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Annual report 2009- 2010

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Annual report 2009- 2010 Powered By Docstoc
					      Southport & Ormskirk Hospital
      providing safe, clean and friendly care   NHS Trust




Annual report 2009-2010
► Contents


     Introduction                                      3

     The Trust and our services                        4

     Caring in numbers                                 5

     Better care for our patients                      7

     Improving performance                             11

     Quality and patient safety                        14

     Care – As Care Should Be                          17

     Research and innovation                           19

     A greener Trust                                   21

     Staff and volunteers                              23

     A hospital in the community                       27

     Corporate responsibility                          31

     Operating and financial review                    33

     Executive directors and non-executive directors   43

     Remuneration report                               44




                                                            1
2
► Welcome to our Trust




In step … Chief Executive Jonathan Parry and Chairman Sir Ron Watson


                    Welcome to the Trust’s Annual Report for      We anticipate many benefits from bringing
                    2009/10.                                      into one organisation services currently
                                                                  provided by three. This creation of the ICO
                    The report gives a summary of many of
                                                                  should eventually lead to an application
                    the changes, the improvements and
                                                                  for Foundation Trust status.
                    performance of the Trust last year, and is
                    produced to inform you about our              We hope you find the report informative
                    stewardship of your hospital.                 and, like us, are proud of the many
                                                                  achievements our staff have been able to
                    As ever it has been an eventful year as
                                                                  deliver for the community.
                    you will discover in the pages ahead.
                    The year to come promises to be no
                                                                  Sir Ron Watson CBE       Jonathan Parry
                    different with the Trust likely to have
                                                                  Chairman                 Chief Executive
                    become part of a new integrated care
                    organisation (ICO) by this time next year.
                                                                                       Southport, June 2010
                    At the time of writing, the Trust continues
                    discussions with NHS Central Lancashire
                    and NHS Sefton with whom we have
                    agreed in principle to create the new
                    organisation.




                                                                                                           3
► The Trust and our services
Southport & Ormskirk Hospital NHS Trust           Much of West Lancashire is rural with the
was formed 10 years ago following the             largest concentration of population being
merger of Southport & Formby District             in Ormskirk and Skelmersdale. There are
General Hospital and Ormskirk District            some of the most deprived wards in the
General Hospital.                                 country in West Lancashire. The semi-
                                                  rural geography places emphasis on
These hospitals, about eight miles apart,
                                                  access to healthcare and the high
provide acute healthcare to a population
                                                  emphasis on agriculture attracts a
of 229,000 primarily within West
                                                  significant number of migrant workers.
Lancashire, and Southport and Formby.
                                                  The Trust has two main commissioners:
The Trust employs approximately 2,600
                                                  NHS Sefton and NHS Central Lancashire
whole-time equivalent staff and has 520
                                                  PCT.
inpatient beds and 50 day case beds.
                                                  Services are also commissioned by:
The Trust also hosts the Regional Spinal
Injury Service whose catchment area                   •   Liverpool PCT
covers Cumbria, North Wales and the Isle
of Man as well as the Cheshire,                       •   NHS Ashton, Leigh and Wigan
Merseyside and Greater Manchester area.               •   NHS Bolton
Southport and Formby has one of the                   •   NHS Halton and St Helens
highest proportions of older people in the
country and there are many residential                •   NHS Knowsley
and nursing homes. It is also socially and        The Trust continues to have close links
economically diverse with areas of both           with the University of Liverpool.
relatively high income and significant
deprivation.
Southport is a coastal resort and as such
attracts more than 5m visitors placing an
increased     seasonal     demand      on
healthcare.




 OUR CLINICAL SERVICES
 Accident & Emergency           Anaesthetics                 Acute Medicine
 Acute Paediatrics              Audiology                    Clinical Microbiology
 Critical Care                  Cardiology                   Dermatology
 Elderly Medicine               ENT                          Gastroenterology
 General Surgery                Genitourinary Medicine       Gynaecology
 Haematology                    Obstetrics                   Ophthalmology
 Pathology                      Radiology                    Rehabilitation
 Respiratory Medicine           Rheumatology                 Stroke
 Therapy Services               Trauma & Orthopaedics        Urology




4
► Caring in numbers




      Inpatients: 58,160                             Urgent care: 79,123
      The total number of inpatients this year is    There was a decrease in people using our
      similar to the previous year with a total of   emergency services because of the
      58,160.                                        closure of the Ormskirk Minor Injuries Unit
                                                     (MIU).
      More than 95% of inpatients are treated in
      18 weeks or less with an average wait          That service is now part of the West
      from referral to treatment of 11 weeks.        Lancashire Health Centre based at the
                                                     Ormskirk hospital site.
                 Day cases       Inpatients
       08/09     23,583          34,725              Of those who attended, 77,849 or 98.4%,
                                                     were seen and either discharged or
       09/10     23,953          34,207
                                                     admitted within four hours.
                                                                   08/09            09/10
      Outpatients: 270,411                            Southport
                                                                   48,482           48,908
      Our outpatient clinics saw fewer patients       A&E
      this year due to a fall in follow-up            Ormskirk
                                                                   11,314           8,094
      appointments with 270,411 in total.             MIU
                                                      Ormskirk
      However,    the     number      of      new
                                                      A&E          21,959           22,121
      appointments overall rose by 3.3%.
                                                      (children)
      More than 97% of outpatients are treated
      in 18 weeks or less with an average wait
      from referral to treatment of six weeks.       Births: 3,133
                 New                Follow-up        Births at Ormskirk maternity unit were
                 appointments                        similar to the previous year.
       08/09     64,665             217,709                          Births
       09/10     66,791             203,620           08/09          3,136
                                                      09/10          3,133




                                                                                              5
6
► Better care for our patients
      Community warfarin clinics                      Currently 67% of NHS Sefton patients
                                                      previously seen in hospital have moved to
      a hit with patients                             community clinics. This is expected to rise
      Community warfarin clinics were begun by        to more than 80% as more clinics open.
      the Trust for north Sefton in June 2009.
      The service is more convenient for
      patients who need to regularly monitor
      their prescription for the anticoagulant
      drug. Currently there are six health centre-
      based community clinics in north Sefton:
      two in Formby, two in Southport town
      centre, one in Ainsdale and one in
      Churchtown with more planned soon.
      Early research shows the vast majority of
      patients are extremely pleased with the
      convenience and rapid turnaround at the          Stress-free treatment
      new community clinics.
                                                       Warfarin clinic patient Ann Behenna
      In particular they like shorter waiting times    (above right), of Churchtown, said:
      – down from up to two hours in the               “The circumstances at the hospital
      hospital to 10 minutes in the clinics. This      were very difficult because there
      has been achieved with no alteration in          were so many people.
      the exceptionally high standard of care          “I was never sure where to sit and I
      already provided by the hospital based           was worried I'd miss my name
      system.                                          being called.
      The new clinics complement the nine              “The clinic here takes out all the
      already established in the south of the          stress of it.”
      borough in Bootle, Crosby, Maghull,
      Waterloo and Thornton.
      The service is run by a team of biomedical
      scientists (BMS) from the pathology             Pain service in demand
      department with support from the                One of the largest increases in demand
      pharmacy team.                                  this year has come from the pain service
      Moving the clinics into the community has       which saw nearly 40% more patients this
      relieved pressure at the hospital, allowing     year – an increase from 2,100 to 2,900.
      other clinics to open on certain days. This     The service has three consultants
      has improved the experience of patients         running four outpatient clinics and four
      attending     both   the    hospital    and     procedure lists each week at Ormskirk.
      community-based anticoagulant clinics.          There is also a specialist nurse, who has
      Housebound patients unable to attend            her own clinic, and two staff nurses.
      clinics were previously managed using a         Procedures are performed under x-ray
      postal system reliant on district nurses        screening or ultrasound guidance, using
      sending samples into the pathology              strict full aseptic technique.
      service.                                        A combined primary and secondary care
      We now provide a full domiciliary service       pathway for the management of patients
      with BMS staff providing patients with the      with back pain has been agreed with the
      same instant monitoring and dose                community pain service.
      alteration in their homes as is available in
      clinic.




                                                                                               7
One of this year’s more than 3,000 hearing aid assessments

One-stop hearing aid clinic                   A robust new process for reviewing
                                              cancer services was introduced in 2009
Seven out of 10 patients who need a           consisting of annual self-assessments
hearing aid get one fitted on the same        against each measure as detailed in the
day as they are assessed.                     Manual of Cancer Standards, a mixture of
This is thanks to a new one-stop hearing      internal validation, external verification
aid clinic begun this year and means          and cancer peer review visits.
patients wait an average of just three        This process provides the organisation,
weeks from being referred by their GP to      patients and public with assurance we are
receiving their hearing aid.                  complying with stringent quality measures.
Patients who require hearing aids that        Within the first year of this new process,
cannot be fitted on the day of                we achieved high levels of compliance for
assessment are waiting on average a           breast, lung, skin, diagnostic gynaecology
further three to four weeks.                  and urology cancer across a range of
                                              services, highlighting numerous areas of
                                              good practice.
Cancer services
Extra   chemotherapy       clinics,    new    We have also made treatment more
equipment for treating skin cancers and       convenient for patients.
improved data collection have been the        For many years we have had an excellent
emphasis for cancer service this year.        relationship with Clatterbridge Centre for
The service has also seen more stringent      Oncology in Wirral with five visiting
changes to the criteria for meeting           consultant oncologists holding sessions at
Government targets and the way our            our hospitals.
performance is evaluated.                     Because the demand for solid tumour and
Despite these changes we continue to          haematology chemotherapy is increasing
meet the targets and have achieved            year on year, an additional half-day
excellent results in our evaluation.          session of chemotherapy has been
                                              introduced on Wednesday afternoons.




8
               This has meant more of our patients can             Maternity matters
               have their chemotherapy or other
               treatment locally, thus avoiding the long           Our focus this year within maternity
               trip to Clatterbridge.                              services has been on support for
                                                                   mothers’ families after the birth of their
               Because of the importance of data                   child.
               collection in the tracking of patients with
               cancer through their treatment, we have             We found a few areas where we felt our
               invested in a system known as the                   services could be enhanced and we have
               Somerset Cancer Register.                           been working with mothers to establish
                                                                   what exactly they thought could be
               This register is web-based and allows               improved.
               more than one user to enter data about a
               cancer patient during their treatment. It is        We also established staff focus groups
               used by the cancer multi-disciplinary               looking at key topics in maternity
               teams to improve patient waiting times by           including bereavement, promotion of
               ensuring patients are referred, diagnosed           midwifery-led care, developing a home
               and treated within the national cancer              birth service and building services in
               waiting time targets.                               children’s centres.
               All two-week wait cancer patients’ and              The aim of the groups is to develop and
               newly diagnosed cancer patients’ waiting            improve    services   while    ensuring
               times are tracked daily throughout their            midwives are involved in the decision
               pathway by the cancer services support              making to give them ownership of the
               team using the register. Weekly, monthly            service.
               and annual performance reports are
                                                                   A bereavement focus group of staff and
               produced and data extracted on an
                                                                   patients was established with the remit of
               individual patient level.
                                                                   reviewing current practice and care
                                                                   pathways.
                                                                   A debriefing service has been developed,
                                                                   staff training introduced and a midwife
                                                                   with specialist interest in bereavement
                                                                   appointed. The group has also been
                                                                   involved in fundraising.




                                                 Additional chemotherapy sessions cut
Hi-tech kit improves                             the miles for patients
                                                 An extra half-day chemotherapy session began this
skin cancer treatment                            year at Southport, meaning more patients are treated
Staff from the dermatology unit at               locally rather than at Wirral’s Clatterbridge centre.
Ormskirk with a newly-acquired
radiosurgery device, which with a                Patient Ursula Demutti (far left) said: “When I had to go
photodynamic therapy machine,                    to Clatterbridge, it took the whole day with the
now allows the treatment of skin                 travelling. Now I live three minutes away ... it’s
cancers without the need for                     wonderful.”
invasive surgery.




                                                                                                           9
Ormskirk maternity unit welcomes a new life – one of 3,133 babies born there in 2009

Two new clinics have been introduced           obstetrician and lead midwife who now
this year aimed at helping mothers after       run a specialist weekly clinic in the
the birth of their child.                      antenatal outpatients.
The VBAC clinic was introduced in May          This service is for women with existing
2009 and is held weekly by a consultant        mental health problems or for those who
obstetrician and consultant midwife            develop problems during pregnancy.
working in partnership to promote normal
                                               Government         recommendations   say
birth after caesarean section.
                                               women should have access to maternity
Women are given the opportunity to             services directly through the midwife as
discuss their previous birth experiences       first point of contact.
and develop a management plan to
                                               This is to offer choice in care and place
support a vaginal birth choice.
                                               of birth and speed up the referral
Perinatal mental health problems are           process.
common and can have a long lasting
                                               We have been collaboratively working
effect on maternal health and child
                                               with NHS Sefton and NHS Central
development. In acknowledgement of
                                               Lancashire to put this service in place.
this and in response to national advice,
we have identified a lead consultant




10
► Improving performance
     Small, simple changes and
     EQIPed for the future                           Case study: EQIP
     During this year the Performance and            thinking in radiology
     Improvement Department introduced a             The radiology department has
     new way of working as part of the quality       an improvement target to
     strategy.                                       reduce DNAs (patient who do
     EQIP (Enabled Quality Innovation                not attend for their
     Partnerships) is the practice of making         appointment) to 1% and as a
     small, simple changes to improve                result reduce re-booking of
     working practices and ultimately provide        appointments to 5%.
     a higher quality patient experience.            The EQIP-inspired
     More than 100 staff went through EQIP           improvement project started in
     workshops which proved to be a huge             August 2009 and it achieved its
     success and gained excellent feedback.          goal with a reduction of DNAs
                                                     from 3% to 1% and a reduction
     These gave staff the ability to seek            in the re-booking rate from 11%
     improvement and look at different               to 4%.
     perspectives. They learnt new techniques
     in problem solving and working                  Tricia Green, radiology
     collectively as a team.                         administration manager said:
                                                     “We would not expect to
     Michelle Morgan, clinical governance and        reduce the rates much further,
     audit manager said: “The two-day course         but sustaining a DNA rate of
     was motivational and generated lots of          less than 1% and a re-booking
     new ideas and ways of working – it was          rate of less than 5% would be a
     lots of fun and I enjoyed the team              great result.”
     working.”
     EQIP’s 2010 workshops were started in
                                                 The    therapist   can  also assess
     May. EQIP improvement notice boards
                                                 equipments      needs,  make  home
     were established in each department and
                                                 assessments and liaise with other
     ward, allowing teams to post suggestions
                                                 relevant professionals.
     for improvement and displaying progress.
     This will support the wider strategy of     If, following an A&E consultation, patients
     small step, simple changes made by front    are      identified  as   requiring     an
     line teams.                                 occupational therapy assessment, these
                                                 are carried out within the department. If
                                                 necessary, physiotherapy assessments
     Therapist boosts A&E                        are carried out by the in-patient
     The use of a dedicated occupational         orthopaedic service.
     therapist in the accident and emergency     Based on their experience at other trusts,
     department at Southport has successfully    our consultants have quickly appreciated
     reduced admissions into hospital.           the value of using the skills of an
     This is because the therapist is able to    occupational therapist at such an early
     support assessments, treatment and          stage. On average 90 patients are
     recommendations for a safe discharge of     assessed in this way each month.
     newly arrived patients. Previously they     In the over 65s, prompt assessment can
     would have been admitted to a ward first    also cut the risk of further physical,
     before having the assessments.              functional and cognitive deterioration,




                                                                                         11
thereby       reducing     longer    term       that have been stopped has been
rehabilitation and resulting in a positive      included and this information can then be
outcome for the patient.                        transferred to the discharge prescription.


CHKS                                            Medical records
For the ninth year running the Trust was        To reduce the number of patients
named as one of the CHKS 40 Top                 queuing to book into outpatient clinics,
Hospitals in 2009.                              patients' case-notes are now placed in
                                                secure trolleys kept outside the clinic
These awards celebrate excellence
                                                consultation rooms.
among CHKS clients across the UK and
are based on the evaluation of 21 key           This has improved the service to the
performance indicators covering safety,         patient because the receptionists are no
clinical effectiveness, health outcomes,        longer trying to find case-notes in a
efficiency, patient experience and quality      small, cramped area, which was adding
of care.                                        considerable minutes on the booking-in
                                                process.
We have entered this programme for the
last eight years and each year we have          It has also improved the overall tidiness
been named in the 40 Top Hospitals. It is       of the reception area, which in turn has
a fantastic achievement.                        improved the ease with which it can be
                                                kept clean.
This award is particularly satisfying as it
is an opportunity to be judged against          Merging the inpatient, outpatient and 18-
other trusts across the country.                week booking teams into one office has
                                                helped them work more effectively in
                                                managing their work load and identifying
Pharmacy                                        problems together.
As part of our continual drive to improve       It is now easier and quicker to sort out
patient safety, we have introduced a new        issues as they all work in the same office.
drug chart for all adult patients except
those in the spinal injuries unit. A new        The outpatient access office staff are
paediatric chart will also be introduced.       now working in teams managing their
                                                own    specialities rather  than    as
The chart was designed with input from          generalists.
nursing, medical and pharmacy staff.
                                                This means they have more ownership of
The major changes include an improved           their speciality and have developed good
allergy box to encourage the actual             working relationships with the business
allergic reaction to be documented; an          managers, clinicians and specialist
indication section so that prescribers can      nurses, thus ensuring issues are raised
detail the indication for antibiotic therapy;   early and reducing the need to “fire fight”
a section for prescribers to print their        problems.
name so that they can be more easily
identified; and an improved section for
non-administration so nursing staff can
annotate why a particular medicine has
not been given (e.g. low blood pressure).
As an additional safety feature additional
charts are incorporated into the main
prescription sheet.
This improves safety as prescribers know
that patients are on additional therapy
such as insulin or anticoagulants.
In order to enhance the information we
provide to GPs once a patient has been
discharged, a section detailing medicines




12
13
► Quality and patient safety
The Trust is committed to creating a              Leadership for safety
culture that makes the safety of patients
our highest priority and adheres in both          Improving patient safety ultimately
word and deed to the primary aim of               requires collaboration between all staff.
“first, do no harm”.                              Many changes are well within the scope
                                                  of a committed team but where they are
To ensure the healthcare we provide is            not, it is crucial that the organisation’s
safe and harm-free, we reconfigured the           leaders empower and support them.
governance         and      effectiveness
departments to form the Department of             The most encouraging and powerful
Quality and Integrated Governance,                demonstration over the past year of our
under the executive leadership of the             staff’s commitment to improving the
Director of Nursing and Midwifery.                quality and safety of the healthcare we
                                                  provide was the endorsement of
This reinforced our existing commitment           leadership walkrounds.
to build the momentum and engagement
required to progress patient safety               Executive and non-executive teams
improvements.                                     developed a programme of visits to talk
                                                  with frontline staff about safety issues, to
                                                  find out about the processes and the
Quality initiatives                               systems and ultimately what worries
Throughout the Trust much quality                 them.
improvement work was already underway             During these walkrounds the team also
with involvement in projects such as the          comes into contact with patients and their
Advancing Quality programme, Matching             relatives, but unfortunately sometimes
Michigan and the Saving Lives                     the environment and time limitations
campaign.                                         means their stories and experiences
To build on the best of that work, we             cannot be gone into in detail. We have
became involved in the national Patient           now started using patient stories to bring
Safety First Campaign. This safer patient         their voice to the Trust Board.
initiative involves staff focusing initially on
four areas of work, underpinned by work           Praise from watchdog
involving leadership.                             We were recognised as one of the best
The clinical areas are intensive care,            NHS trusts in the North West for patient
general ward care, surgical care and              safety by the independent health
medicines management. In these areas a            watchdog, Dr Foster Intelligence.
number of evidence-based care practices           It ranked us sixth out of 23 in a study
which are known to improve the safety of          which looked at a basket of patient
patients have been put in place.                  safety, clinical effectiveness and patient
At the same time members of the                   experience indicators.
executive team, and quality and patient           We were also highlighted for the quality
safety team, embarked on the national             of our keyhole (or laparoscopic) surgery
Leading Improvement in Patient Safety             for gall bladder conditions and the very
(LIPS) programme.                                 low number of day cases where patients
This programme is about building the              have to stay overnight.
capacity and capability within hospital           Medical Director Mohsen Iskander
teams to improve patient safety and               added: “I was particularly pleased to see
works to support the Patient Safety First         our use of keyhole techniques for gall
campaign.                                         bladder surgery being highlighted.




14
15
                                                “Keyhole surgery is used widely in the
                                                Trust because of the many benefits it can
                                                have for patients.
                                                “These include a reduced risk of
                                                infection, less pain with the need for less
                                                medication, less scarring and a shorter
                                                stay in hospital which means getting back
                                                to a normal life more quickly.”


                                                Revalidating doctors
                                                The Trust is leading the way in a new
                                                revalidation scheme of the regulation of
                                                the UK’s doctors.
                                                We are one of six Merseyside NHS trusts
                                                that have formed a consortium to assess
                                                the scheme before it is rolled out across
                                                the country. Once fully implemented, it
                                                will provide extra reassurance for
                                                patients that the doctors treating them
     Case study: safer                          are keeping their skills up to date.
     through the keyhole                        The scheme demands doctors are
     Patricia Wallace, 73, lives with           relicensed to practice every five years.
     husband Bill in Aughton, near              Relicensing will be underpinned by
     Ormskirk.                                  mandatory annual reviews which will
     Last year she underwent keyhole            draw on a full range of performance
     surgery to remove her gall bladder         measures such as prescribing habits,
     and has nothing but praise for the         and feedback from patients and
     surgeons and staff.                        colleagues.

     "I had been feeling unwell earlier in      Specialist      practitioners,    including
     the year and went to my GP who             consultants, will also be required to show
     referred me to hospital. In the            they still meet the particular standards
     summer, I saw consultant surgeon           relating to their area of practice under a
     Rohan Gunasekera at Ormskirk               second element known as recertification.
     hospital who said he thought I             The scheme will be overseen at each
     needed my gall bladder removed. He         hospital trust by a “responsible officer”
     said that he would be doing it             who will ensure all elements of
     laparoscopically.                          revalidation are implemented.
     "I went in to Southport hospital on the
     morning of 4 November, had the
     operation that afternoon and was
                                                What next?
     home again the following day. For          We are now moving to the next stage of
     the first few days I felt a bit sore but   our quality improvement programme,
     within three weeks I was feeling fine      which means making the safety of
     with no tenderness at all.                 patients everyone’s highest priority,
                                                building on what is already achieved.
     "All in all I have been really
     impressed. It was good to have only        We will also be promoting the knowledge,
     stayed in hospital for one night, it’s     skills, behaviours and attitudes required
     always nice to get back home.”             from clinical and non-clinical staff to
                                                make our work and the care we provide
                                                as safe as possible.




16
► Care – As Care Should Be




One of the new individual rooms for patients on the refurbished G ward at Ormskirk


                    Matron champions                               rolled out across the Trust with areas,
                                                                   including    catering   and    portering
                    privacy and dignity                            appointing their own P&D champions.
                    Ensuring the privacy and dignity of            In the mortuary, for example, the
                    patients has been a high priority for the      champion visited all the local undertakers
                    Trust this year.                               to understand how the Trust can improve
                    This included not only delivering same-        the privacy and dignity of visiting families.
                    sex accommodation but also ensuring            The Trust’s Care – As Care Should Be
                    shared facilities are minimised and staff      campaign has developed out of this work,
                    respect the patients’ rights.                  embedding the concept of privacy and
                    A lot of work has been done to make this       dignity across the whole spectrum of
                    happen in the Trust and one of the main        patient need, including people with
                    driving forces has been the appointment        learning disabilities and those at the end
                    of a privacy and dignity matron to             of life.
                    deliver on single-sex accommodation and        Patients, families and visitors were
                    make sure it is maintained.                    surveyed during a week dedicated to
                    Such was the success of the                    Care – As Care Should Be in November.
                    appointment that the concept has been




                                                                                                             17
The feedback – which included negative
comments from incidents some years
back – were analysed and acted on.
This is being reported back in “what
we’ve done” posters all around the Trust.
It is intended to repeat the survey every
three months.
Patient    privacy    has    also     been
transformed in the intensive care unit at
Southport hospital with the installation of
five enclosed patient bays.
The era of using only curtains to shield
patients drew to an end last year with
construction of the fully partitioned,
glazed bays.
Narrow-slatted blinds, sealed inside
double-glazed     window      units,    and
                                              The refurbished bereavement suite at Southport
automatic sliding doors with adjustable
closure settings allow the level of privacy
to be varied as required.                     New bereavement suite
The new layout also has the benefit of        The bereavement suite next to the
reducing the potential spread of infection    mortuary at Southport hospital received a
and aiding in cleaning.                       major facelift.

Deputy director of nursing Angela Kelly       The previously spartan rooms are now a
says: “Often patients are being ventilated    modern, calm space where families can
but the new bays allow greater privacy        grieve and pay their respects more
for families, especially those visiting       comfortably.
patients who are seriously ill.”
Throughout the rest of our hospitals, we      Top marks for PEAT
are in the process of rolling out a new       The Trust’s two hospitals are individually
corporate curtain which incorporates an       inspected for the quality of their
edge design to raise awareness of both        environment, food, and the privacy and
privacy and dignity and hand hygiene.         dignity of patients – the so-called PEAT
                                              scores.
Refurbished wards                             At Ormskirk hospital The National Patient
It is well-documented that single room        Safety Agency scored the environment
accommodation is good for both infection      and food categories “excellent” and
prevention and control and the privacy        privacy and dignity “good” and at
and dignity of patients.                      Southport they scored the food
                                              “excellent” and privacy and dignity and
With this in mind a programme of ward         the environment categories “good”.
refurbishments was started at Ormskirk
with the transformation of G ward.
This has gone from a ward of four six-
bedded bays and four single rooms to a
ward with four bays with three beds and
11 single rooms, four with en-suites. In
addition, all the washroom and toilets are
single sex.




18
► Research and innovation




Dr Aisbitt with Heather Aiscough, Clinical Education Centre Manager, and ‘SimMan’ with reporter Nishma
Hindochi from Radio Lancashire at the opening of the Clinical Education Centre extension at Southport

                    Patient simulators help                        Education Centre at       Southport    that
                                                                   opened in December.
                    train better doctors
                                                                   All of its functions and reactions can be
                    The Trust’s clinical education centre is       controlled remotely by a tutor from
                    accredited with the University of              behind a two-way mirror. The new
                    Liverpool in recognition of our high           facilities also include a computer suite,
                    standard of training.                          quiet room and tutorial rooms.
                    The Trust’s over-riding consideration is       Dr Mike Aisbitt, accident and emergency
                    patient care and safety. In recognition of     consultant and simulation lead, said:
                    this philosophy, the Trust decided to          “SimMan is a tremendous piece of kit and
                    upgrade and add to the patient simulator       at times frighteningly life-like.
                    equipment available to doctors and
                    nurses when the strategic health               “This is a great training aid for junior
                    authority invited bids for additional          doctors who will use it to learn and hone
                    education funding.                             diagnostic skills in a safe environment
                                                                   and ultimately patients will benefit from
                    The two new simulators, one adult and          this investment.
                    one neonatal, are used for the
                    professional development of all health         “It is very unusual for a hospital of our
                    care staff to improve teamwork and             size to have ready access to such a great
                    clinical decision-making.                      educational tool.”
                    These life-size simulators breathe, have       The extension was designed in-house
                    a pulse and blood pressure, can sweat,         and built by a local firm. It was funded by
                    bleed, react to medicine, hear what the        the Trust, the Mersey Deanery (the body
                    staff say and can even talk back to them.      that trains junior doctors) and the
                                                                   Dinwoodie Trust, a charity that supports
                    The adult model, known as SimMan, is           doctors’ education.
                    housed in a new extension to the Clinical




                                                                                                           19
Research powers ahead                                continues    to   fund     a  research
                                                     administrator post independently of
This year has seen a remarkable growth               Department of Health funding.
in research capability within many clinical
areas made possible by a significant                 As well as directly funding research
increase in funding from the Department              investigations, resources have also been
of Health. In 2007/08 funding was                    provided to make undertaking research
£37,000; in 2009/10 it was £388,000.                 easier in the form of time, personnel,
                                                     equipment and infrastructure.
This 10-fold increase is based on
previous    and   anticipated     future             In terms of recruitment to trials and
recruitment into National Institute for              general research activity, we do
Health Research “portfolio” studies.                 proportionally much better than larger,
Commercial research activity also                    better-resourced trusts.



NOTABLE ACHIEVEMENTS IN RESEARCH

Paediatrics           Second highest UK recruiter to MAGNETIC study

Reproductive          First acute trust outside lead centre to open OPPTIMUM study
health

Stroke                Consistent top UK recruiter to TRACS study (commended)

Rheumatology          Top UK recruiter for fibromyalgia study; regional pilot for commercial exemplar project

Alcohol               NIHR grant for RCT into efficacy of brief interventions


                      New electronic approval system has reduced turnaround times
                      System developed to ensure accrual figures are accurate and up to date
R&D
                      Developed a system to differentiate between routine and research investigations to
Department
                      ensure Support Services are fully reimbursed research costs
                      Research passports and honorary contracts allow research personnel to work across
                      trusts with a minimum of red tape

EXTRA RESOURCE FROM R&D FUNDING
Radiology             Research PACS assistant, print and refurbishment of CT suite
Pathology             Infection control IT module; medical laboratory assistant; refrigerated centrifuge
Paediatrics           Neonatal cranial ultrasound probe and training package; research facilitator
Reproductive
health                Fibronectin kits and training; research facilitator

Cancer services       Nurse-led cancer genetics clinic; research facilitator; clinical trials data coordinator
Stroke                Research facilitator
Musculoskeletal       Research facilitator
Pharmacy              Clinical trials pharmacist
Gastro-enterology     Research facilitator




20
► A greener Trust
      The Trust has seen a significant             The department hosts an annual World
      reduction in energy consumption this         Environment Day and also runs an
      year following work to increase energy       environmental champions group with
      efficiency.                                  members from facilities, nursing and
                                                   administration groups. This generates
      Examples of this include new corridor
                                                   ideas for recycling and reduction of waste
      lighting, laundry improvements and the
                                                   and energy in more sustainable ways.
      installation of automatic external doors.
                                                   The Trust recycles 31.7% of its waste by
      We now use 650,000kWh (5.5%) less            weight.
      electricity and water consumption has
      been cut by 8,000m3 (5%).
      Like-for-like consumption for gas shows
      an increase of 5.5% but this is due to a
      rise in the amount of electricity exported
      to the National Grid from the combined
      heat and power system at Ormskirk
      Hospital.
      After taking this increase into account,
      3% less gas was used.


      Energy Centre
      The energy centre in Ormskirk is a
      continuing success, having more than
      doubled the amount of electricity
      exported from just over 1m kilowatt hours
      last year to nearly 2½m kilowatt hours
      this year.                                   Home-cooked for goodness
      That is enough electricity to power
      around 520 three-bedroom houses for a        Catering
      whole year.                                  The catering departments provide a high
      A similar energy centre at Southport         quality, efficient service to patients and
      Hospital is now under consideration. The     visitors with all produce sourced locally to
      Trust expects to choose an approved          cut the “food miles” meals travel.
      developer to take the scheme forward         A balanced menu offers patients a variety
      shortly.                                     of hot and cold meals twice a day with as
                                                   many fresh ingredients as possible
      Sustainability                               cooked at both hospital kitchens.
      Sustainability means ensuring a better       They cater for a wide range of dietary
      quality of life for everyone now and         needs and prepare around 565 meals for
      generations to come. It is a unifying        patients at both lunch and evening meal.
      theme of Government policy.                  Snacks are also offered to patients at
                                                   mid-morning and mid-afternoon.
      One of the roles of the Trust facilities
      department is promoting environmental        This year the Trust bought new cafe-bar
      issues by training staff and raising         drinks trolleys to provide a variety of hot
      awareness, for example by developing a       drinks for patients on the wards.
      waste management e-learning tool.




                                                                                            21
22
► Staff and volunteers
      Championing equality
      and diversity                                 World class HR
                                                    The human resources department is
      We have continued our close working
                                                    participating in a North West initiative to
      relationship with Sefton Equalities
                                                    develop world class human resources
      Partnership and produced our first Single
                                                    services.
      Equality Scheme.
      The scheme replaces the previous              An external assessment of the HR service
      gender, disability and race equality          was completed in the areas of “getting the
      schemes and provides a holistic               basics right” and supporting people
      approach to ensuring equality and             management. The results highlighted
      diversity is at the centre of all workforce   many areas of good practice, particularly
      and service developments.                     in recruitment and payroll services.


      Staff engagement                              Health and well-being
      The views and opinions of staff were          We are pleased to have developed a
      sought using a variety of means including     partnership with Active Sefton to provide
      focus groups supported by the Trust’s         on-site pilates and salsa classes and
      trade union representatives, executive        wellness days, which support and
      director walkabouts and “talk to the chief    encourage staff to take responsibility for
      executive” sessions.                          their own health and well-being.
      The staff opinion survey again showed         We also continue to support staff with in-
      the Trust to be a great place to work, with   house counselling and physiotherapy via
      very pleasing results in the areas of         occupational health.
      training and support. Individual action
      plans will ensure that the feedback
      received from staff is acted upon to          e-HR developments
      continually improve the experience of         Work has been ongoing to continue
      working for the Trust.                        modernising HR services, making use of
                                                    the most up to date technology.

      Staff development                             This has included providing managers
                                                    with up to date information about their
      We commissioned a senior leaders
                                                    staff at the touch of a button to support
      development programme, involving a
                                                    management decision making.
      series of master classes, a development
      centre and the completion of stretch
      projects.                                     Staff options schemes
      Two years on from signing the Leitch skills   A range of staff options have been made
      pledge, more than 230 staff in pay bands      available this year including a cycle to
      1 to 4 have enrolled on training              work scheme and a creche which
      programmes leading to a minimum level         operates at the Ormskirk site day nursery
      two qualification.                            Tiddlywinks.
      This has been made possible by the            These arrangements are made with the
      continued support of the joint investment     approval of HM Revenue and Customs
      framework, which has also funded 24 staff     where payment is made from gross
      to achieve a teaching or assessing            salary, generating a saving on income tax,
      qualification to support staff training and   national insurance and the NHS pension
      development.                                  scheme.




                                                                                            23
PRIDE AWARDS WINNERS 2009                                                                        Facing page:
                                                                                                 Pride of our Trust
Inspirational role model             Kath Todd (ward 15A)                                        … winners of the
                                                                                                 2008/09 Pride
                                                                                                 Awards
                                     Kevan Johnson (ward 7B)
Patient’s Award
                                     Medical Day Unit

Service transformation/
                                     Malcolm Heathcoat (pathology)
innovation

Team of the year                     Emergency Assessment Unit


                                     Barbara Rimmer (occupational therapy)
Unsung hero (staff)                  Carol Breeze (theatres)
                                     Derek Bober (catering)
                                     Doris Shewring (specialist services)


Unsung Hero (Volunteer)              Pam Nanson (outpatients, Ormskirk)
                                     Rene Rimmer (reception)




Pride Awards 2009                                  Sue has been central to training the multi-
                                                   disciplinary team in respiratory and
Following the great success of the                 ventilatory support, as well as reviewing
2008/09 Pride Awards, the Trust agreed             practice and writing care protocols.
the event should be run annually to
recognise the pride and professionalism            In addition she works extensively with
demonstrated by our staff to support the           regional specialist commissioners for the
delivery of safe, clean and friendly patient       provision of sleep and long-term
care.                                              ventilatory services to enable patients to
                                                   return home and live as full a life as
First AHP consultant                               possible.
The importance of the work done in
improving the lives of spinal cord injured
patients was recognised this year with the
appointment of our first allied healthcare
professional consultant.
Sue Pieri-Davies has held the clinical
specialist ventilatory support post for a
number of years within the North West
Regional Spinal Injuries Centre, working
with patients who need help in breathing
following injury to their spinal cord.
Sue has been increasing her skills and
knowledge over the years and this year
met the requirements to be designated a
consultant.                                          Sue Pieri-Davies: AHP consultant




24
► A hospital in the community
                       Give and Let Live                               The campaign was run in conjunction with
                                                                       the three main local newspapers, the
                       champions organ donation                        Southport Visiter, the Ormskirk Advertiser
                       The Trust supported a national campaign         and the Formby Times.
                       to encourage people to sign the Organ
                                                                       Stories were featured weekly during early
                       Donation Register with one of its own,
                                                                       2010 about local people who had received
                       Give and Let Live.
                                                                       them or whose relatives had donated
                       It was overseen by non-executive director       organs. It was also supported by the
                       Jane Daly and supported by the Trust’s          mayor and council leaders of Sefton
                       new donor transplant coordinator, Dr Bill       Council, by Southport Football Club and
                       Bickerstaffe, our lead clinician for organ      by the local Fire and Rescue Service.
                       donation and Dawn Lee, who has 11
    Dawn Lee           years’ experience championing donation
                                                                       Dr Bickerstaffe said: “At present people
                                                                       often have a lack of knowledge and
                       and supporting donor families.
                                                                       unfounded fears about the process of
                       Eight thousand people are waiting for the       donation.
                       chance of a transplant in the UK.
                                                                       “We hope the campaign helped educate
                       Research for NHS Blood and Transplant
                                                                       staff, and promoted a culture of openness,
                       shows 90% of Britons are in favour of
                                                                       awareness and information about organ
                       donation in principle and 96% would take
                                                                       donation among patients and their
                       an organ if they needed one – but only 16
                                                                       families.”
                       million people are on the register.




Dr Bill Bickerstaffe




                       Health checks for children of Chernobyl
                       The Chernobyl nuclear disaster in Ukraine still affects lives after nearly 25 years.
                       Eight children (pictured) who live within 100 miles in neighbouring Belarus visited
                       Ormskirk hospital in June 2009 as part of a four-week visit to the UK. They were
                       brought over by the Burscough group of charity Medicine and Chernobyl. The
                       children aged nine to 11 stayed with local families and enjoyed days out as well as
                       having health checks at Southport Health Centre and the hospital.




                                                                                                              27
Civic visitors
Two parties of civic visitors were welcomed to our hospitals this year. In the first (left), Cllr George
Roberts, Mayor of West Lancashire with his wife, Eileen, and Cllr Alf Doran, Mayor of Sefton, and Gill
Cutherbertson, Mayoress of Sefton, visited the children’s accident and emergency department at
Ormskirk. In the second, they were shown round the North West Regional Spinal Injuries Centre at
Southport by clinical director Dr Clive Glass.



     £173,000, toys, trees and Easter eggs … thank you to everyone
     We are, as ever, extremely
     grateful to everyone who made
     donations this year and in total
     £173,338.02 was given to the
     hospital charitable trust.
     Our thanks to all, and pictured
     right are a number of the
     people who have donated either
     money or equipment.
     We are grateful once again this
     year to Dune FM and Dobbies
     Garden Centre, of Southport,
     who organised a Christmas
     appeal for toys for the
     children's unit at Ormskirk.
     Dobbies also donated a
     Christmas tree and the
     decorations to the children's
     outpatients.
     Thanks too to Barclaycard in
     Kirkby who gave around 80
     eggs and a number of Easter
     hats and to St Helens-based
     Central Fitness who hosted a
     charity “eggstravaganza” to
     raise money for the Ormskirk
     Neonatal Unit.




28
29
30
► Corporate responsibility
      Patient rights                                class for staff to assist them to be
                                                    responsible for their own health and well
      and welfare                                   being. This responsibility has recently
      A number of initiatives and measures          been included in staff job descriptions.
      have been put in place to ensure the          We provide a staff physiotherapy service
      rights and welfare of our patients is         and a confidential counselling service.
      maintained, including:                        We      have    reviewed   our     stress
      Care - As Care Should Be is our banner        management policy and provide stress
      for patient-focussed care issues including    risk assessment training for managers,
      campaigns with which service users can        resilience training for managers and
      become involved (see page 17);                stress management training for staff.
      New electric profiling beds not only          We introduced Pride Awards to improve
      benefit patients and staff that use them      staff morale and recognition within the
      but their easy-clean design contributes to    Trust which cumulates with an annual
      our commitment to reducing healthcare         awards ceremony, which has been
      acquired infection;                           received well by staff (see page 24).
      Working closely with colleagues in            More than a thousand staff received the
      Queenscourt Hospice we have been              seasonal flu vaccine – a record for the
      involved in the North West Ambulance          Trust – and we were just short of the
      Rapid End of Life Care pilot and are the      thousand mark for swine flu vaccinations,
      only Trust to completely take part in the     a programme that started a month later.
      first Gold Standards Framework Acute
      Hospitals pilot;
                                                    Community engagement
      A new tier of senior nurses has been
      introduced with a remit for quality and       To ensure the views of our patients are
      integrated       governance.        This      taken into consideration in the decision
      demonstrates     our    commitment    to      making process, the Patient Experience
      continuous quality improvement;               Group has been reviewed this year. The
                                                    group is in the process of being split into
      We have introduced a patient feedback         two functions: one to inform development
      system for all inpatients and plan to         of Trust policy and strategy and the other
      introduce it to outpatient areas next year;   to carry out research and surveys
      We have enrolled on two campaigns to          gauging the opinions of our patients.
      drive patient safety, the Leading
      Improvements     in   Patient     Safety      Sustainability
      campaign and the National Patient Safety
      1st campaign;                                 A sustainability strategy was developed
                                                    in response to the NHS Carbon
      We are developing the use of patient          Reduction Strategy for England and the
      stories as powerful tools to highlight the    national Good Corporate Citizen agenda.
      impact our actions or omissions can have
      on our patients, visitors and service         It answers the need to take action on
      users.                                        climate change while also ensuring the
                                                    built environment is managed in a
      Staff benefits                                sustainable and efficient way as
                                                    resources allow.
      As part of our health and well-being
      strategy and the NHS Constitution staff       We recognise the need to consider the
      pledges, we have teamed up with Dunes         environmental impact of our business
      Leisure of Southport to start a pilates       activities and through this strategy seek




                                                                                            31
Professional and friendly … a smile for everyone on the drugs trolley round


to define and benchmark the significant        • Emphasising the values of safe, clean,
impact we have on the environment.               friendly and professional during
                                                 induction for new staff as essential to
Our carbon reduction will be measured
                                                 the wellbeing of everyone
and managed as part of our core
business.                                      • Tightened our assurance over training
                                                 to ensure that mandatory means
Governance and ethics                            mandatory
This year the Board has received and
reviewed a number of key reports which         • Mindful of the need to both look and
impact on the governance arrangements.           be professional, we have a new
                                                 supplies system and decluttered wards
While not part of our day-to-day activities,     and departments
the ethos of our ethical approach is
embedded in the investment criteria            • Improved      sickness     monitoring
adopted for charitable donations with no         because of the burden absences place
support provided to gambling, alcohol,           on remaining staff – and acting where
tobacco or armament related industries.          necessary
                                               • Providing doctors with new uniforms
                                                 which allow them to be bare below the
Professionalism                                  elbow
Following extensive interviews with staff
during    2008,    the   Trust    placed       • Improving the monitoring of our
professionalism as an underpinning value         policies and ensuring a robust root
to the Trust’s statement of “safe, clean         cause analysis is carried out after any
and friendly”.                                   hospital acquired infection to ensure
                                                 lessons are learnt
This year we have taken forward the
concept of professionalism in the              • Reviewed the punctuality of staff and
following areas:                                 set efficiency targets for each division.

• Recognising that the quality of the
  work environment impacts on staff and
  patients,    we    began      a   major
  refurbishment of wards to improve
  privacy, dignity and cleanliness.




32
► Operating and financial review
      Financial review summary:                                  moved to HRG 4 (Healthcare
                                                                 Resource Groups). This had a
      an introduction                                            positive effect on the Trust’s
      This is the first year of IFRS (International              results
      Financial Reporting Standards) compliant             •     Managed service contracts for
      accounts and they have a different layout,                 radiological equipment and an
      naming      conventions      and     primary               Energy Centre were re-classified
      statements.                                                under PFI disclosures
      The 08/09 comparator year figures are                •     Capital loan received from
      based on the restated 08/09 IFRS                           Department of Health of £3m
      accounts submitted to the Department of                    repayable over 5 years. This
      Health in December 2009 and not the                        was utilised to open the Urgent
      UKGAAP 08/09 accounts published on                         Care Centre at Ormskirk (known
      the Trust’s website.                                       as the West Lancashire Health
                                                                 Centre)
      The table below shows the change in
      basic terms on the move to international             •     Joint venture with West
      standards:                                                 Lancashire Out of Hours service,
                                                                 the results of which have been
                                                                 consolidated into the Trust’s
                                                                 accounts using proportional
       UK GAAP              IFRS                                 consolidation (50% share)
       Income               Revenue
       Balance sheet        Statement of              Financial targets
                            financial position        There are five key financial targets and
       Fixed                Non-current               performance against those targets is
       Stocks               Inventories               shown below:
       Debtors              Receivables               Retained surplus (breakeven duty).
       Creditors            Payables                  Note that the bottom line results of the
       Income and           Retained                  Trust on the face of the Statement of
       expenditure          earnings                  Comprehensive Income (SOCI) actually
       reserve                                        show a deficit of £7,267k.
                                                      However in terms of performance
      In order to provide an assessment of the        monitoring against the breakeven duty two
      Trust’s financial performance in 2009/10 it     alterations are made:
      is important to note the following key           •       The impairment of £7,651k is
      accounting changes and events:                           added back as these are now
          •    Impairment of non-current                       excluded from the breakeven duty
               assets excluded from the                •       The     incremental    expenditure
               breakeven duty                                  associated with IFRIC 12 schemes
          •    Property valuation dropped by                   (£116k) is also excluded from the
               £22.843m. Of this £7.651m was                   breakeven duty
               an impairment and is shown
               within operating expenses              The Trust has two schemes assessed
                                                      under IFRIC 12 (managed service
          •    Dividend payment based on
                                                      contracts for radiological equipment and
               actual results rather than
                                                      an Energy Centre) which has resulted in
               forecast
                                                      increased expenditure going through
          •    The national tariff which is used      09/10 accounts. Note this had no cash
               as the basis for how the Trust         impact it is technical accounting only.
               gets paid from commissioners




                                                                                              33
                                       Target          Actual 09/10      Variance Full accounts             Achieved
                                       09/10                                      note no.
 Retained surplus                         £500,000           £500,000            £0                  39.1     Yes
 Return on capital employed                 3.50%              3.50%         0.00%                   39.2     Yes
 Capital Resource Limit                 £8,450,000         £8,443,000        £7,000                  39.4     Yes
 External Financing Limit               £2,604,000         £2,597,000        £7,000                  39.3     Yes
 Better Payment Practice Code                   95%               94%            1%                   13       No


To comply with HM Treasury guidance the               Better Payment Practice Code. The
incremental expenditure is excluded from              Better Payment Practice Code requires
breakeven.                                            the Trust to aim to pay all undisputed
                                                      invoices by the due date or within 30 days
Return on capital employed. The
                                                      of receipt of goods or a valid invoice,
calculation for this is the dividend payable
                                                      whichever is later. Performance for non
divided by average net relevant assets
                                                      NHS suppliers was marginally under the
(total assets at bottom half of balance
                                                      95% target.
sheet less donated asset reserve less
money held in Government Banking                      Turnover. Turnover has increased from
Service accounts).                                    £138.448m in 08/09 to £146.757m this
                                                      year. This represents a 6% increase.
In previous years the dividend payable
was based on a forecast and set in                    Of this increase 2.2% relates to inflation
advance so could not be altered in the                with the balance a combination of
year even if there was a major revaluation            changes in the payment by results tariff
exercise.                                             (now based on HRG 4 – healthcare
                                                      resource groups) and increased activity.
The rules changed in 09/10 so that the
dividend payable was based on actual                  Operating expenses. Expenditure has
performance and so could be altered in                increased from £132.798m in 08/09 to
year.                                                 £149.754m this year. This represents a
                                                      12.77% increase.
Capital resource limit. The capital
resource limit (CRL) is a control on capital          The main areas have been the impairment
expenditure in full accruals terms. All               of £7.651m, pay cost increase of £6.21m,
NHS bodies have capital resource limits               clinical negligence premium increase of
which they are not permitted to                       £1.265m with the balance from volume
overspend.                                            and price increases in clinical and general
                                                      supplies.
The Trust under spent against its CRL by
£7,000 and this is within the £50k                    Pay costs have risen by 6.6% since last
tolerance limit set by the Department of              year which is well above the level of pay
Health.                                               awards and increments. Of this £2.4m
                                                      relates to pay awards, unsocial hours and
External Financing Limit. The External
                                                      incremental drift.
Financing Limit (EFL) is a cash-based
control for NHS Trusts. An overshoot                  An additional £2m was put into the pay
against this cash control is not permitted.           budget to cover cost pressures (eg. £440k
                                                      observation ward, £332k for extra staffing
The Trust managed its cash within its
                                                      on 10A, £173k on A&E consultants, £116k
external financing limit of £2,604k and
                                                      anaesthetics to give a few examples).
undershot this target by £7,000. This was
within the £10k tolerance limit set by the            Further costs are associated with SAS
Department of Health.                                 doctors (£623k), anti-coagulant service
                                                      (£151k) and increased agency costs of
                                                      £867k. The increased agency costs is due
                                                      to difficulties in recruiting medical staff.




34
Work gets under way on the extension and refurbishment of A&E at Southport

                       Asset base. The Trust undertook an            demonstrates that the Trust is using its
                       impairment review of all its property         assets efficiently to generate revenue.
                       assets as there was an indication of
                                                                     Liquidity. Liquidity (the ease with which
                       impairment based on general economic
                                                                     an asset can be converted to cash) has
                       conditions.     A reconciliation of the
                                                                     reduced slightly since last year. This can
                       movement on the Trust’s asset base is
                                                                     be seen in the Statement of Financial
                       detailed below:
                                                                     Position line “net current assets/
                                                  £’000s             (liabilities)”.
                                                                     At the end of 2008/09 the Trust had net
                        Opening balance           127,044            current liabilities of £3.414m and at the
                                                                     end of 2009/10 this had slightly risen to
                        Less revaluation          -22,843
                                                                     £4.215m.
                        In year additions          8,745
                                                                     The worsening position was in the main
                        Less depreciation          -5,480            due to recording the capital loan principal
                                                                     payment of £600k due next year as a
                                                  107,466
                                                                     current liability rather than non-current.
                                                                     Whilst it is not ideal operating with net
                       Overall the value of the Trust’s asset base   current liabilities, the Trust has managed
                       has reduced by £19.578m.              It is   the position without having an adverse
                       advantageous to the Trust to operate with     effect on payments to suppliers or staff.
                       as low as possible asset valuation as this




                                                                                                             35
Viability. The Trust’s financial standing is     Pension policy. The Scheme is a “final
assessed every year as part of the Audit         salary” scheme. Annual pensions are
Commission’s Use of Resources score.             normally based on 1/80th for the 1995
                                                 section and of the best of the last three
As the Trust has achieved its statutory
                                                 years pensionable pay for each year of
breakeven for the past 3 years, has met
                                                 service, and 1/60th for the 2008 section of
its capital resource limit target for the last
                                                 reckonable pay per year of membership.
3 years and is projecting a £0.7m surplus
in 2010/11 the Trust is anticipating             Members who are practitioners as defined
receiving an excellent rating for the            by the Scheme Regulations have their
financial standing element of the Use of         annual pensions based upon total
Resources.                                       pensionable earnings over the relevant
                                                 pensionable service.
The Trust is currently in discussions with
NHS Central Lancashire and NHS Sefton            With effect from 1 April 2008 members
who have agreed in principle to create a         can choose to give up some of their
new organisation which will see real             annual pension for an additional tax free
partnership and the bringing together of         lump sum, up to a maximum amount
services from primary care and hospital          permitted under HMRC rules.
that are currently separate. This creation
                                                 This new provision is known as “pension
of an integrated care organisation (ICO)
                                                 commutation”.
will eventually lead to an application for
Foundation Trust (FT) status.                    Financial performance. This section
Auditors. The Trust’s external auditors          contains the Trust’s summary financial
are KPMG. Auditor’s remuneration for the         statements together with the Auditor’s
audit of 2009/10 accounts was £152,000.          report on the summary financial
                                                 statements.
The contact address is: KPMG LLP, St
James Square, Manchester, M2 6DS.                 It should be noted that the summary
                                                 financial statements might not contain
Independence of the external auditors is         sufficient   information  for  a   full
confirmed through a self-declaration. This       understanding of the Trust’s financial
declaration is considered annually by the        position and performance.
Audit Committee.
                                                 A full copy of the accounts, including the
Legal advisors. The Trust’s legal                statement on internal control is available
advisors are Hill Dickinson’s solicitors         on the Trust’s website:
based in Liverpool.
                                                 www.southportandormskirk.nhs.uk.
Pay awards. The remuneration of pay
awards was consistent with national
guidance for 2009/10.




36
37
 


STATEMENT OF COMPREHENSIVE INCOME FOR THE YEAR ENDED 31 MARCH 2010

                                                                                       2009/10      2008/09
                                                                                          £000         £000
Revenue
Revenue                                                                             
Revenue from patient care activities                                                     134,658      127,692 
Other operating revenue                                                                   12,099       10,761 
Operating expenses                                                                     (149,754)    (132,798)
Operating surplus (deficit)                                                               (2,997)       5,655 
Finance costs:                                                                      
Investment revenue                                                                            24          294
Other gains and (losses)                                                                       6          755
Finance costs                                                                              (784)        (734)
Surplus/(deficit) for the financial year                                                 (3,751)        5,970 
Public dividend capital dividends payable                                                (3,516)      (5,753)
Retained surplus/ (deficit) for the year                                                (7,267)          217
 
Other comprehensive income                                                      
Impairments and reversals                                                               (15,192)     (50,005)
Gains on revaluations                                                                          0          503
Receipt of donated/government granted assets                                                 302           95
Net gain/(loss) on other reserves (e.g. defined benefit pension scheme)                        0            0
Net gains/(losses) on available for sale financial assets                                      0            0
Reclassification adjustments:                                                                                 
‐ Transfers from donated and government grant reserves                                     (257)        (255)
‐ On disposal of available for sale financial assets                                           0            0
Total comprehensive income for the year                                                 (22,414)     (49,445)




38 

 
 

 


STATEMENT OF FINANCIAL POSITION AS AT 31 MARCH 2010
                                             31 March 2010       31 March 2009       1 April 2008

Non‐current assets                                  £000                £000       £000 
Property, plant and equipment                    107,466             127,044            173,748 
Intangible assets                                       0                   0                   0
Investment property                                    0                    0                 0
Other financial assets                                 0                    0                 0
Trade and other receivables                          882                1,024               346
Total non‐current assets                         108,348             128,068            174,094 
Current assets                                                                      
Inventories                                        2,341                2,305             2,277 
Trade and other receivables                        7,310                7,138             7,657 
Other financial assets                                 0                    0                 0
Other current assets                                   0                    0                 0
Cash and cash equivalents                            390                  383               377
                                                  10,041                9,826            10,311 
Non‐current assets held for sale                       0                    0             2,269 
Total current assets                              10,041                9,826            12,580 
Total assets                                     118,389             137,894            186,674 
Current liabilities                                                               
Trade and other payables                         (12,351)            (12,631)           (12,161)
Other liabilities                                       0                   0                (8)
DH Working capital loan                                 0                   0                  0
DH Capital loan                                     (600)                   0                  0
Borrowings                                          (331)                   0                  0
Other financial liabilities                             0                   0                  0
Provisions                                          (974)               (609)              (934)
Net current assets/(liabilities)                  (4,215)             (3,414)              (523)
Total assets less current liabilities            104,133             124,654            173,571 
Non‐current liabilities                                                           
Borrowings                                        (7,662)             (8,027)            (7,789) 
DH Working capital loan                                 0                   0                  0
DH Capital loan                                   (2,100)                   0                  0
Trade and other payables                          (1,685)             (1,366)            (1,042) 
Other financial liabilities                             0                   0                  0
Provisions                                          (716)               (781)              (815)
Other liabilities                                       0                   0                  0
Total assets employed                             91,970             114,480            163,925 

Financed by taxpayers' equity:                                                      
Public dividend capital                           94,128              94,224             94,224 
Retained earnings                                 (8,016)              (749)              (966)
Revaluation reserve                                 4,181             19,184             68,541 
Donated asset reserve                               1,437              1,574              1,872 
Government grant reserve                              240                247                254
Other reserves                                          0                  0                  0
Total Taxpayers' Equity                           91,970             114,480            163,925 
                                                                                                    39

 
STATEMENT OF CHANGES IN TAXPAYERS' EQUITY
                                                                      Public        Retained       Revaluation   Donated    Gov’t grant      Other       Total
                                                                    dividend        earnings           reserve      asset      reserve    reserves
                                                                      capital                                     reserve


                                                                      £000            £000              £000       £000         £000        £000        £000
Balance at 31 March 2008
As previously stated                                                94,224            (966)           68,541      1,872           254           0    163,925
Prior Period Adjustment                                                  0                0                0          0             0           0          0
Restated balance                                                    94,224            (966)           68,541      1,872           254           0    163,925

Changes in taxpayers’ equity for 2008/09
Total Comprehensive Income for the year:
    Retained surplus/(deficit) for the year                                     0        217               0          0              0          0         217
    Transfers between reserves                                                  0          0               0          0              0          0           0
    Impairments and reversals                                                   0          0        (49,860)      (145)              0          0    (50,005)
   Net gain on revaluation of property, plant, equipment                        0          0             503          0              0          0         503
   Net gain on revaluation of intangible assets                                 0          0               0          0              0          0           0
   Net gain on revaluation of financial assets                                  0          0               0          0              0          0           0
    Net gain on revaluation of non current assets held for sale                 0          0               0          0              0          0           0
    Receipt of donated/government granted assets                                0          0               0         95              0          0          95
    Net gain/loss on other reserves (e.g. defined benefit pension               0          0               0          0              0          0           0
scheme)
    Movements in other reserves                                                 0              0            0          0             0          0           0
    Reclassification adjustments:
        - transfers from donated asset/government grant reserve           0                0               0      (248)            (7)          0      (255)
        - on disposal of available for sale financial assets              0                0               0          0              0          0          0
    Reserves eliminated on dissolution                                    0                0               0          0              0          0          0
    Originating capital for Trust establishment in year                   0                0               0          0              0          0          0
    New PDC received                                                      0                0               0          0              0          0          0
    PDC repaid in year                                                    0                0               0          0              0          0          0
    PDC written off                                                       0                0               0          0              0          0          0
    Other movements in PDC in year                                        0                0               0          0              0          0          0
Balance at 31 March 2009                                             94,224            (749)          19,184      1,574           247           0    114,480
 
 
    STATEMENT OF CHANGES IN TAXPAYERS' EQUITY
                                                                        Public    Retained Revaluation    Donated      Gov’t      Other     Total
                                                                      dividend    earnings    reserve        asset     grant   reserves
                                                                        capital                            reserve   reserve
                                                                         (PDC)

                                                                          £000       £000         £000       £000      £000       £000       £000
    Changes in taxpayers’ equity for 2009/10
    Balance at 1 April 2009                                             94,224       (749)      19,184      1,574       247          0    114,480
    Total Comprehensive Income for the year
        Retained surplus/(deficit) for the year                              0     (7,267)            0          0        0          0     (7,267)
        Transfers between reserves                                           0           0            0          0        0          0           0
        Impairments and reversals                                            0           0     (15,003)      (189)        0          0    (15,192)
            Net gain on revaluation of property, plant, equipment            0           0            0          0        0          0           0
            Net gain on revaluation of intangible assets                     0           0            0          0        0          0           0
            Net gain on revaluation of financial assets                      0           0            0          0        0          0           0
        Net gain on revaluation of non current assets held for sale          0           0            0          0        0          0           0
        Receipt of donated/government granted assets                         0           0            0        302        0          0         302
        Net gain/loss on other reserves (e.g. defined benefit
    pension scheme)                                                          0          0            0          0         0          0          0
         Movements in other reserves                                         0          0            0          0         0          0          0
         Reclassification adjustments:
             - transfers from donated asset/government grant
    reserve                                                                   0          0           0      (250)        (7)         0      (257)
             - on disposal of available for sale financial assets             0          0           0          0          0         0           0
    Reserves eliminated on dissolution                                        0          0           0          0          0         0           0
    Originating capital for Trust establishment in year                       0          0           0          0          0         0           0
    New PDC received                                                          0          0           0          0          0         0           0
    PDC repaid in year                                                     (96)          0           0          0          0         0        (96)
    PDC written off                                                           0          0           0          0          0         0           0
    Other movements in PDC in year                                            0          0           0          0          0         0           0
    Balance at 31 March 2010                                            94,128     (8,016)       4,181      1,437       240          0     91,970


 


 
 


STATEMENT OF CASH FLOWS FOR THE YEAR ENDED 31 MARCH 2010

                                                                 2009/10    2008/09
                                                                    £000       £000
Cash flows from operating activities
Operating surplus/(deficit)                                      (2,997)      5,655
Depreciation and amortisation                                      5,480      5,389
Impairments and reversals                                          7,651           0
Net foreign exchange gains/(losses)                                     0          0
Transfer from donated asset reserve                                (250)      (248)
Transfer from government grant reserve                                (7)        (7)
Interest paid                                                      (767)      (716)
Dividends paid                                                   (3,516)    (5,753)
(Increase)/decrease in inventories                                   (36)       (28)
(Increase)/decrease in trade and other receivables                   (30)     (159)
(Increase)/decrease in other current assets                             0          0
Increase/(decrease) in trade and other payables                      741      (317)
Increase/(decrease) in other current liabilities                        0          0
Increase/(decrease) in provisions                                    283      (377)
Net cash inflow/(outflow) from operating activities                6,552      3,439

Cash flows from investing activities
Interest received                                                     24        323
(Payments) for property, plant and equipment                     (9,181)    (6,467)
Proceeds from disposal of plant, property and equipment                8      3,241
(Payments) for intangible assets                                       0          0
Proceeds from disposal of intangible assets                            0          0
(Payments) for investments with DH                                     0          0
(Payments) for other investments                                       0          0
Proceeds from disposal of investments with DH                          0          0
Proceeds from disposal of other financial assets                       0          0
Revenue rental income                                                  0          0
Net cash inflow/(outflow) from investing activities              (9,149)    (2,903)
Net cash inflow/(outflow) before financing                       (2,597)        536

Cash flows from financing activities
Public dividend capital received                                        0         0
Public dividend capital repaid                                       (96)         0
Loans received from the DH                                         3,000          0
Other loans received                                                    0         0
Loans repaid to the DH                                             (300)          0
Other loans repaid                                                      0         0
Other capital receipts                                                  0         0
Capital element of finance leases and PFI                               0     (530)
Cash transferred to NHS Foundation Trusts                               0         0
Net cash inflow/(outflow) from financing                           2,604      (530)

Net increase/(decrease) in cash and cash equivalents                   7          6
Cash (and) cash equivalents (and bank overdrafts) at the
beginning of the financial year                                      383       377
Effect of exchange rate changes on the balance of cash held in
foreign currencies                                                     0          0
Cash (and) cash equivalents (and bank overdrafts) at the end
of the financial year
                                                                     390       383     42
 




► Executive directors
                                            Chief Executive Jonathan Parry (centre) 
                                            with the Trust’s executive directors. 
                                            Clockwise from top left are:  
                                            Dr Geraldine Boocock (Medical 
                                            Director); Sharon Partington (Director 
                                            of Human Resources); Steve Taylor 
                                            (Director of Capital and Facilities);  
                                            Mike Frayne (Deputy Chief Executive 
                                            until September 2009); Sheilah 
                                            Finnegan (Director of Strategy, 
                                            Commerce and Communication to 
                                            September 2009, then Chief Operating 
                                            Officer);  Dr Mohsen Iskander (Medical 
                                            Director until June 2009, then Medical 
                                            Responsible Officer ); Liz Yates 
                                            (Director of Nursing); Colin Throp 
                                            (Director of Finance and, from 
                                            September 2009, Deputy Chief 
                                            Executive)




► Non-executive directors
        Trust Chairman Sir Ron Watson CBE
        (top left) with (clockwise) non‐
        executive directors David Rainey 
        (until January 2010); Jane Daly; 
        Rodney Dykes; Helen Thompson; 
        and Jacky Citarella 




     

                                                                                       43
 




► Remuneration report
Salary and pension entitlements of senior managers
a) Remuneration

Name and Title                    2009-10                                 2008-09

                       Salary        Other      Benefits in     Salary      Other      Benefits
                     (bands of   remuneration      kind       (bands of   remunerat
                       £5000)      (bands of    rounded to      £5000)       ion        in kind
                                     £5000)         the                   (bands of   rounded to
                                                  nearest                   £5000)    the nearest
                                                   £100                                  £100

                      £'000s        £'000s        £'00s        £'000s      £'000s       £'00s

J Parry              135-140                        25        135-140                     25
(Chief Executive)
G Boocock             20-25        135-140                     20-25       135-140
(Medical Director)
M Iskander             5-10         35-40           11         30-35       150-155        55
(Medical Director
until 30/06/09)
C Throp              105-110                        3         100-105                     3
(Director of
Finance)
E Yates               85-90                         0          85-90                      12
(Director of
Nursing)
S Finnegan            50-55                         1
(Chief Operating
Officer – from
14/09/09)
M Frayne              40-45                                    90-95
(Deputy Chief
Executive – left
13/09/09)

R Watson              20-25                                    20-25
(Chairman)
J Citarella            5-10                                     5-10
(Non-executive
Director)




       

44 
 

H Thompson              5-10                                         5-10
(Non-executive
Director)
R Dykes                 5-10                                         5-10
(Non-executive
Director)
D Rainey                5-10                                         5-10
(Non-executive
Director– left
31/01/10)
J Daly                  5-10
(Non-executive
Director– started
01/04/09)


Details of benefits in kind stated above relate to lease cars and taxable mileage.

b) Pension benefits

Name & title           Real increase in     Lump sum at          Total accrued       Lump sum at age 60
                       pension at age     aged 60 related to   pension at age 60      related to accrued
                        60 (bands of       real increase in    at 31 March 2010      pension at 31 March
                           £2,500)         pension (bands      (bands of £5,000)        2010 (bands of
                                              of £2,500)                                    £5,000)

                            £'000s              £'000s              £'000s                 £'000s

J Parry (Chief                 0-2.5            0-2.5                50-55                150-155
Executive)

G Boocock (Medical          -2.5-0              -2.5-0               65-70                200-205
Director)

M Iskander (Medical            0-2.5            2.5-5                35-40                110-115
Director)

C Throp(Director of            0-2.5            2.5-5                45-50                140-145
Finance)

E Yates (Director of           0-2.5            0-2.5                25-30                 80-85
Nursing)

S Finnegan (Chief              2.5-5           10-12.5               35-40                110-115
Operating Officer)

M Frayne (Deputy            -2.5-0              -2.5-0               25-30                 75-80
Chief Executive)




     

                                                                                                    45
 

Name & title           Cash Equivalent     Cash Equivalent     Real increase in     Employer's
                       Transfer Value at   Transfer Value at   Cash Equivalent     contribution to
                        31 March 2010       31 March 2009       Transfer Value      stakeholder
                                                                                    pension (to
                                                                                      nearest
                                                                                    hundred £s)

                            £'000s              £'000s              £'000s              £'00s

J Parry (Chief              1,029                932                  51                  0
Executive)

G Boocock (Medical          1,560               1,429                 59                  0
Director)

M Iskander (Medical          N/A                 N/A                 N/A                  0
Director)

C Throp (Director of        1,077                963                  66                  0
Finance)

E Yates (Director of         563                 507                  31                  0
Nursing)

S Finnegan (Chief            716                 574                 114                  0
Operating Officer)

M Frayne (Deputy             398                 366                   6                  0
Chief Executive)

 

As Non-executive members do not receive pensionable remuneration, there will be no entries in
respect of pensions for Non-executive members.

Cash Equivalent Transfer Values

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
disclosure applies.




       

46 
 

The CETV figures and 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 scheme or arrangement) and uses common market
valuation factors for the start and end of the period.

Members of the remuneration committee:

R Watson (Chairman)

J Parry (Chief Executive)

S A Partington (Director of Human Resources)

J Citarella (Non-executive Director)

H Thompson (Non-executive Director)

Remuneration policy

    a) Remuneration packages must be such as to enable people of appropriately high ability to
       be recruited, retained and motivated - within levels of affordability;
    b) All NHS bodies are parts of the public sector and what they do, including the pay of their
       employees, must be publicly defensible;
    c) A properly defensible remuneration package requires a clear statement of responsibilities
       with rewards linked to their measurable discharge;
    d) Wherever possible, it will be advisable to seek independent advice about pay structures
       and the state of the market for the kind of managers to be recruited - including consultation
       with neighbouring NHS bodies.


Service contracts

Directors’ contracts are not time limited and the required notice period is 12 months.

Signed as Accountable Officer of the Trust



J Parry

Chief Executive




     

                                                                                                  47
 

Independent auditors’ report to the Directors of the Board of Southport and Ormskirk
Hospital NHS Trust on the Summary Financial Statements

We have examined the summary financial statements which comprise the Statement of
Comprehensive Income, the Statement of Financial Position, the Statement of Changes in
Taxpayers’ Equity and the Statement of Cash Flows.

This report is made solely to the Board of Southport and Ormskirk Hospital NHS Trust in
accordance with Section 2 of the Audit Commission Act 1998. Our audit work has been
undertaken so that we might state to the Board of Southport and Ormskirk Hospital NHS Trust
those matters which we are required to state to them in an auditor’s report and for no other
purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to
anyone other than Southport and Ormskirk Hospital NHS Trust and the Board of Southport and
Ormskirk Hospital NHS Trust, as a body, for our audit work, for this report, of for the opinions we
have formed.

Respective responsibilities of directors and auditors
The directors are responsible for preparing the Annual Report.

Our responsibility is to report to you our opinion on the consistency of the summary financial
statement within the Annual Report with the statutory financial statements. We also read the other
information contained in the Annual Report and consider the implications for our report if we
become aware of any misstatements or material inconsistencies with the summary financial
statement.

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

Opinion
In our opinion the summary financial statements are consistent with the statutory financial
statements of the Trust for the year ended 31 March 2010 on which we have issued an unqualified
opinion.




Andrew Bostock (Senior Statutory Auditor)
for and on behalf of KPMG LLP, Statutory Auditor

Chartered Accountants
St James’ Square
Manchester
1 June 2010

The maintenance and integrity of the Southport and Ormskirk Hospital NHS Trust web site is the
responsibility of the directors; the work carried out by the auditors does not involve consideration of these
matters and, accordingly, the auditors accept no responsibility for any changes that may have occurred to
the financial statements since they were initially presented on the web site.




       

48 
 




 
 

Southport and Ormskirk Hospital NHS Trust 

Southport and Formby District General Hospital 
Town Lane 
Kew, Southport 
Merseyside, PR8 6PN 
Tel    01704 547471 
 
Ormskirk and District General Hospital 
Wigan Road 
Ormskirk 
Lancashire, 
L39 2AZ 
Tel    01695 577111 
 
www.southportandormskirk.nhs.uk
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Published and produced by the Marketing and Communications Department 
Southport and Ormskirk Hospital NHS Trust 
June 2010 
 

				
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