180,000) (75,000) Sale of current asset investments 180,000 75,000 RETURNS ON INVESTMENTS AND SERVICING OF FINANCE: Net cash flow from management of liquid resources 0 0 Interest received 1,048 630 Interest paid 0 (45) Net cash (outflow) before financing (18,172) (9,808)

Net cash inflow from returns on investments FINANCING and servicing of finance 1,048 585 Public dividend capital received 24,844 9,000 CAPITAL EXPENDITURE Other capital receipts 6,426 2,438 (Payments) to acquire tangible assets (46,595) (23,056) Receipts from sale of Tangible Fixed Assets 149 23 Net cash inflow from financing 31,270 11,438 (Payments) to acquire intangible assets (144) (530) Increase in cash 13,098 1,630 Net cash (outflow) from capital expenditure (46,590) (23,563)

DIVIDENDS PAID (12,529) (11,526)

Net cash (outflow) before management of liquid resources and financing (18,172) (9,808) 60 Annual Report and Accounts 2005/06 61

'discontinued' where they meet and for financial all of the following conditions: reporting purposes; Notes to the accounts a) the sale (this may be at nil Operations not satisfying all of consideration for activities these conditions are classified Accounting Policies 1 Monitor has directed that considered material in relation transferred to another as continuing. the financial statements of NHS to the accounts. public sector body) or for the Year Ending Foundation Trusts shall meet termination is completed Activities are considered to be 31st March 2006 the accounting requirements of 1.1 Accounting period. either in the period before 'acquired' whether or not they the NHS Foundation Trust The Trust achieved Foundation the earlier of three months are acquired from outside the Financial Reporting Manual Status on 1st July 2004. The after the commencement public sector. which shall be agreed with HM comparative figures are of the subsequent Treasury. Consequently, the therefore presented on a 9 period and the date on 1.4 Income Recognition following financial statements month basis i.e. 1 July 2004 to which the financial Income is accounted for have been prepared in 31 March 2005. statements are approved; applying the accruals accordance with the 2005/06 b) if a termination, the former convention. The main source of NHS Foundation Trust Financial 1.2 Accounting convention activities have ceased income for the Trust is from Reporting Manual issued by These accounts have been permanently; commissioners in respect of Monitor, the body responsible prepared under the historical c) the sale or termination has healthcare services provided for overseeing Foundation Trust cost convention modified to a material effect on the under local agreements. activities. The accounting account for the revaluation of nature and focus of the Income is recognised in the policies contained in that fixed assets at their value to reporting Trust's period in which services are manual follow UK generally the business by reference to operations and represents provided. Where income is accepted accounting practice their current costs. NHS a material reduction in its received for a specific activity for companies (UK GAAP) and Foundation Trusts, in operating facilities which is to be delivered in the HM Treasury's Financial compliance with HM Treasury's resulting either from its following financial year, that Reporting Manual to the extent Financial Reporting Manual, are withdrawal from a income is deferred. that they are meaningful and not required to comply with particular activity or from appropriate to the NHS, as the FRS 3 requirements to a material reduction in The Trust has amended its determined by HM Treasury, report "earnings per share" or income in the Trust's accounting policy on income which is advised by the historical profits and losses. continuing operations; recognition where the Financial Reporting Advisory d) the assets, liabilities, results provision of a healthcare Board. The accounting policies 1.3 Acquisitions and of operations and activities service has commenced have been applied consistently discontinued operations are clearly distinguishable, before the Year End. For in dealing with items Activities are considered to be physically, operationally these partially completed Annual Report and Accounts 2005/06

patient spells, the income these arrangements the Trust licences are capitalised as individual or collective cost relating to the patient activity is received income protection of intangible fixed assets where Digital Hearing Aids were accrued. The accrued income is £6,908,000 from the expenditure of at least £5,000 capitalised in accordance calculated based on the Department of Health is incurred. They are amortised with the direction of the number of days of incomplete during 2005/06. over the shorter of the term of Secretary of State in 2003- spells accrued at an average the licence and their useful 04 and the first quarter of tariff for that type of 1.5 Intangible fixed assets economic lives. 2004-05, and will be procedure. The change in Intangible assets are capitalised written down over 5 years. accounting policy has resulted when they are capable of 1.6 Tangible fixed assets in a prior period adjustment to being used in a Trust's activities Valuation the NHS Foundation Trust's for more than one year; they Capitalisation Tangible fixed assets are stated 2004/05 accounts, and an can be valued; and they have a Tangible assets are capitalised at the lower of replacement income accrual in the current cost of at least £5,000. if they are capable of being cost and recoverable amount. year. The change of accounting used for a period which On initial recognition they are treatment is in accordance Intangible fixed assets held for exceeds one year and they: measured at cost (for leased with FRS 5 and UITF 40. operational use are valued at assets, fair value) including any historical cost and are individually have a cost of costs such as installation The NHS Foundation Trust depreciated over the estimated at least £5,000; or directly attributable to bringing changed the form of its life of the asset on a straight collectively have a cost of at them into working condition. contracts with NHS line basis, except capitalised least £5,000 and They are restated to current commissioners to follow the Research and Development individually have a cost of value periodically. The Department of Health's which is revalued using an more than £250, where the carrying values of tangible Payment by Results appropriate index figure. The assets are functionally fixed assets are reviewed for methodology from 2004/05. To carrying value of intangible interdependent, they had impairment in periods if events manage the financial impact of assets is reviewed for broadly simultaneous or changes in circumstances this change on the NHS impairment at the end of the purchase dates, are indicate the carrying value may Foundation Trust and on its first full year following anticipated to have not be recoverable. commissioners the Department acquisition and in other simultaneous disposal dates of Health has implemented periods if events or and are under single All land and buildings are transitional gain and clawback changes in circumstances managerial control; or restated to current value using arrangements. These are on a indicate the carrying value may form part of the initial professional valuations in sliding scale, as the change is not be recoverable. equipping and setting up of accordance with FRS15 every phased in over the four year a new building, ward or five years. A three yearly period to 2008/09. Under Purchased computer software unit irrespective of their interim valuation is also carried 62 Annual Report and Accounts 2005/06 63

out. Professional valuations are Market Value figures have only the value from the Gross primary lease term. carried out by the Valuation been supplied for operational Domestic Product deflator. Office. The valuations are assets once they have been Equipment surplus to Equipment is depreciated on carried out in accordance with taken out of operational use requirements is valued at net current cost evenly over the the Royal Institution of and subsequently disposed of. recoverable amount. estimated life of the asset. Chartered Surveyors (RICS) Appraisal and Valuation Assets in the course of Depreciation, amortisation Where the useful economic life Manual insofar as these terms construction are valued at cost and impairments of an asset is reduced from that are consistent with the agreed and are valued by professional Tangible fixed assets are initially estimated due to the requirements of the valuers as part of the five or depreciated at rates calculated revaluation of an asset for sale, Department of Health and HM three yearly valuation or when to write them down to depreciation is charged to bring Treasury. In accordance with they are brought into use. estimated residual value on a the value of the asset to its the requirements of the straight-line basis over their value at the point of sale. Department of Health, the last Residual interests in off-balance estimated useful lives. No asset valuations were sheet private finance initiative depreciation is provided on Fixed asset impairments undertaken in 2004 as at the (PFI) properties are included in freehold land and assets surplus resulting from losses of prospective valuation date of 1 assets under construction to requirements. economic benefits are charged April 2005 and were applied within tangible fixed assets at to the Income and Expenditure on 31 March 2005. the amount of unitary charge Assets in the course of Account. All other impairments allocated for the acquisition of construction and residual are taken to the revaluation The valuations are carried out the residual value with an interests in off-balance sheet reserve and reported in the primarily on the basis of adjustment. The adjustment is PFI contract assets are not statement of total recognised Depreciated Replacement Cost the net present value of the depreciated until the asset gains and losses to the extent for specialised operational change in fair value of the is brought into use or that there is a balance on the property and Existing Use residual value as estimated at reverts to the Foundation revaluation reserve in respect of Value for non-specialised the start of the contract and at Trust, respectively. the particular asset. operational property. The value the balance sheet date. of land for existing use Buildings, installations and purposes is assessed at Existing Operational equipment other fittings are depreciated on their Use Value. For non-operational than IT equipment, which is current value over the properties including surplus considered to have nil inflation, estimated remaining life of the land, the valuations are carried is valued at net current asset as advised by the Trust's out at Open Market Value. replacement cost through professional valuers. Leaseholds Additional alternative Open annual uplift by the change in are depreciated over the Annual Report and Accounts 2005/06

1.7 Donated fixed assets Health, including those for and amortised over the life of 1.11 Research and Donated fixed assets are achieving three star status, are the PFI contract by charge to the Development capitalised at their current value accounted for as Government Income and Expenditure Expenditure on research is not on receipt and this value is grants. Where the Government Account. Where, at the end of capitalised. Expenditure on credited to the Donated Asset grant is used to fund revenue, the PFI contract, a property development is capitalised if it Reserve. Donated fixed assets are expenditure it is taken to the reverts to the Trust, the meets the following criteria: valued and depreciated as Income and Expenditure Account difference between the expected described above for purchased to match that expenditure. fair value of the residual on there is a clearly defined assets. Gains and losses on Where the grant is used to fund reversion and any agreed project; revaluations are also taken to the capital expenditure the grant is payment on reversion is built up the related expenditure is Donated Asset Reserve and, each held as deferred income and over the life of the contract by separately identifiable; year, an amount equal to the released to the Income and capitalising part of the unitary the outcome of the project depreciation charge on the asset Expenditure Account over the life charge each year, as a tangible has been assessed with is released from the Donated of the asset on a basis consistent fixed asset. reasonable certainty as to: Asset Reserve to the Income and with the depreciation charge for - its technical feasibility; Expenditure Account. Similarly, the asset. Where the balance of risks and - its resulting in a product any impairment on donated rewards of ownership of the PFI or service which will assets charged to the Income 1.9 Private Finance Initiative property are borne by the Trust, eventually be brought and Expenditure Account is (PFI) transactions it is recognised as a fixed asset into use; matched by a transfer from the The NHS follows HM Treasury's along with the liability to pay for - adequate resources exist to Donated Asset Reserve. On sale Technical Note 1 (Revised) "How it which is accounted for as a enable the project to be of donated assets, the value of to Account for PFI transactions" finance lease. Contract completed and to provide the sale proceeds is transferred which provides definitive payments are apportioned any consequential increases from the Donated Asset guidance for the application of between an imputed in working capital. Reserve to the Income and note F to FRS 5. finance lease charge and a Expenditure Reserve. service charge. Expenditure so deferred is Where the balance of the risks limited to the value of future 1.8 Government Grants and rewards of ownership of the 1.10 Stocks benefits expected and is Government grants are grants PFI property are borne by the PFI Stocks are valued at the lower of amortised through the Income from Government bodies other operator, the PFI obligations are cost and net realisable value. and Expenditure Account on a than income from primary care recorded as an operating This is considered to be a systematic basis over the period trusts or NHS Foundation Trusts expense. Where the Trust has reasonable approximation to expected to benefit from the for the provision of services. contributed assets, a prepayment current cost due to the high project. It is revalued on the Grants from the Department of for their fair value is recognised turnover of stocks. basis of current cost. 64 Annual Report and Accounts 2005/06 65

The amortisation charge is Treasury's discount rate of Scheme. Both are risk pooling employer contribution payable calculated on the same basis as 2.2% in real terms. schemes under which the Trust in the year to 31 March 2006 used for depreciation i.e. on a pays an annual contribution to was £35,353k (nine months to quarterly basis. Expenditure Clinical negligence costs the NHS Litigation Authority 31 March 2005, £24,849k). which does not meet the criteria The NHS Litigation Authority and, in return, receives Employers pension cost for capitalisation is treated as an (NHSLA) operates a risk pooling assistance with the costs of contributions are charged to operating cost in the year in scheme under which the NHS claims arising. The annual operating expenses as and which it is incurred. NHS Trust pays an annual membership contributions, and when they are incurred. Foundation Trusts are unable to contribution to the NHSLA any 'excesses' payable in disclose the total amount of which in return settles all respect of particular claims, are Additional pension liabilities research and development clinical negligence claims. charged to operating expenses arising from early retirements expenditure charged in the Although the NHSLA is as and when they become due. are not funded by the Scheme Income and Expenditure administratively responsible for except where the retirement is Account because some research all clinical negligence cases the 1.13 Pension costs due to ill-health. The full and development activity legal liability remains with the Past and present employees are amount of the liability for the cannot be separated from Trust. The total value of clinical covered by the provisions of the additional costs is charged to patient care activity. Fixed assets negligence provisions carried by NHS Pension Scheme. The the Income and Expenditure acquired for use in research and the NHSLA on behalf of the Scheme is an unfunded, Account at the time the Trust development are amortised over Trust is disclosed at note 17. defined benefit scheme that commits itself to the the life of the associated project. covers NHS employers, General retirement, regardless of the Since financial responsibility for Practices and other bodies, method of payment. 1.12 Provisions clinical negligence cases allowed under the direction of The Trust provides for legal or transferred to the NHSLA at 1 the Secretary of State, in constructive obligations that April 2002, the only charge to England and Wales. As a are of uncertain timing or operating expenditure in consequence it is not possible amount at the balance sheet relation to clinical negligence in for the Trust to identify its date on the basis of the best 2005/06 relates to the Trust's share of the underlying Scheme estimate of the expenditure contribution to the Clinical assets and liabilities. Therefore, required to settle the Negligence Scheme for Trusts. the Scheme is accounted for as obligation. Where the effect of a defined contribution scheme the time value of money is Non-clinical risk pooling and the cost of the Scheme is material, the estimated risk- The Trust participates in the equal to the contributions adjusted cash flows are Property Expenses Scheme and payable to the Scheme for the discounted using the the Liabilities to Third Parties accounting period. The total Annual Report and Accounts 2005/06

1.14 Liquid resources exchange gains and losses are Account on a straight-line basis charged to the relevant Deposits and other investments taken to the Income and over the term of the lease. functional headings on a cash that are readily convertible into Expenditure Account. basis, including losses which known amounts of cash at, or 1.19 Public Dividend Capital would have been made good close to, their carrying amounts 1.17 Third Party Assets (PDC) and PDC Dividend through insurance cover had are treated as liquid resources in Assets belonging to third parties Public Dividend Capital NHS Foundation Trusts not been the cashflow statement. The (such as money held on behalf represents the outstanding bearing their own risks Trust does not hold any of Patients) are not recognised public debt of an NHS (with insurance premiums then investments with maturity dates in the accounts since the Trust Foundation Trust. At any time being included as normal exceeding one year from the has no beneficial interest in the Secretary of State can issue revenue expenditure). date of purchase. them. Details of third party new PDC to, and require assets are given in Note 26 to repayments of PDC from, the 1.15 Value Added Tax the accounts. NHS Foundation Trust. 2 SEGMENTAL ANALYSIS Most of the activities of the All of the Trust's activities are in Trust are outside the scope of 1.18 Leases A charge, reflecting the forecast the provision of healthcare, VAT and, in general, output tax Where substantially all risks and cost of capital utilised by the therefore no segmental analysis does not apply and input tax on rewards of ownership of a NHS Foundation Trust, is paid is required of the Trust's income purchases is not recoverable. leased asset are borne by the over as public dividend capital and net assets under this note. Irrecoverable VAT is charged to Trust, the asset is recorded as a dividend. The charge is the relevant expenditure tangible fixed asset and a debt calculated at the real rate set by category or included in the is recorded to the lessor of the HM Treasury (currently 3.5%) capitalised purchase cost of minimum lease payments on the forecast average carrying fixed assets. Where output tax discounted by the interest rate amount of all assets less is charged or input VAT is implicit in the lease. The interest liabilities, except for donated recoverable, the amounts are element of the finance lease assets and cash with the Office stated net of VAT. payment is charged to the of the Paymaster General. The Income and Expenditure average carrying amount of 1.16 Foreign Exchange Account over the period of the assets is calculated as a simple Transactions that are lease at a constant rate in average of opening and closing denominated in a foreign relation to the balance relevant net assets. currency are translated into outstanding. Other leases are sterling at the exchange rate regarded as operating leases 1.20 Losses and Special ruling on the dates of the and the rentals are charged to Payments transactions. Resulting the Income and Expenditure Losses and Special Payments are 66 Annual Report and Accounts 2005/06 67

3. Income 9 Months 9 Months 3.1 Income from Activities 2005/06 to 31/3/05 3.3 Income from Activities 2005/06 to 31/3/05 £000 £000 £000 £000

Elective income 121,901 85,287 Primary Care Trusts 473,468 344,653 Non Elective income 155,292 104,673 Local Authorities 216 387 Outpatient income 81,250 56,722 Department of Health 25,533 2,225 Other types of activity income 117,860 82,184 NHS Other 1,096 597 A&E Income 9,804 6,682 Non NHS: Private patients 2,319 2,230 PBR transitional relief 16,114 13,677 Non NHS: Overseas patients (non reciprocal) 942 135 Private Patient Income 3,261 2,365 Road Traffic Act 1,840 1,321 TOTAL 505,482 351,590 Non NHS: Other 68 42

Base year TOTAL 505,482 351,590 2005/06 (2002-03) 3.2 Private patient income: £000 £000 4. Other Operating Income 9 Months Private Patient Income 3,261 2,774 2005/06 to 31/3/05 Total patient related income 505,482 367,782 £000 £000

Proportion (as percentage) 0.65% 0.75% Research and Development 7,764 5,633

Section 15 of the 2003 Act requires that the Trust's proportion of private patient Education and Training 52,044 36,178 income in relation to its total patient related income does not exceed that same percentage whilst the Trust was an NHS Trust in 2002/03. This requirement has Transfers from the donated asset reserve in respect of been met. depreciation, impairment, disposal of donated asset 2,459 1,502 Transfers from the government grant reserve in respect of depreciation, impairment and disposal of government grant financed assets 0 831 Non patient care services to other bodies 33,487 22,608 Other 10,336 8,606

TOTAL 106,090 75,358 Annual Report and Accounts 2005/06

5. Operating Expenses

5.1 Operating expenses comprise: 2005/06 9 Months Total to 31/3/05

£000 £000 Services from other NHS Foundation Trusts 2,417 556 Services from other NHS Trusts 6,016 5,655 Services from other NHS bodies 5,266 4,728 Purchase of healthcare from non NHS bodies 5,029 4,988 Directors' costs 1,209 717 Staff costs 396,021 274,979 Drugs costs 50,294 34,440 Supplies and services - clinical 60,700 42,760 Supplies and services - general 7,193 5,176 Establishment 7,094 4,837 Transport 683 454 Premises 19,476 12,201 Bad debts 840 180 Depreciation and amortisation 23,145 16,178 Fixed asset impairments and reversals 1,346 2,096 Audit fees 115 137 Other auditor's remuneration 20 0 Clinical negligence 5,819 3,836 Other 6,641 4,628

TOTAL 599,324 418,546 68 Annual Report and Accounts 2005/06 69

5.2 Operating leases

5.2/1 Operating expenses include: 2005/06 9 Months to 31/3/05 £000 £000

Other operating lease rentals 1,728 1,218

1,728 1,218

5.2/2 Annual commitments under non - cancellable operating leases are: 9 Months 9 Months 2005/06 2005/06 to 31/3/05 to 31/3/05 Land and buildings Other leases Land and buildings Other leases

£000 £000 £000 £000

Operating leases which expire:

Within 1 year 0 276 2 318 Between 1 and 5 years 236 724 0 651 After 5 years 157 247 264 312

393 1,247 266 1,281 Annual Report and Accounts 2005/06

5.3 Salary and Pension entitlements of senior managers

A) Remuneration

Name and Title To 31 March 2006 Salary Other Remuneration Benefits in Kind (bands of £5000) (bands of £5000) Rounded to the £000 £000 nearest £100

Mr A J Cash, Chief Executive 185-190 - - Mr J Watts, Director of Human Resources 110-115 - - Mr N Priestley, Director of Finance 130-135 - - Mrs H Tierney - Moore, Chief Nurse (Left 1 January 2006) 85-90 - - Miss A Smith, Acting Chief Nurse (28 November 2005 - 5 March 2006) 25-30 - - Mrs H Scholefield, Chief Nurse (Commenced 1 February 2006) 15-20 - - Mr C Welsh, Medical Director 145-150 - - Mr C C Linacre, Director of Service Development 115-120 - - Mr J P Donnelly, Non-Executive Director 15-20 - - Ms V R Ferres, Non Executive Director 15-20 - - Mr V G W Powell, Non Executive Director 15-20 - - Mr J M Stoddart, Non Executive Director 15-20 - - Professor A P Weetman, Non Executive Director 15-20 - - Ms O V Bright, Non Executive Director 15-20 - - Mr D Stone, Chairman 55-60 - - 70 Annual Report and Accounts 2005/06 71

5.3 Salary and Pension entitlements of senior managers

B) Pension Benefits Name and title Real increase in Total accrued Cash Equivalent Cash Equivalent Real Increase in Employer's pension and pension and related Transfer Value Transfer Value Cash Equivalent Contribution to related lump lump sum at age 60 at 31 March 2006 at 31 March 2005 Transfer Value Stakeholder Pension sum at age 60 at 31 March 2005 (bands of £2500) (bands of £5000) £000 £000 £000 £000 £000 To nearest £100 Mr A J Cash 47.5 - 50 260 - 265 1,022 789 150 25,900 Mr J Watts 12.5 - 15 190 - 195 814 718 55 15,800 Mr N Priestley 32.5 - 35 140 - 145 467 340 83 18,200 Mrs H Tierney - Moore, Chief Nurse 10 - 12.5 135 - 140 463 403 26 11,900 (Left 1 January 2006) Miss A Smith, Acting Chief Nurse 10 - 12.5 80 - 85 252 203 8 3,500 (28 November 2005 - 5 March 2006) Mrs H Scholefield, Chief Nurse 0 - 2.5 125 - 30 391 344 4 2,600 (Commenced 1 February 2006) Mr C Welsh 27.5 - 30 235 - 240 1,086 917 102 20,300 Mr C C Linacre 15 - 17.5 205 - 210 917 809 62 16,700

As Non-Executive members do not receive pensionable remuneration there are no entries in respect of pensions for Non-Executive members.

A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member's accrued benefits and any contingent spouse's pension payable from the scheme. A CETV is a payment made by a pension scheme, or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which the disclosure applies. The CETV figures, and from 2004-05 the other pension details, include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries. Real Increase in CETV - This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another pension scheme or arrangement) and uses common market valuation factors for the start and end of the period. Annual Report and Accounts 2005/06

6. Staff costs and numbers

6.1 Staff costs 9 Months 9 Months 9 Months 2005/06 2005/06 2005/06 to 31/3/05 to 31/3/05 to 31/3/05 Total Permanently Other Total Permanently Other Employed Employed

£000 £000 £000 £000 £000 £000

Salaries and wages 331,258 325,877 5,381 227,534 223,166 4,368 Social Security Costs 23,716 23,716 0 17,442 17,442 0 Employer contributions to NHSPA 35,354 35,354 0 24,849 24,849 0 Other pension costs (81) (81) 0 (130) (130) 0 Agency/contract staff 6,804 0 6,804 5,952 0 5,952

397,051 384,866 12,185 275,647 265,327 10,320

In addition to the above, £929k (9 months to 31.3.2005, £574k) is included in the cost of fixed asset additions (note 11.1) in respect of capitalised salary costs.

6.2 Average number of persons employed 9 Months 9 Months 9 Months 2005/06 2005/06 2005/06 to 31/3/05 to 31/3/05 to 31/3/05 Total Permanently Other Total Permanently Other Employed Employed

Number Number Number Number Number Number

Medical and dental 1,325 1,273 52 1,263 1,215 48 Administration and estates 2,433 2,310 123 2,301 2,198 103 Healthcare assistants and other support staff 1,308 1,308 0 1,209 1,209 0 Nursing, midwifery and health visiting staff 4,815 4,426 389 4,615 4,274 341 Scientific, therapeutic and technical staff 1,873 1,853 20 1,825 1,800 25

Total 11,754 11,170 584 11,213 10,696 517 72 Annual Report and Accounts 2005/06 73

6.3 Employee benefits

9 Months 2005/06 to 31/3/05 £000 £000 None 0 0

0 0

6.4 Early Retirements Due to Ill Health 9 Months 9 Months 2005/06 2005/06 to 31/03/05 to 31/03/05 £000 Number £000 Number Number of early retirements agreed on the grounds of ill health 23 31 Cost of early retirements agreed on grounds of ill health 802 675

As explained in note 1.13, these costs were borne by the NHS Pensions Agency. Annual Report and Accounts 2005/06

7. Performance on payment of debts 9. Interest Payable and similar charges 9 Months The Better Payment Practice Code requires the Trust to pay all undisputed invoices by to 31/3/05 the due date or within 30 days of receipt of goods or a valid invoice, whichever is 2005/06 Total later. The Trust's performance against this code is set out below: £000 £000 9 Months 2005/06 to 31/3/05 Interest on early retirements - directors' early retirements costs 0 45 repayable over five years Number of non NHS invoices paid 144,803 105,858 0 45 Number of non NHS invoices paid within 30 days 136,713 101,071 Percentage of invoices paid within 30 days 94.41 95.48 10.1 Intangible Fixed Assets Software Total Licences £000 £000 £000 £000 Value of non NHS invoices paid 207,946 150,997 Gross cost at start of period 1,477 1,477 Value of non NHS invoices paid within 30days 196,705 137,793 Percentage of invoices paid within 30 days 94.59 91.26 Reclassifications 93 93 Additions purchased 27 27 Amounts included within Interest Payable (Note 9) Disposals (151) (151) arising from claims made under the Late Payment Gross cost at 31 March 2006 1,446 1,446 of Debts (Interest) Act 1998 0 0 Amortisation at start of period 577 577 Compensation paid to cover debt recovery costs Impairments 3 3 under this legislation 0 0 Provided during the year 219 219 Disposals (151) (151) 8. Profit on Disposal of Fixed Assets Amortisation at 31 March 2006 648 648 9 Months Profit/loss on the disposal of fixed assets is made 2005/06 to 31/3/05 Net book value up as follows: Total Total - Purchased at start of period 885 885 £000 £000 - Donated at start of period 15 15 - Total at start of period 900 900 Profit on disposal of land and buildings 0 23 Profit on disposal of equipment 103 0 - Purchased at 31 March 2006 787 787 - Donated at 31 March 2006 11 11 103 23 - Total at 31 March 2006 798 798 74 Annual Report and Accounts 2005/06 75

11. Tangible Fixed Assets

11.1 Tangible fixed assets at the balance sheet date comprise the following elements:

Land Buildings Dwellings Assets under Plant and Transport Information Furniture Total excluding construction Machinery Equipment Technology & fittings dwellings and payments on account £000 £000 £000 £000 £000 £000 £000 £000 £000 Cost or valuation at start of period 26,444 323,093 2,586 19,026 90,456 785 14,238 16,393 493,021 Additions purchased 0 2,188 15 33,309 2,422 96 215 576 38,821 Additions donated 0 (1) 0 5,915 935 0 14 0 6,863 Impairments 0 (513) 0(409) 00 0 0 (922) Reclassifications 0 15,368 0 (20,650) 3,735 0 756 698 (93) Other in year revaluation 0 (4,566) 0 88 1,817 16 0 347 (2,298) Disposals 0 0 0 0 (5,782) (67) (1,368) (100) (7,317) At 31 March 2006 26,444 335,569 2,601 37,279 93,583 830 13,855 17,914 528,075

Depreciation at 1 April 2005 0 0 0 0 55,316 620 10,469 10,597 77,002 Provided during the year 0 13,720 109 0 6,739 47 1,035 1,276 22,926 Impairments 0 0 0 0 323 3 68 27 421 Reclassifications 0 446 0 0 (458) 0 (27) 39 0 Other in year revaluation 0 (446) 0 0 1,099 12 0 223 888 Disposals 0 0 0 0 (5,718) (67) (1,368) (100) (7,253) Depreciation at 31 March 2006 0 13,720 109 0 57,301 615 10,177 12,062 93,984

Net book value - Purchased at start of period 25,098 294,610 2,397 17,507 28,935 142 3,743 5,389 377,821 - Donated at start of period 1,346 28,483 189 1,519 6,205 23 26 407 38,198 Total at start of period 26,444 323,093 2,586 19,026 35,140 165 3,769 5,796 416,019

- Purchased at 31 March 2006 25,098 295,316 2,312 31,700 30,125 198 3,646 5,499 393,894 - Donated at 31 March 2006 1,346 26,533 180 5,579 6,157 17 32 353 40,197 Total at 31 March 2006 26,444 321,849 2,492 37,279 36,282 215 3,678 5,852 434,091 Annual Report and Accounts 2005/06

11.2 Analysis of tangible fixed assets: Land Buildings Dwellings Assets under Plant and Transport Information Furniture Total excluding construction Machinery Equipment Technology & fittings dwellings and payments on account £000 £000 £000 £000 £000 £000 £000 £000 £000

Net book value - protected assets at 31 March 2006 26,444 321,849 2,492 0 0 0 0 0 350,785 - unprotected assets at 31 March 2006 0 0 0 37,279 36,282 215 3,678 5,852 83,306 Total at 31 March 2006 26,444 321,849 2,492 37,279 36,282 215 3,678 5,852 434,091

11.3 Assets held at open market value

There were no assets held at open market value at the Balance Sheet date.

11.4 Net book value of assets held under finance leases and hire purchase contracts at the Balance Sheet date:

No assets were held under finance leases or hire purchase contracts at the Balance Sheet Date.

11.5 The net book value of land, buildings and dwellings at 31 March 2006 comprises:

31 March 2006 31 March 2005 Total Protected Unprotected Total Protected Unprotected £000 £000 £000 £000 £000 £000

Freehold 350,785 350,785 0 352,123 352,123 0

12. Fixed asset investments

No fixed asset investments were held at the Balance Sheet date. 76 Annual Report and Accounts 2005/06 77

13. Stocks 15. Current Asset Investments 9 Months to 31 March 2006 31 March 2005 2005/06 1 March 2005 £000 £000 Total Total £000 £000 Raw materials and consumables 8,097 8,931 Balance at start of period 0 0 TOTAL 8,097 8,931 Investments purchased 180,000 75,000 Investments sold (180,000) (75,000) 14. Debtors 31 March 2006 31 March 2005 At end of period 0 0 £000 £000 16. Creditors Amounts falling due within one year: 16.1 Creditors at the balance sheet date are made up of: NHS debtors 23,064 18,434 Provision for irrecoverable debts (1,400) (712) 31 March 2006 31 March 2005 Other prepayments and accrued income 1,751 1,060 £000 £000 VAT Receivable 685 594 Amounts falling due within one year: Other debtors 8,270 8,983 Sub Total 32,370 28,359 NHS creditors 10,727 7,588 Non - NHS trade creditors - revenue - other 13,738 11,420 Amounts falling due after more than one year: Non - NHS trade creditors - capital 6,554 7,639 Tax and social security costs 8,076 7,779 NHS debtors 277 240 Other creditors 3,608 3,576 Other debtors 2,144 1,804 Accruals and deferred income 7,448 10,691 Sub Total 2,421 2,044 50,151 48,693 TOTAL 34,791 30,403 NHS creditors include;

NHS Debtors include £0 prepaid pension contributions at 31 March 2006 (£53k - £0k (31 March 2005, £358k) for payments due in future years under at 31 March 2005.) arrangements to buy out the liability for early retirements; and

- £4,411k (31 March 2005, £4,082k) outstanding pensions contributions at 31 March 2006. Annual Report and Accounts 2005/06

16.2 Prudential Borrowing Limit 9 Months 9 Months 9 Months 2005/06 2005/06 2005/06 to 31/3/05 to 31/3/05 to 31/3/05 Target Actual Planned Target Actual Planned £000 £000 £000 £000 £000 £000

Prudential Borrowing Limit set by Monitor 85,200 0 0 10,000 0.00 0.00 Working Capital Facility 46,000 0 0 15,000 0.00 0.00 Actual borrowing in year 0 0 0 0 0 0 Minimum Dividend Cover > 1 2.92 2.91 > 1 3.15 2.75

As the Trust did not require any loans in 2005/06, only the minimum dividend cover ratio is applicable.

The NHS foundation trust is required to comply and remain within a prudential borrowing limit.

This is made up of two elements:

the maximum cumulative amount of long-term borrowing. This is set by reference to the five ratio tests set out in Monitor’s Prudential Borrowing Code. The financial risk rating set under Monitor’s Compliance Framework determines one of the ratios and therefore can impact on the long term borrowing limit.

the amount of any working capital facility approved by Monitor. 78 Annual Report and Accounts 2005/06 79

17. Provisions for liabilities and charges 31 March 2006 31 March 2005 Pensions relating to other staff Legal claims Other Total Total £000 £000 £000 £000 £000

At start of period 1,807 818 4,204 6,829 10,540 Change in discount rate 253 0 0 253 0 Arising during the year 702 466 6,838 8,006 6,678 Utilised during the year (184) (240) (907) (1,331) (10,048) Reversed unused (107) (149) (218) (474) (410) Unwinding of discount 45 0 0 45 69 At 31 March 2006 2,516 895 9,917 13,328 6,829

Expected timing of cashflows

Within one year 146 895 9,917 10,958 5,142 Between one and five years 553 0 0 553 439 After five years 1,817 0 0 1,817 1,248 Annual Report and Accounts 2005/06

Pensions relating to other staff case are covered by the NHSLA, 18 Reserves represent the liability relating to and not included above. staff retiring before April 95 18.1 Movement in taxpayers' equity: 9 Months to (£611k) and Injury benefit "Other" costs relate to costs 31 March 2006 31 March 2005 Liabilities (£1,905k). likely to be incurred under the £000 £000 new Consultant Contract Injury Benefits are payable to (£128k),amounts provided Taxpayers' equity at start of period 409,688 375,656 current and former members of under the 'Agenda for Change' Prior period adjustment 0 4,866 staff who have suffered injury pay deal (£9,725k) and at work. These cases have been provisions under the Carbon 1 April 2005 (restated) 409,688 380,522 adjudicated by the NHS Emmissions Trading Scheme Surplus for the financial year 13,131 8,938 Pensions Authority. (£64k). Consultation with Public dividend capital dividend (12,529) (8,645) individual members of staff on (Losses) / gains from revaluation of purchased fixed assets (776) 18,795 The value shown is the the Agenda For Change and New public dividend capital received 24,844 9,000 discounted present value of Consultants' Contracts is Transfers from donated asset reserve 1,995 1,078 payments due to the individuals continuing. The amount that for the term indicated by becomes payable under the 436,353 409,688 Government Actuary life Carbon Emmissions Scheme is expectancy tables, and the subject to the Trust's actual 18.2 Movements in public dividend capital 9 Months to actual value of this figure emissions in 2006-07. 31 March 2006 31 March 2005 represents the main uncertainty £000 £000 in the amounts shown. Of the above total provision and related payments , some Public Dividend Capital at start of period 280,275 271,275 Legal claims relate to claims £609,683 has been covered by New Public Dividend Capital received 24,844 9,000 brought against the Trust for "back-to-back" income Public Dividend Capital at 31 March 2006 305,119 280,275 Employers Liability or Public arrangements with the Trust's Liability. These cases are major Purchasers. handled by the NHSLA, who provide an estimate of the £23,006,752 is included in the Trust's probable liability. provisions of the NHS Litigation Authority at 31/03/2006 in Actual costs incurred are subject respect of clinical negligence to the outcome of legal action. liabilities of the Trust (31/3/2005 Costs in excess of £10,000 per £19,933,755). 80 Annual Report and Accounts 2005/06 81

18.3 Movements on Reserves

Movements on reserves in the year comprised the following: 2005/06 Revaluation Donated Government Income and Total Reserve Asset Reserve Grant Reserve Expenditure Reserve £000 £000 £000 £000 £000

At start of period 80,634 38,213 169 5,508 124,524 Prior period adjustment 9,448 0 (169) (4,390) 4,889

1 April 2005 (restated) 90,082 38,213 0 1,118 129,413

Transfer from the Income and Expenditure Account 0 0 0 602 602

Loss on other revaluations/indexation of fixed assets (776) (2,410) 0 0 (3,186)

Transfer of realised profits (losses) to the Income and Expenditure Account (30) 0 0 30 0

Receipt of donated assets 0 6,864 0 0 6,864

Transfers to the Income and Expenditure Account for depreciation, impairment, and disposal of donated assets 0 (2,459) 0 0 (2,459)

Other transfers between reserves (3,254) 0 0 3,254 0

At 31 March 2006 86,022 40,208 0 5,004 131,234 Annual Report and Accounts 2005/06

19. Notes to the Cash Flow Statement

19. 1 Reconciliation of operating surplus to net cash flow from operating activities:

9 Months to 2005/06 31 March 2005 £000 £000

Total operating surplus 12,248 8,402 Depreciation and amortisation charge 23,145 16,178 Fixed asset impairments and reversals 1,346 2,096 Transfer from donated asset reserve (2,459) (1,502) Transfer from the government grant reserve 0 (831) (Increase)/decrease in stocks 834 517 (Increase)/decrease in debtors (3,959) 5,970 Increase / (decrease) in creditors 2,543 (2,972) Increase / (decrease) in provisions 6,201 (3,162)

Net cash inflow from operating activities 39,899 24,696

19.2 Reconciliation of net cash flow to movement in net debt 9 Months to 2005/06 31 March 2005 £000 £000

Increase in cash in the period 13,098 1,630

Change in net debt resulting from cashflows 13,098 1,630

Net funds at start of period 8,957 7,327

Net funds at 31 March 2006 22,055 8,957 82 Annual Report and Accounts 2005/06 83

19.3 Analysis of changes in net debt At 1st April 2005 Cash changes in year At 31 March 2006 £000 £000 £000

OPG cash at bank 396 20,793 21,189 Commercial cash at bank and in hand 8,561 (7,695) 866

8,957 13,098 22,055

Third party assets held by the NHS Foundation Trust (note 26) 21

20. Capital Commitments

Commitments under capital expenditure contracts at the balance sheet date were £12.7million (31 March 2005, £26.3 million).

The major components of these commitments are as follows:

Scheme Amount £000

Renal expansion 2,538 Weston Park Hospital site redevelopment 2,134 Research facilities 2,029 Cardiology expansion scheme 1,507 Electrical infrastructure development 1,217 Medical equipment 1,354

21. Post Balance Sheet Events

There were no material Post Balance Sheet events. Annual Report and Accounts 2005/06

22. Contingencies 9 Months to 2005/06 31 March 2005 £000 £000

Gross value (413) (339) Amounts recoverable 0 0

Net contingent liability (413) (339)

Contingencies represent the consequences of losing all current third party legal claims. 84 Annual Report and Accounts 2005/06 85

23. Related Party clinical commitments at considered to give rise to any Transactions Thornbury and Claremont potential conflicts of interest. private hospitals, both of Sheffield Teaching Hospitals which are sited in Sheffield. In The Trust is a significant NHS Foundation Trust is a the period the Trust purchased recipient of funds from corporate body established by healthcare from these two Sheffield Hospitals Charitable order of the Secretary of State hospitals in the sum of £825k Trust. Grants received in the for Health. and £1.0m respectively. year from this Charity amounted to £1.7m. The Trust considers other NHS The Trust also purchased The Trust has also received Foundation Trusts to be related orthopaedic healthcare from revenue and capital payments parties, as they and the Trust Sheffield Orthopaedics Ltd, a from a number of other are under the common control limited company who manage charitable funds. of Monitor. During the year healthcare provided at the the Trust contracted with above hospitals. This Certain of the trustees of the certain other Foundation Trusts amounted to £2.5m during charitable trusts from whom for the provision of clinical and the period. Certain members the Trust has received grants non clinical support services. of the Trust's employees have are members of the NHS The value of activity an interest in this company. Foundation Trust Board. undertaken with these organisations was not material Certain members of the Trust's to the accounts. Governors' Council are appointed from key During the year none of the organisations with which the Board Members or members of Trust works closely. These the key management staff or governors represent the views parties related to them has of the staff and of the undertaken any material organizations with and for transactions with Sheffield whom they work. Teaching Hospitals NHS This representation on the Foundation Trust. Governors' Council gives important perspectives from Professor C Welsh and these key organisations on the Professor A P Weetman have running of the Trust, and is not Annual Report and Accounts 2005/06

24. Private Finance Transactions

24.1 PFI schemes deemed to be off-balance sheet 9 Months to 2005/06 31 March 2005 £000 £000

Amounts included within operating expenses in respect of PFI transactions deemed to be off-balance sheet - gross 0 0

Amortisation of PFI deferred asset 0 0

Net charge to operating expenses 0 0

The Trust is committed to make the following payments during the next year, in which the commitment expires:

31st to 35th years (inclusive) 622 0

The estimated annual payments in future years are expected to be materially different from those which the trust is committed to make during the next year. The likely financial effect of this is £2,483k (31.3.05 £2,483k). This is the full year annual payment , whilst next year's payments will only start partway through the year.

£000 Estimated capital value of the PFI scheme 25,700 Contract Start date: Dec. 2006 Length of project (years) 30 Number of years to end of project 32 Contract end date Nov 2036

The PFI scheme is a scheme to build a new medical ward block on the Northern General Hospital Site (Hadfield Block). 86 Annual Report and Accounts 2005/06 87

Key dates: 25 Financial Instruments undertaking its activities. Interest-Rate Risk 3.06% of the Trust's financial Financial Close - 20 December 2004 FRS 13, Derivatives and Other As allowed by FRS 13, debtors assets and 100% of its Projected Practical completion - December 2006 (date of Financial Instruments, requires and creditors that are due to financial liabilities disclosed commencement of unitary charge) disclosure of the role that mature or become payable under this note carry nil or End of concession period - November 2036 financial instruments have had within 12 months from the fixed rates of interest. Sheffield during the period in creating balance sheet date have been Teaching Hospitals NHS The unitary payment is £2,483,000 per annum at 2004/05 prices . or changing the risks an entity omitted from all disclosures Foundation Trust is not, This will be increased in line with the rise in the Retail Price Index faces in undertaking its other than the currency therefore, exposed to on 1 April each year. activities. Because of the profile. Provisions are shown significant interest rate risk. The residual interest projected value at November 2036 is based on continuing service provider gross. Any amounts The following two tables average percentage for similar schemes, and will be replaced by relationship that the NHS Trust expected in reimbursement show the interest rate profiles projections from professional valuers on practical completion of the has with local Primary Care against a provision (and of the Trust's financial assets scheme. Trusts and the way those included in debtors) are and liabilities: There are no deferred assets associated with this scheme. Primary Care Trusts are separately disclosed. financed, the NHS Foundation Detail; £,000 Trust is not exposed to the Liquidity risk - value of deferred asset 0 degree of financial risk faced The NHS Foundation Trust's - value of residual interest 17,658 by business entities. Also net operating costs are financial instruments play a incurred under annual service 24.2 'Service' element of PFI schemes deemed to be on- much more limited role in agreements with local Primary balance sheet creating or changing risk than Care Trusts, which are would be typical of the listed financed from resources voted There are no PFI schemes deemed to be on-balance sheet. companies to which FRS 13 annually by Parliament. The mainly applies. The NHS NHS Foundation Trust also Foundation Trust has limited largely finances its capital powers to borrow or invest expenditure from funds made surplus funds and financial available from Government assets and liabilities are under an agreed borrowing generated by day-to-day limit. Sheffield Teaching operational activities rather Hospitals NHS Foundation than being held to change the Trust is not, therefore, risks facing the NHS exposed to significant Foundation Trust in liquidity risks. Annual Report and Accounts 2005/06

25.1 Financial Assets Fixed rate Non-interest bearing Total Floating rate Fixed rate Non-interest Weighted average Weighted average Weighted bearing interest rate period for which fixed average term Currency £000 £000 £000 £000 % Years Years At 31 March 2006

Sterling 22,332 21,648 277 407 2.2% n/a n/a

Gross financial assets 22,332 21,648 277 407

Currency At 31 March 2005 £000 £000 £000 £000 %

Sterling 9,197 8,295 240 662 2.2% n/a n/a

Gross Financial assets 9,197 8,295 240 662 88 Annual Report and Accounts 2005/06 89

25.2 Financial Liabilities Fixed rate Non-interest bearing Total Floating rate Fixed rate Non-interest Weighted average Weighted average Weighted bearing interest rate period for which fixed average term Currency £000 £000 £000 £000 % Years Years At 31 March 2006

Sterling (315,036) 0(9,917) (305,119) 2.2% n/a n/a

Gross financial liabilities (315,036) 0 (9,917) (305,119)

Currency £000 £000 £000 £000 % At 31 March 2005

Sterling (287,104) 0(6,829) (280,275) 2.2% n/a n/a

Gross financial liabilities (287,104) 0 (6,829) (280,275)

Note: The public dividend capital is of unlimited term. Annual Report and Accounts 2005/06

Foreign Currency Risk

The Trust has negligible foreign currency income or expenditure.

25.3 Fair Values

Set out below is a comparison, by category, of book values and fair values of the NHS Foundation Trust's financial assets and liabilities as at 31 March 2006.

Book Value Fair Value Basis of fair valuation £000 £000 Financial assets Cash 22,055 22,055 Debtors over 1 year: - Agreements with commissioners to cover creditors and provisions 277 277 Note a 22,332 22,332

Financial liabilities Provisions under contract (9,917) (9,917) Note b Public dividend capital (305,119) (305,119) Note c Total (315,036) (315,036)

Notes a These debtors reflect agreements with commissioners to cover creditors over 1 year for early retirements and provisions under contract, and their related interest charge/unwinding of discount. In line with note b below, fair value is not significantly different from book value. b Fair value is not significantly different from book value since, in the calculation of book value, the expected cash flows have been discounted by the Treasury discount rate of 2.2% in real terms. c The figure is the full value of PDC in the balance sheet and 'book value' equals 'fair value'. 90 Annual Report and Accounts 2005/06 91

26 Third Party Assets 28. Public Dividend This is calculated as follows: Capital Dividend The Trust held £21,168 (31 31st March 2006 31 March 2005 March 2005 £7,654) at bank The Trust is required to £000 £000 and in hand at 31 March 2006 absorb the cost of capital at a which relates to monies held by rate of 3.5% of average net Total Capital and Reserves 436,353 409,687 the NHS Trust on behalf of relevant assets. The rate is patients. This has been calculated as the percentage Less - Donated Asset Reserve (40,208) (38,213) excluded from the cash at bank that dividends paid on public and in hand figure reported in dividend capital totalling Less - Cash held at Office of the Paymaster General (21,189) (396) the accounts. £12,529k (9 months to 31 March 2005 £11,526k) bear Net Relevant Assets before revaluation 374,956 371,078 27 Losses and Special to the average net relevant Payments assets during the twelve National Revaluation Exercise (18,489) month period of £363,772k There were 562 (9 months to (9 months to 31 March 2005 Total Net Relevant Asssets 374,956 352,589 31 March 2005, 131) cases of £344,474k), that is 3.4%. losses and special payments Average Net Relevant Assets 363,772 344,474 totalling £1,106k (9 months to Dividend paid per Cash Flow statement 12,529 11,526 31 March 2005, £125k) approved during financial year. Percentage 3.4% 3.3%

There were 2 cases (9 months The Trust's actual rate of return of 3.4% (9 months to 31 March 2005 3.3%) is not materially to 31 March 2005 - no cases) different from its forecast rate of 3.5%. of losses exceeding £100,000. Note: The total costs included in this note are on a cash basis and will not reconcile to the amounts in the notes to the accounts which are prepared on an accruals basis. Annual Report and Accounts 2005/06 Statement on internal control 2005/06

The Trusts conducts Scope of responsibility including its Financial Strategy in place a governance and steering groups throughout As Accounting Officer, I have and Risk Management Strategy. management framework across the Trust. its affairs in responsibility for maintaining a the whole organisation, which accordance with the sound system of internal control These duties include both includes a Governance Progress against my own principles of sound that supports the achievement legislative responsibility to a Committee and a Healthcare objectives is measured, of the NHS Foundation Trust’s number of statutory established Governance Committee, which monitored and assessed by the corporate policies, aims and objectives, agencies and a duty under the are Committees of the Trust Independent Regulator of NHS governence whilst safeguarding the public Health Act 1999 to ‘put and Board. I have also taken steps Foundation Trusts, the funds and departmental assets keep in place arrangements for to ensure that roles, functions Chairman and the Trust Board. for which I am personally the purpose of monitoring and objectives of Directors and responsible. I am also and improving the quality of Directorate Management Teams The Audit Commission and responsible for ensuring that patient care’. are unambiguous, clearly Internal Audit Services provide the NHS Foundation Trust is detailed and understood. These independent assurance and administered prudently and The Independent Regulator of objectives are regularly monitor progress against the economically and that resources NHS Foundation Trusts has monitored and reviewed by my development and integration of are applied efficiently and established a risk-based Executive Director colleagues an Assurance Framework as effectively. I also acknowledge approach towards regulation and myself. well as ensuring that the my responsibilities as set out in and the Trust’s compliance with organisation operates within the NHS Foundation Trust the terms of authorisation. This The Governors’ Council, the six principles of Good Accounting Officer consists of three main established in compliance with Governance in Public Services Memorandum. I am also components; the annual plan, the Health Service Act, is now which are set out below: personally accountable for all in-year monitoring and, where well established and governance related issues. appropriate, interventions. contributing effectively to the Focusing on the These responsibilities are governance of the Trust with organisation’s purpose and reflected in the Trust’s To allow me to discharge my elected Governors sitting on on outcomes for citizens and Governance Framework personal accountabilities I have various committees and service users > 92 Annual Report and Accounts 2005/06 93

Performing effectively in absolute assurance of committees exist to provide Directorate Managers are clearly defined functions effectiveness. The system of this. These include the: required to have in place and roles internal control is based on an effective arrangements for the ongoing process designed to: Management Audit management of risk relevant to Promoting values for Committee their Directorate’s size and the whole organisation identify and prioritise the Governance Committee circumstances. Very detailed, and demonstrating risks to the achievement of Healthcare Governance specialised and externally good governance the organisation’s policies, Committee accredited training is provided through behaviour aims and objectives of Finance Committee for the managers and staff Sheffield Teaching Hospitals HR Committee within the organisation who Taking informed, transparent NHS Foundation Trust, Remuneration Committee have specific responsibility for decisions and managing risk the management of risk. Evaluate the likelihood of The above are formal Developing the capacity and those risks being realised committees of the Trust Board The risk and capability of the governing and the impact should they with Executive and control framework body to be effective be realised, and to manage Non-Executive Director The Assurance Framework has them efficiently, effectively membership. The Governance identified a number of gaps in Engaging stakeholders and and economically. Committee has a defined assurance and controls. The making accountability real role to oversee the actions most significant gap concerns The system of internal control taken to manage significant the assurance and controls to These principles underpin the has been in place in Sheffield risk issues, its focus manage the uncertainties need for absolute Teaching Hospitals NHS being provided by the created by the complex policy accountability, probity and Foundation Trust for the year Assurance Framework. environment in which the NHS transparency within the NHS. ended 31 March 2006, and up as a whole operates and which to the date of approval of the Each significant risk theme is is felt particularly keenly by The purpose of the system annual report and accounts. owned by one or more Foundation Trusts. Specifically of internal control Executive Directors and my the management of anticipated The system of internal control is This system has been subjected office, through my Assistant changes in the level of designed to manage risks to a to independent audit and Chief Executive, have an emergency patient flows into reasonable level rather than to verification by the Internal overarching responsibility for the Trust is a particular eliminate all risk of failure to Audit Service. the development of a cohesive challenge. The framework has achieve policies, aims and and integrated framework and also identified gaps in the risk objectives; it can therefore only Capacity to handle risk shared processes for the management arrangements provide reasonable and not A number of structures and management of all risk. and the internal major > Annual Report and Accounts 2005/06

> incident arrangements. Across compliance with the standards. partnership arrangements. requirements and its financial all the gaps identified above My Board colleagues and I In order to ensure that all targets in respect of income action plans are in place which recognise that the provision and stakeholders are adequately and expenditure and capital are rigorously and regularly delivery of quality healthcare informed and involved in the investments. These plans monitored by the Board when cannot be achieved in isolation management of these risks, the incorporate the Trust’s plans for it meets to consider from the wider health and social Trust participates fully in the improving productivity and governance issues. service community of Sheffield Sheffield City Council Scrutiny efficiency in order to offset the and South Yorkshire and that a Board and liaises closely with income losses arising from the Risk appetites are determined number of the risks it faces have the academic institutions. national efficiency target by the process of setting the the potential to impact on other The PALS service in the Trust applied to all NHS providers Trust’s plan for the members of the healthcare was one of the pilot sites set up and the implementation of the forthcoming year in the community, the Sheffield across the country as this new Payment by Results funding context of the uncertainties of Universities and ultimately service was introduced four system; plus local investment the external environment. The the people of Sheffield and years ago. The service has proposals. The financial plans key aspects of the plan are South Yorkshire. different ways of feeding back reflect organisation wide plans then monitored in-year by the information gained through and initiatives but are also Board and adjusted accordingly The Chief Officers of the health contact with patients in order translated into Directorate as the risks can be better and social care organisations for the Trust to develop services budgets and productivity and assessed. In particular the within Sheffield meet regularly and improve patient care, and efficiency plans. Increasingly, financial risks identified at the to address strategic, their overall experience at one financial planning at all levels is beginning of the year are performance, financial and of our hospitals. This feedback influenced by the income reviewed by the Board each service development issues and is delivered at a local assumed from national tariffs month including an assessment agree action to be taken to directorate level and also at a and Reference Cost Indices of the financial consequences address any system wide risks or strategic level, and which broadly compare actual of the risk and an assessment concerns. Various partnership encompasses both individual costs to expected tariff income. of the likelihood that it boards and sub-committees experiences and also Financial plans are approved by will occur. focussed on particular aspects emerging patterns. the Board, supported by of the strategy and its detailed scrutiny from its In line with the requirements of implementation are well Review of economy, Finance Committee. An Annual the Healthcare Commission the established and report to the efficiency and effectiveness Plan is submitted to Monitor, Trust has assessed itself against Chief Officers Group and the of the use of resources reflecting financial, service and the Standards for Better Health Sheffield Health & Social Care The Trust produces detailed governance aspects, each of and submitted its final community works together annual plans reflecting its which is ascribed a risk rating declaration indicating through well established service and operational by Monitor. > 94 Annual Report and Accounts 2005/06 95

> This plan incorporates functions to ensure the controls system is in place. independent reviews projections for the following are operating effectively and to The Governance Committee of undertaken on behalf of the two years which facilitates advise on areas for the Trust Board has reviewed National Health Service forward planning by the Trust. improvement. All action plans the Assurance Framework with Litigation Authority (NHSLA) agreed are monitored and a particular focus on the Internal Audit reports The in-year use of resources is implementation is reviewed significant risks facing the Trust External Audit Reports monitored by the Board and its regularly and reported to as a whole and within each sub committees via a series of Management Audit Committee objective the two principle risks My review of the effectiveness detailed monthly reports as appropriate. Any high-risk facing the Trust in relation to of the system of internal control covering finance, activity, issues identified are corrected that objective. Significant is assisted by the deliberation of capacity, human resource immediately. actions have already been taken the Management Audit management and risk. These to improve controls against Committee and the Governance documents are a consolidation Review of effectiveness these risks and the Governance Committee. A plan to address of detailed reports that are As Accounting Officer, I have Committee monitors the weaknesses and ensure provided at Directorate and responsibility for reviewing the ongoing action plans on a continuous improvement of the Department level to allow active effectiveness of the system of quarterly basis. In particular the system is in place. As part of management of resources on an internal control. My review of Trust has identified the this process the Executive operational level. Quarterly the effectiveness of the system uncertainties created by national Directors have been actively monitoring returns are of internal control is informed financial (payment by results) engaged in considering and submitted to Monitor from by the work of the internal and planning systems as the reviewing the system of internal which a risk rating is again auditors and the executive most significant risk. control. The Management Audit attributed to the financial, managers within the NHS Committee has been receiving service and governance aspects. Foundation Trust, and The Assurance Framework itself and monitoring relevant audit comments made by the external provides me with evidence that reports and the Internal Audit All the above is underpinned by auditors in their management the effectiveness of controls Service continues to work the Trust Scheme of Delegation, letter and other reports. I have intended to manage the risks to against a risk-based audit plan. Standing Orders and Standing been advised on the the organisation achieving its Financial Instructions, which implications of the result of my principal objectives have been allow the Board to ensure review of the effectiveness of reviewed. My review is also resources, are controlled only by the system of internal control by informed by: Signed those appropriately authorised. the Board, the Management Audit Committee and a plan to the Management Letter to Chief Executive Officer The Trust also makes use of address weaknesses and ensure Directors from the Audit (On behalf of the board) both Internal and External Audit continuous improvement of the Commission 15 June 2006 This annual report and accounts has been produced by Sheffield Teaching Hospitals NHS Foundation Trust. For further information on any aspect of this report or enquiries regarding our services, please visit www.sth.nhs.uk or write to:

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