Get documents about "Booking Agency Contracts for Several Ongoing Performances
Description
Booking Agency Contracts for Several Ongoing Performances document sample
Document Sample
King’s College Hospital
NHS Foundation Trust
Annual Plan
2009-10
Contents
• Executive Summary
• 2008-09 Overview and Performance
• King‟s Vision and Strategic Objectives
• Finance & Activity 2009-10
• Risk Analysis
• Performance Targets 2009-10
• Governance & Membership
• Board Statements
1
Introduction & Context
Executive Summary
• 2008-09 was a very successful year for King‟s - performance was strong in
terms of national targets (such as 18 weeks and 4 hour A&E waits) and our
financial position (£15.5 million surplus), and there were a number of
positive strategic developments for the hospital (including AHSC
accreditation and proposed Stroke and Trauma designation)
• Over the past few months strategy development work has laid the
foundations for robust forward plans. The emerging strategy will influence all
aspects of the hospital‟s activities, including the capital programme, our
performance targets, the focus of our management teams, and the plans of
the Clinical Divisions
• Key elements of the 2009-10 forward plan include the increasing focus on
Quality, a continued drive for greater efficiency (average length of stay
reductions), building strong partnerships in the local health sector, and
shaping King‟s Health Partners as a successful partnership, equipped to
deliver on its bold ambitions
2
Executive Summary –
King‟s in 2008-09
• Targets: Board of Directors compliance for all core standards. Initial
evaluation indicates that the Trust has achieved on all existing and new
2008-09 Overview national targets, where the thresholds are know as part of the Care
Quality Commissions Annual Health Check review for 08/09. Trust
& Performance delivered against key operational targets for infection control (most
notably a 40% reduction in C-Difficile cases), 18 weeks referral to
treatment and Accident & Emergency „4 hour waits‟
• Finance: Risk rating at month 12 was the maximum score of 5, which will
maintain the Trusts excellent rating for „Use of Resources‟. Surplus of
£15.6 million achieved, £3 million above plan; 97% expenditure cost
improvement programme delivered; year end cash balance of £33.9
million
• Staff Development: Top 20% scores in 11 of the Healthcare
Commissions‟ 36 key scores, training and development scored
particularly well and a high proportion of staff feel satisfied with their
quality of work, patient care they deliver and team working. A high
proportion of staff would recommend King‟s as a place to work. In year we
were a pilot for the national e-learning management system and
implemented various training initiatives for medical/ dental staff as well as
the management development programme
• King’s Health Partners (AHSC): accredited in March 2009, one of only 5
Academic Health Sciences centres in England, leading the way to bring
significant improvements in health and wellbeing for patients
• High profile visits, R&D and Strategy: King‟s received a series of high
profile visits in recognition of King‟s innovative range of services. It was a
successful year in terms of R&D, passing the MHRA (government
agency) inspection
• Improving Patient Experience: we continued to develop the innovative
internal How are we doing survey? patient feedback programme which
enabled us to deliver improvements in patients satisfaction
3
Executive Summary –
Strategy in 2009-10
• The ambition of KCH is to be a world-class healthcare provider, giving
outstanding quality of care to our local population and providing
King’s innovative specialist care to a wider geographical area
Vision
• We will be leaders in efficient delivery, to resource continual
innovation, as well as top performers in terms of patient experience,
safety and clinical outcomes. We will train and support our staff to
provide exemplary care.
• We will work with our local partners to drive improved health
outcomes, in parallel to enhancing our international reputation. We will
lead networks of care to improve patient pathways across regional
boundaries.
• We will establish King‟s Health Partners, investing to develop world-
class services at KCH, ensuring the benefits of clinical academic
Strategic
integration are delivered through effective Clinical Academic Groups
Objectives
• We will lead trauma and stroke locally, and establish key roles in other
2009-10
clinical networks. We will work closely with LSL Alliance to ensure that
in partnership we deliver a more efficient, and patient responsive,
health system locally
• We will make significant improvements in efficiency and productivity to
support the national focus on quality to provide the best patient
experience and ensure the best clinical outcomes are delivered. We
will also work towards world-class workforce & facilities at King‟s
4
Executive Summary –
The plan for 2009-10
• Further expansion of payment by results, introducing more granularity
and specificity to our income. The new structure, titled HRG4, has led to
Finance & Activity reductions in our income, hence the requirement to improve efficiencies
2009-10 across the Trust
• Trust surplus target set at £9.5 million
• Cost Improvement Target set at 5% (£22.6 million)
• Budgets agreed and control totals signed off by divisions
• Deliver a financial risk ratio of „4‟ and maintain an „excellent‟ rating from
the care quality commissions measure of use of resources
Performance • Modification of performance framework to focus indicators in line with
Lord Darzi‟s quality agenda – Clinical Effectiveness, Safety and Patient
Targets
Experience
2009-10 • Performance targets directed by the Care Quality Commission Annual
Health Check, Monitor, KCH Strategic Direction and the PCT contracts
• Key focus indicators: Reduce length of stay, improve day case rates,
reduce infection rates, reduce mortality rates, deliver 18 weeks referral to
treatment, the Accident & Emergency „4 hour wait‟ and improve the
patient experience
• Robust quality and performance management arrangements in place to
track delivery. Review of scorecards based on quality and Trust strategy
5
Executive Summary –
Governance, Membership & Risk Analysis
• Constitution approved, self certification underway, good
Governance & involvement with local health economy
• Active membership engagement programme in place (e.g.
Membership
successful consultation events on Trust strategy)
• Membership development strategy for 2008/2011 approved with
targets for membership recruitment
• In March 2009, „King‟s Health Partners‟ was accredited as one of
the first Academic Health Sciences Centres in the UK. In addition
to the Trust, the partnership includes Guy‟s and St Thomas‟ NHS
Foundation Trust, King‟s College London and South London and
Maudsley NHS Foundation Trust
• A key risk is an inability to manage demand, (e.g. from
Risk trauma/stroke instability in local health economy, failure to deliver
bed-releasing efficiencies) impacting on performance targets,
Analysis and our ability to manage the tertiary workload
• Mitigation strategies include joint working with LSL Alliance to
manage demand, phased site development to create additional
beds, and robust performance management against efficiency
targets
6
Contents
• Executive Summary
• 2008-09 Overview and Performance
• King‟s Vision and Strategic Objectives
• Finance & Activity 2009-10
• Risk Analysis
• Performance Targets 2009-10
• Governance & Membership
• Board Statements
7
Chief Executive‟s statement on
2008/09
• This last financial year we recorded an excellent performance at the Trust, hitting
all our key targets, in particular infection control, 18 weeks and A&E performance.
We also ended the year with a healthy financial position and a risk rating of 5
• Particular highlights and key areas for out future strategy were our AHSC
accreditation and the proposed Stroke and Trauma designations
• We continued to hit the headlines with the development of innovative surgery and
treatments for our patients – for example our Transapical aortic valve replacement
programme and our work on the prevention of DVT in hospital.
• We celebrated the long-awaited opening of two new wards in our children‟s
hospital – paediatric critical care and paediatric liver – that are helping transform
the patient experience in this area. Neither of these wards could have opened
without the support of chartable donations – by Thomas cook, for the Critical care
Centre, and by parents of current and past patient in Paediatric liver.
• We have carried out an active community engagement programme with our
members, focusing on the need to increase the numbers of younger members by
forging links with local higher education
8
2008/09 High profile visits
A series of high profile visits and milestones occurred during the year
• Visits
– May 2008 – Dawn Primarolo MP, Health Minister visited king‟s thrombosis service in
recognition of King‟s being named the first NHS exemplar centre for the treatment of Venous
Thrombo Embolism (VTE) in hospital patients
– October 2008 – Ann Keen MP, Health Minister, visited King's to witness a primary
angioplasty being performed
– March 2009 - Rt Hon Gordon Brown MP, Prime Minister, along with Secretary of State Alan
Johnson and Health Minister Ann Keen visited King‟s to launch a new Nursing Commission
• Events
– July 2008 – KCH was asked to host a Department of Health conference “From spreadsheets
to bed sheets” on the importance of embedding infection control into performance
management measures
– July 2008 – King‟s celebrates 1,000th bone marrow transplant
– November/December 2008 – BBC “Hospital Heroes” series broadcast daily. Based in King's
Emergency Department, the series also showcased other specialist clinical areas.
– March 2009 – King‟s Health Partners Academic Health Sciences Centre was accredited by
the Department of Health
• Estate
– May 2008 – opening of new Thomas Cook 16 bed Paediatric Critical Care Centre
– March 2009 – opening of Rays of Sunshine specialist paediatric liver ward
9
King‟s Health Partners review
of 2008/09
• Accredited March 2009
• Four independent partners
• One of only five Academic Health Sciences
Centres in England
• Leading the way to bring significant
improvements in health and well-being for
our patients in London and people
everywhere
• Combining excellent research, clinical
expertise and world class teaching building
on our international reputations
• To change the focus of healthcare from the
treatment of disease to a focus on ill health
prevention, health promotion, screening and
early intervention
• To address the needs of the whole person,
by integrating excellent psychological and
physical healthcare
10
Summary of 2008-09 -
Patient Experience
• During 2008/09 we have continued to develop the innovative internal How are we doing? patient feedback
programme, first launched in 2004, which is a core driver for improvement. Over the same period, patient
satisfaction with the trust's services and staff has increased significantly. Continuing previous trends,
between 2007/08 and 2008/09, there was a further 2.5% increase in patient satisfaction with the
environment (cleanliness and food), a 2% improvement in the way staff interact with patients, and a
1% increase in other areas of care
• How are we doing? was launched in Dental.
• We began the process of developing a standard patient feedback tool for all outpatients to be piloted in
summer 2009 and rolled out autumn 2009. A trust wide comment card scheme also continues to provide
useful feedback and suggestions.
• During the year the Trust‟s First Choice programme refocused its work programme around improving the
patient experience. Working with the patient and public involvement team, the first phase of this work
focused on four key areas:
1. Learning from others
We visited a number of high performing NHS Trusts including University College Hospitals and the Royal
Marsden and also private sector companies such as Tesco to learn from their patient / customer
programmes
2. Patient Experience Report
In December 2008 we launched a new monthly patient experience report which integrates patient feedback
from Complaints, the Patient Advice and Liaison Service (PALS), How are we doing? data and patient
comments. The report has data at Trust and Division levels and is a key tool to drive improvement
3. Patient Engagement Guide
A guide for King‟s staff to help them engage with patients in service design and evaluation was launched
and available to all staff
4. Outpatient feedback
We piloted a range of methods for getting patient feedback in Outpatient areas e.g. patient survey, face to
face interviews following Net Promoter Score methodology and touch screen kiosks 11
Summary of 2008-09 -
Trust Performance
• Annual Health Check 2008-09 (Initial Evaluation)
• Core Standards
– Board of Directors approved compliance against all 24 national core standards. (28th April 2009)
• Existing Commitment Indicators
– Trust assessment is that we have performed well in all 10 indicators. Despite an increasing
demand on our elective and emergency services in 2008/09 we delivered against waiting time
targets, on the day cancellations and access to our genito-urinary medicine (GUM) clinics. In
addition we achieved against the national „4 hour waiting time target‟, achieving 98.3% of our
patients being seen within 4 hours of coming to the emergency services
• New National Priorities
– Not as easy to predict how the Trust performed as for a number of the indicators, thresholds have
not yet been released
– We continue to perform well under the health and wellbeing indicator in comparison to the
previous year and nationally
– We believe that the Trust performs strongly under the areas of audit, with good processes and
data quality in place
– The Trust is one of the top performing nationally in the national sentinel stroke audit (2008)
– The Trust achieved ahead of trajectory for numbers of MRSA bacteraemias and C-Difficille, with
a notable 40% improvement in the latter
– We delivered against the targets for 18 weeks throughout the year and maintained a strong
performance against cancer waiting times
12
Summary of Past year
2008-09 (1/7)
Performance - Existing Commitment Indicators
13
Summary of Past year
2008-09 (2/7)
Performance - Existing Commitment Indicators cont….
More tables of national targets
14
Summary of Past year
2008-09 (3/7)
Performance - Existing Commitment Indicators cont….
15
Summary of Past year
2008-09 (4/7)
Performance - New National Priorities
More tables of national targets
16
Summary of Past year
2008-09 (5/7)
Performance - New National Priorities cont…..
17
Summary of Past year
2008-09 (6/7)
Performance - New National Priorities cont…...
18
Summary of Past year
2008-09 (7/7)
Performance - New National Priorities cont…..
19
Summary of 2008/09 –
Finance Position
The overall risk rating at month 12 is 5 against a target plan of 4. The Trust recorded a surplus of
£15.573m as at month 12, which is £3.072m above month 12 plan.
After final discussions with the District Valuer, the interim revaluation of the Trust‟s land and buildings
resulted in an impairment of £1.786m. The impairment for completed capital projects was £1.752m
and the economic impairment for land was £0.034m. These impairments are considered exceptional
items and do not impact on the Trust‟s rating with Monitor.
The Trust has invoiced the PCTs £4.4m activity over-performance for Quarter1 (£1.79m LSL), £6.9m
for Quarter 2 (£2.53m LSL), £8.7m for Quarter 3 (£2.9m LSL) and £7.6m for Quarter 4 (£2.68m LSL).
Total net payments of £26.034m have been received to date. £1.723m remains outstanding net of
credit notes issued.
Annual Target Month 12 Target Month 12 Actual Variance to date
Trust CIPs
£'000 £'000 £'000 £'000
Pay / Non-pay 6,375 6,375 6,173 202
Income Generation 8,698 8,698 31,468 (22,770)
Total CIPs 15,073 15,073 37,641 (22,568)
The income generation refers to additional activity above contract baselines for the year.
The Trust's liquidity ratio is 36.1 days at the end of Month 12, giving a current liquidity risk rating of 5.
The liquidity ratio is above the 2008/09 plan of 25.6 days, due to the high volume of debtors raised in
month 12 (predominantly quarter 4 PCT contract over-performance).
The cash balance at the end of month 12 is £33.886m (marginally below the 2008/09 plan of
£34.680m). The reduced cash balance is a result of paying creditors more promptly in March in the
current economic climate.
The capital gross spend to m12 is £27.2m against a net budget of £39.2m. The under spend of £12m
against this budget is mainly due to the delays in the Energy CHP (Combined Heat & Power)
Scheme.
20
Summary of 2008/09 –
Financial Risk Ratios
Weight Month 12 08/09 08/09 Plan
Financial Criteria (%) Metric to be scored Month 12 Rating Plan Rating
Achievement of Plan 25 EBITDA achieved (% of plan) 101.3% 5 134.7% 5
Underlying Performance 25 EBITDA Margin (%) 7.0% 3 7.5% 3
Financial Efficiency 12.5 Return on Assets excluding dividend (%) 10.1% 5 8.1% 5
12.5 I&E surplus margin (%) 3.4% 5 2.6% 4
Liquidity 25 Liquidity Ratio (days) 36.1 5 25.6 4
FINANCIAL RISK RATING {Weighted Average of Financial Criteria} 5 4
Financial Criteria Metric to be scored RATING CATEGORIES
5 4 3 2 1
Achievement of Plan EBITDA achieved (% of plan) 100 85 70 50 <50
Underlying Performance EBITDA Margin (%) 11 9 5 1 <1
Financial Efficiency Return on Assets excluding dividend (%) 6 5 3 -2 <-2
I&E surplus margin net of dividend (%) 3 2 1 -2 <-2
Liquidity Liquidity Ratio (days) 35 25 15 10 <10
Finance Risk Rating Rating 5 Lowest Risk - no regulatory concerns
Rating 4 No regulatory concerns
Rating 3 Regulatory concerns in one or more components. Significant breach of
Terms of Authorisation unlikely.
Rating 2 Risk of significant breach in Terms of Authorisation in the medium term,
e.g. 9 to 18 months in the absence of remedial action.
Rating 1 Highest Risk - high probability of significant breach of Terms of
Authorisation in the short-term, e.g. less than 9 months, unless remedial
action is taken.
21
Summary 2008/09 – Divisional
Income & Expenditure
• The Divisions achieved their contribution targets across the board and generated an operating surplus of
£17.4m.
• A key contributing factor was the achievement of the cost improvement targets for both expenditure and
income.
• 93% of the cash releasing savings were achieved and the additional income targets were significantly
exceeded.
• The PBR tariff does not benefit General Medicine, yet this division was on target, despite the intense
activity pressures.
• The ability to generate income of £23m over and beyond PCT contract values was a tremendous effort in
a capacity restricted environment and was the result of improved productivity as well as investment. This
additional activity generated a higher operating surplus from the previous year of £2m after ignoring the
exceptional item of asset impairment.
• The return on the additional activity emphasises the need for further development of service line
reporting in 2009/10 and drive for efficiencies.
• The stand out activity over-performances were in Surgery (£5.6m), Cardiac (£4.2m), Women’s &
Children’s (£3.4m), Liver (£2.5m) and General Medicine (£1.8m). The other divisions were all around
the £1m mark for activity over-performance against PCT contracts.
• The Private Patient income performance increased within the cap and was also a significant contributor
to the additional surplus.
• The impairment cost was recorded against the Corporate Service Division.
• The overall staffing budget was in balance despite the CIP pressure to freeze vacancies and the non pay
budgets for clinical supplies and drugs were significantly exceeded as a result of the additional activity.
22
Summary 2008/09 – Income
and Expenditure
Last Months
Annual Budget YTD Budget YTD Actual YTD Variance Variance Movement
Division Heading £'000 £'000 £'000 £'000 £'000 £'000
Income (73,996) (73,996) (78,576) 4,580 3,622 958
Pay 32,658 32,658 32,157 501 774 (273)
Non-Pay 14,880 14,880 18,688 (3,808) (2,949) (859)
Recharges 7,435 7,435 8,021 (586) (536) (50)
Cardiac and Neurosciences Total (19,023) (19,023) (19,710) 687 911 (224)
Income (15,691) (15,691) (18,432) 2,741 2,150 591
Pay 34,936 34,936 34,616 320 343 (23)
Non-Pay 20,996 20,996 25,948 (4,952) (3,689) (1,263)
Recharges (36,967) (36,967) (39,834) 2,867 2,664 203
CSDS Total 3,274 3,274 2,298 976 1,468 (492)
Income (68,162) (68,162) (71,979) 3,817 3,381 436
Pay 50,410 50,410 51,924 (1,514) (1,217) (297)
Non-Pay 17,248 17,248 19,840 (2,592) (2,246) (346)
Recharges (1,972) (1,972) (2,439) 467 128 339
Critical Care and Surgery Total (2,476) (2,476) (2,654) 178 46 132
Income (31,695) (31,695) (31,713) 18 347 (329)
Pay 16,536 16,536 15,669 867 907 (40)
Non-Pay 2,692 2,692 3,335 (643) (597) (46)
Recharges 1,159 1,159 1,391 (232) (161) (71)
Dental Total (11,308) (11,308) (11,318) 10 496 (486)
Income (71,478) (71,478) (74,856) 3,378 3,259 119
Pay 30,686 30,686 31,555 (869) (574) (295)
Non-Pay 15,470 15,470 17,154 (1,684) (1,329) (355)
Recharges 6,717 6,717 7,279 (562) (576) 14
Liver and Renal Total (18,605) (18,605) (18,868) 263 780 (517)
Income (71,673) (71,673) (73,569) 1,896 975 921
Pay 43,664 43,664 43,237 427 731 (304)
Non-Pay 6,452 6,452 8,517 (2,065) (1,683) (382)
Recharges 8,543 8,543 8,811 (268) (246) (22)
General Medicine Total (13,014) (13,014) (13,004) (10) (223) 213
Income (55,702) (55,702) (57,812) 2,110 1,082 1,028
Pay 17,369 17,369 16,661 708 655 53
Non-Pay 19,134 19,134 21,516 (2,382) (1,486) (896)
Recharges 6,577 6,577 6,762 (185) (353) 168
Specialist Medicine Total (12,622) (12,622) (12,873) 251 (102) 353
Income (73,399) (73,399) (75,537) 2,138 1,292 846
Pay 42,508 42,508 42,904 (396) (217) (179)
Non-Pay 5,298 5,298 6,521 (1,223) (703) (520)
Recharges 6,726 6,726 6,760 (34) (38) 4
Women's and Child Health Total (18,867) (18,867) (19,352) 485 334 151
Income (12,002) (12,002) (14,720) 2,718 1,617 1,101
Pay 1,790 1,790 1,941 (151) (125) (26)
Non-Pay 2,548 2,548 3,401 (853) (726) (127)
Recharges 3,027 3,027 3,333 (306) (224) (82)
Private Patient Service Total (4,637) (4,637) (6,045) 1,408 542 866
Income (18,302) (18,302) (19,807) 1,505 1,631 (126)
Pay 27,765 27,765 26,781 984 1,035 (51)
Non-Pay 66,842 66,842 70,376 (3,534) (1,719) (1,815)
Recharges (626) (626) (519) (107) (74) (33)
Interest and Dividends 9,098 9,098 9,122 (24) (515) 491
Corporate Services Total 84,777 84,777 85,953 (1,176) 358 (1,534)
Income (492,100) (492,100) (517,001) 24,901 19,356 5,545
Pay 298,322 298,322 297,445 877 2,312 (1,435)
Non-Pay 171,560 171,560 195,296 (23,736) (17,127) (6,609)
Recharges 619 619 (435) 1,054 584 470
Interest and Dividends 9,098 9,098 9,122 (24) (515) 491
Trust total Total (12,501) (12,501) (15,573) 3,072 4,610 (1,538)
23
Private Patient Income
2008/9 2009/10 2010/11 2011/12
£'000 £'000 £'000 £'000
Private Patient Income 14,115 14,715 14,891 15,069
Total patient related income 443,042 469,320 495,953 513,380
Proportion (as a percentage %) 3.19 3.14 3.00 2.94
Section 44 of the 2006 Act requires that the proportion of private patient income to the
total patient related income of the NHS Foundation Trust should not exceed 3.5 per cent,
its proportion when the organistion was an NHS Trust in 2002/03.
The additional income is based on inflation price increases and two private patient beds
on William Gilliat Ward.
There is potential to increase this income level of income if all the beds in the Guthrie
Ward are used for Private Patient work.
24
Summary 2008/09 – Cost
Improvement Programme
Total CIPs
Actual
Annual target overperformance Variance to plan
£'000 £'000 £'000
Cardiac 1,559 5,833 (4,274)
Neuro 807 1,819 (1,012)
CSDS 311 1,284 (973)
Dental 684 1,997 (1,313)
GEM 1,076 2,770 (1,694)
Liver 2,086 4,669 (2,583)
Renal 887 2,041 (1,154)
Spec Med 1,396 2,539 (1,143)
Surgery 1,772 6,628 (4,856)
W&C 1,608 5,083 (3,475)
Corporate 2,137 2,353 (216)
Private Patient 750 625 125
Total 15,073 37,641 (22,568)
25
Summary 2008/09 –
Expenditure breakdown
Annual YTD YTD YTD Last Month Movement
SUBJECTIVE Budget Budget Expend Variance Variance in Month
£'000 £'000 £'000 £'000 £'000 £'000
PAY
Medical Staff 98,350 98,350 96,543 1,807 1,351 456
Nursing Staff 103,084 103,084 104,775 (1,691) (836) (855)
A&C Staff 46,460 46,460 46,286 174 594 (420)
PAMS 14,068 14,068 13,213 855 836 19
Senior Managers 1,277 1,277 1,383 (106) 137 (243)
Scientific/Professional 33,280 33,280 33,399 (119) 238 (357)
Other 1,803 1,803 1,846 (43) (8) (35)
PAY Sub-total 298,322 298,322 297,445 877 2,312 (1,435)
NON-PAY
Clinical Supplies 46,752 46,752 55,205 (8,453) (6,333) (2,120)
Drugs 36,378 36,378 42,058 (5,680) (4,580) (1,100)
Capital Charges 10,292 10,292 12,072 (1,780) (12) (1,768)
Recharges 619 619 (435) 1,054 584 470
Other / Reserves 87,236 87,236 95,083 (7,847) (6,717) (1,130)
Non-PAY Sub-total 181,277 181,277 203,983 (22,706) (17,058) (5,648)
Expenditure Total 479,599 479,599 501,428 (21,829) (14,746) (7,083)
Income Total (492,100) (492,100) (517,001) 24,901 19,356 5,545
Income and Expenditure (12,501) (12,501) (15,573) 3,072 4,610 (1,538)
26
Summary 2008/09 –
Trust Balance Sheet
2008/2009
Plan
30 Mar 2008 30 April 2008 31 May 2008 30 June 2008 31 July 2008 31 Aug 2008 30 Sep 2008 31 Oct 2008 30 Nov 2008 31 Dec 2008 31 Jan 2009 29 Feb 2009 31 Mar 2009
£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000
FIXED ASSETS
Intangible assets 751 730 717 708 666 637 718 802 771 754 596 559 1,010 730
Tangible Assets 252,429 251,920 253,633 254,187 254,019 254,585 255,160 255,781 257,893 258,560 261,689 262,885 265,507 275,600
253,180 252,650 254,350 254,895 254,685 255,222 255,878 256,583 258,664 259,314 262,285 263,444 266,517 276,330
CURRENT ASSETS
Stock and Work in Progress 8,673 8,519 8,576 9,314 8,611 8,940 8,817 8,849 8,884 8,651 9,017 8,782 9,433 8,890
Debtors 29,691 27,908 26,536 26,797 35,300 36,039 39,606 35,127 41,885 41,268 45,171 43,281 37,979 28,000
NHS Trade Debtors 15,616 12,689 9,160 4,381 8,494 14,997 16,238 8,908 13,045 8,667 17,834 15,486 22,200 8,170
Non NHS Trade Debtors 3,804 3,306 3,480 2,836 2,529 2,113 2,500 1,992 2,959 3,186 3,070 4,398 2,761 3,820
Other Debtors 8,124 5,879 2,981 1,621 3,836 8,302 7,578 7,821 7,584 8,278 7,414 6,001 7,963 6,520
Accrued Income & Prepayments 2,147 6,006 10,915 17,959 20,441 10,627 13,290 16,406 18,297 21,137 16,853 17,396 5,055 9,490
Cash @ bank and in hand 26,087 28,488 33,350 33,740 29,830 28,863 18,604 27,935 23,601 35,882 35,075 34,308 33,886 33,210
64,451 64,915 68,462 69,851 73,741 73,842 67,027 71,911 74,370 85,801 89,263 86,371 81,298 70,100
Creditors: Amount falling due within one
year (51,037) (49,631) (52,474) (53,807) (52,572) (57,260) (49,197) (50,938) (51,444) (52,018) (55,977) (54,138) (55,587) (50,020)
NHS Trade Creditors (11,991) (3,973) (4,470) (3,497) (4,250) (3,906) (3,367) (3,009) (2,297) (1,960) (2,537) (4,267) (4,587) (16,770)
Non NHS Trade Creditors (11,572) (9,001) (7,171) (8,628) (5,035) (7,767) (8,104) (5,299) (5,780) (2,645) (7,001) (9,972) (7,293) (2,680)
Other Creditors (14,940) (15,047) (15,780) (15,727) (13,407) (18,591) (14,042) (17,640) (15,653) (16,591) (15,649) (16,149) (17,759) (16,120)
Accruals & deferred income (12,534) (21,610) (25,053) (25,955) (29,880) (26,996) (23,684) (24,990) (27,714) (30,822) (30,790) (23,750) (25,948) (14,450)
NET CURRENT ASSETS (LIABILITIES) 13,414 15,284 15,988 16,044 21,169 16,582 17,830 20,973 22,926 33,783 33,286 32,233 25,711 20,080
Long Term Debtors 4,958 5,132 5,132 5,146 5,146 5,146 5,146 5,097 5,092 5,087 5,094 5,036 5,018 5,160
TOTAL ASSETS LESS CURRENT
LIABILITIES 271,552 273,066 275,470 276,085 281,000 276,950 278,854 282,653 286,682 298,184 300,665 300,713 297,246 301,570
Creditors: Amounts falling due after
more than one year
Obligations under Finance Leases (12,974) (13,633) (13,573) (13,513) (13,453) (13,393) (13,333) (13,273) (13,213) (13,154) (13,094) (13,034) (12,252) (12,980)
Provisions for liabilities and charges (13,152) (13,155) (13,155) (13,045) (12,990) (10,502) (10,454) (10,413) (10,261) (10,220) (10,180) (10,078) (10,147) (10,030)
TOTAL ASSETS EMPLOYED 245,426 246,278 248,742 249,527 254,557 253,055 255,067 258,967 263,208 274,810 277,391 277,601 274,847 278,560
FINANCED BY:
TAXPAYERS' EQUITY
Public dividend capital 122,065 122,064 122,064 122,065 122,065 122,065 122,065 122,065 122,065 128,052 128,052 128,052 128,052 122,070
Revaluation reserve 81,082 81,036 81,821 81,804 81,751 81,697 81,645 81,575 81,539 81,502 81,465 81,429 80,802 82,080
Donated Asset Reserve 18,780 18,727 19,225 19,212 19,190 18,829 18,564 18,518 18,495 18,490 18,584 18,795 18,785 27,410
Income and expenditure reserve 23,499 23,565 23,565 23,565 23,565 23,565 23,567 23,567 23,567 23,567 23,567 23,569 38,025 36,000
Loan 0 0 0 0 2,283 2,283 2,283 4,373 4,373 9,183 9,183 9,183 9,183 11,000
This years Income/Expenditure 0 886 2,067 2,881 5,703 4,616 6,943 8,869 13,169 14,020 16,540 16,573 0 0
TOTAL TAXPAYERS' EQUITY 245,426 246,278 248,742 249,527 254,557 253,055 255,067 258,967 263,208 274,814 277,391 277,601 274,847 278,560
Note:
Other Debtors include:- Private Patient's Debtors, VAT reclaims, Lease Prepayments, Provision for Bad Debts
Other Creditors include:- PP Consultant's Fees; NI, PAYE and Superannuation Accruals; KCL Cross-account; NHS Professionals & NHS Supply Chain Accruals, Capital Creditors
27
Summary 2008/09 –
Capital Expenditure
Total per capital category Budget Expenditure
Period
Carry over Adj. During Total Budget Cost to Total Cost
from 07/08 Plan 08/09 08/09 08/09 08/09 Actual YTD Complete 08/09
Major works 2,520 25,236 (1,393) 26,363 26,363 18,588 0 18,588
Minor works 209 513 47 769 769 885 0 885
IT and infrastructure 882 1,318 (230) 1,970 1,970 474 0 474
Medical Equipment 121 7,528 1,074 8,723 8,723 5,739 0 5,739
Intangibles 0 46 502 548 548 606 0 606
Donated 821 (280) 347 888 888 888 0 888
Total Capital Position : 4,553 34,361 347 39,261 39,261 27,180 0 27,180
Period Actual to Anticipated Y/E
Budget Budget date Changes Forecast
Gross capital expenditure b/f 39,261 39,261 27,180 - 27,180
Less:
Disposed assets at NBV 425 425 - - -
Capital Donations held on Trust, NOF monies 888 888 888 - 888
Total 1,313 1,313 888 - 888
Capital Charge against Capital Resource Limit 37,948 37,948 26,292 - 26,292
Depreciation / DoH Capital Resource Limit 14,520 14,520 10,286 - 10,286
External Borrowing Loan (FTFF) - Energy Scheme 11,021 11,021 9,183 - 9,183
DOH Energy Scheme Grant 4,479 4,479 4,479 - 4,479
Dental Hospital Clinical Information System Funding 1,200 1,200 1,200 - 1,200
NIHR Capital Funding for Equipment 308 308 308 - 308
Internal Cash Resources 6,420 6,420 - - -
FT Capital Plan 37,948 37,948 25,456 - 25,456
Variance : + over / (-) under 0 0 836 0 836
28
Summary 2008/09 –
Cash Flow
Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 ANNUAL
ACTUAL ACTUAL ACTUAL ACTUAL ACTUAL ACTUAL ACTUAL ACTUAL ACTUAL ACTUAL ACTUAL ACTUAL Forecast
08/09
£'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s
Balance B/F 26,087 28,488 33,350 33,740 29,830 28,863 18,604 27,935 23,601 35,882 35,075 34,308 26,087
Income
NHS Clinical Income
Southwark PCT SLA (Excl Merit Awards) 7,980 7,980 7,980 7,980 7,980 7,980 7,980 7,980 7,980 7,980 7,980 7,980 95,760
Lewisham PCT SLA 2,159 2,253 2,206 2,206 2,206 2,202 2,187 2,174 2,108 2,097 2,066 2,050 25,914
Lambeth PCT SLA 5,308 5,309 5,308 5,308 6,658 3,958 5,308 5,308 5,308 5,308 5,308 5,308 63,697
LSL PCT Other (Palliative Care) 400 86 78 110 206 151 248 113 1,274 236 248 890 4,040
SLAs : Other PCTs (incl PICU, NICU, BMT, HIV, Neuro Rehab) 9,585 11,533 12,906 10,479 8,885 11,107 10,653 10,458 10,945 10,112 11,346 10,522 128,531
Provider to Provider Income 892 885 882 1,076 755 1,105 1,730 586 1,088 674 1,041 1,646 12,360
PCT NCAs 173 350 44 64 33 40 155 57 113 193 150 344 1,716
DoH - patient activity (NSCAG) - 3,582 1,791 1,789 1,789 1,789 1,789 1,789 1,799 1,799 1,799 1,801 21,516
DoH - MFF 4,018 4,022 4,022 4,022 4,022 4,022 5,452 4,022 4,022 4,022 4,022 8,185 53,853
RTA's 80 45 71 40 73 79 42 56 44 46 77 86 739
BMT Tissue Typing 118 201 - - 80 - - - 41 76 81 65 662
Patient SLA Overperformance 2008/2009 - - - - - 2,150 2,312 164 3,383 1,718 3,098 8,702 21,527
Patient SLA Overperformance 2007/2008 2,476 1,470 6 541 264 62 - - 771 - 16 ( 59 ) 4,005
Non-NHS Clinical Income - - - - - - - - - - - -
Private Patients 1,151 1,939 941 1,390 946 1,276 1,026 1,681 1,207 2,926 2,181 2,397 19,061
Other Income - - - - - - - - - - - -
Research and Development Levy 370 - 21 - 19 - 390 - - 775 - 484 2,059
Research Centres and Grants Income 1,073 - - 1,073 - - 1,105 - 59 1,073 - - 4,383
Training & Educ: SIFT facilities, placement & HD 1,613 1,613 1,613 1,593 1,608 1,608 1,608 1,608 1,608 1,608 1,608 1,608 19,296
Training & Educ: MADEL & PGME 1,086 1,086 1,086 1,403 1,165 1,165 1,311 1,186 1,186 1,199 1,188 1,188 14,249
Training & Educ: Dental (SIFT) 584 584 584 697 612 612 612 612 612 612 612 612 7,345
Training & Educ: SELSHA WDC & Dental NMET 305 ( 304 ) 305 333 385 312 463 334 334 - 466 298 3,231
Other Categary C Income (Car Parking, Accomodation) 603 1,031 1,167 570 878 541 691 675 410 429 576 1,518 9,089
Medical Staff Distinction Awards 274 274 274 274 274 274 274 274 274 274 274 274 3,288
Haven Contract 114 113 116 ( 25 ) 114 114 - 114 114 114 114 114 1,116
Caregroup Operational Income 1,730 690 344 1,129 589 359 1,015 939 905 707 1,269 2,179 11,855
VAT reclaims 383 987 526 712 714 1,211 789 745 725 672 736 733 8,933
Consultant's Fees income (Private Patients) 187 - 338 268 199 232 - - - - - - 1,224
sub-total 42,662 45,729 42,609 43,032 40,454 42,349 47,140 40,103 45,539 44,666 46,240 58,925 539,448
Expenditure
Pay monthly (incl Pay Awards) 12,277 12,300 12,310 12,573 13,115 13,298 13,138 13,266 13,370 13,230 13,663 13,525 156,065
PAYE/NIC/SUPER (CHAPS) 9,044 9,084 9,022 8,971 9,221 9,729 9,153 9,541 9,590 9,725 9,601 9,848 112,529
Agency Spend 1,422 1,274 1,211 1,202 1,015 1,322 1,058 863 1,055 1,221 1,153 2,056 14,852
Consultants' Fees 187 - 338 268 199 232 - - 422 204 520 381 2,751
Medical School recharges 500 - 500 1,000 - - - 500 - 500 - - 3,000
PFI project 2,194 2,797 3,051 5,367 3,885 2,190 2,714 2,539 2,609 2,778 2,625 2,857 35,606
AAH Pharmaceuticals 341 250 373 270 250 369 250 448 300 530 530 429 4,340
NHSLA Clinical Negligence - - - - 398 398 796 797 796 398 398 - 3,981
Non-pay Direct Debits (leases, rates) 1,058 795 1,993 2,157 710 1,104 1,003 826 1,628 852 701 1,934 14,761
Monthly / Weekly Creditor Payments 2,382 844 2,843 4,012 1,956 6,043 5,247 6,281 4,745 4,530 8,770 7,745 55,398
Non-pay Revenue Trade Creditors (Incl. CIPs) 10,507 11,936 9,402 12,996 9,104 12,542 5,638 5,840 7,778 7,797 7,299 14,736 115,575
sub-total 39,912 39,280 41,043 48,816 39,853 47,227 38,997 40,901 42,293 41,765 45,260 53,511 518,858
Cash from operations 2,750 6,449 1,566 ( 5,784 ) 601 ( 4,878 ) 8,143 ( 798 ) 3,246 2,901 980 5,414 20,590
Capital & Financing Items
Capital gross exp (Purchased) 349 1,223 1,276 446 1,617 1,155 940 3,600 1,838 3,605 1,761 1,327 19,137
Capital gross exp (Donated) - 440 118 28 72 19 9 29 23 150 31 174 1,093
Capital Income (Donated) - - - - - - - - - - - - -
PDC Dividends (TDR) - - - - - 4,370 - - - - - 4,370 8,740
PDC Payable (EFL) - - - - - - - - ( 5,987 ) - - - ( 5,987 )
Loan Received - ( 2,283 ) - - ( 2,090 ) - ( 4,810 ) - - - ( 9,183 )
Loan Repaid - - - - - - - - - - - - -
Interest on investments - ( 76 ) ( 218 ) ( 65 ) ( 121 ) ( 163 ) ( 47 ) ( 93 ) ( 99 ) ( 47 ) ( 45 ) ( 35 ) ( 1,009 )
Interest Paid on Overdraft (5.5% ) - - - - - - - - - - - - -
sub-total 349 1,587 1,176 ( 1,874 ) 1,568 5,381 ( 1,188 ) 3,536 ( 9,035 ) 3,708 1,747 5,836 12,791
Net Inflow / Outflow 2,401 4,862 390 ( 3,910 ) ( 967 ) ( 10,259 ) 9,331 ( 4,334 ) 12,281 ( 807 ) ( 767 ) ( 422 ) 7,799
Forecast Balance C/F 28,488 33,350 33,740 29,830 28,863 18,604 27,935 23,601 35,882 35,075 34,308 33,886 33,886
29
Summary 2008/09 - Public
Sector Payments Policy
Paid to NHS Organisations Amount Paid on Time
Through Direct Through Direct
2008/2009 AP Debit Total AP Debit Total % of % of % Paid Cum Ave
£'000 £'000 £'000 £'000 £'000 £'000 AP DD on Target on Target
April 1,787 1,585 3,372 507 1,585 2,092 28% 100% 62% 62%
May 2,059 1,273 3,332 550 1,273 1,823 27% 100% 55% 58%
June 3,386 1,252 4,638 963 1,252 2,215 28% 100% 48% 55%
July 2,625 2,397 5,022 1,678 2,397 4,075 64% 100% 81% 61%
August 2,515 1,060 3,575 1,253 1,060 2,313 50% 100% 65% 62%
September 3,014 1,721 4,735 807 1,721 2,528 27% 100% 53% 61%
October 2,893 1,853 4,746 1,800 1,853 3,653 62% 100% 77% 63%
November 1,909 1,541 3,450 206 1,541 1,747 11% 100% 51% 61%
December 2,963 1,453 4,416 1,798 1,453 3,251 61% 100% 74% 63%
January 1,255 1,919 3,174 448 1,919 2,367 36% 100% 75% 64%
February 2,867 1,552 4,419 1,710 1,552 3,262 60% 100% 74% 65%
March 4,266 2,057 6,323 4,180 2,057 6,237 98% 100% 99% 68%
31,539 19,663 51,202 15,900 19,663 35,563 50% 100% 69%
Paid to Non NHS Organisations Amount Paid on Time
Through Direct Through Direct
2008/2009 AP Debit Total AP Debit Total % of % of % Paid Cum Ave
£'000 £'000 £'000 £'000 £'000 £'000 AP DD on Target on Target
April 11,875 3,563 15,438 10,759 3,563 14,322 91% 100% 93% 93%
May 12,437 3,822 16,259 7,072 3,822 10,894 57% 100% 67% 80%
June 10,664 2,650 13,314 7,849 2,650 10,499 74% 100% 79% 80%
July 14,671 7,776 22,447 8,482 7,776 16,258 58% 100% 72% 78%
August 10,624 4,780 15,404 8,795 4,780 13,575 83% 100% 88% 80%
September 16,651 3,646 20,297 11,989 3,646 15,635 72% 100% 77% 79%
October 8,800 3,937 12,737 7,241 3,937 11,178 82% 100% 88% 81%
November 13,921 4,194 18,115 11,937 4,194 16,131 86% 100% 89% 82%
December 12,015 4,474 16,489 11,977 4,474 16,451 100% 100% 100% 84%
January 14,630 4,163 18,793 14,119 4,163 18,282 97% 100% 97% 85%
February 14,603 3,726 18,329 12,948 3,726 16,674 89% 100% 91% 86%
March 21,227 5,195 26,422 19,336 5,195 24,531 91% 100% 93% 86%
162,118 51,926 214,044 132,504 51,926 184,430 82% 100% 86% 30
Summary of 2008-09:
Staff Development
New initiatives within the last year :
• Implementation of various training initiatives for medical/dental staff
including Keele Clinical Leadership programmes and follow-up learning
sets, and a professional development programme for FTY2 trainees
• Piloting of a pre-employment medical induction with roll out planned for
August 2009
• Management Development Programme for junior managers to develop
leadership and management skills
• Vocational training for new Midwife Support Worker role
• Workshops for front-line staff working with deaf and disabled people
• Development of a „key skills‟ programme with Southwark College to support
the achievement of vocational qualifications and progression to
professional/higher education training
• Continued Diversity Awareness Training workshops (ongoing since 2006)
• Development/implementation of professional training initiatives, e.g.. Mental
Capacity Act, Safeguarding Vulnerable Adults, Emergency Planning for
major incidents
• Pilot site for national e-learning management system (NLMS) with Trust-
wide roll out planned for 2009
• Provided facilitated action learning sets for a range of Trust staff
31
Summary of 2008-09:
Equality & Diversity
Achievements include:
• Participation in DoH national Pacesetters Programme. Programme
tackles health and workplace inequalities. King‟s has developed six
new equality-led projects which include service and workforce issues
• Equality Impact Assessments for services, functions and policies
aligned to ongoing 3 yearly reviews
• Staff access to 24/7 independently run Harassment & Bullying Helpline
• Work experience programme and placements for people with
disabilities
• King‟s awarded Positively Diverse Lead Site status.
• Establishment of staff led diversity networks – Cultural Diversity Group,
Deaf & Disability Workforce Group and Lesbian, Gay, Bisexual &
Transgender Forum.
• Publication of the Trust‟s Disability Guide and Disability Charter and
establishment of the role of Disability Network Advisors.
• Recruitment of workforce to reflect our diverse community – 46% from
BME backgrounds and proportion of middle/senior managers from BME
increased from 25% in 2002 to 41% in 2008.
32
Summary of 2008-09:
Staff Survey
• Top 20% scores in 11 of the Healthcare Commissions‟ 36 key scores.
The results are used to improve our employment practices.
• Training and development scored particularly well. King‟s staff are
much more likely to have high quality appraisals and access to training
compared with staff in other Trusts. They are also much more likely to
report they have good opportunities to develop their potential at work.
• A high proportion of staff feel satisfied with the quality of work and
patient care they deliver.
• King‟s also achieved good scores in areas such as team working,
communication and for the proportion of staff who would recommend
King‟s as a place to work.
• There was a marked drop in the number of staff reporting work related
stress in 2006. This has been sustained.
• Overall King‟s fared less well on health & safety questions.
• Staff rate the Trust as above average when dealing with harassment
and violence and for its procedures for reporting errors, near misses or
incidents.
33
Summary of 2008/09: Refocused
First Choice Programme
Service-Based Transformation
E = Experience
Sa = Safety
5 6 7
St = Staff
Theatre Neuro- Existing
Transformation sciences work
Transforming
• „Releasing Time to Care‟ Sa St E
Experience
1 Ward-based • VitalPAC
Patient
Improvements • Safety/clinical scorecards
• Understand patient experience
and use it to drive E Sa
Patient Involvement &
2 Experience
improvements in Outpatient
Booking, Admissions,
Discharge, Care Environment
Capabilities
• Leadership & teamwork
Building
Teamwork &
Staff
competency development in
3 Leadership Liver & Child Health St E
• Living our Values – defining
King‟s values and behaviours
• Collect/organise/link existing
Sa E
4 Data & Information data
Strengthening
Processes
• Present data so it‟s
Business
understandable and actionable
• Develop skills to mine, analyse St
and present data
• WHO Surgical checklist • Achieve 18 Wks
• CC&S
• Surgery Compass
• Child Health
• Instrumentation
• Liver
• Theatre Quality Round
• Doing what we schedule 34
Summary of 2008/09: First
Choice King‟s Programme (1/2)
Theatres: 9-month project to deliver • Safety Checklist: WHO global standard adapted to meet King‟s needs; now
measurable improvements in safety, implemented in all theatres to time and take-up at 70% in first month. King‟s now
seen as a UK „early-adopter‟ success.
quality and efficiency through 4
• Instruments: Losses down from 35 to less than 4 per week - £90k per year;
targeted workstreams relations with contracted supplier revolutionised
• Doing What We Schedule: Reduced cancellations, DNAs and extra cases booked in
Day Surgery; added at least 624 cases per year - £1m
• Surgery Compass: Theatre teams have become national leaders through the
successful launch of this web-based tool to identify and show financial and
operational opportunities for improvement
Releasing Time to Care (The • Successful application and funding for this national NHS project. We are visited by
Productive Ward): National other Trusts and seen as an exemplar site.
• Successful launch and basic implementation in 7 wards. Team boards displaying
programme to increase quality of
„Patient Status at a Glance‟ and key performance indicators (KPIs) in situ in all
patient experience by freeing and wards – vital to LOS management.
using more nursing time for direct • „Well Organised Ward‟ (5S) results obvious in ward areas; supplies stores and
patient care. catalogue now consistently colour coded across the Trust
• VitalPAC: Pilot of electronic vital sign collection on two medical wards to improve
early identification of deteriorating patients
• Clinical Scorecard: Identified core clinical performance indicators informing
production of Quality Accounts
Patient Experience: Initial work to • Patient Experience Report: Adds depth and human dimension to HRWD survey
make patient involvement results and dissemi-nation; enables actions-based planning. Seen as high-quality
example compared to peer Trusts.
methodology consistent and to
• Patient Engagement Guide: Updates King‟s Patient Involvement methodologies and
measure and communicate provides a simple „how-to‟ guide; enables managers and staff to understand patient
performance more effectively experience and act to improve.
• Successful outpatient surveys in Ophthalmology and Suite 5 to test and pilot core
patient involvement tools and techniques; feedback shared with patients along with
simple and timely improvements.
35
Summary of 2008/09: First
Choice King‟s Programme (2/2)
18 Weeks: Change Leaders • Targets for 18 Weeks achieved and sustained into 2008. In
designed and assisted work to Neurosurgery the care process for spinal patients radically redesigned.
deliver target in Neurosurgery, • Spinal Surgery results earned King‟s a Regional Finalist spot in the 2009
Gynaecology, Dental Outpatients NHS Innovation Health and Social Care Awards in the category of
and Day Surgery Innovative Acute Care
Teamwork and Leadership: A • Leadership Model developed for Liver and Child Health to inform
project to identify the key leadership capabilities and behaviours along patient pathway. Leadership and
qualities and behaviours that teamwork capability professionally assessed in individuals and core
improve patient care and build on teams. Management teams refocused to deliver. Discharge process in
them Liver wards linked to behaviours; early significant improvements in
timely discharges and HRWD scores.
King’s Values: A Trust-wide project • Successful bid to become NHS Learning Partner as part of the national
to identify and act on the values that values project. Plan produced and welcomed by NHS Institute as best
unite, motivate and focus all King‟s seen. Staff from Executive to frontline now actively engaged in Listening
staff in the service of patient care Phase while HR and Corp Comms teams are mobilising to embed
values across King‟s.
36
Research & Development
Review 2008-09
• 2008-09 was a successful year in terms of research
and development at King‟s
• In December 2008 we were re-inspected by the
MHRA (government regulatory agency) following a
poor report the previous year, we passed the
inspection and it was confirmed that our research
governance systems were much improved
• We successfully achieved much closer joint working
with Guy‟s and St. Thomas‟ R&D department,
recruiting staff on common job descriptions, as well as
harmonizing R&D systems and processes to
streamline these for clinical researchers.
• R&D clinical leads were appointed in all divisions to
drive increases in R&D output and oversee local
governance arrangements
• In order to strengthen R&D at KCH, and in the context
of AHSC development, the Trust approved £1.5m pa
for 3 years to invest in building clinical research
capability. After a rigorous peer review process, each
division now has 1-2 projects funded, against which
they will need to deliver agreed output
37
Summary of 2008-09:
Innovations and Developments
Clinical Service developments:
• Stroke : As part of KHP, King‟s was successfully designated as a Hyper acute
(HASU), acute and TIA centre for the south East of London as part of the
consultation – „the shape of things to come‟. This will see the number of HASU
beds at King‟s quadrupling.
• Trauma: As part of KHP, King‟s successfully received designation as a Major
Trauma centre supporting a network of trauma centres in South East London
(including the new South London Health Trust)
• Breast Cancer – King‟s is the first hospital in the UK to trial the use of 3-D digital
X-ray technology for breast cancer screening and diagnosis
• Heart valve replacement – King‟s is the first hospital in the UK to replace an
artificial aortic valve using the transapical aortic valve replacement (TAVI)
technique.
38
Summary of 2008-09:
Strategic Developments
Strategic Development and King’s Health Partners:
• During 2008-09 there was considerable work carried out in order to shape what
began as the embryonic concept of an Academic Health Sciences Centre for
South London, into a strong formal partnership between 3 foundation trusts
(King‟s College Hospital, South London and the Maudsley and Guy‟s and St.
Thomas‟) and King‟s College London. King‟s Health Partners has been built
around a tripartite mission of clinical, research and educational excellence
• Work focused in a number of areas, including:
• Development of governance arrangements, including establishing a
Partnership Board and Transitional Executive
• Developing the concept of Clinical Academic Groups, to drive real
integration of clinical services and academic activities
• Building a robust infrastructure, based on existing joint projects, such as
BRCs and JCTO
• This effort was rewarded, when in March 2009 an international expert panel
organised by the DoH accredited King‟s Health Partners (KHP) as one of the 5
UK Academic Health Sciences centres.
39
Contents
• Executive Summary
• 2008-09 Overview and Performance
• King‟s Vision and Strategic Objectives
• Finance & Activity 2009-10
• Risk Analysis
• Performance Targets 2009-10
• Governance & Membership
• Board Statements
40
King‟s Health Partners vision
To advance health and well being by integrating world-class research, care,
education and training through:
• Translating research more rapidly into clinical practice and effectively disseminating
these advances through education and training
• Harnessing the power of discovery science to transform the nature of healthcare by
moving from treatment towards population screening and disease prevention
• Recognising the special needs and inequalities in health amongst the local population
and addressing these through earlier intervention and personalised medicine, as well
as helping local people to maintain, improve and enhance their health
41
Strategic Vision for
King‟s College Hospital
• Throughout its history, King‟s College Hospital has strived to provide exceptional
and innovative care for its patients, and fulfilling careers for its staff. As a key
member of King‟s Health partners we will build on this foundation to achieve new
levels of performance
• We will respond to a new national focus on quality, utilising the application of world-
class academic endeavour to ensure that excellent patient experience and the best
clinical outcomes are delivered. We must also be top performers in terms of
efficiency and productivity, in order to resource continual innovation. We will train,
develop and support our staff, so they have the skills, leadership and motivation to
deliver continual improvements
• Our local population has major health needs and inequalities, and we must work
with local partners to demonstrate improvements in their health status, in parallel to
enhancing our national and international reputation. We will also develop local
healthcare and academic networks, providing leadership where appropriate, to
improve pathways of care across wider regional areas. The configuration of service
delivery at King‟s may change, both in response to commissioning initiatives, and as
a result of opportunities across KHP
• To deliver this vision we will need to redevelop and renew the Denmark Hill campus,
addressing the urgent need for capacity, responding to the changing patterns of
healthcare delivery, and working in conjunction with KCL to improve research &
educational facilities
42
Key pressures arising from the
external environment
• Funding will become increasingly constrained as a consequence of
the recession. As a result KCH will need to maximise efficiency of its
Economic context
current operations, to enable it to absorb the expected demand. We
will also need to work with KHP to drive efficiencies across partners
• Reconfiguration of services in London has been led with Stroke and
Trauma - Paediatric Trauma, Cardiovascular and Cancer services
Service will be reviewed shortly, significantly influencing the provider
Reconfiguration landscape. The formation of the new South London Health Trust, and
our developing relationship with the Lewisham hospital will also
influence our plans
• Lord Darzi has ensured that Quality is the key priority across the
National NHS. KCH will be one of the first to develop quality accounts –
Priorities measures such as mortality will soon be publicly available. A
continued focus will be to maintain our strong performance and
compliance with the 18 week target on referral to treatment time
• An step change will be required to ensure that PCTs develop their
Commissioning „world class‟ commissioning roles with improved performance
& Primary Care management of providers
developments
• A shift to primary care of some conditions currently managed within
the hospital setting continues to be driven and will be managed by
KCH and LSL Alliance on a collaborative basis
43
Key Internal Challenges
Developing Strategic • Agreeing priorities for the AHSC, and investing to develop of world
class peaks
King’s Health Objectives
• Development of CAGs across all services and academic depts, with
Partners input across all the partners and all the disciplines
Financial constraints • Development of the AHSC within the 2010/11 onwards financial
settlement and the need to create efficiencies
Capacity Constraints • With the increasing emergency workload we need to plan for
Managing expanded bed capacity to manage inpatient demand – delivered
Demand through estate expansion and increased efficiencies.
Service Redesign • Achieve 18 week targets for compliance in all specialties not only as
an average across the Trust. This will mean significant pathway
design and extensive CAS development
• To expand our critical care provision for the expansion of Stoke and
Critical Care
Clinical Trauma services, and to enable admission of tertiary patients from
our networks across SE London
Priorities • Focus on quality to expand good practice and benchmark against
Improving outcomes the best hospital trusts in the country by developing quality
accounts. New initiatives and targets e.g. standardising mortality
and morbidity meetings, significant reductions in hospital acquired
infections, and improved patient experience
• Refocus on quality and operational efficiency to ensure King‟s is in
First Choice King‟s the top quartile amongst its peers in terms of performance
Transformation measures e.g. ALOS.
• Ensure that transformation effort is directed at implementation of
the Trust‟s strategic objectives
44
Strategic Objectives
2009/10
There are specific strategic objectives for KCH, building on the Trust’s own
strengths and capabilities, whilst delivering the KHP vision….
• Develop King’s Health Partners
– Agree a joint strategy for the partners of the AHSC to build and deliver on the tripartite mission
– Continue to develop the structures of the Clinical Academic Groups (CAGs) to ensure real clinical
academic integration across KHP, learning from first wave CAGs, e.g. Cardiovascular
• Local Delivery and Networks
– Develop our Trauma and Stroke service by supporting our network of DGHs through clinical,
education and training services
– Support NHS Southwark by providing innovative solutions to community based care and develop
treatment closer to people‟s homes
• Quality Focus
– Development of quality accounts (including a scorecard approach) and more co-ordinated
management of quality initiatives, driving improvements in patient experience, safety and clinical
outcome
• Developing a world class workforce
– Enhance our workforce capacity and capability to respond to strategic priorities and future service
developments. Promote and embed a culture in which shared organisational values ensure
individual respect, well being, and equality of opportunity
• Building at Denmark Hill
– Develop the hospital site to deliver care in modern healthcare facilities, with adequate capacity to
manage predicted workload
• Financial Strategy
– Provide a framework for strong financial management and diversification of income 45
Patient Experience
Objectives 2009/10
The trust is working on three major projects to improve the patient
experience during 2009/10:
1. Contacting King's: will improve how people contact King's through all formats from
letters, phone calls and the internet
2. Outpatient Transformation: is developing and piloting a new systems to improve the
patients experience of King's. We are working with staff and patients in gastroenterology to
transform people's experience of attending outpatients at King's
3. Feedback from Outpatients: This project is developing a standard outpatient feedback
tool (separate from the HRWD? Survey) so that outpatients can share their views with us
to enable us to make improvements to the outpatient experience
46
Example of Clinical Service
level objectives for 2009/10
All Divisions have
developed
business plans for
the year which will
be signed off and
performance
managed
47
Quality and Performance
objectives in 2009/10: First Choice
Length of Stay Reduction – minimum bed release by December of 20 beds
Releasing Time To Care & Patient Status displays: Division-based Rapid Improvement Projects:
Objectives: reduce LOS, 90% discharges by 11am • Echocardiograms: Reduce the time from inpatient test
and more time for nurses to care for patients request to result – from 3 weeks down to 24 hours
Key work modules: Patient Status Display Boards, • Medicine Emergency Care Pathway: Reduce LOS
Ward performance scorecards and display boards, and establish a Medical Admissions Unit. Redesign the
Well Organised Ward, Admission and Discharge care pathway so patients are streamed to areas where
Processes, Ward Manager Leadership Development they receive best quality care.
and implementation of Electronic Patient Status • Medical Surgical Interface: Minimise patient transfers
Display Boards. between consultants and avoid delays in care
Quality – King’s Values: Quality – Patient Experience:
Objectives: Engage staff, patients and stakeholders to Outpatient redesign - Endoscopy: Radical redesign of
Identify the values and core behaviours that have services for efficiency (low waits, single visit, maximised
meaning and purpose for all staff from the executive suite use of capacity) and quality.
to the patient bedside. Develop context and infrastructure Outpatient feedback: Getting faster, better information
to ensure we act on them consistently – especially in about what outpatients feel about our services using a
branding, recruitment, inductions, training and decision- web-based survey tool
making. Contacting King’s: Responding faster and more
Key work phases: a) Listening b) Testing and Engaging accurately to our patients upon first contact with our Trust
c) Communicating d) Embedding e) Measuring
Programme Management for Strategy:
Objectives: Implement a simple but effective project management and reporting
framework and ensure its use in order to assure the Board about strategic delivery
48
Human Resources –
Objectives 2009/10
• Identify opportunities to promote „joint working‟
including career development and mobility of
workforce between King‟s Health Partners AHSC
• Identify measures for assessing talent management
progress and develop policy on accessing national
programmes and schemes, including the scope for
the introduction of Assessment/Development
Centres to assist staff develop potential
• Continue the programme of action to ensure year on
year progress towards achieving representative
ethnicity and gender of senior staff
• Develop opportunities for introducing more
„performance related‟ reward frameworks, and review
new AfC on-call arrangements to maximise
opportunities for „out of hours‟ working
• Ensure effective implementation of the EWTD 2009
legislation for doctors in training
• Implementation of the Skills Pledge to train all staff
up to Level 2
49
Research & Development
Objectives for 2009/10
• Implement the R&D investment projects in all the
divisions and have second round of bids in Sept 09
• Continue to strengthen the central R&D office,
including a full time statistician appointment
• To appoint R&D facilitator posts to work with
divisions and clinical researchers to help in grant
applications & project design, supporting R&D
leads
• All divisions to implement local R&D governance
arrangements
• To introduce performance management metrics in
all divisions to monitor R&D output
• To produce financial reports on R&D income and
expenditure for all divisions
• Work with KHP partners on developing the virtual
“research and innovation office” across all
campuses
50
Contents
• Executive Summary
• 2008-09 Overview and Performance
• King‟s Vision and Strategic Objectives
• Finance & Activity 2009-10
• Risk Analysis
• Performance Targets 2009-10
• Governance & Membership
• Board Statements
51
Finance 2009/10 -
Key Messages
Establishment of 2009/10 Budgets
Income
• The contracting process with PCTs for 2009/10 was protracted due to fundamental changes to the DoH PbR (Payment by
Results) mechanism, using HRG version 4 for coding different activity
• The market forces factor was reduced from 29.21% to 22.56% and a consequential reduction in income of £12m
• The other key loss was on the introduction of the Patient Same Day Tariff of £4m; but there were gains on A&E , Critical
Care, Drugs and Devices
• The introduction of non-mandatory tariffs for outpatient procedures and unbundled diagnostic tests was not agreed by
NHSL and this restricted the benefits of the new PbR changes to Acute Trusts
• A negotiated position was reached with the London PCTs whereby they would fund an increase of 3.5% on PBR activity
and invest for future outpatient tariff changes to reduce the negative impact of PbR in 2009/10
• An additional non-recurring payment of £4.3m was funded by NHSL, in order to limit the impact of the Cuyler R&D Levy
transitional loss of £4.3m. This mitigated against the HCAS funding reduction from Southwark PCT of £4.9m
• The Trust has set income targets for the Divisions based on last years activity outturn and the implementation of new
service developments..
Expenditure
• The pay budgets were rolled over from 2008/9 and funded for agreed pay awards and Agenda for Change incremental drift
• The non-pay budgets were funded at outturn to enable the Division‟s to achieve last years activity levels
Surplus and Cost Improvement Plans
• The savings plan was set at 5% in order to achieve an operating surplus of £9.5m which will enable the urgent site capital
developments, to meet future activity requirements (e.g. new Trauma and Emergency Centres) and to maintain a
sustainable cash-flow
• The surplus is reduced from the previous year due to the PBR financial impact and also material cost pressures arising
from the introduction of the International Financial Reporting Standards (IFRS) to the NHS in 2009/10. The Trust's PFI
scheme for the Golden Jubilee Wing will be on-balance sheet from 1st April 2009, along with a number of equipment
leases, increasing the capital charges
• The other cost pressures funded are the increase in NHSLA premium and the rental of the Lewisham hospital site
52
Finance 2009/10
Plan Summary
Actual Plan Forecast Forecast
2008/09 2009/10 2010/11 2011/12
£m £m £m £m
Income
NHS Income 428.93 454.61 481.06 498.31
Private patient income 14.12 14.72 14.89 15.07
Other income 74.48 72.93 75.52 77.93
Total income 517.53 542.25 571.48 591.31
Expenses
Pay Costs - 297.38 - 320.52 - 348.00 - 366.76
Non Pay Costs - 183.27 - 174.97 - 176.27 - 175.53
Operating costs - 480.65 - 495.49 - 524.27 - 542.28
EBITDA 36.88 46.76 47.20 49.03
Depreciation - 10.29 - 14.06 - 14.88 - 15.64
Profit/(loss) on asset disposal - 0.03 - - -
Net interest - 0.36 - 11.14 - 11.18 - 11.31
Taxation - 0.01 - - -
PDC Dividend - 8.74 - 12.06 - 12.66 - 12.76
Impairment & Restructuring Costs - 1.79 - 3.79 - 5.67 - 2.55
Net Surplus / (Deficit) 15.66 5.71 2.81 6.77
Surplus Before Exceptional Items 17.45 9.50 8.48 9.32
EBITDA 36.88 46.76 47.20 49.03
Debtors - - 1.53 1.94 - 3.76
Creditors - 3.47 1.76 2.65
Other changes in Working Capital - 3.49 3.76 - 1.49
Other - - 2.00 - 3.77 1.01
Cash flow from operations 15.66 50.20 50.90 47.44
Capital expenditure - - 50.04 - 20.55 - 12.30
Asset sale proceeds - - - -
Net interest - - 9.63 - 9.65 - 9.85
Dividends (paid) - - 12.06 - 12.66 - 12.73
Movement in Loans - 1.47 - 0.50 - 0.50
PDC Received/(repaid) - 6.00 - -
Other - 7.75 - 0.93 - 0.94
Net cash inflo/outflow 15.66 - 6.31 6.61 11.13
Period end cash 33.89 25.41 30.70 40.52
Financial Risk Rating 5 4 4 4
53
The impact of HRG 4 - Key
changes
• Planned Same Day tariff (PSD) – This is for day cases whereas previously we had been
getting full tariff.
• Short stay elective tariff – Where there is a big difference between a PSD and inpatient
tariff.
• Short stay emergency tariff - No more 50% cap
• Market Forces Factor – drops from 29% to 22%. Also paid locally by PCTs so contract
monitoring will now include this.
• Outpatient Tariffs – Non-mandatory tariffs for outpatient procedures (the same as the PSD
tariffs). Also Multi disciplinary teams and non-face to face contact prices.
• Critical Care – Non-mandatory tariffs for this as well (currently local prices)
• Diagnostic Imaging unbundled –
– Diagnostic Imaging MRI
– Diagnostic Imaging CT
– Diagnostic Imaging Dexa
– Diagnostic Imaging Contrast Fluoroscopy
– Diagnostic Imaging Ultrasound (not obstetric)
– Diagnostic Imaging Nuclear Medicine
• Drugs and Devices – similar in operation but more drugs included.
• A&E – tariff information was not robust so it stays the same.
• Specialist top ups remain for orthopaedics and child health
• Patient transport excluded – paid for separately by PCTs
• Commissioning for Quality and Innovation schemes (CQUIN) is 0.5%
(NB Due to NHS London guidance OP and diagnostic income is capped at 2008/09 levels for
2009/10)
54
Finance 2009/10 - Income
and expenses (1/2)
Income received from:
Income based on:
• Income target is based on last
Other Operating
Income, £22.9 , 4% Non Clinical Income -
years outturn and new service
Market Forces Private Patients, developments
Factor, £41.9 , 8% £14.7 , 3%
Education & Research & • PCT contracts were uplifted
Development, £5.5 ,
Training, £44.5 , 8%
1%
by 1.7% for price inflation and
0.5% for meeting quality
targets.
• PCT contracts included £3.2m
Clinical Income -
NCG/Consortia,
of growth activity for Renal ,
£40.8 , 8% achieving 18 weeks targets,
the use of Lucentis.
Clinical Income -
PCTs, £371.9 , 68%
• New PBR drugs and devices
income of £3.2m
£m's • Demand management of
£3.2m within London
55
Finance 2009/10 – Income
and expenses (2/2)
Expenses from:
Net Interest rec/paid,
PFI, £16.8 , 3% £11.3 , 2% Depreciation, £14.1
Other Operating , 3%
expenses, £23.6 , PDC Dividend, £12.1 Expenses based on:
4% , 2%
• Last years outturn plus
Impairment, £3.8 ,
Non Clinical pay inflation of 2.2% and
1%
Supplies, £37.6 ,
7% non-pay inflation of 2.5%.
• The use of the Lewisham
Clinical Supplies,
£53.1 , 10%
hospital site
• New service
developments at KCH site
Staff costs and
benfits, £320.5 , • Expansion of Research
60% and development
Drugs, £44.1 , 8%
£m's
56
Finance 2009/10 -
Expenditure and CIPs
Plan Actual Plan Plan Plan
CIP details Com m ents
2008/09 2008/09 2009/10 2010/11 2011/12
The 2008/9 plan excluded income generation CIPs and the actual figure
CIP am ount (£m ) 6.4 15.8 24.8 14.4 14.4 includes the estimated margin on additional activity to plan.
The CIP target is 5% in 2009/10 to fund the capital investment plan. The
CIP as % of operating costs 0% 3% 5% 3% 3% income CIPs are reduced from 2010/11 due to the economic downturn.
Quarter1 Quarter2 Quarter3 Quarter4 Total Identified Recurrent Total Total
Type a description of the risk here… 2009/10 2009/10 2009/10 2009/10 2009/10 2009/10 2009/10 2010/11 2011/12 Schem e lead
£m £m £m £m £m £m £m £m £m
Cardiac & Neurosciences Divisional General
3.2 Manager
0.517 0.905 0.905 0.905 3.200 2.757 1.872 1.872
Surgery Divisional General
3.4 Manager
0.539 0.943 0.943 0.943 3.400 3.300 2.016 2.016
General Medicine Divisional General
3.6 Manager
0.574 1.005 1.005 1.005 3.500 3.500 2.016 2.016
CSDS, Dental and Private Patients Divisional General
2.6 Managers
0.498 0.697 0.697 0.697 2.600 2.100 1.440 1.440
Specialist Medicine Divisional General
2.6 Manager
0.409 0.716 0.716 0.716 2.600 2.453 1.440 1.440
Liver and Renal Divisional General
2.9 Manager
0.466 0.816 0.816 0.816 2.900 2.600 1.728 1.728
Womens & Child Health Divisional General
3.6 Manager
0.571 0.999 0.999 0.999 3.600 3.338 2.160 2.160
Corporate Division Directors/Heads of
3.0 Departments
0.757 0.757 0.757 0.757 3.000 2.600 1.728 1.728
Totals 4.3 6.8 6.8 6.8 24.8 24.8 22.6 14.4 14.4
Initiative issues Details Actions to Resolve
Additional income activity and additional surplus margins 2008/9 Activity levels not purchased for 2009/10, New Business Cases. Ensure capacity to meet activity demand/implement new services.
Pay reduction of costs Review rotas, job plans - PAs, recharges from other NHS, freeze vacancies. General Managers to review all pay budgets.
Clinical non-pay reduction of costs Auto Replenishment cabinets to reduce clinical and surgical consumable spend. Implementation throughout all theatres, relevant depts and w ards.
Non-Clinical non-pay reduction of costs Reduction of Consultancy spend and tender contracted out services. Develop in-house expertise and negotiate better VFM.
57
Planned Capital
Expenditure Analysis
2009/10 2010/11 2011/12
Project spend spend spend Details Timing
Planned Capital Expenditure Analysis
Projects commenced
(£m) (£m) (£m)
Energy CHP Centre (£8.6m), Dental Extension (£1.8m), Sydenham Renal Dialysis Centre (£1.1m), New and April to
2008/9 c/f 17.8 replacement medical equipment (£3.4m). September 2009
Site Development and Property purchases (£12.5m), Clinical Research Facility (£10.4m, £8m donated), Neurology Institute (£500k), Property
utilisation of Lewisham 22.5 2.0 Lewsiham £350k. purchases - June
Hospital 2009
Emergency and Trauma Emergency Centre (£6m), Trauma (£11m) Tbc: Awaiting
Centres 2.6 12.6 2.0 Public
Consultation
Community Speciality Midwifery Clinic (£800k), Breast Screening (£612k), Renal units (£2m) Mid Year 2009
Developments 1.1 1.8
Redevelopmement Womens' Administration Offices and Delivery Suite (£500k), Suite 8&9 (£2m), Wadington Ward conversion to Mid Year 2009
Projects 0.5 2.0 4.5 theatres (£2.5m), Block 7 G/F Ward Conversion (£2m).
Other minor projects Minor works, IT, Medical Equipment Replacement rolling programmes. September 2009
5.5 4.0 4.0 to March 2010
Total 50.0 20.6 12.3
2009/10 2010/11 2011/12
Funding details Comments
(£m) (£m) (£m)
Cash from operations 29.5 20.6 12.3 2008/9 Surplus and capital under-spend against plan in 2008/9 funds the significant spend in 2009/10.
Cash from asset sales
New PDC received 6.0 Emergency Centre Funding approved by DoH
Loans from FTFF 6.0 Energy CHP Centre Loan approved by FTFC
Commercial loans
Charitable donations 8.5 Clinical Research Facility
Other sources
Total 50.0 20.6 12.3
maintenance capex from cashflow (worksheet CF)
non-maintenance capex (50.0) (20.6) (12.3) from cashflow (worksheet CF)
Total -50.0 -20.6 -12.3
58
Finance 2009/10 –
Contribution by Division
Contribution based on:
Current Planned Change • The financial contribution
% % % refers to the direct clinical
and operating income less
Cardiac 33 34 1 the direct costs that are
Neuro 27 19 -8 accountable to the
Division. The overhead
Surgery 9 9 0 costs relating to the site
Dental 38 37 -1 and corporate
departments are
General Medicine 23 17 -6 excluded. The contribution
is represented as a % of
Liver 25 24 -1
direct income.
Renal 36 40 4 • A number of the %
Specialist Medicine 24 18 -6 contributions have
reduced due to the PBR
Womens 40 33 -7 impact and funding cost
pressures.
Child Health 23 16 -7
• Renal has increased due
Private Patients 39 41 2 to the PCT investment in
the service.
59
Finance 2009/10 - Facilities:
Committed and Uncommitted
Pursuant to Section 46 of the Act, the Prudential Borrowing Limit (PBL) for KCH for the
year 2008-2009 (reviewed annually by Monitor) is the sum of the following:
(i) Maximum cumulative long term borrowing : £98 million, and
(ii) Approved working capital facility: not to exceed £25.0 million.
As at 31st March 2009, KCH had the following borrowings against the PBL:
(i) £12.974 million on-balance sheet PFI Finance Lease (Ruskin Wing), and
(ii) £ 9.183 million in FTFF long-term loans
No further borrowing has incorporated into the planning years and is not anticipated that
the Trust will need to utilise its working capital facility.
The change to IFRS accounting policies will mean several items, most notably the Golden
Jubilee Wing, will be reclassified as Finance Leases and, hence, count as borrowing
against the PBL.
60
Financial Risk Rating
Ratios for 2009/10
Weight 2009 2009 2009 2010 2011 2012
Q1 Q2 Q3 Q4 Yr Yr
EBITDA Margin rating 25% 3 3 3 3 3 3
EBITDA % of plan achived rating 10% 5 5 5 5 5 5
Financial Efficiency 40% 3 3 4 4 4 4
Liquidity days rating 25% 3 2 3 3 3 4
Weighted Average Rating 3 3 3 4 4 4
Overriding rules
Plan submitted on time YES
Plans submitted complete and correct YES
PDC dividend paid in full YES
Year 2 OR Year 3 deficit NO
Year 2 AND Year 3 deficit NO
Lowest ranked metric a '1'? FALSE FALSE FALSE FALSE FALSE FALSE
One financial criteria '1' or '2' FALSE TRUE FALSE FALSE FALSE FALSE
Two financial criteria '1' or '2' FALSE FALSE FALSE FALSE FALSE FALSE
Two financial criteria at '1' FALSE FALSE FALSE FALSE FALSE FALSE
Unplanned breach of PBC NO
Less than 1 year as an Foundation Trust FALSE FALSE FALSE FALSE FALSE FALSE
Limit due to overriding rules 0 3 0 0 0 0 61
Contents
• Executive Summary
• 2008-09 Overview and Performance
• King‟s Vision and Strategic Objectives
• Finance & Activity 2009-10
• Risk Analysis
• Performance Targets 2009-10
• Governance & Membership
• Board Statements
62
Risk Analysis – Strategic Risks
Key Risks Potential Mitigation
• Growth in demand for service is • LSL Alliance/KCH joint project to have
greater than planned robust plan in place with regular
reporting to joint executive leads
• Inability of stroke/trauma network to • Protocols in place for repatriation and
repatriate patients
monitored as a KPI
• Inability to respond to reductions in • Tight budgetary controls and
funding (tariff) through efficiencies performance management in place
• Unable to recruit required • Development of workforce plan for
numbers/right skilled staff period of recruitment to include overseas
and development of staff „in house‟
• Inability to find suitable space for • Phased and prioritised movement of
developments services to support trauma and stroke
63
Risk Analysis – Governance
Risks
Governance risk description Magnitude Likelihood Mitigating action
(5=worse) 5=most likely)
Compliance with terms of authorisation relating to: 4 2
Clinical quality Strong clinical leadership and quality and performance
management frameworks. Unconditional CQC registration
under the Hygiene Code.
Service performance
Highly performing foundation trust achieving all core national
targets and standards
Risk management processes Integrated and robust risk management processes and trust-
wide risk register
Compliance with the authorisation Current risk rating of 5 (Finance) and green (governance and
mandatory services)
Board roles structures and capacity Established process of Board evaluation/performance review
and induction for new Board members
Delivery of AHSC with other partners 4 2 Successful accreditation as an AHSC
Partnership Board & transitional Executive in place.
Signed Memorandum of Understanding between AHSC
partners
Building collaborative relationships with key NHS partners 4 2 Key stakeholders represented on Board of Governors
and stakeholders Close collaboration with local health networks e.g trauma &
stroke
Quality Accounts do not drive sufficient improvement in safety 3 2 Publishing Quality Accounts 2009/10
and clinical quality Integrated quality and performance management systems
Effective systems for monitoring risk/safety, clinical
effectiveness and patient experience
To secure representative membership 2 2 Membership Development Strategy including recruitment
targets (achieved).
Specific initiatives targeting areas of under representation.
64
Risk Analysis – Finance
and Mandatory Services
Finance Risk Description Magnitude Likelihood Mitigating action
(5=worst) (5=most likely)
Implied Clinical income downside case - reducing by 0.5% in The Trust will develop commercial income flows to replace historic
2011/12. Potential £2m income reduction. 3 4 NHS income streams.
Implied Efficiency assumption downside case of 4% (2010/11) and The % CIP targets as a % of operating expenses are planned: 5%
4.5% (2011/12). 3 4 (2009/10); 3% (20010/11); 3% (2011/12). Assessment of the
financial viability of patient service lines.
Non -recurring transitional funding for the Cuyler R&D allocation loss The Trust expects to recover this non -recurring income through the
(£4.3m). 4 3 introduction of mandatory outpatient tariffs for outpatient
procedures and unbundling diagnostics.
Non-recurring outpatient investment of £2m by London PCTs to meet The Trust expects to recover this non -recurring income through new
the future implications of tariff changes re outpatient 3 3 mandatory tariffs for outpatient services. The data required
procedures/unbundling diagnostic tariffs. for this charging mechanism is available.
Financial penalties in respect to breaching national and local quality Risk and Performance management frameworks embedded across
targets and loss of CQUIN funding (£2m). 2 2 the Trust and linked to the development of Quality accounts.
Non -achievement of CIP targets above implied 3% target in The Trust has a track record of achieving CIP targets and plans have
2009/10. Additional £10m cash releasing savings. 5 3 been actioned for 2009/10 to achieve the targets. General
Managers accountable for targets.
Planned additional activity growth and capacity constraints year on The Trust is investing in a significant capital site investment plan and
year. Significant site development of £23m and stepped 5 3 utilising purpose built assets at Lewisham to meet this
revenue costs to be completed on schedule. challenge.
Financial stability of key PCT commissioners and the payment of The Trust has negotiated a reduced surplus target to assist PCT
additional activity growth. 3 2 purchasing power and agreed to NHSL guidance to reduce
PBR cost pressures.
Development of Commercial Services and additional income, Potential additional income flows have been excluded, as a prudent
including Private Patient expansion. A number of beds on the 2 2 measure against the challenging CIP targets. PP income is
PP ward are currently allocated to NHS use. 3.2% as a proportion of income (cap is 3.5%).
Development of the AHSC and the potential financial benefits Potential financial benefits have been excluded as prudent measure
regarding economies of scale, research and development of 2 2 against the challenging CIP targets. The benefits do need to
patient services. be formalised and quantified.
65
Contents
• Executive Summary
• 2008-09 Overview and Performance
• King‟s Vision and Strategic Objectives
• Finance & Activity 2009-10
• Risk Analysis
• Performance Targets 2009-10
• Governance & Membership
• Board Statements
66
Challenging Performance
Targets 2009/10
• Deliver against the Care Quality Commissions Annual Health Check
– This is the first year of the Care Quality Commission, who replaced the
Healthcare Commission on 1st April 2009. We need to continue to deliver against
the existing commitment indicators and new national priority indicators, which are
currently in development. No new indicators have been introduced, but we expect
developments in year
• Developing the Trust wide performance framework to include quality indicators
in line with the Lord Darzi vision
– Introduce quality indicators into Trust wide scorecards
– Deliver our first set of Quality Accounts in 2009/10
– Understand and improve performance on quality indicators
• Delivery of Strategic/PCT Contract milestones
– Reduction in length of stay
– Reduction in infection rates
– Maintain successful 18 weeks referral to treatment performance
– Continue to deliver against the Accident & Emergency „4 hour wait target‟
– Deliver stretch targets on MRSA bacteraemias ahead of national expected limit
– Improvements on data quality
– Introduction of quality performance measures, with financial penalties for non
compliance (CQUINS) 67
Key Performance Targets
for 2009-10 (1/2)
68
Key Performance Targets
for 2009-10 (2/2)
69
Setting Targets – challenging
but achievable targets
Activities
Set top down – Review King‟s aspirations in line with the strategic direction
aspirations for – Analyse historical data to understand what had been achievable
Trust and Divisions
– Analyse/define peer benchmarks (CHKS, international benchmarks
where appropriate)
– Explain methodology and Trust aspirations for target-setting
to Divisions
Divisions define
own targets – Divisions develop bottom-up targets based on the agreed
methodology and internal analysis of improvement
opportunities for each service
Challenge to come – Work with Divisions to challenge targets set to ensure
up with stretch but stretch (match top-down and bottom-up)
achievable targets
70
Tracking Quality & Performance –
Trust wide policy
Meeting
Week 3 of each
month Week 4 Week 4 Week 2 Supporting
materials
Performance Interaction between Performance
Committee each level ensures Committee
that everyone is Performance
working towards a Review
Operations consistent set of meeting with Trust score-
director objectives Operations card & report
Director
Divisional
Division Management Division
Team meeting score-card &
report
Team meeting
Timeline of the meetings is
Team meeting bound by the dates of the
Team Scorecards & Performance Committee and
Team meeting reports from Scorecard/information availability
each team on day 10 of each month
Team meeting
Issues are identified and
addressed at the team level
71
Contents
• Executive Summary
• 2008-09 Overview and Performance
• King‟s Vision and Strategic Objectives
• Finance & Activity 2009-10
• Risk Analysis
• Performance Targets 2009-10
• Governance & Membership
• Board Statements
72
Trust Governance
• Strong broadly representative Foundation Trust membership- detailed in the
separate membership section of this report.
• All elections to the Board of Governors are held in accordance with the election rules
as stated in the constitution. Elections last took place in Autumn 2008.
• Appropriately constituted Board of Directors and Board of Governors, operating
within a collaborative framework
• Trust compliant with all core existing targets and national core standards and
anticipates full compliance prospectively
• Effective arrangements in place to monitor and continually improve the quality of
healthcare, including patient safety, provided to the trust‟s patients
• Effective risk and performance management to identify and address risks to ensure
continued compliance with the trust‟s authorisation
73
Trust Governance
• The Board of Directors has signed self-certification statements relating to the
following areas: clinical quality, service performance, other risk management
processes, compliance with the terms of authorisation and board roles, structures
and capacity.
• The Trust enjoys collaborative relationships with a range of NHS bodies, including
„King‟s Health Partners‟ organisations ( Guy‟s and St Thomas‟, South London and
Maudsley NHS Foundation trusts and King‟s College London ), the 2 local PCTs of
Lambeth and Southwark and the London Strategic Health Authority.
• The Trust works closely with the London Boroughs of Lambeth and Southwark and
the Overview and Scrutiny Committees. Both London Boroughs and PCTs of
Lambeth and Southwark are represented on the Board of Governors.
74
Trust Membership
• Membership numbers have increased during 2008/09 and total membership as at April
2009 stands at 14,733. The Trust has set recruitment targets in the Membership
Strategy and has a number of planned recruitment initiatives during the year.
• An active membership engagement programme was carried out, including a series of
five constituency based community events on the trust‟s forward plans, a programme of
members‟ seminars, members focus groups, Annual Open Day and the issue of the
Trust‟s Member‟s newsletter.
• The Trust‟s public membership is broadly representative of the local community, with
the exception of young people, where the Trust plans further targeted activity this year.
In the last year, the Trust has established an exciting partnership with Lambeth College
of Further Education.
• Governors have been very engaged with the Trust over the last year, contributing
directly through Governor Working Groups and Committees including Nominations,
Membership, Patient Experience and Safety Committees, and Transport and Standards
for Better Health Working Groups.
• Full details on membership and development plans are contained within the
membership report which is attached as an Appendix.
75
Contents
• Executive Summary
• 2008-09 Overview and Performance
• King‟s Vision and Strategic Objectives
• Finance & Activity 2009-10
• Risk Analysis
• Performance Targets 2009-10
• Governance & Membership
• Board Statements
76
Board Statements (1/5)
For clinical quality, that:
The board is satisfied that, to the best of its knowledge and using its own processes
(supported by Care Quality Commission information and including any further metrics
it chooses to adopt), its NHS foundation trust has, and will keep in place, effective
arrangements for the purpose of monitoring and continually improving the quality of
healthcare provided to its patients; and
The board will self-certify annually that, to the best of its knowledge and using its own
processes, it is satisfied that plans in place are sufficient to ensure ongoing
compliance with the Care Quality Commission‟s registration requirements.
For service performance, that:
The board is satisfied that plans in place are sufficient to ensure ongoing compliance
with all existing targets (after the application of thresholds) and national core
standards, and a commitment to comply with all known targets going forwards.
77
Board Statements (2/5)
For other risk management processes, that:
Issues and concerns raised by external audit and external assessment groups
(including reports for NHS Litigation Authority assessments) have been addressed and
resolved. Where any issues or concerns are outstanding, the board is confident that
there are appropriate action plans in place to address the issues in a timely manner;
All recommendations to the board from the audit committee are implemented in a
timely and robust manner and to the satisfaction of the body concerned;
The necessary planning, performance management and risk management processes
are in place to deliver the annual plan;
A Statement of Internal Control (“SIC”) is in place, and the NHS foundation trust is
compliant with the risk management and assurance framework requirements that
support the SIC pursuant to most up to date guidance from HM Treasury (www.hm-
treasury.gov.uk);
The trust has achieved a minimum of Level 2 performance against the requirements of
their Information Governance Statement of Compliance (IGSoC) in the Department of
Health‟s Information Governance Toolkit; and
All key risks to compliance with their Authorisation have been identified and addressed.
78
Board Statements (3/5)
Compliance with the Authorisation
The board is required to confirm that:
The board will ensure that the NHS foundation trust remains at all times compliant
with their Authorisation and relevant legislation;
The board has considered all likely future risks to compliance with their Authorisation,
the level of severity and likelihood of a breach occurring and the plans for mitigation
of these risks; and
The board has considered appropriate evidence to review these risks and has put in
place action plans to address them where required to ensure continued compliance
with their Authorisation.
79
Board Statements (4/5)
Board roles, structures and capacity
The board is required to confirm that:
The board maintains its register of interests, and can specifically confirm that there
are no material conflicts of interest in the board;
The board is satisfied that all directors are appropriately qualified to discharge their
functions effectively, including setting strategy, monitoring and managing
performance, and ensuring management capacity and capability;
The selection process and training programmes in place ensure that the non-
executive directors have appropriate experience and skills;
The management team have the capability and experience necessary to deliver the
annual plan; and
The management structure in place is adequate to deliver the annual plan objectives
for the next three years.
80
Board Statements (5/5)
Signature Signature
Printed Name Tim Smart Printed Name Michael Parker
Date 29 May 2009 Date 29 May 2009
In capacity as Chief Executive & In capacity as Chairman
Accounting Officer
Signed on behalf of the board of directors, and having regard to the views of the
governors.
81
Appendices to go to Monitor
Annual Plan financial model
Schedule 2 – Mandatory services activity schedule
Schedule 3 – Mandatory Education Schedule
Membership Report
82
