Highland NHS Board 1 December 2009 Item 4.3
NHS HIGHLAND ANNUAL REPORT
Report by Anne Gent, Director of Human Resources
The Board is asked to:
Note the final draft Annual Report for 2008-09. Approve the draft for publication.
1 Background and Summary
NHS Boards are required to publish an annual report conveying the activities of the NHS Board. The principal purpose of the local NHS annual report is to account to the local community and other local stakeholders for key aspects of its performance during the year, as part of public accountability.
The key principles to be followed in annual reporting should include:
- Accessibility: how the report and the information it contains can be made accessible to as many local people and interests as possible, through adopting appropriate presentation, style and media;
- Communications: can the report be used to achieve a range of communications objectives, including communicating key messages to staff, patients, the public, key partners such as local authorities, and representative groups such as local MSPs and councillors?
- Transparency and Openness: annual reports are an important part of the accountability process by which the local community can measure the effectiveness of local NHS services.
(Scottish Executive 2001-2002)
2 Annual Report 2008-09
The attached draft Annual Report for 2008-09 has been prepared with input from across all parts of the organisation, and it reflects the key achievements and challenges during the year.
The NHS Board is asked to consider the draft Annual Report and approve it for publication in December 2009.
3 Contribution to Corporate Objectives
The Annual Report is a means of communicating about the activities of NHS Highland to people in local communities, our own staff, partner agencies, and other stakeholders. The report for 2009-10 includes information about the Corporate Objectives for the year, and about our key achievements during that period. NHS Highland Annual Report
2008/2009
NHS HIGHLAND Annual Report 2008/2009
Compiled by the Communications Team Assynt House, Beechwood Business Park, INVERNESS, IV2 3BW 01463 717123 [email protected]
If you wish to have sections of this document reproduced in another format or language please contact the above address.
2 Contents
Background 4
Chair’s Foreword 6
The best start in life 8
Healthier Highland 9
Closer to Home 11
Technologies and 12 developments to improve patient care
Improving mental health 16
Waiting times 17
Valuing staff 20
Complaints 21
Financial Commentary 23
3 Castle Urquhart, Inverness-shire
NHS Highland looks after the health of 300,000 residents with the Highland and Argyll and Bute Council areas. We also see a proportion of our patients from the influx of tourists to the Highlands, which at certain times of the year can double or even triple the local population. Our 11,000 staff provide care to patients in 25 hospitals, over 110 community clinics and health centres, and in patients’ own homes across all Highland towns and villages, including 30 inhabited islands and many small, remote communities.
We have two main roles. One is to promote good health and wellbeing in our communities. We cannot do this alone, so we work closely with local people and with partner organisations such as the local Councils. We also provide a huge range of clinical services for people who have ill health.
NHS Highland is governed by the NHS Board. The role of the NHS Board is to:
• Improve and protect the health of the local people • Improve health services for local people • Focus clearly on health outcomes and people’s experience of their local NHS system • Promote integrated health and community planning by working closely with other local organisations • Be accountable for the performance of the local NHS system
4 Aonach Mor, Lochaber
Care and services across the huge territory of NHS Highland are provided by our five Operational Units – four providing cover in geographical areas, and one running our main district hospital, Raigmore Hospital in Inverness. Services in each geographical area are organised and run by a Community Health Partnership. The Community Health Partnerships each have their own local managers and clinical leaders, and they work with local patients, carers and with a wide range of partners to plan and deliver services. The acute hospital services provided by staff in Inverness are managed and led by the Raigmore Hospital Management Team. Highland patients also use specialist services though regional and national centres, such as Aberdeen or Glasgow.
Community Health Partnerships
Argyll and Bute Community Health Partnership provides services for 91,000 people across 2,600 square miles, including 26 inhabited islands.
Mid Highland Community Health Partnership provides health services to around 80,500 people across 5,900 square miles, covering Lochaber, Skye and Lochalsh, Ross, Cromarty and West Ness.
South East Highland Community Health Partnership provides health services to around 89,400 people across 5,900 square km including the city of Inverness.
North Highland Community Health Partnership provides health services in Caithness and Sutherland for around 39,000 people across 7,800 square km.
5 Chair’s Foreword:
Garry Coutts
Last year has been an extremely busy but hugely rewarding one for NHS Highland. We have carried on with our aim of making the organisation more streamlined and efficient so that we can direct our resources into front line services. This is essential if we are to develop new facilities and services for our patients.
Some examples of what we have achieved include;
• a new £3.2 million healthcare centre in Lochalsh • a new CT scanner in Caithness General Hospital • progressing plans for the new Migdale Hospital in Bonar Bridge • the Ministerial opening of the new Campbeltown Community Casualty Unit • opening of the new Jura Progressive Care Centre • progressing plans for the new £1.8 million linear accelerator for Raigmore Hospital
As well as delivering these frontline health services we have put resources into a range of other health activities and initiatives throughout NHS Highland including:
• working with our Council partners to promote healthy eating in schools • introducing our alcohol awareness campaign • new Tele-endoscopy clinic at Raigmore Hospital • implementing new initiatives to tackle childhood obesity • new stroke services for patients attending Caithness General Hospital
We have also been continuing with the national strategy of ‘Shifting the Balance of Care’ to ensure that our patients are cared for as close to home as possible in an environment that is suited to their needs.
We know this is what patients want. We also know from clinical evidence that this is far and away the best way of ensuring good outcomes for people who need medical treatment. In the future we will redesign more of our services in this way.
6 An example of this redesign is that last year we carried out a major consultation into the future delivery of mental health services in Argyll and Bute. This proposed the closure of a large acute hospital and its replacement with comprehensive community services and smaller inpatient facilities. Our proposals were approved by the Cabinet Secretary for Health and Wellbeing and we are now moving to the implementation stage.
We are also improving efficiency to allow us to treat people faster than ever before. At the end of March 2009 we had met our targets to ensure;
• no patient waited over 12 weeks for a consultant appointment • cancer patients have benefited from faster diagnosis and treatment • A rise of 20% since 2004/05 in the number of people receiving a day case procedure - and we plan to further increase this over the next 2 years
Changes like those we have implemented in the past year are not easy to deliver Some people are understandably concerned that when we change things they will not be as good or as convenient as the services they currently enjoy. We will always try to implement change in a way that meets everyone’s expectations and answers their concerns, but we know this is not always possible. I want to assure you, however that my board and I are committed to putting patients first and will not countenance change unless we believe it is for the long term good of the Highland community.
Finally I would just like to put on record my thanks to all of our staff for their hard work and continued commitment to excellent health care across the Highlands.
7 The best start in life
Funding for Childhood Obesity
NHS Highland welcomed funding to help us promote healthy weight in the region’s children.
The Scottish Government allocated £126, 000 for 2008/2009 to allow the NHS to deliver support to families with overweight children encouraging them to have a healthier diet and be more physically active.
The money will be used to provide programmes across Highland which will support families to have healthier diets and take more physical exercise.
Childsmile is coming to Caithness
An exciting new oral health improvement programme – Childsmile – was brought to Caithness by NHS Highland.
Parents of every newborn child within Caithness were offered the chance of joining the Childsmile programme enabling them to receive additional help and support in looking after the health of their baby’s teeth.
Families were offered the chance of a home visit when their baby is three months old to discuss the benefits of the Childsmile programme, benefits include:
• Ongoing preventative support for keeping your child’s teeth healthy • Registration with local NHS dentists for your child, and • Additional toothbrushes, toothpaste and free-slow drinking cups for your child.
8 Argyll and Bute Schools Bite into Healthy Eating
Argyll and Bute Council was delighted to announce that all of its primary and secondary schools are now officially recognised as being ‘Health Promoting Schools’.
Health Promoting Schools recognise that environmental factors have a great influence on the choices people make. They aim to make it easy as possible to pick the healthy option.
Healthy eating is recognised as a major contributor to future health and wellbeing; teaching children the importance of good nutrition sets them up for the future.
The Health Promoting Schools initiative is delivered in partnership by the Council and NHS Highland, and has been made possible by the dedication and hard work of pupils and staff who are leading the way forward in changing attitudes towards health and fitness.
Healthier Highland
Action against Hepatitis C
NHS Highland welcomed the launch of Phase 2 of the Hepatitis C Action Plan. The next stage in the work to improve care for people with the virus and reduce its spread was launched by Public Health Minister Shona Robison.
We also took the opportunity to appeal for people to take part in a workshop as part of our local efforts to set priorities for the improvement of treatment, testing, diagnosis, care and prevention.
How Many Miles?
Staff at Raigmore Hospital, Inverness were encouraged to take that extra step after pedometers were delivered to each department by the hospital’s Health Improvement Team.
We are all encouraged to be physically active for at least 30 minutes every day to benefit our general health and fitness and activity, like walking, that can be included in a normal day is more likely to be maintained.
Staff were encouraged to see how many steps they take in a working day and it was soon noticed that some of our staff were already very active. Two of our Outpatient Porters found that they are walking the equivalent of a trek from Inverness to Beauly – that’s 14 miles a day, or around 28,000 steps.
9 New health initiatives launched at Ross-shire hospital
Two new initiatives were launched at the County Community Hospital in Invergordon in December to help ensure a healthy environment for staff and patients and encourage staff and the wider community to adopt healthier lifestyles.
Staff were working hard to find ways to implement the Scottish Government’s Healthy Working Lives (HWL) and Health Promoting Health Service (HPHS) initiatives at their establishment.
NHS Highland chair Garry Coutts attended the Easter Ross hospital at the beginning of December to meet the staff involved and learn more about the projects.
Displays at the launch provided information on a variety of subjects, including smoking cessation and health and nutrition.
10 Closer to home
NHS Highland’s plans for improving services emphasise the importance of reducing unnecessary travel. Here diagnostic technology is being used remotely to facilitate the examination of a patient’s upper airway. The consultant in Raigmore views the images, as the Western Isles Hospital carries out the scoping procedure.
Innovative ENT Tele-endoscopy clinic goes live
The first Ear, Nose and Throat (ENT) endoscopy clinic via tele-link with patients on the Western Isles took place in June 2008 thanks to the Scottish Centre for Telehealth (SCT).
They are supporting health boards across NHS Scotland to redesign and improve patient access to healthcare no matter where they live. The project between Raigmore Hospital and the Western Isles Hospital was set up with a view to continuing this as a sustainable service for the local population.
This is the second phase of a pilot project that uses diagnostic technology remotely to facilitate the examination of a patient’s upper airway. The project involves examining selected patients; primarily those referred with voice disorders, throat disorders and swallowing difficulty, in the Outpatient Department at the Western Isles Hospital - while videolinking to the ENT Department at Raigmore. The Consultant at Raigmore is able to talk to the patient and also view the images, enabling him to make a diagnosis and plan further medical intervention if necessary.
First Epilepsy Video Link
NHS Highland, in partnership with social care charity Quarriers and the Scottish Epilepsy Centre ran a telemedicine pilot for epilepsy services with the first video link between New Craigs Hospital, Inverness and the Scottish Epilepsy Centre at Quarriers Village taking place in October.
The pilot, which lasted six months, offered a specialist epilepsy service to people with learning disabilities, including advice to medical staff, who would not normally have access to it. It also presented the opportunity to evaluate the benefits and effectiveness of this pilot in improving access to services in remote and rural areas and treatment outcomes for patients.
11 Left: Ministerial visit to Campbeltown Hospital’s Community Casualty Unit
Technologies and developments to improve patient care
New Centres Opened
Throughout the year we have had various new centres and units opened across our area. Some examples include…
Our new £300,000 Community Casualty Unit at Campbeltown Hospital, with its own dedicated entrance for the public complete with reception and waiting areas was officially opened in April 2008. The clinical area has two consulting rooms and a four bedded resuscitation bay which will allow staff to care for multiple casualties simultaneously.
In August 2008 our new Healthcare Centre in Lochalsh was officially opened. The purpose-built Healthcare Centre is home to up to 50 staff including a GP practice and two dental surgeries. Over time the new facilities and additional staff will allow NHS Highland to expand access to NHS dentistry to an additional 1000 people. The Centre also provides a base for district nurses, midwives, the Community Mental Health Team, physiotherapist, speech and language therapist, occupational therapist, learning disability team and public health practitioner.
And in September 2008 older residents on Jura welcomed the opening of our Jura Progressive Care Centre, which will help them to remain on the island. This facility is designed to help people who have reached the stage of requiring residential and nursing care stay as close to their homes and families as possible.
The project consists of a progressive care centre with a communal lounge, dining area and kitchen, five self contained one bedroom properties, a respite facility and six general needs properties for the community.
12 New Centres Planned for Highland
2008-09 also saw NHS Highland started some important developments for the people of Highland…
New build Migdale Hospital in Bonar Bridge
Plans are progressing for the new build Migdale Hospital in Bonar Bridge.
A Project Team, whose members include representatives from the local community, hospital nurses and the Sutherland Access Panel, has been meeting regularly and a second draft of the new hospital’s proposed Above: Artists impression of the new design is being worked on by the Design build Migdale Hospital in Bonar Bridge Team appointed by NHS Highland.
Invergordon Dental
In October work on the new three surgery NHS Highland dental clinic in Albany Road, Invergordon was well underway. The clinic, situated in the refurbished old Health Centre building will provide more suitable facilities for the Dental Service currently based at Southlodge Primary School as well as the capacity to register an additional 2,000 patients with an NHS dentist.
Nairn Town and County Hospital
And finally Phase 1 of the £12million Nairn Town and County hospital is due to open in the summer of 2009 (opened as planned). The new health facility has been designed by Glasgow based PMP architects who listened to patient and local residents’ views at the initial design stage. The new hospital will provide 20 in- patient beds, an accident and emergency department to include a new ambulance station, physiotherapy, podiatry, x-ray, occupational therapy and speech therapy and day hospital facilities, as well as local offices for social services. The existing hospital will be refurbished to create a home for dentistry and pharmacy. New accommodation will also be provided for the two GP practices relocating from Lodgehill and Ardersier.
13 Stroke Services in Highland
Caithness General Hospital in Wick has developed new services for Stroke patients in the north and is one of the first Rural General Hospital’s in Scotland to be offering these treatments.
The first of these services, the Novel Rapid Access Neurovascular (TIA) service started up at the hospital on in April 2009. Transient Ischemic Attack (TIA – often known as mini stroke) patients will be seen within 24 hours and treated, not only will this save lives but it will also prevent further strokes.
The Thrombolysis Service, which is a clot busting medication used on some types of stroke patients, was introduced at Caithness General Hospital in May. Approximately 80% of strokes are caused by a blockage of blood supply to part of the brain. Thrombolysis is the use of clot busting drugs to open up these blocked arteries. This can allow blood flow to be restored to brain cells and reduce the amount of damage done by the stroke. Patients who reach hospital within the time frame (up to a maximum of four and a half hours from the onset of the stroke happening) may be eligible this treatment.
Raigmore Hospital’s Stroke Unit held an open day in September 2008 to showcase some of the hard work and ideas that have gone into caring for people throughout Highland who have suffered a stroke.
The Stroke Unit Team led by Dr Paul Findlay is always looking for ways to provide improved and innovative stroke care for the patients, their families and carers. The open day was a great way to highlight to the public some of the work and issues they have addressed.
Demonstrations were held of how we have been able to improve care for patients and those around them. These included a demonstration of how using a Nintendo Wii can help with rehabilitation as well as the launch of our driving protocol, a Highland wide tool which gives advice to health professionals about driving following a stroke.
The day also saw the official opening of our new clinic room by Chest Heart and Stroke Scotland Chief Executive, David Clark. This room is used for rapid treatment for patients who have come in with a minor stroke or a transient ischaemic attack (TIA, commonly referred to as a mini stroke).
14 New Equipment and Services for Highland Patients
North Highland CT Scanner Opens
In August 2008 the first patients were seen at Caithness General Hospital using the new Computed Tomography (CT) scanner. The scanner uses X-rays and a powerful computer to convert x-rays into detailed images of the body. It is used to investigate a wide variety of illnesses including stroke, head injury, cancer, and many other medical conditions.
Images taken in Caithness General are sent electronically to Raigmore Hospital where a Consultant Radiologist looks at the image and makes a diagnosis. An estimated 600 patients a year are expected to have scans done at Caithness General. These patients currently have to travel to Raigmore Hospital in Inverness; a round trip of around 200 miles.
New Service Improves Condition of Chronically Ill Patients
Highland patients with chronic lung disease are reporting a marked improvement in their condition following the introduction of a new rehabilitation service. People suffering from chronic bronchitis, emphysema, or both have Chronic Obstructive Pulmonary Disease (COPD), which results in restriction of the airflow to the lungs. Symptoms include coughing and breathlessness.
It is incurable, but funding from the Scottish Government has enabled NHS Highland to introduce COPD rehabilitation services across the area for which Mid Highland Community Health Partnership (CHP) is responsible. This covers Ross, Cromarty and West Ness, Skye and Lochalsh and Lochaber.
Bowel Cancer Screening
A spotlight has been shone upon screening services across Scotland, heightening the importance of taking part in screening when offered. Screening involves a target population undertaking tests which may show up a cancer before the symptoms have emerged.
Currently, breast screening is offered to women aged 50-70 every 3 years with women aged 71 and over encouraged to attend through self referral to their local screening centre. Cervical screening is routinely offered every three years to women aged between 20 and 60 years of age. Currently men in the general population do not routinely undergo screening – that is until now.
From the 1st of April 2009 men and women 50-74 years old in the Argyll and Bute area will be invited to undergo bowel cancer screening. This will be the first time men and women will be offered screening together.
Bowel Screening for the rest of NHS Highland’s area will be launched in December 2009.
15 Right: Lochgilphead Mental Health Event
Improving Mental Health
In June 2007 Argyll & Bute Community Health Partnership (CHP) published a local vision for mental health services ‘Building on our Experience’ which set out the general principles and improvements in mental health care and services which the CHP and others, including Argyll and Bute Council, provide for the local population.
Throughout the year the CHP developed more detailed plans for what future mental health services will look like, how they will be provided and where they will be located. In doing this there are many factors that need to be considered including:
• The views of people with mental health needs • The views of staff working in mental health services • The views of wider groups of health and social care professionals such as GPs • The views of other providers of community services such as the local authority and the voluntary sector • What is known to be helpful in providing good quality and effective mental health care • What is required of the CHP by Government Policy • Value for public money • The practicalities of providing services across a large geographic area
16 Waiting times: Faster diagnosis and treatment
Waiting times remain a challenge, not just for NHS Highland but on a national level. Throughout the year we have made significant progress in ensuring patients in Highland are now receiving faster treatment.
With all the extra work put in by staff across NHS Highland we were well placed to meet the new target of a 15 week wait for consultant appointments by the end of March 2009. In fact, by the 31st March 2009 we had no patients waiting over 12 weeks for a consultant appointment.
Cancer patients in Highland have been benefiting from faster diagnosis and treatment. We have improved information systems and put service changes in place to meet these targets. With the large number of people involved in the care of each cancer patient, weekly monitoring meetings are held to identify and address any unnecessary delays in individual cases.
NHS Highland has never been busier. In the year 2008/2009 there were:
• More than 48,000 inpatients in our hospitals • More than 21,000 patients were treated as day cases • More than 70,000 new outpatients appointments • More than 93,000 attendances were recorded at A&E
This is just a fraction of the work done by NHS staff and contractors including GPs, dentists and community pharmacists. 90% of patient contacts take place in the community not hospitals.
Inpatient Activity
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2004/05 2005/06 2006/07 2007/08 2008/09
17
Day case activity
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Since 2004/05 there has been a rise of more than 20% in the number of patients having a day case procedure and over the next 2 years we plan to further increase the use of day case surgery to reduce the time patients have to spend in hospital and help reduce pressure on hospital beds
Number of patients waiting for inpatient or day case treatment, split by band of wait
4000
3500 3000
2500
2000
1500
1000
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0 Mar-05 Mar-06 Mar-07 Mar-08 Mar-09
Total Waiting 18 weeks+
18 Outpatient activity
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The number of new patients attending their first outpatient appointments has increased by more than 18% since 2004/05
Accident and Emergency performance
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2004/05 2005/06 2006/07 2007/08 2008/09
Attendances at accident and emergency departments have fallen by over 10% over the past year which has been part of a plan to reduce the number of people who suffer the pain and distress of a health crisis which leads to an emergency admission. We have invested more in services that keep people well, through identification of those people who are at risk of admission or readmission to hospital and ensure they have the support they need to manage their health problems in their own homes.
19 Valuing Staff
“to have well trained, supported and valued staff to support the community’s health and healthcare needs”*
*(one of NHS Highland’s 3 ambitions)
One way of recognising the commitment and innovation show by NHS Highland staff is through the Staff Awards Scheme. In 2008 there were 10 categories - Community Staff, Support Worker, Hospital Worker, Improving Patient Services, Volunteer, Best Publication, Best Team, Mental Health or Learning Disability Staff, Health Improvement and Behind the Scenes Worker.
Left: Winners from the Staff Awards 2008
Staff are nominated by colleagues, patients and carers, and public partners are involved in the judging of entries.
The NHS Highland Staff Awards showcase the passion for improving patient care that is the hallmark of our employees.
20 Complaints
We need to know when things go wrong, so that we can put them right. Complaints are viewed positively, as a way in which we can learn and improve what we do. Here are three examples of how we have used complaints to improve services and procedures.
A patient raised concerns regarding the attitude of a trainee doctor and the apparent lack of sympathy they received whilst attending A&E. The hospital management team agreed that this complaint will be shared with trainee doctors to ensure that recognition of the patient's experience and feelings are taken into account during their care.
A wheel chair user complained that the disabled toilets in the outpatient clinic they attended did not have any pull down grab bars, only fixed side bars. They pointed out that not everyone is disabled on the same side so fixed bars are not of any use to a lot of people. The facility was reviewed and identified that it no longer complied with current regulations. It was arranged for grab rails to be fitted until the toilets can be upgraded to meet current standards.
A patient’s referral to a hospital out with NHS Highland was delayed. As a result of the complaint the department have changed the way they administer referrals internally, and ensure that referrals are faxed where appropriate to speed up the process.
Volume of complaints and speed of response
• 300 Complaints received
• 65% responded to in 20 working days
Outcome overall
• 23% of complaints were upheld • 45% of complaints were partially upheld • 33% of complaints were not upheld
21 Main issues raised and outcomes 2008/09 Issue Number Percentage Outcome Number Percentage Attitude / Behaviour 62 21% Upheld 9 15% Partly Upheld 35 56% Not Upheld 18 29% Clinical Treatment 69 23% Upheld 7 10% Partly Upheld 28 41% Not Upheld 34 49% Communication 40 13% Upheld 11 28% Partly Upheld 18 45% Not Upheld 11 28%
Competence 10 3% Upheld 2 20% Partly Upheld 3 30% Not Upheld 5 50%
Delays 1 11 4% Upheld 2 18% Partly Upheld 5 45% Not Upheld 4 36% Environment / 23 8% Upheld 8 35% Domestic Partly Upheld 8 35% Not Upheld 7 30% Other 12 4% Upheld 3 25% Partly Upheld 3 25% Not Upheld 6 50%
Outpatient / 2 1% Upheld 0 0% Other Clinic 2 Partly Upheld 1 50% Not Upheld 1 50% Procedural Issues 10 3% Upheld 0 0% Partly Upheld 5 50% Not Upheld 5 50% Shortage / 20 7% Upheld 8 40% Availability Partly Upheld 8 40% Not Upheld 4 20% Transport 4 1% Upheld 0 0% Partly Upheld 2 50% Not Upheld 2 50%
Waiting Time - date of 6 2% Upheld 3 50% admission Partly Upheld 3 50% Not Upheld 0 0% Waiting Time - date of 30 10% Upheld 15 50% appointment Partly Upheld 14 47% Not Upheld 1 3% Waiting Time - tests 1 0% Upheld 0 0% results Partly Upheld 1 100% Not Upheld 0 0%
1 Logged as a separate category from August 2008 2 Only logged as a separate category for March-July 2008
Contact details have changed to:
The Complaints Team NHS Highland Phone: 01463 705997 PO Box 5713 Fax: 01463 713844 Inverness E-mail: [email protected] IV1 9AQ
22 Financial Commentary
The Scottish Government sets three financial targets for Health Boards:
To operate within the given revenue budget (the Revenue Resource Limit) To operate within the given capital budget (the Capital Resource Limit) To operate within the given cash allocation
In 2008/09, Highland Health Board met all three targets and, in addition the Revenue Re- source Limit has been underspent by £70k and this was carried forward into 2009/10. This provides non-recurring resource to support the revenue position in 2009/10.
Capital expenditure was £25.935m against an allocation of £25.976m and as such shows an underspend of £41k. Capital funding of £4 million has been banked with the Scottish Government for use in future years and supports the capital expenditure plan approved for 2009/10 and beyond.
Operating Cost Statement for the year ended 31 March 2009
2008/09 2007/08 £m £m
Clinical Services Costs Hospital and Community 451.8 435.6 Family Health 152.9 141.4 Total Clinical Services Costs 604.7 577.0
Other Non Clinical Costs 17.1 17.5
Gross Operating Costs 621.8 594.5
Less: Income 46.8 49.3
Net Operating Costs 575.0 545.2
Summary of Revenue Resource Out-turn
2008/09 2007/08 £m £m
Net Operating Costs 575.0 545.2 Less: Capital Grants (to) Other Bodies (1.7) (3.0) Profit/(loss) on disposal of fixed assets (0.1) 0.5 Annually Managed Expenditure (2.1) 0 Less: FHS Non Discretionary Allocation (33.5) (25.9)
Net Resource Outturn 537.6 516.8 Revenue Resource Limit 537.7 522.1 0.1 5.3 Saving against Revenue Resource Limit
23
Balance Sheet as at 31 March 2009 Restated 2008/09 2007/08 £m £m FIXED ASSETS Intangible Fixed Assets 0.7 0 Tangible Fixed Assets 273.6 273.8 Total Fixed assets 274.3 273.8
Debtors falling due after more than one year 9.9 9.7 CURRENT ASSETS Stocks 4.3 4.4 Debtors 20.8 24.8 Cash at bank and in hand 0.1 0.1 25.2 29.3
CURRENT LIABILITIES Creditors due within one year (72.6) (68.2) Net current (liabilities) (47.4) (38.9) Total assets less current liabilities 236.8 244.6
CREDITORS DUE AFTER MORE THAN 1 YEAR (14.2) (14.5)
PROVISIONS FOR LIABILITIES AND CHARGES (10.9) (8.8) (25.1) (23.3) 211.7 221.3 FINANCED BY: General Fund 120.3 123.0 Revaluation Reserve 88.5 93.8 Donated Asset Reserve 2.9 4.5 211.7 221.3
24 Independent auditor’s statement to the members of Highland Health Board on the summary financial statement
I have examined the summary financial statement which comprises the Operating Cost Statement and the Balance Sheet.
This report is made solely to the parties to whom it is addressed in accordance with the Public Finance and Accountability (Scotland) Act 2000 and for no other purpose. In accordance with paragraph 123 of the Code of Audit Practice approved by the Auditor General for Scotland, I do not undertake to have responsibilities to members or officers, in their individual capacities, or to third parties.
Respective responsibilities of the Board and Auditor
The Board of Highland Health Board is responsible for preparing the summary fi- nancial statement within the Annual Report in accordance with guidance issued by the Scottish Government Health Directorates.
My responsibility is to report to you my opinion on the consistency of the summary financial statement with the full audited financial statements of the Board and the Directors Report.
I also read the other information contained in the Annual Report and consider the implications for my report if I become aware of any apparent misstatements or ma- terial inconsistencies with the summary financial statement. The other information comprises only the paragraphs contained within the financial commentary.
Basis of opinion
I conducted my work having regard to Bulletin 2008/3 ‘The auditor’s statement on the summary financial statement’ issued by the Auditing Practices Board. My report on the board’s full annual financial statements describes the basis of my opinion on those financial statements and on the Directors Report.
Opinion
In my opinion the summary financial statement is consistent with the full audited an- nual financial statements and the Directors Report of Highland Health Board for the year ended 31 March 2009.
I have not considered the effects of any events between the date on which I signed my report on the full financial statements and the date of this statement.
David McConnell Assistant Director of Audit (Health) Audit Scotland 7th floor, Plaza Tower EAST KILBRIDE October 2009
25
The NHS Highland Annual Report 2007/2008
For more information on services and how you can participate in the constant work to improve care in Highland visit our website www.nhshighland.scot.nhs.uk and click on the Get involved button.
Front page photo shows Cul Beag, Inverpolly National Nature Reserve
Photo credits - NHS Highland Communications Team, NHS Highland Medical Illustration Team and Scottish Centre for Telehealth
26 4 Governance Implications
Staff Governance The Annual Report provides information about the work of our staff to patients, communities, and to staff themselves, reflecting the staff governance standard. Staff have contributed directly to the preparation of this report.
Patient Focus and Public Involvement The Annual Report is one means of communicating with patients and communities about our activities throughout the year. It is published in a variety of formats, hard copy, published on the website and audio files are made available on request. Feedback on the Annual Report is invited, by various means, on the back page.
Clinical Governance As a communication tool, the Annual Report provides opportunity to describe how NHS Highland has tackled some of the main challenges in providing high quality clinical care.
Financial Governance The level of resource invested in the annual report should be commensurate with a professional and effective end product.
5 Impact Assessment
The Annual Report can be made available in languages other than English and in different formats on request.
Anne Gent Director of Human Resources
20 November 2009
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